Often one of the first things that women hear when they are given the diagnosis of PCOS is that they will be infertile or at least have a challenging time getting pregnant. Such news can be devastating. What I prefer to tell women is that we know there is a problem, BUT we also know how to treat it! Sometimes there is a journey to health and fertility, but not always. Many women with PCOS can have successful pregnancies with only simple interventions.
When couples go for infertility testing, about half the time all the tests come back with normal results. Patients often find this reassuring, but as their doctor if there is nothing wrong, I don’t have anything to fix. I love to see infertility patients with PCOS because at least I know what the issue is that I need to correct: they are not ovulating regularly due to insulin resistance.
As I mentioned in my last post, diet and exercise are key to treating PCOS. Women with PCOS who loose just 10% of their body weight will often see a return to ovulation. Weight loss and Metformin will lead to ovulation 60% of the time. Metformin is safe to take at the time of conception. Continuing it during pregnancy has been the basis of debate and is provider dependent.
Pregnitude is a dietary supplement recently available in the US that has been shown to help women improve their fertility, especially women with PCOS. It contains folic acid and myo-inosol, which is derived from a B vitamin complex. Myo-inosol is a natural insulin sensitizer made by the human body. The product was the focus of an article in the August edition of The Female Patient that listed 2 small but significant scientific studies which found improved menstrual regularity and ovulation in those taking the supplement versus folic acid alone. 82% of women on the supplement ovulated within 3 months, while only 63% on folic acid alone ovulated. The supplement allowed women to ovulate much quicker as well, 24 days versus 40 days. Women undergoing IVF who took the supplement had significantly more eggs retrieved (12) on the supplement than those on placebo (8). The supplement is taken as a powder mixed in water twice a day and is available over the counter. The cost is ~$30 a month if ordered from their website or bought from Walgreens.
Almost daily, I get requests for a ‘more natural’ option for fertility and Pregnitude appears to be the perfect answer. It also appears ideal for women who don’t meet the definition of infertility (one year of trying without conceiving) but are frustrated that conception seems to be taking longer than they think it should.
When diet, exercise and Metformin have not resulted in pregnancy, then it may be time to discuss Clomid. Mention the words ‘fertility drugs’ and people see visions of women getting shots in the butt, seven babies and a reality show. Clomid is the mildest of the fertility medications. It has a risk of twins of 10% but triplets or higher is extremely rare. Clomid is taken for 5 days during the cycle and has an ovulation rate of 70%. Clomid is inexpensive at less than $50 a month. So if you can’t afford Clomid, you likely can’t afford a baby.
To monitor if Clomid is working, your doctor will either perform ultrasounds or check progesterone levels at different points of your cycle. Once you have found a dose of Clomid that produces ovulation, you will usually conceive within 3-6 months. If you haven’t conceived in 6 months, the likelihood that you will is extremely low, so additional therapies should be considered. This is the point where I will refer my patients to a reproductive endocrinologist (infertility specialist).
Clomid is an estrogen receptor modulator. It acts to starve your body of estrogen for 5 days, tricking your ovaries into ovulating. A lot of women report significant hot flushes and mood swings during the 5 days they are on the medication. Like estrogen itself, it can increase your risk of blood clots, so it should not be taken if you have a history of DVT or stroke.
PCOS does not have to be synonymous with infertility. PCOS can present challenges for those wishing to conceive, but these challenges can often be overcome with minimal interventions. For more on the diagnosis of PCOS, see the first post in this series.
Sources for this series of posts include: Clinical Gynecologic Endocrinology and Infertility, Seventh Edition pages 465-498; Summary from Up to Date; ACOG technical bulletin #109, in addition to the article from The Female Patient that was linked to within the post.
What fertility interventions have you taken in order to become pregnant with PCOS?