PCOS - Pregnancy
PCOS is a leading cause of fertility problems but does not mean you will not be able to conceive. Florida Fertility Institute is pleased to provide PCOS care to those women seeking to become pregnant.
To become pregnant, ovulation must occur. This is when an egg is released, making itself available for fertilization by sperm. Weight reduction of even 5-10%, a low glycemic index diet and addressing underlying insulin resistance can help restore ovulation in some women. This will also help reduce risks after you become pregnant. Obesity carries increased risk of miscarriage, birth defects, gestational diabetes, stillbirth, pre-term birth, pre-eclampsia, and C-section.
In many cases, even with modifications, medications are needed to help a woman ovulate.
Ovulation medications are effective in approximately 80% of patients and 50% of these will become pregnant.
Ovulation Induction Medications
- Letrozole (Brand Name: Femara) – Although not FDA-approved for fertility purposes, it has been available in the U.S. for over 20 years. Multiple studies have demonstrated the safety and effectiveness in using this medication to stimulate ovulation in women. It works by blocking conversion of androgens to estrogen and lowering estrogen levels. This causes the hormone signals from the brain and pituitary to increase in an effort to then try to increase estrogen levels to compensate. These increased hormones also cause follicle development. Most common side effects include nausea, hot flashes, headaches, and fatigue. Research studies have indicated that 90% of pregnancies resulting from Letrozole are singleton births. There is about a 10% chance of twins. In some recent studies, Letrozole has been shown to have higher live-birth and ovulation rates in infertile women with PCOS. There appears to be lower chances of pregnancies with multiples, and fewer side effects with Letrozole than with Clomiphene Citrate. It is considered the first line treatment for ovulation induction in PCOS.
- Clomiphene Citrate (Brand Name: Clomid or Serophene) – This drug has been on the market for over 40 years and has been shown to be safe and effective in numerous women with ovulatory disorders. It works by binding to estrogen receptors so that estrogen cannot send signals to the hypothalamus. This causes the brain to believe more estrogen is needed and to signal higher levels of hormones in an effort to increase estrogen. These increased hormones are also responsible for follicle development (this is where the egg that is released during ovulation is found). Most common side effects include nausea and hot flashes. Approximately 90% of pregnancies resulting from Clomiphene Citrate are singleton births. Less than 1% of reported deliveries are triplets or more.
Getting your body as healthy as possible for pregnancy should be your goal. You should start on a prenatal vitamin. Gestational diabetes (diabetes during pregnancy) is a primary concern for mom and baby. This can lead to enlarged fetal development resulting in preeclampsia, a complication of pregnancy characterized by a sudden rise in blood pressure and body swelling around the 20th week of pregnancy or preterm birth or delivery by c-section. Potential damage to other organs such as the liver and kidneys can also occur. Your OBGYN will monitor you carefully during your pregnancy, evaluating your blood sugar levels. With proper medical care and guidance coupled with careful planning and good self-care, you can have a safe pregnancy and healthy baby.