You Asked: PCOS & Cervical Insufficiency

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:

Hi Amy,

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!

Molly

Answer from Dr. Rashmi Kudesia, MD MSc

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. Kudesia is a board-certified Reproductive Endocrinology and Infertility specialist, practicing at Houston IVF in Houston, Texas. She joined Houston IVF in 2018 after practicing in New York City, where she was named a “New York Super Doctors Rising Star” in 2016 and 2017.

After completing her Baccalaureate degree in Biology & Medicine magna cum laude from Brown University, she received her M.D. with honors from the Duke University School of Medicine, where she was selected into a clinical research training program co-sponsored by the National Institutes of Health. Her residency training in Obstetrics & Gynecology at the New York Hospital-Weill Cornell Medical Center was followed by subspecialty training in Reproductive Endocrinology and Infertility (REI) at the Albert Einstein College of Medicine-Montefiore Medical Center, alongside a Masters’ of Science degree in Clinical Research Methods. She subsequently served as a Clinical Assistant Professor at the Icahn School of Medicine at Mount Sinai, as well as the Research Rotational Director for the REI fellowship, and Medical Director of the Brooklyn office of the Reproductive Medicine Associates of New York.

Dr. Kudesia is a Fellow of the American College of Obstetricians and Gynecologists, and an active member of the American Society for Reproductive Medicine (ASRM), Society for Reproductive Endocrinology and Infertility, Androgen Excess & Polycystic Ovary Syndrome Society, and American Medical Association (AMA). She has served in multiple local and national leadership roles in organized medicine, including her current positions as Secretary of the ASRM Women’s Council Executive Board and the ASRM delegate to the AMA Young Physicians’ Section.

Dr. Kudesia has also presented scientific research at national and international conferences, and has received multiple awards and grants for her work. She has published peer-reviewed articles and book chapters, including in leading journals such as Fertility & Sterility and the American Journal of Obstetrics & Gynecology, as well as editing a theme issue on reproductive medicine for the American Medical Association Journal of Ethics. Her current areas of focus include improving in vitro fertilization cycle prognosis, polycystic ovary syndrome, LGBT fertility, and fertility awareness, counseling, and access to care. She actively promotes women’s health and wellness on social media via Twitter, Facebook, and Instagram.