How likely is it to get pregnant with PCOS?

Santina M

How likely is it to get pregnant with PCOS?

While cumulative probability of childbirth is similar between groups, women with PCOS need longer time to achieve their first childbirth.  Earlier diagnosis and intervention can shorten the time to pregnancy and improve the chances for live birth. You need to educate yourself and seek care from fertility specialists. It is also essential that you start as early as possible. Lets take a deeper look at PCOS…

What is PCOS?

PCOS, as the name implies, is a syndrome, i.e., a collection of symptoms.  These symptoms vary between individuals.  Your reproductive endocrinologist specialist (REI) will conduct a thorough health history review and order hormone analysis that can help with a diagnosis.  

The three features of PCOS are:

  • 1, High levels of “male” sex hormones (androgens), such as testosterone
  • 2, A large number of immature ovarian follicles (fluid-filled sacs that develop and release eggs)
  • 3, Irregular menstrual cycles (typically less than 10 per year)

[Illustration 1: Three PCOS Features, branded Fertility Cloud]

If you have two out of three, yes you do have PCOS. Later we will explain how to check for all three [link to the section checking for PCOS].

[Form 1: PCOS Symptoms Lead Generation Form]

How many people suffer from PCOS?

Millions. 1 in 10 women. Moreover, 70% of people with PCOS are either misdiagnosed or undiagnosed. So you may suspect you have PCOS, but still not know for sure. Get checked.

[Illustration 2.

10 in 100 women have PCOS, 7 of those 10 don’t know or are misdiagnosed]

What causes PCOS?

Although we do not currently know the exact underlying cause of PCOS, we think it is due to abnormal hormone secretion in the brain along with abnormal insulin sensitivity in the muscles, and here is how it works:

  • 1, High levels of insulin are caused by your cells not responding normally to insulin. It’s called insulin resistance. Insulin controls how food is changed into energy. As a result of resistance, your insulin blood levels become higher.
  • 2, High levels of insulin are caused by your cells not responding normally to insulin. It’s called insulin resistance. Insulin controls how food is changed into energy. As a result of resistance, your insulin blood levels become higher.

Why is it harder to get pregnant with PCOS?

Because PCOS makes women ovulate irregularly or not at all. Ovulation is a key requirement for getting pregnant. 

  • 1, If an egg is not released (ovulates), there is nothing for the sperm to fertilize and create an embryo.
  • 2, If the ovulatory process is irregular, it is difficult to identify a fertile window that makes for the most productive intercourse.

How do I know I have PCOS?

Help us to help you!:

  • 1, Track your menstrual cycles.  How frequently they occur and how long they last ( and how painful or heavy they are). Report if your cycles are greater than 45 days apart or less than 10 per year
  • 2, Complete the work up recommended by your REI: get bloodwork done or order home test kits to check certain hormone levels
  • 3, Confirm polycystic ovaries using an ultrasound

Remember! PCOS is a spectrum and will have variable presentation and symptoms. The diagnosis is made when two of the three criteria are present.

Can I get pregnant with PCOS naturally?

Yes, but the time to pregnancy is 2.5 years longer for patients with PCOS, although it may be even longer than that. Combined with effects of age on fertility, it can be a perilous situation. You can work on eating healthier, losing weight, or quitting smoking.  However, lifestyle interventions alone do not work for the majority of women, and they will need additional interventions to establish regular ovulation.

Is it possible to get pregnant with PCOS quickly?

Yes. However, getting pregnant in general is not a quick process. While a completely healthy young couple has a 25% chance of getting pregnant during a single cycle, chances of “absolutely healthy” individuals reduce with aging. PCOS makes it even more complicated. A few of our patients have conceived on their first cycle using standard medicated treatment. Although this is a rare case, Charity W from Oklahoma decided to share her experience with you:

[Video 1: Testimonial by Charity W (OK) inserted]

Can I get pregnant with PCOS and no periods?

Yes. As you’ve seen in the testimonial above, Charity didn’t have periods at all and she got pregnant during her first cycle of treatment. Although medical miracles are rare, women with PCOS have one of the best prognosis when undergoing fertility treatment and most of them will eventually become pregnant. Even if they didn’t have periods before the treatment.

How to get pregnant with PCOS?

The good news is that with treatment, most patients would get pregnant. If the initial lifestyle changes like losing weight are not successful in establishing regular menses or you are not able to delay treatment, we recommend you start acting immediately, especially if you are over 35 years old, as the chances of pregnancy begin to decline. Also, there are some medical disorders that can mimic PCOS, so we strongly recommend you visit a Reproductive Endocrinologist with experience in evaluating and managing women with PCOS. Please, do not hesitate and do not lose your precious time.

There are two types of medicines used in fertility treatments for patients with PCOS:

  • 1, Clomiphene or Letrozole is usually the first treatment recommended for women with PCOS who are trying to get pregnant. Both medicines induce ovulation by encouraging recruitment, growth, and the monthly release of an egg from the ovaries (ovulation).
  • 2, Metformin makes the body more sensitive to ovulation inducing medications if Clomiphene/Letrozole are unsuccessful in encouraging ovulation

We can also recommend as appropriate supplements  from Theralogix (insert registered ™ symbol) that have been proven to help with fertility.  They include CoQ10, Inositol, and prenatal vitamins.  There are also supplements available for men to improve sperm quality.

Metformin is often used to treat type 2 diabetes, but it can also lower insulin and blood sugar levels in women with PCOS. As well as stimulating ovulation, encouraging regular monthly periods, and lowering the risk of miscarriage, metformin can also have other long-term health benefits, such as lowering high cholesterol levels.

Are there any real success stories of getting pregnant with PCOS?

There are millions of stories like this. The following one is also real and very complicated at the same time. Keep in mind that you should not take it as treatment advice. Every case can be individualized.

Tiffany came to Fertility Cloud after undergoing three cycles of clomid and two cycles of letrozole ovulation induction. She was a twenty-eight-year-old woman who had not been pregnant previously. She was diagnosed with PCOS at age twenty-one and has been on birth control until she started trying to get pregnant.

Repeat testing confirmed the diagnosis of PCOS. Unfortunately, she did not ovulate on clomiphene and her initial trial of letrozole. Our approach was to make her ovaries more sensitive to ovulation induction. We started her on metformin and a small dose of dexamethasone. Then we increased her dose of letrozole. She ovulated in the first month and became pregnant after three cycles. 

So, what does it mean for me?

The good news is that women with PCOS typically have some of the best prognosis when undergoing fertility treatment. Most of them will eventually become pregnant. Treatment has evolved significantly and has become more effective as well. The general rule in fertility treatments is the sooner you begin, the more likely you are to succeed. And it’s smart to choose an experienced doctor with an understanding of PCOS.  Don’t delay!  A consultation with a qualified REI can clear up any confusion or concerns you may have about getting pregnant with PCOS.

Age and Fertility- Written by a specialist.

According to research over the last 40 years, a healthy 30 year old woman has about a 20% chance of getting pregnant each month. A healthy, ovulatory 40-year-old woman’s chance per month is 5% (1,6). The decline is slow and steady up until the age of about 35. After that the decline becomes steeper. These ranges and time frames have been established through multiple studies and have been consistent for the last 30+ years. The decline in fertility is attributed to depletion of ovarian oocyte (eggs) reserve and is determined by genetic, environmental, and lifestyle factors.(2).

Now, for the good news. Age at conception does have bearing on time to pregnancy in a healthy, ovulatory woman. In general, fecundity (a woman’s physiological ability to have a child) is reported as age ranges because it is difficult to correlate a specific age to a specific chance of success. There are also factors that can affect reproductive aging. These include other medical conditions that can have an effect such as endometriosis, fibroids, genetic conditions (errors in number of chromosomes), environmental influences, obesity, smoking, thyroid gland dysfunction, history of sexually transmitted diseases (STDs), and ovulatory dysfunction, to name a few (2,3).

PCOS stands for Polycystic Ovarian Syndrome, it is the most common form of ovulatory ovarian dysfunction.  The pathology of PCOS makes ovulation irregular and unpredictable, making the timing of intercourse for conception difficult. 

There could also be issues with male fertility such as erectile dysfunction and sperm quality issues. Male evaluation initially consists of a semen analysis and potentially other endocrine blood testing to evaluate any severe sperm abnormality.

HOW CAN ASSISTED REPRODUCTIVE TECHNOLOGY HELP?

Most of the factors other than extreme reproductive age are usually treatable. When you get started, the first step is a comprehensive evaluation of both you and your partner (if applicable). We test your ovarian reserve to gauge likelihood of adequate number of eggs produced per cycle, prolactin levels since the elevated levels can affect regularity of ovulation, and PCOS testing. If there are any positive findings, we can offer prescription medications or supplements beneficial for conception (5).

There are supplements that both partners can take that have been shown to be beneficial for conception.  Lifestyle modification and diet changes (such as following the Mediterranean diet) can also positively impact your chances.  Controlling your stress and regular moderate exercise also confer benefits (3,4).

Please click the link below for a consultation with an experienced Reproductive Endocrinologist. You can also follow us on Facebook or return to our website for updated information about your fertility journey.

References

1.   Menken J, Trussell J, Larsen U. Age and infertility.  Science. 1986;233:1389-1394.

2.   Utting, D., & Bewley, S. (2011). Family planning and age-related reproductive risk. The Obstetrician & Gynaecologist, 13(1), 35–41. https://doi.org/10.1576/TOAG.13.1.35.27639

3.   Collins GG, Rossi BV. The impact of lifestyle modifications, diet, and vitamin supplementation on natural fertility. Fertil Res Pract. 2015 Jul 25;1:11. doi: 10.1186/s40738-015-0003-4. PMID: 28620516; PMCID: PMC5424364.

4.   Dimitrios Karayiannis, Meropi D Kontogianni, Christina Mendorou, Minas Mastrominas, Nikos Yiannakouris. Adherence to the Mediterranean diet and IVF success rate among non-obese women attempting fertility. Human Reproduction, 2018; DOI: 10.1093/humrep/dey003

5.   Unfer, V., Nestler, J. E., Kamenov, Z. A., Prapas, N., & Facchinetti, F. (2016). Effects of Inositol(s) in Women with PCOS: A Systematic Review of Randomized Controlled Trials. International journal of endocrinology, 2016, 1849162. https://doi.org/10.1155/2016/1849162

6. Sozou PD, Hartshorne GM (2012) Time to Pregnancy: A Computational Method for Using the Duration of Non-Conception for Predicting Conception. PLOS ONE 7(10): e46544. https://doi.org/10.1371/journal.pone.0046544

Menstrual Cycle- Written by a specialist.

Menstrual Cycle

By Fertility Cloud Head Nurse Svetlana Izrailevsky, BSN, RN.

What is a menstrual cycle?  In reality, a menstrual cycle consists of 3 broad categories of cycles:  hormones, ovarian (follicular) cycle, Endometrial lining cycle, and Cervical mucus development cycle.  It is important to understand that these cycles are taking place in tandem, in parallel and in relationship to each other.  That means that what happens in one of these cycles will affect the developments in the other ones.  

First, lets review the hormones involved in the menstrual cycle:

FSH–FSH helps control the menstrual cycle and stimulates the growth of eggs in the ovaries. FSH levels in women change throughout the menstrual cycle, with the highest levels happening just before an egg is released by the ovary. This is known as ovulation.

LH– LH helps control the menstrual cycle. It also triggers the release of an egg from the ovary. This is known as ovulation. LH levels quickly rise just before ovulation.

Estradiol, also called E2, is the main estrogen in nonpregnant females of childbearing age. It’s mostly made in the ovaries and is important for uterine lining development.

Progesterone is a hormone that’s made mainly by the ovaries. Each month, progesterone prepares your uterus for pregnancy. During a normal menstrual cycle, an ovary releases an egg and your progesterone levels begin to rise. Progesterone makes the lining of your uterus grow thicker so that a fertilized egg can attach (implant) inside of the uterus and grow into a baby. If you don’t become pregnant, your progesterone levels will fall. The lining of your uterus will become thinner again. When your uterus starts to get rid of the extra blood and tissue, your menstrual period will begin.  If you become pregnant, progesterone levels will continue to rise to about 10 times higher than usual to support the pregnancy.

Now, lets us look at the 3 main time frames of the cycle:

These different cycles communicate via hormone messengers. For example, when the egg inside the follicle is mature, it sends a signal to the pituitary gland via the increased levels of Estradiol hormone. This stimulates the rise in LH hormone levels which finishes the maturation of the egg and allows it to break out of the follicle–ovulate. At the same time, Progesterone level rises to support the uterine lining and the uterine lining undergoes a transformation where the recetors for the embryo become activated and stand ready.

The diagram below illustrates how the different cycles are connected:



LET’S LOOK AT SOME COMMON QUESTIONS THAT COME UP:

  • What is the best time to get pregnant during my cycle? What should I be doing to maximize the potential for conceiving?

When we are speaking of a regular 28-30 day cycle, your fertility window is between cycle day 10-15.  We would recommend intercourse every other day starting on cycle day 10.  Once you note your LH surge by using ovulation predictor kits, you should have intercourse daily on the day of the LH peak/surge and the subsequent 2 days.  

Please remember that LH hormone stays elevated for a very short time, just about 24 hours so we do not recommend that you keep checking your LH after you see the peak.  

Male partners, if applicable, should do ejeculation every 2-3 days starting with your cycle day 1.  We would like to have the freshest sperm sample available for insemination.  Please do not hold off on regular ejeculation because that increases the number of dead and dying sperm in the sperm sample that will be produced for the insemination.

  • Wait!  What if my cycles are not regular?

For some patients, the cycles are regular and predictable, but long.  It is possible to have a regular ovulatory cycle with the overall length of 35 days, for example.  However, there are also women who have irregular ovulatory cycles due to ovarian dysfunction.  This dysfunction is usually related to improper hormone levels of Estradiol and FSH.

  • What does the follicle stimulating hormone (FSH) do again?

FSH–FSH helps control the menstrual cycle and stimulates the growth of eggs in the ovaries. FSH levels in women change throughout the menstrual cycle, with the highest levels happening just before an egg is released by the ovary. This is known as ovulation.  

  • What about Estradiol?

Estradiol, also called E2, is the main estrogen in nonpregnant females of childbearing age. It’s mostly made in the ovaries and is important for uterine lining development.  As you can see in the diagram above, Estradiol rises slowly before ovulation and stays elevated for a period of about 7 days after the ovulation.  This is so that there is no ovarian follicular recruitment happening during the period of potential fertilization and implantation.   Elevated levels of Estradiol can interfere with production of FSH so if the Estradiol levels are high at the beginning of the cycle, the regular growth and development of the follicles can be impacted. 

Estradiol can be elevated as a result of conditions such as polycystic ovarian syndrome (PCOS) or presence of elevated levels of BPA in the system. Bisphenol A (BPA) is a chemical produced in large quantities for use primarily in the production of polycarbonate plastics. It is found in various products including shatterproof windows, eyewear, water bottles, and epoxy resins that coat some metal food cans, bottle tops, and water supply pipes. https://www.niehs.nih.gov/health/topics/agents/sya-bpa/index.cfm.  

  • I ovulated 2 days past normal ovulation days, does that mean my period will start two days later than expected?

The next menstrual period will start once the Progesterone and Estradiol levels fall, if there is no conception.  They typically occur 10-14 days after ovulation occurs.  If you ovulate 2 days later than you usually do, your menses might be delayed accordingly.

  • I have been taking Progesterone to support my uterine lining.  Will that impact my menses?

Yes!  If you are taking Progesterone, you are not likely to start menses even if you are not pregnant. You will be asked to do a home pregnancy test and stop  taking the Progesterone if the test is negative.  You can expect your menses 2-5 days after stopping the medication.  Some patients may begin spotting even before stopping Progesterone.  The spotting/bleeding you will get after the Progesterone may be a little heavier than your usual menses and the first day of bleeding will count as cycle day 1 for next treatment.

  • It was my first time taking Clomid, is it normal that I expect menses to be delayed even with negative HPT?

Clomid does not directly impact the length of menses.  However, it does help regulate the ovulatory process so your menstrual cycle will look different.  For some patients, cycles are a bit shorter and for others they are longer as Clomid works to increase production of FSH hormone.

  • What does LH hormone timing look like in the cycle?

LH rises slowly only a few days before ovulation and then has a sharp rise known as LH peak or surge, 24-36 hours before ovulation.  It only stays elevated for about 24 hours and then drops sharply.  It does not begin to rise again with the start of the menses, at least not right away.

How to get pregnant with Unexplained Infertility.

Our hearts melt when our patients text us: “We did it! I can’t believe it.” We want to share a story of one of our patients who underwent IVF and other procedures and lost her hope. However this story does have a happy end.


“Alice tried everything and her hope was lost…”

By Dr. Gary Levy

(Board-Certified Reproductive Endocrinologist, Chief Medical Officer of Fertility Cloud)


I would like to introduce to you the story of Alice (name changed for the purposes of this blog post).

Alice is a patient that came to us with the diagnosis of unexplained (undiagnosed) infertility. Alice had an evaluation that demonstrated normal ovarian reserve, her AMH was 3.58 ng/mL (the lab norm is from 1 to 7.6 ng/mL), her fallopian tubes were open as documented by a hysterosalpingogram test and her spouse’s sperm evaluation was completely normal. In addition, her male partner had two prior children from a previous relationship. Alice had been trying to conceive for over fourteen months prior to seeking care with us. She underwent a few cycles of letrozole and then underwent IVF and did not get pregnant with a frozen embryo transfer.

After seeing her through our, always accessible, telehealth platform, we realized that Alice likely suffers from LPD. We discussed additional testing for PDG monitoring and confirmed our suspicions.

We discussed her treatment options, and she underwent ovarian stimulation and progesterone support and got pregnant on her second treatment cycle. She was ecstatic, as her experience at FC allowed her to be successful and receive an answer to the question that has been unanswered for a long time providing much needed closure in a much more affordable manner.”