Polycystic Ovary Syndrome (PCOS) affects about 35% of women today, causing irregular cycles and ovulation challenges that make conception more difficult. Beyond weight management, many women with PCOS require specific medications to normalize their cycles and aid in ovulation.  

Dr. Vimal Grover, Senior Director Obstetrics & Gynaecology, Fortis La Femme, GK, says, “Women with PCOS need to take special care during and before pregnancy.”  

Here’s how to manage PCOS for a healthy pregnancy 

Planning Pregnancy with PCOS 

Dr. Grover advises that women with PCOS should aim to conceive between the ages of 25 and 35, as fertility can decline with age. One of the primary challenges is managing weight, as excess weight not only impacts fertility but also affects pregnancy outcomes. Weight loss is crucial, as being overweight can reduce the chances of spontaneous conception. 

For women who struggle to conceive naturally, ovulation induction is often necessary. However, this treatment increases the risk of multiple pregnancies, raising the rate from 1% to 9%. Multiple pregnancies are considered high-risk for both the mother and baby, requiring close monitoring by an obstetrician in a specialized high-risk pregnancy clinic. 

Insulin Resistance and Its Impact 

Insulin resistance is a common issue in PCOS and can negatively affect egg quality, increasing the risk of miscarriage. Managing insulin resistance through weight loss or medications such as insulin sensitizers can improve fertility and reduce complications. In cases where ovulation induction is unsuccessful, IVF is a viable option and is commonly used for PCOS patients. IVF success rates for women with PCOS range from 70% to 80%. 

Progesterone Support During Pregnancy 

Women with PCOS are at a slightly higher risk of miscarriage due to low progesterone levels. To prevent this, progesterone is often prescribed orally, vaginally, or through injections. Proper hormonal support is key to sustaining pregnancy and reducing the chances of complications. 

Managing Pregnancy After Conception 

Babies born to mothers with PCOS have a higher risk of birth defects, often due to insulin resistance and other factors. Dr. Grover recommends maintaining healthy blood sugar levels, taking prenatal supplements, and avoiding unnecessary medications during the first trimester to reduce these risks. Regular prenatal check-ups are essential to monitor both maternal and fetal health. 

For women who conceive through IVF, progesterone support may need to continue for an extended period, as these pregnancies require more careful management. However, once a woman with PCOS has successfully conceived, her fertility often improves, and she may not need as much assistance with subsequent pregnancies. 

The Importance of Contraception Between Pregnancies 

After a successful pregnancy, fertility can return to normal in PCOS patients, sometimes unexpectedly. Dr. Grover stresses the importance of using contraception between pregnancies, as irregular cycles may lead women to believe they aren’t ovulating when, in fact, they could conceive again without realizing it. 

While pregnancy in women with PCOS can present unique challenges, with the right care, medication, and monitoring, it is entirely possible to have a healthy pregnancy. Proactive management of weight, insulin resistance, and progesterone levels, along with specialized obstetric care, ensures the best outcomes for both mother and baby.