Polycystic ovary syndrome affects young women of reproductive age. Pregnant women with PCOS face the risks of miscarriage, preterm delivery, and the birth of a small baby. Problems like diabetes mellitus, hypertensive disorders of pregnancy are also more common in these women. Polycystic ovary syndrome (PCOS) is a mixed disease with variable causative factors. Basically, it causes ovulatory dysfunction with high androgen levels in women. It is an endocrine disorder in young women with modifiable risk factors. Women with PCOS struggle to get pregnant and often seek fertility treatment. However, it is possible to conceive naturally with PCOS with few lifestyle plans.

What hinders natural conception in PCOS women?

The reproductive issues with PCOS are manifold starting with problems of ovulation and cycle irregularity. From a very young age, PCOS manifests as irregular menstrual cycles with periods of heavy bleeding. Uncertainty over the cycle makes women more stressed and has higher chances of missing the fertility calendar. Also, periods of heavy bleeding make them sick and depressed. Some women may not grow the endometrium at all due to high androgen. These women don’t get their cycles without medications.

Pregnancy in PCOS

Normally a pregnant woman has increased insulin resistance due to the secretion of various hormones. This increased insulin resistance diverts the maternal glucose towards the baby. PCOS women have increased insulin resistance which gets exaggerated when they enter into pregnancy. Hence, these women are at increased risk for early miscarriages. Obese women have at higher risk due to the excess fat tissue. Gestational diabetes mellitus (GDM), pregnancy-induced hypertension (PIH), preeclampsia, preterm delivery, and birth of small for gestational age (SGA) infants are more common in these women.

What are the risks to the baby in pregnancy with PCOS?

PCOS pregnancy can go for high blood pressure and preeclampsia. It is associated with very preterm birth and the risk of gestational diabetes. Infants born to mothers with PCOS are more likely to be large for gestational age. These babies are at increased risk of premature delivery.  Babies may have an increased risk of meconium aspiration and having a low Apgar score at birth. As these children grow, they may have an increased rate of hospitalizations in childhood and adolescence. Also, a greater prevalence of the metabolic disorder, diseases of the nervous system and asthma is observed in these babies. Birth defects seen in infants born to women with PCOS may include problems of the heart, brain, kidneys, and of gut. 

Polycystic ovary syndrome and spontaneous miscarriage

PCOS women are at risk of early abortions, usually, these are first trimester miscarriages. Early pregnancy loss is significantly higher in women with PCOS.  Some of the causes of these abortions are

  • Hormone disturbances like high LH and androgens, the altered ratio of LH & FSH
  • Use of ovulation induction drugs like clomiphene 
  • Thin endometrium
  • Glucose intolerance 

What should I do to conceive naturally with PCOS?

Take Supplements

Supplementation with natural molecules helps to reduce the symptoms of PCOS women. These molecules also aid conception by improving the quality of oocytes and reducing insulin resistance. Hyperandrogenism, oxidative stress, and inflammation of PCOS can be alleviated by these antioxidants.

  • Inositols, 
  • Resveratrol, 
  • Flavonoids and flavones, 
  • Vitamin C, E,& D 
  • Omega-3 fatty acids 
  • Folic acid- high-dose folate may reduce the increased risk of congenital anomalies seen in women with PCOS, particularly those that are obese

Use of contraceptives

     If you are PCOS with irregular cycles your doctor may advise you to take oral contraceptive pills for regularising. Some women may not bleed at all without these pills. These pills will suppress ovulation and you won’t be able to conceive when you are on them. But ovulation returns and the cycle becomes regular after a course of treatment. Hence you may try these medications for 3-4 months prior to conceiving. Although it may take a longer period to conceive these drugs may reduce your LH and assist in natural conception. Long-term use of these tablets may lead to weight gain. 

Modify your lifestyle to conceive naturally with PCOS

  Lifestyle factors such as diet and exercise are most important for PCOS women. Likewise, appropriate BMI is essential for a healthier pregnancy and reducing complications of PCOS.

Weight stabilization: If you are having a normal BMI then you must take care not to gain anymore. On the other hand,  women with established obesity should go on a weight loss diet. Weight reduction of 5%–10% can improve ovulation and subsequent conception. Moreover, it reduces metabolic complications in pregnant mothers. Accordingly, you should try to achieve the targeted weight within 6-12 months. A delay in weight stabilization before conception may have an accumulative negative impact.  

Smoking: You and your partner must try to stop smoking before trying to conceive. On the whole, smoking is a major cause of male factor infertility with reduction in motility of sperm. Furthermore, pregnant mothers should stop smoking to avoid complications like early pregnancy loss and premature delivery. 

Exercises: A low-carb diet with 150 min of exercise per week is ideal for PCOS women. You should exercise five times per week for 30 min at a time. Aerobic exercises are more beneficial. Regular exercises reduce insulin resistance even when weight is not lost. Together, exercise and diet modifications give optimum results when you are trying to conceive naturally with PCOS

Avoid psychological stress

          Hormone alterations in PCOS lead to depression and anxiety in women. The growth of excess hair in the face may change the gender orientation. Menstrual irregularities, acne, obesity add to all these factors. These psychological factors negatively affect the quality of life. As a result, these women have higher rates of anxiety, depression, social phobia, eating disorders, and suicide attempts. High stress is reflected as hyperprolactinemia and needs treatment. Reduction of stress with the help of psychological intervention helps to achieve pregnancy earlier.

Insulin resistance in pregnancy      

        In women without PCOS insulin resistance is seen as pregnancy advances. This occurs as a natural phenomenon to divert more glucose towards the baby by avoiding maternal utilization.  It is probably mediated by increases in various hormones like estradiol, progesterone, prolactin, cortisol, human chorionic gonadotropin. Other specific hormones are placental growth hormone (PGH), and human placental lactogen (HPL). These are the hormones mainly responsible for insulin resistance in pregnancy. 

Bariatric surgery

   PCOS with metabolic syndrome is difficult to treat as they are resistant to most conventional therapy. Metabolic syndrome consists of central obesity, elevated triglycerides, decreased high-density lipoprotein, hypertension, and elevated fasting blood glucose. Bariatric surgery can be effective in achieving significant weight loss in these cases. It restores normal hormone balance and reduces the risks of pregnancy and maternal complications. Most surgical procedures are now performed laparoscopically. Usually performed Bariatric surgeries are gastric banding, gastric bypass, and gastrectomy. Following these procedures, there is significant weight loss & improvement in ovulation. You may achieve a normal pregnancy after Bariatric surgery, but your baby needs to be monitored for complications like growth restrictions. Bariatric surgery in morbid obesity helps to correct hirsutism, acne, diabetes, and hypertension.

Lean PCOS and pregnancy

Not all PCOS women are obese, some underweight women also may have these symptoms.  Lean PCOS women are known to have baseline intrinsic insulin resistance. In advanced pregnancy, lean PCO women secrete high amounts of insulin. Hirsutism, acne, and high androgens are more evident in lean women. Taking high amounts of vegetables and fruits is advisable. Myoinositol improves ovulation and menstrual irregularities.

Diet plan to conceive naturally with PCOS

Women following a strict diet plan often suffer from nutrient deficiency. A balanced diet provides sufficient nutrients and energy for well-being. Planning a proper diet that promotes health and longevity and reduces the risk of diet-related chronic diseases is essential. Although many such diet programs are available, suitability for PCOS women is in question.  Since PCOS women must work on weight management and fertility simultaneously, they should follow a well-balanced food chart. Such a diet should be based on the following principles

  • Energy restriction 
  • Diet with high fiber content and low in fat
  • Low-glycaemic-index-carbohydrate foods
  • Vitamins, minerals, and antioxidants 

Exercises for women trying to conceive naturally with PCOS

PCOS changes in women start at a much younger age. Hence, they should follow a behavioral lifestyle change from early adolescence. Irregular menstrual cycles, excess body hair, and acne are annoying features of a young adult. Moreover, irregular cycles with androgenemia indicate risk for PCOS in later age. Education, regular exercises, and diet goals are mandatory. Regular and moderate exercises can reduce insulin resistance in PCOS. Thus, it aids in normal ovulation and natural conception. Exercises in PCOS can reduce following parameters:

  • BMI
  • Waist circumference ratio
  • Free androgen index
  • Insulin resistance

Effective exercises must plan a minimum of 20 h over 10–12 weeks. 2hrs of exercise in one week suffice to meet the goal. Both aerobic and resistance training is essential. Various such exercises are

  • Cycling
  • Running
  • Swimming
  • Aerobics
  • Dancing

       You should follow intense physical activity with a proper diet plan when planning to conceive naturally with PCOS.

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