Polycystic ovary syndrome (PCOS) is a health problem that, according to the Office on Women's Health, affects one in 10 women. It's treatable and common, but because of the imbalance of reproductive hormones it can cause issues with fertility. For some women, knowing how to get pregnant with PCOS is a big help when it comes to conceiving a child. After all, pregnancy for any woman, even those without PCOS, isn't exactly easy. The American Pregnancy Association noted that even when everything is done "right," and there are no complications, the average healthy couple only has a 25 percent chance of conceiving each month. (I know. Not what your high school sex education class led you to believe.) That's a really small margin, especially if your period is regular and you know that you're ovulating.
But with PCOS, that number can potentially decrease. Dr. Brooke Hodes-Wertz, assistant professor in the Department of Obstetrics and Gynecology at NYU Langone's Fertility Center, tells Romper in an email that PCOS is a spectrum and presents in different ways. "Most patients have irregular menses and irregular menses usually signifies that one is not ovulating regularly," she says. "The uterus knows when to bleed based on when one ovulates (which is when an egg is released). Progesterone also gets released and roughly two weeks later, once the progesterone levels have lowered, you would get your period." With all this in mind, Hodes-Wertz says it's safe to assume that if someone is having irregular menses, they usually are not ovulating, are ovulating very late in the cycle, or are ovulating sporadically over time. In turn, this makes it difficult to time intercourse around ovulation to conceive, she adds.
Janet M. Choi, M.D., Medical Director of CCRM New York, agrees with Hodes-Wertz. Choi tells Romper in an email that women with PCOS tend to have very irregular periods or none at all. "In many instances, the irregularity stems from absent or inconsistent ovulation. Most women with PCOS do not ovulate every month, making it harder to conceive naturally," Choi says. But she adds that because ovulation can occur when a woman has PCOS, even if it's totally unpredictable, women younger than 35 to 36 years old could try naturally for a few months before seeking medical help.
So if you're ready to conceive, where do you start? While ovulation predictor kits are popular for many women trying to get pregnant, both Choi and Hodes-Wertz recommend that those with PCOS try a different approach. "Ovulation kits tend to be hard to interpret for women with PCOS," Choi says. "There's a lot of false positives and the occasional false negatives."
According to Hodes-Wertz, an irregular cycle (which is pretty standard with PCOS) can often be frustrating and confusing when it comes to ovulation tests. "Women may need to track late into their cycle, and it's not the most accurate in PCOS patients. Some PCOS patients will not get a surge because they are not ovulating, and some will always show up positive, no matter when they test, due to baseline high levels of luteinizing hormone (LH) in PCOS patients."
Despite the difficulty in getting pregnant, both Hodes-Wertz and Choi recommend that women try for a few months on their own to conceive before seeking a medical evaluation. "I think the easiest thing to do is to try and have regular intercourse — two to three times per week and spaced a couple of days apart — for a few months while being mindful of when periods start and stop," Choi says. "If you find that several months have passed and you haven't got a period, first do a pregnancy test. If that's negative, think about consulting with your OB-GYN or a fertility specialist."
Hodes-Wertz agrees and also suggests trying for a few months if you're having long cycles. If your cycles are very irregular or you aren't having a period, you should see a specialist.
What happens once you see your doctor? Hodes-Wertz notes that a specialist can help you track your cycles with blood work and possibly an ultrasound. They may also give you medicine to help you ovulate if your body isn't doing it on its own. "Before starting any treatment, your doctor will likely do some blood testing to rule out other medical issues which can lead to irregular or absent periods, like thyroid disease or other hormonal issues," Choi says. "Assuming normal testing, your doctor might then prescribe you medications, such as Clomid, to help induce ovulation in a more predictable fashion."
Getting pregnant when you have PCOS may be difficult, but all hope is not lost. Talk to your OB-GYN or a fertility specialist when you're ready to try conceiving and they can advise you on what to try, in addition to frequent, unprotected sex. If you need treatment or medication, your healthcare provider will know what works best for you and your situation. Try to be patient, and remember to keep up with hobbies and other fun things to make the TTC tango seem less overwhelming.