It can start as early as adolescence or before. It usually is a lifetime disease and does not go away. However, it can be controlled and symptoms can get better with life style changes and treatment from a good fertility expert who has experience in reproductive endocrinology.
How to get pregnant with PCOS?
The first step is to confirm if she is ovulating. If she is ovulating then she can try for one year ensuring intercourse around time of ovulation. At the same time she must introduce life style changes. If after one year she does not conceive she will need treatment. In case she is not ovulating she requires lifestyle change and drugs to induce ovulation.
Life style changes: These are very important. Aerobic exercises are 5 times a week for half an hour and must be incorporated in daily routine. Diet low in carbohydrates containing fresh fruits and vegetables should be taken. A weight loss of 5 to 10% should be the target. A modest weight loss often helps women to regulate their cycles and ovulate. Besides this, smoking should be stopped and alcohol should only be taken in moderation. A preconception health checkup with the general practioner is recommended.
Medicines which help in ovulation:
1. Clomiphene/ Letrozole: These are oral medications which helps these women to ovulate and release an egg. They are taken for 5 days in the early part of the period. One has to be careful as they may adversely affect the lining of the uterus and this should be checked on ultrasound when monitoring growth of follicle.
2. Metformin: The main reason for not ovulating is increased levels of insulin and blood sugar in these women. Metformin brings down these levels and decreases raised androgen levels also.
3. FSH Injections: These are an alternative to oral tablets like clomiphene and may have better results for conceiving as they do not have any adverse effects on lining of uterus. In case oral medications do not work the injections can be tried.
In case she still does not conceive after trying for a few months she may have other reasons of not conceiving and may require IVF. Here eggs would be developed by giving FSH injections and then retrieved from the body and fertilized with partner’s sperm. Once embryo is made it is deposited in the uterus by a thin catheter. It is imperative to identify a good competent IVF doctor and IVF centre specialized in such cases as often these cases are difficult due to poor egg quality and chances of hyperstimulation.
It must be understood that although women with PCOS take longer to have a baby they have similar number of children when compared to women without PCOS. Women with PCOS must comprehend that they are not totally infertile and may require contraception as natural conception is possible.