Polycystic ovary syndrome, better known as PCOS, is a chronic health condition related to hormone imbalance that affects one in 10 women of childbearing age. It disrupts ovulation, meaning your periods are irregular and your ovaries don’t grow and release eggs according to schedule. As you can imagine, PCOS is a common cause of infertility–but it doesn’t make it impossible for a woman to get pregnant.
“PCOS is a spectrum,” explains Anuja Dokras, M.D., director of the Penn Polycystic Ovary Syndrome Center at Penn Medicine in Philadelphia. “There will be patients who ovulate every month, some patients who ovulate erratically, and then there’s only a small subset that just don’t ovulate at all.”
If you ovulate, you have a chance of getting pregnant–but the more you can manage your condition prior to conceiving, the more you can increase your odds. Here’s everything you need to know about PCOS and pregnancy, from three OB/GYNs who work with women with PCOS every day.
1. Is it possible to get pregnant naturally with PCOS?
The short answer is yes. The longer answer is that the more regular your periods are, the easier time you’ll have getting pregnant. “Oftentimes, women with PCOS may achieve pregnancy and not realize it because they don’t have regular periods,” says Genevieve Neal-Perry M.D., chair of the UNC School of Medicine Department of Obstetrics and Gynecology in Chapel Hill, NC. “It’s hard to know, if your periods are irregular, whether it’s a missed period or a pregnancy.”
Ovulation, the window of your menstrual cycle during which you can get pregnant, typically occurs around day 14 of a typical 28-day cycle. For women with PCOS, that window can be more erratic, making it tougher to time sexual activity to the days when you’re most fertile.
Interestingly, the menstrual cycle for women with PCOS tends to regulate gradually with age. “The likelihood of pregnancy increases as women get older because their cycles become more regular as they approach the age of menopause,” Dr. Neal-Perry explains.
Andrea Dunaif, M.D. professor of medicine and chief of the Division of Endocrinology, Diabetes, and Bone Disease for the Mount Sinai Health System in New York City, tells her patients this is a sort of “silver lining” for women with PCOS–you may be fertile for longer than your non-PCOS friends. One 2018 study in Frontiers in Endocrinology found that women with PCOS may have a slight advantage in reproductive chances after age 40, specifically with IVF treatments. The authors also noted, however, that PCOS patients over 35 who want to get pregnant should be talking through a plan with their doctor ASAP.
2. How can I manage my PCOS symptoms to help me get pregnant more easily?
You’re planning ahead–and that’s a smart move! There are several concrete steps you can take to manage your PCOS prior to conception, making it easier to get pregnant and safer to carry a baby to term. Dr. Neal-Perry explains that one thing common in women with PCOS is weight gain due to high androgen levels. “When they lose weight, they start to see regular periods,” she notes. “So, with regular periods, it’s often associated with ovulation, and that increases your chance of a pregnancy.”
Women with PCOS also frequently live with diabetes or prediabetes–more than half will receive this diagnosis before the age of 40. If you’re diabetic, it’s critical to manage this with medication and lifestyle changes to avoid any pregnancy complications (such as gestational diabetes).
Dr. Dunaif notes that it’s helpful to talk with your doctor to make sure your medications won’t interfere with your chances of getting pregnant. “A lot of women come to me because they want to prepare themselves to have a healthy pregnancy,” she says. “If they have weight management issues or pre-diabetes, they want to deal with those so that the pregnancy is healthier … It’s very important to discuss with your physician.”
3. Are the signs of early pregnancy different in PCOS than in any other pregnancy?
Nope. Women with PCOS can expect to have the same symptoms associated with early pregnancy: morning sickness, breast tenderness, and fatigue, to name a few. The trick is knowing that you’re pregnant in the first place. “The most common sign of a pregnancy is a missed period, and that’s what makes it tricky with PCOS,” Dr. Neal-Perry notes. Because, “that’s also a common sign of PCOS.”
4. Does PCOS ever affect the reading of a pregnancy test?
One thing you can do is take an at-home pregnancy test to find out if you’re expecting, and for the most part, you can expect to see an accurate result. But in rare instances, a woman with PCOS has naturally high LH levels (a reproductive hormone) that may interfere with a pregnancy test reading.
“If [LH] is high enough, it can give you a false positive,” Dr. Neal-Perry says. “It can happen, but it’s not common.” For a second opinion, you can get a blood test to detect pregnancy, which won’t be influenced by your PCOS.
5. What are the pregnancy risks associated with PCOS?
PCOS does come with a variety of pregnancy risks and complications, including miscarriage, gestational diabetes, preeclampsia (a sudden blood pressure spike), and preterm birth. Women with PCOS are more likely to require C-sections, due in large part to these other risk factors. Dr. Dokras notes that women with PCOS are also at higher risk for perinatal depression, which shows up in the third trimester and postpartum.
“One of the big problems has been teasing out the effects of PCOS with the effects of being overweight,” Dr. Dunaif explains.
“Being overweight has a very negative effect on pregnancy outcomes”–but there is also evidence that PCOS is an independent pregnancy risk due to insulin resistance. The best thing you can do to prevent this is be proactive about your health.
6. What can a woman with PCOS do during pregnancy to lower her risk of complications?
It’s all about condition management. Dr. Dunaif suggests paying “attention to not having excessive weight gain and following weight gain guidelines with her obstetrician.” This has a dual positive effect: it lowers your pregnancy risk and increases positive health outcomes for your baby. “There’s very good data now that the mother’s weight gain during pregnancy is a risk factor for the child later on for diabetes and obesity,” she explains.
Working closely with your doctor is a must, especially if you are overweight or diabetic and considered to have a higher-risk pregnancy. Dr. Dokras recommends glucose testing early in pregnancy to watch out for pre-diabetes, as well as depression screening early on to assess the risk for perinatal and postpartum depression.
Dr. Neal-Perry emphasizes the importance of eating a healthy, balanced diet and tracking your weight gain during pregnancy to make sure it’s progressing healthily (your doctor can help you with this). Take the appropriate prenatal vitamins and stay active in your day-to-day life. “Some people think that when you’re pregnant, that means you don’t exercise, and that’s not really accurate,” she says. A 2019 study in Medicine & Science in Sports & Exercise found that exercising during pregnancy can improve motor skills in the infant, thus potentially reducing risk for childhood obesity.
As mentioned earlier, the best time to start making lifestyle changes is before you get pregnant in the first place. “It’s always best to do these things before you’re pregnant,” Dr. Neal-Perry says. “But certainly, if you’re pregnant you want to make sure that your care is optimized.”
7. Is it safe to breastfeed with PCOS?
Now that we’ve covered pregnancy, the natural follow-up question involves breastfeeding. Is it a smart and safe thing to do with PCOS? The answer here is a resounding yes! “Breastfeeding is good for mom and for baby,” Dr. Neal-Perry says. It can help a new mom lose weight faster, and it has a range of health benefits for the infant: increased immune support and protection against obesity, lymphoma, leukemia, and types 1 and 2 diabetes. Not to mention, it’s great bonding time with your baby.
That said, breastfeeding isn’t always easy at first.
“Breastfeeding in the beginning is hard, and it takes a lot of commitment,” Dr. Neal-Perry says. She compares it to riding a bike: you won’t do it perfectly the first few times, but the more you work at it, the easier it becomes. “Hang in there at the beginning,” she suggests, and you’ll see the payoff before long. If you’re really struggling, a lactation consultant can help you figure out the proper technique and feel more confident.