SingaporeMotherhood | Pregnancy

June 2024

I have PCOS. How Can I Improve My Chances of Getting Pregnant?

If your periods are irregular, and you have been trying to conceive without success, you might want to check whether you have Polycystic ovary syndrome or PCOS. This is caused by hormonal imbalances that can have a significant impact on fertility, making it harder for you get pregnant. Dr Harvard Lin, Consultant Obstetrician, Gynaecologist, and Urogynaecologist at the Asian Obstetrics & Gynaecology Centre (AOGC), tells us more about this common endocrine disorder.


What is PCOS?

In women suffering from PCOS, the body may produce abnormal levels of reproductive hormones such as luteinising hormone and testosterone, the most common androgen (male sex hormone). While all women produce some androgen, women with PCOS produce more than normal. As a result, these women often experience irregular or absent menstrual cycles.

According to SingHealth, PCOS is the first cause of anovulatory infertility in Singapore, which is found in 70 to 80% of affected women.

Anovulation occurs when an egg does not release, or in other words, does not ovulate, from a woman’s ovaries.

Image: freepik

One of my patients, a 32 year-old woman, was trying to get pregnant on her own for four years. She was slim, exercised regularly, and kept a healthy diet. She came to me asking for in-vitro fertilisation (IVF). A blood test and an ultrasound scan revealed she was not ovulating. She was given a course of ovulation induction, and she then successfully conceived.

Another patient only had menstruation once or twice a year. An ultrasound scan revealed that she had an abnormally thickened womb lining. In addition, a biopsy revealed pre-cancerous cells developing in the womb lining. As the cells were not cancerous, we treated her condition conservatively with hormonal control, and she is now back to normal.

However it is crucial to note that having polycystic ovaries is not always bad news, and that you can still get pregnant. Furthermore, while younger women may experience significant side effects from the hormone imbalance associated with polycystic ovaries, this condition tends to improve with age.

Dr Harvard Lin

How does PCOS affect fertility?

  1. Ovulation issues: PCOS disrupts the normal hormonal balance needed for regular ovulation. Hence women may experience irregular or infrequent ovulation, leading to difficulty conceiving.
  2. High levels of androgens: PCOS is often associated with higher levels of androgens (male sex hormones) such as testosterone. This can interfere with the development and release of eggs from the ovaries, further disrupting ovulation and fertility.
  3. Formation of follicles (cysts): Women with PCOS often have multiple small follicles (fluid-filled sacs) in their ovaries, which inhibit the maturation of eggs. These follicles may fail to develop fully or release eggs during the menstrual cycle.
  4. Irregular menstrual cycles: PCOS can cause irregular menstrual cycles, with longer or shorter intervals between periods. This makes it difficult to predict fertile days and optimise timing for conception.
  5. Endometrial changes: Changes in hormone levels affect the uterus lining (endometrium). This makes it less receptive for a fertilised egg to implant.
  6. Insulin resistance: Many women with PCOS also have insulin resistance, a condition where cells do not respond efficiently to insulin (a hormone that regulates blood sugar). This can lead to higher insulin levels and increased androgen production, further exacerbating hormonal imbalances that affect ovulation and fertility.
  7. Increased risk of miscarriage: Women with PCOS may have a higher risk of miscarriage. This is thought to be related to hormonal imbalances and irregularities in ovulation and menstrual cycles.

How did I get polycystic ovaries?

The exact cause is not yet known, but it is believed to be influenced by a combination of genetic, hormonal, and lifestyle factors.

For instance, women whose family members have a history of PCOS insulin resistance or Type 2 diabetes are at higher risk of developing the condition.

In addition, certain lifestyle factors, such as sedentary behaviour, poor dietary habits, and obesity can also increase the risk of developing this condition, or make existing symptoms worse.

Obesity, in particular, can worsen insulin resistance and hormonal imbalances.

Chronic stress can also affect the development of PCOS symptoms.


What can I do to reduce my chances of developing PCOS?

While there is no guaranteed method to prevent PCOS, you can adopt certain strategies to minimise its symptoms. Maintain a balanced diet, engage in regular exercise, and achieve a healthy weight suitable for your body. These can all help to mitigate the impact of PCOS.

Is PCOS affecting my ability to get pregnant?

Here are some signs and symptoms to watch for if you suspect that PCOS is affecting your ability to conceive:

  1. Irregular menstrual cycles: Some of the hallmark symptoms of PCOS are irregular periods, or cycles that are longer than usual (oligomenorrhea), or absence of periods (amenorrhea). These make it challenging to conceive.
  2. Difficulty ovulating: PCOS often disrupts the normal ovulation process, leading to infrequent or absent ovulation. You can assess this by tracking your menstrual cycle and monitoring your ovulation using basal body temperature charting or ovulation predictor kits.
Image: Tetiana SHYSHKINA on Unsplash


How can I check if I have it?

Consult with a gynaecologist or fertility specialist. There is no single test that can, by itself, show that you have PCOS. Your physician must conduct a thorough evaluation. This includes your medical history, a physical examination, ultrasound imaging to assess ovarian morphology, as well as hormone testing. Blood tests also provide insights into hormonal imbalances and ovarian function, aiding in the diagnosis and management of PCOS-related fertility issues.

What can I do to improve my chances of getting pregnant?

Image: pikisuperstar on Freepik

Trying to conceive with PCOS involves some of the same steps recommended for a healthy pregnancy.

  • Manage your weight and BMI: Shedding just 5% of excess weight can enhance fertility and alleviate symptoms.
  • Adopt a healthy diet and exercise plan: Opt for nutrient-dense foods. Replace sugary items, simple carbs, and unhealthy fats with fresh and cooked fruits and vegetables, whole grains, and lean proteins.
  • Track your menstrual cycles: An ovulation app can help you to monitor your menstrual cycle, and identify fertile days.
  • Monitor your blood sugar levels: Balanced blood sugar levels and correct insulin resistance are vital for successful conception, a healthy pregnancy, and the future health of your baby.
  • Consider supplements: Certain vitamins and minerals play a crucial role in fertility. Consult your doctor about appropriate supplements, which may include folic acid, vitamins B6, B12, C, D, E, and coenzyme Q10.
  • Medication options: Your doctor may prescribe medications like metformin to regulate insulin levels or clomiphene citrate to balance oestrogen levels.

Would IVF help?

Before considering advanced fertility treatments like IVF, do explore less invasive options such as intrauterine insemination (IUI). IUI involves directly injecting a concentrated sperm sample closer to the egg, increasing the likelihood of pregnancy. Your doctor may recommend IVF if other interventions are unsuccessful. Women with PCOS have shown high success rates with IVF.


Featured image: freepik

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I have PCOS. How Can I Improve My Chances of Getting Pregnant?