PCOS Q&A with Dr. Gleaton

Every month, Dr. Gleaton answers all your questions about fertility, pregnancy, birth and more. Follow us on Instagram to ask your questions!

 By OBGYN Dr. Gleaton

Polycystic ovarian syndrome (PCOS) affects about 1 in 10 women of reproductive age. Its presentation can vary widely: some women are asymptomatic while others can experience weight gain, hirsutism (male-pattern hair growth such as hair on the chin and face), as well as hair loss, acne, irregular or missed menstrual periods, and infertility. This month, Dr. Gleaton answered all your questions about PCOS and fertility. 

What additional pregnancy risks come along with a PCOS diagnosis? 

PCOS is associated with increased pregnancy risk of miscarriage, gestational diabetes, preeclampsia, preterm labor, and breast-feeding difficulty

I have PCOS. Can I still get pregnant?

PCOS is a condition characterized by hormone imbalance which often leads to infrequent ovulation. Once ovulation is restored through medications and/or weight loss, pregnancy is definitely achievable!

I have PCOS and I am prediabetic. Do I need to get blood sugar down before conceiving? 

It's always a good idea to have a preconception visit with your OBGYN prior to TTC when you have chronic conditions that may impact pregnancy. In addition to blood sugar, other important labs and measures such as a hemoglobin A1C, thyroid panel, testosterone levels, and BMI assessment can help establish your baseline and ensure the timing is right to get pregnant. Patients who skip this step are at higher risk for poor pregnancy outcomes including miscarriage and pregnancy complications.

Can higher androgens impact egg quality, even with normal ovulation? 

Yes. Even when ovulating, egg quality can be affected.  Each egg is contained within an ovarian follicle. Follicle development and function can be altered in PCOS ovaries. The follicular fluid surrounding the eggs have higher levels of androgens instead of the typical estrogens. In addition PCOS follicles often fail to reach their optimal size and are much smaller than a mature follicle that's destined to ovulate. 

Inositol? Is it safe to use? Which form is best for TTC? How long should you take it for? 

Inositol, often cited as Myo-inositol (MI) and D-chiro-inositol (DCI), is a supplement that can be used to improve glucose levels and insulin resistance. Although supplementation with inositol for PCOS remains experimental, many studies suggest inositol can decrease insulin resistance, improve ovarian function, and reduce androgen levels.

Studies suggest that both forms of inositol are important —MI for improving ovulation function, and DCI for reducing insulin levels. 

There is no uniform agreed on duration of treatment. Since inositol is considered overall safe when ttc and during pregnancy, it may be worthwhile to consider adding this to your regimen after discussing with your OBGYN. 

How is someone diagnosed with PCOS? 

Surprisingly, there is not a universally accepted definition of PCOS!

However, most providers agree that PCOS is diagnosed using three criteria, with only two of the three required to achieve the diagnosis:

1. Having too much male hormone (androgens/ testosterone) observed either on physical exam or lab results
2. Having too few cycles ( typically less than 8 per year)
3. Having too many follicles on your ovaries (typically > 12 follicles on either ovary observed during ultrasound). Notably a 2018 paper recommended increasing the follicle requirement to 20 follicles per ovary to avoid overdiagnosis in some patients. 

Does taking CoQ10 help improve chances for pregnancy in PCOS? If so, how much? 

CoQ10, an antioxidant that powers the mitochondria or energy center of cells, has shown promise in enhancing egg quality in some infertility patients but not all.

A study evaluating CoQ10 along with clomiphene citrate (clomid) compared to clomid alone showed an increase in clinical pregnancy rates by 30%. 

CoQ10 is considered safe with typically minimal side effects, so definitely worth discussing with your ob/gyn as an addition to your fertility regimen.  Although no universally accepted dose, dosages up to 1,200 mgs have been used in divided doses. 

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TTC with PCOS. Tips? General advice? 

Although PCOS affects ovulation and is associated with infertility, there are things to do to improve your chances when TTC!

1. Weight loss - work to decrease weight by 10%. This often restores monthly ovulation, thus increases pregnancy rates
2. Exercise - improves metabolic abnormalities often seen in PCOS
3. Get a physical - Include testing for pre-diabetes or diabetes, elevated cholesterol, and other hormone imbalances like thyroid abnormalities can allow early detection and treatment of metabolic issues that may interfere with fertility efforts. 
4. If you are diagnosed with insulin resistance or pre-diabetes, adding metformin can be helpful.
5. Regularly check in with your OBGYN - Discuss ovulation medications early on to ensure you understand if and when you’re a candidate to start these. 
6. Consider adding supplements that have shown benefit including CoQ10, inositol, folate, and prenatal vitamins

I have PCOS. I usually have a period each month but the last three months I haven’t had anything. 

PCOS is a common cause of oligomenorrhea or amenorrhea which means too few or no cycles. When previously normal cycles suddenly change, this could indicate a shift in hormonal levels and can be caused by stress, dietary and weight fluctuations, or medication changes. Contact your ob/gyn provider for more information.

What are some natural ways women who suffer from PCOS balance their hormones? 

PCOS patients can naturally enhance hormone balance by weight reduction, exercise, and considering supplements recommended for optimal hormone balance. These include inositol, magnesium, vitamin D, chromium, coenzyme Q10, and omega DHA.

Is it possible to get pregnant if I ovulate in my cycle (Day 18/30 with PCOS)? 

Yes! It's always possible to get pregnant if you’re ovulating no matter when it occurs.  

Can having PCOS affect my ability to conceive? 

Yes, PCOS represents a hormone imbalance which can alter how frequent you ovulate, thus how frequent you see your cycle. If you’re ovulating less often, then it will likely take longer to achieve pregnancy. 

TTC tips for those with PCOS? 

Although PCOS affects ovulation and is associated with infertility, there are things to do to improve your chances when TTC!

1. Weight loss - work to decrease weight by 10%. This often restores monthly ovulation, thus increases pregnancy rates
2. Exercise - improves metabolic abnormalities often seen in PCOS
3. Get a physical - Include testing for pre-diabetes or diabetes, elevated cholesterol, and other hormone imbalances like thyroid abnormalities can allow early detection and treatment of metabolic issues that may interfere with fertility efforts. 
4. If you are diagnosed with insulin resistance or pre-diabetes, adding metformin can be helpful.
5. Regularly check in with your ob/gyn - Discuss ovulation medications early on to ensure you understand if and when you’re a candidate to start these. 
6. Consider adding supplements that have shown benefit including -CoQ10, inositol, folate, Prenatal vitamin ( can we hyperlink these to our products?)

What causes PCOS? How is it treated? 

The exact cause of PCOS is unknown. It is a hormonal disorder where elevated testosterone and insulin levels can cause failure to ovulate or have cycles, excessive hair growth on face and body, and higher rates of obesity, diabetes, and heart disease.

What is the best fertility treatment for PCOS?

This depends on the individual patient scenario but we do know that correcting the underlying metabolic condition of increased androgens and insulin resistance with weight loss and exercise is recommended as the first Best step in patients who are overweight or obese. 

If ovulation is not restored with these measures, patients cannot reach their goals or are not overweight,  it is very possible to achieve ovulation with oral ovulation medications - mainly letrozole and clomid. Assisted reproductive technology —intrauterine insemination and in vitro fertilization— are not considered first line for PCOS, and are not always required. 

Read more about PCOS:

• PCOS and Nutrition
• Folate and PCOS
• Getting Pregnant with PCOS: Guide & Treatment Options