PCOS & Pregnancy- Some Practical Prenatal Advice from the Expert

Women with PCOS are constantly reaching out to me asking, “What do I do now that I just discovered I am pregnant?”  They are wondering if a woman with PCOS should be monitored in a special way during pregnancy. I asked PCOS fertility expert Dr. Mark Perloe to weigh in on this topic.

The best time to address issues of PCOS and to affect pregnancy outcome is to address the metabolic issues that often accompany PCOS prior to conceiving. PCOS can affect egg quality, implantation, as well as placental development. Your medical history is important to consider. Pregnancy loss with PCOS normally approaches 30% about twice the normal risk. If you have had prior losses and simply take clomiphene to get pregnant without correct metabolic abnormalities, miscarriage rates can be as high as 60%.

Many women are misled that problems with a previous pregnancy was due to low progesterone, and so they feel that once they are pregnant that they should begin progesterone treatment. There are many problems with this unfounded belief. First, progesterone levels may be higher in the morning than later in the day. They may be lower after a meal and the vertical position. Levels can vary dramatically from one lab to the next thus making it difficult to prognosticate from a single value. Most important is the finding that a low progesterone level indicates that the egg likely came from a less than optimum follicle. In that case, the issue may be egg quality or hCG production by the early pregnancy. It appears that in pregnancies with falling progesterone, that hCG levels drop before the progesterone starts to fall. This means that the progesterone is a sign that the pregnancy is threatened but does not mean it is the cause of pregnancy problems.

Rather than worrying what to do once you are pregnant, it’s best begin a program focusing on a reducing inflammation, adopting a healthy diet, and beginning strength-training exercises and supplements or medications that address insulin resistance prior to conceiving. It is not clear that taking these actions or adding progesterone after you’ve conceived will be of much benefit. On the other hand, if you focus on correcting these metabolic disturbances, there is little reason to believe that you’re at any greater risk for problems during your pregnancy.