I often receive questions from Divas about diet, lifestyle, and fertility. I love to hear from these women, and I am happy to answer whenever possible. Sometimes, the question is better answered by an expert in a specific field. When it involves cutting edge fertility research, I turn to Dr. Rashmi Kudesia, a well respected Reproductive Endocrinologist and Infertility Specialist.
Here is a question I recently received:
I am a following of your website and enjoy reading your newsletters etc. I also loved doing your Jumpstart program a few years ago.
After a long road, I become pregnant with twins in October of 2015. In January, I lost both babies due to a second trimester miscarriage due to an incompetent cervix. My husband and I are obviously heartbroken about the loss of our babies (their names are Joseph and Grace).
My doctor explained what incompetent cervix is (the saddest part is that is in something that is usually only diagnosed after a loss, and once you know about it can often have an easy fix). My doctor said that IC and my PCOS were not connected, and that unfortunately, I have two separate issues making having a baby difficult.
I joined a support group in my area of women who have lost a baby. In the group there are many other women who have lost a baby to incompetent cervix, and EVERYONE ONE OF THEM ALSO HAS PCOS!) I am convinced there is some sort of connection. I wondered if you your research and study this is something you’ve ever come across.
If my loss might be an opportunity to better educate others, I’d like to.
Thanks for sharing any thoughts you might have!
Answer from Dr. Rashmi Kudesia, MD MSc
Reproductive Endocrinologist and Infertility Specialist, RMA of New York
The question regarding a possible connection between PCOS and cervical insufficiency (the current term, and much nicer, than incompetency!) is a very interesting one. In general, PCOS is associated with a broad variety of obstetric complications, most frequently gestational diabetes, abnormal fetal birthweights, hypertensive disorders of pregnancy and so forth. At the outset, the association between PCOS and CI is difficult to study, because there are so many confounders. Women with PCOS may be more likely to use fertility treatments to conceive, may be at a higher rate of having twin or even higher-order multiple pregnancy, may at baseline be overweight or have other health issues, and may be predominantly from racial/ethnic groups with known higher rates of obstetric complications in the US. All of these things may contribute to cervical insufficiency.
That being said, there is at least one relatively good study in the US, done through the Kaiser Permanante network. This study demonstrated that, even when restricted to singleton pregnancies, PCOS women (who were largely South Asian and Black) did have an approximately four-fold higher rate of cervical insufficiency than the non-PCOS women. Many of the confounders I mentioned were present in this study – the PCOS women were significantly more overweight, and 78% had high androgen levels. The researchers were not able to do a fully-controlled analysis to determine whether PCOS was still an independent predictor of CI after accounting for these differences.
More research is needed. That being said, the best steps to take for all PCOS women seeking pregnancy is to do the best they can with diet and exercise and try to get into a healthy weight and lifestyle prior to conception, and work with their doctor to choose treatments that give them the best chance of singleton pregnancy. For those that have had CI, they should see a high-risk obstetrician, again prior to conception, to discuss all the possible treatments that could help prevent a repeat of this tragic outcome. I wish the answer were more clear-cut, but I hope this information helps somewhat!
Dr. Rashmi Kudesia is a reproductive endocrinologist and infertility specialist who leads RMA of New York’s Brooklyn office. Dr. Kudesia specializes in treating couples who are trying to build their families.
Dr. Kudesia earned her medical degree from Duke University. She completed her residency in obstetrics and gynecology at New York Presbyterian Hospital/Weill Cornell Medical College. She completed her fellowship training in Reproductive Endocrinology and Infertility as well as a Masters of Science in Clinical Research Methods at Albert Einstein College of Medicine.
Dr. Kudesia has received numerous grants and awards for her academic accomplishments and medical research. She was awarded a Global Women’s Health certificate by Mount Sinai School of Medicine in 2011, and was nominated into the Duke Engel Society, which recognizes intellectual development, service and clinical excellence. Dr. Kudesia is the recipient of the Joan F. Giambalvo Scholarship Research Grant from the AMA Foundation in 2013, as well as multiple in-training research grants. Dr. Kudesia served as a Theme Issue Editor for the American Medical Association’s Journal of Ethics’ issue on Innovation in Reproductive Care, and has held multiple regional and national leadership positions within organized medicine.
Dr. Kudesia is an accomplished lecturer and author and has written numerous scientific research articles and manuscripts in leading medical journals. She has presented many of her research findings at national meetings, including the American Society for Reproductive Medicine (ASRM).