Pcos birth control pregnancy
How PCOS Can Affect Your Fertility: Kelly Morales, MD, FACOG: Obstetrics & Gynecology
How PCOS Can Affect Your Fertility: Kelly Morales, MD, FACOG: Obstetrics & GynecologyPolycystic ovary syndrome (PCOS) can develop at any age. In fact, you may develop the signs and symptoms of PCOS when you first begin menstruating. But most women don’t get diagnosed with PCOS until their 20s and 30s when they’re having difficulty getting pregnant and turn to their OB/GYN for answers.
The good news is, PCOS is treatable, and women’s health experts like Dr. Kelly Morales here in San Antonio, Texas, can help you figure out the best treatment to improve your fertility. Knowing how PCOS affects your fertility may help you understand the specific treatments that are prescribed to improve your chances of pregnancy.
PCOS and your hormones
PCOS develops from an imbalance in reproductive hormone levels. Your menstrual cycle is regulated by the interaction of your hormones, including estrogen and progesterone, which are your female sex hormones.
If you have PCOS, you may produce excess amounts of androgens, which are male sex hormones that can affect your menstrual cycle and ovulation. High amounts of androgens in your body may also cause other symptoms, such as male-pattern baldness, facial hair, or acne.
Many women with PCOS also have elevated insulin levels. Insulin is a hormone made in your pancreas that carries glucose — your body’s preferred source of fuel — from your bloodstream into your cells. If your cells become resistant to insulin, the glucose continues to circulate in your blood, but your pancreas continues to secrete more and more insulin, resulting in elevated blood levels. Too much insulin in your blood triggers your body to up its production of androgens, which further compounds the hormonal effects on your menstrual cycle.
Problems with ovulation
The hormonal imbalance created by the high levels of androgens affect your ovulation. Every month, your body releases an egg for fertilization.
This is referred to as ovulation and occurs about midway through your menstrual cycle. High levels of androgens may affect the health and release of your eggs. If you don’t release an egg, then you can’t get pregnant.
One of the primary symptoms of PCOS is an irregular menstrual cycle. You may notice that your cycle is either very short (21 days) or very long (35 days). Women with long cycles may only release 8-9 eggs a year, and some women with PCOS don’t menstruate or ovulate at all.
Ovulation problems are one of the most common causes of infertility in women, and PCOS is very often the underlying condition leading to the ovulation issues.
Weight gain and fertility
Unfortunately, the high androgen levels also lead to weight gain or make it very difficult for you to lose weight. And because it’s a male hormone, most of the excess weight is in the abdominal area. Being overweight also increases your risk of insulin resistance, which lead to an increase in androgen production, affecting both fertility and weight.
Treating PCOS and improving fertility
Having PCOS doesn’t mean you can’t get pregnant. In fact, PCOS is one of the most treatable causes of infertility in women. Initially, hormonal birth control pills may be recommended to help regulate ovulation and control some of your symptoms. However, you can’t get pregnant when taking birth control pills.
If you’re overweight, following a healthy diet and exercise program may help improve your hormone balance by decreasing both insulin and androgen levels to help regulate ovulation and improve your chances of pregnancy. Losing weight before you get pregnant may also make for an easier pregnancy and delivery.
You may also need medications that increase your ovulation to help for improve your fertility, such as clomiphene or gonadotropins.
PCOS can affect fertility, but that doesn’t mean you can’t get pregnant. Dr. Morales specializes in the diagnosis and management of PCOS and can provide treatment to reduce your symptoms and improve your fertility.
Call our office today or request an appointment online.
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I Have PCOS -- Can I Still Get Pregnant?
Written by WebMD Editorial Contributors
Medically Reviewed by Traci C. Johnson, MD on March 14, 2021
In this Article
- Hormone Differences
- Ovulation Problems
- Regulating Your Period
- Medicines to Help You Ovulate
- Lifestyle Changes
One of the most common reasons a woman has trouble getting pregnant is a condition called polycystic ovary syndrome (PCOS).
It’s a hormone problem that interferes with the reproductive system.
When you have PCOS, your ovaries are larger than normal. These bigger ovaries can have many tiny cysts that contain immature eggs.
Hormone Differences
PCOS causes a woman’s body to produce higher-than-normal levels of androgens. These are hormones that are usually thought of as male hormones, because men have much higher levels of androgens than women.
Androgens are important in the development of male sex organs and other male traits.
In women, androgens are usually converted into the hormone estrogen.
Ovulation Problems
High levels of androgens interfere with the development of your eggs and the regular release of your eggs. This process is called ovulation.
If a healthy egg isn’t released, it can’t be fertilized by sperm, meaning you can’t get pregnant. PCOS can cause you to miss your menstrual period or have irregular periods. This can be one of the first signs that you may have a problem such as PCOS.
Regulating Your Period
Fortunately, there are some treatments that can help women with PCOS have healthy pregnancies.
Your doctor may prescribe birth control pills that contain man-made versions of the hormones estrogen and progestin. These pills can help regulate your menstrual cycle by reducing androgen production.
If you cannot tolerate a combination birth control pill, your doctor might recommend a progestin-only pill.
You take this pill for about 2 weeks a month, for about 1-2 months. It’s also designed to help regulate your period.
Medicines to Help You Ovulate
You won’t be able to get pregnant while you’re taking birth control pills for PCOS. But if you need help ovulating so that you can become pregnant, certain medicines may help:
- Clomiphene (Clomid, Serophene) is an anti-estrogen drug that you take at the beginning of your cycle.
- If clomiphene doesn’t help with ovulation, you may be prescribed the diabetes drug metformin.
- If clomiphene and metformin don’t work, your doctor may prescribe a medication containing a follicle-stimulating hormone (FSH) and a luteinizing hormone (LH). You get this medicine in a shot.
- One other drug that helps with ovulation is letrozole (Femara). It’s sometimes used when other medications aren’t effective.
If you have PCOS and you want to get pregnant, you should work with a doctor who is a specialist in reproductive medicine.
This type of doctor is also known as a fertility specialist.
A specialist will help make sure you get the right dose of medicines, help with any problems you have, and schedule regular checkups and ultrasounds to see how you’re doing. (An ultrasound is a machine that uses sound waves to create images of the inside of your body. It’s a painless procedure that can track the growth and development of your baby).
Lifestyle Changes
For some women, gaining a lot of weight can affect their hormones. In turn, losing weight, if you’re obese or overweight, may help get your hormones back to normal levels. Losing 10% of your body weight may help your menstrual cycle become more predictable. This should help you get pregnant.
In general, living a healthier lifestyle with a better diet, regular exercise, no smoking, less stress, and control of diabetes and other medical conditions should improve your fertility odds.
Remember, if your period isn’t happening when it should, or you’ve already been diagnosed with PCOS, work closely with your doctor to help get it under control.
And if you want to get pregnant, talk with a fertility specialist.
Oral contraceptive use and pregnancy Online magazine
Every year, 1-10 women out of 10,000 of the fair sex who use this method of protection experience pregnancy on the background of combined oral contraceptives (COCs). Although, according to the instructions, it is recommended to additionally use a barrier method (condom or other) only in the first 7 days of taking COCs.
To determine how reliable this or that method of contraception is, an American biologist created the Pearl Index, based solely on experiments.
It reflects the number of pregnancies in 100 girls who use any contraceptive during one year. The lower the index value, the more reliable the contraceptive method under study. The most common method - a condom - has an index of 7-14%. Taking hormonal contraceptive pills is more effective (the index is 0.1 -0.9).
What is the reason for the “failure” of the drug? Let's try to figure it out, because, taking COC, every woman wants to be sure of the result.
1. "Wrong" choice of contraceptive
Often, when she becomes pregnant while taking COCs, the patient blames herself or the doctor for the fact that the pills were chosen incorrectly. Actually it is not. All COCs have a similar composition, contain estrogens (ethinyl estradiol) and gestagens (analogues of natural progesterone), and the differences between them are only in the chemical structure of these substances and their dosages. In any case, the mechanism of action of all such hormonal pills is to block ovulation.
Gestagen-containing birth control pills (mini-pills) block ovulation not in 100% of cases, but they thicken the cervical mucus, preventing the penetration of spermatozoa into the uterus and preventing the implantation of the fetal egg. More often they are prescribed for unstable ovulation, for nursing mothers, for example.
Thus, all oral contraceptives are quite reliable.
2. Violation of the pill regimen
OCs are usually started on the 2-5th day of the menstrual cycle, that is, immediately after the next menstruation begins and there is confidence in the absence of pregnancy.
Many people think that the contraceptive effect of the drug appears immediately, literally from the first pill, in fact it is not. That is why it is recommended to use additional methods of protection in the first 7-14 days from the start of taking COCs.
Also in the instructions for any COC it is said that the tablets should be taken every day at the same time. Violation of the intake regimen can actually cause pregnancy.
If the delay in taking the pill is more than 12 hours, you can not count on reliable protection. You should immediately take the missed dose, take the next one at the usual time, and use other means of protection in addition to COCs, such as a condom or spermicide, for the next seven days.
3. Disorders of the stomach
If vomiting occurs within three hours after taking another COC tablet, it is likely that the medicine was not absorbed and came out with vomit. If, after stopping vomiting, you do not immediately take an extraordinary dose of the drug, it is quite possible to weaken the contraceptive effect and the onset of pregnancy.
If diarrhea occurs, you should not worry, although you can play it safe and take another pill, there will be no harm from it, but protection will be enhanced and pregnancy will not occur - that's for sure.
4. Taking medications
Decreased effectiveness of hormonal protection may be caused by the interaction of COCs with other drugs. In particular, it has been proven that antibiotics from the group of rifampicin and ampicillin, non-steroidal anti-inflammatory drugs, as well as drugs that affect the enzymatic activity of the liver and accelerate the excretion of hormones from the body, affect the contraceptive ability of tablets.
You should always inform your doctor about the use of a hormonal method of contraception and, if it is not possible to change the drug, use additional methods of protection against unwanted pregnancy. It is generally required to use a condom or spermicides within 4 weeks after stopping the medication prescribed for the disease.
If there is a need for long-term treatment, you should stop taking COCs in favor of other methods of contraception.
5. Intermenstrual spotting
By itself, the discharge does not reduce the effectiveness of OK, rather, there is a feedback here. The appearance of bloody discharge between menstruation indicates that the woman's body does not have enough hormones introduced from the outside in order to reliably insure her against the occurrence of an unwanted pregnancy.
If bloody discharge from the genital tract occurs, it is recommended to stop taking the tablets from the package and discuss with the attending gynecologist the replacement of this drug with a higher dose. In conclusion, I would like to say that the onset of pregnancy while taking COCs does not threaten the woman and the unborn child in any way. Such a pregnancy can be left, the probability of fetal malformations in this case is the same as the average for the population.
6.
Pregnancy with OCs
What to beware of is more than 3 weeks of OCs during pregnancy. In the absence of another menstrual bleeding during the seven-day break in taking OK, you should not start the next pack until there is no certainty that there is no pregnancy. It is necessary to do a blood test for hCG or take a pregnancy test.
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