PCOS is the leading cause of female infertility in France. Although little known to the general public, this endocrine disorder impacts the fertility of menstruating people in different ways, notably by disrupting their menstrual cycle: getting pregnant becomes more complicated. More complicated, but not impossible. If you have PCOS and are considering pregnancy or are currently trying, in this article you will find answers to your questions as well as testimonials from people with PCOS who have managed to get pregnant. We hope this will give you strength for your own journey: good luck ❤️

Understanding Polycystic Ovary Syndrome (PCOS)

Polycystic ovary syndrome, generally abbreviated as “PCOS” which we will also use in this article, is due to hormonal imbalance. It is very common among people of childbearing age, since it affects between 5 and 10% of them, from adolescence to menopause.

What is PCOS?

The menstrual cycle is regulated by hormones . When these are disrupted, the cycle is disrupted: this is what happens in polycystic ovary syndrome.

In people with PCOS, sex hormone levels generally vary little during the cycle. The base level of LH, naturally higher than that of FSH, does not increase in the middle of the cycle and does not trigger ovulation.

In addition, this high LH level is the cause of excessive production of ovarian androgens, in particular testosterone, usually produced in small quantities in the female body. The presence of this hormone in large quantities in the bodies of people with PCOS also has repercussions.

What are the symptoms of PCOS?

This high LH level, coupled with this high testosterone level, is responsible for several types of abnormalities in affected menstruators. These are the symptoms of PCOS:

• Menstrual irregularity see anovulation: The menstrual cycle is irregular (the difference between cycle lengths exceeds a gap of 9 days considered normal), to the point where ovulation may not take place;
• Hirsutism: Women with PCOS may experience excessive hair growth on the face, chest, back, or other areas of the body where men typically have hair;
• Consequential hormonal acne: Acne may be more common and severe in women with PCOS due to hormonal imbalances, particularly high androgen levels;
• Hair thinning or baldness: Some women with PCOS may experience hair loss on the top of the head, similar to male pattern baldness;
• Weight gain and difficulty losing weight: Women with PCOS often tend to gain weight, especially around the waist, and may have difficulty losing weight despite diet and exercise efforts. This may be due to lipid abnormalities (high cholesterol and triglycerides) and insulin resistance. These elements can increase the risk of developing type 2 diabetes;
• Presence of a very large number of follicles with incomplete development on the ovaries : This condition hinders fertility by preventing ovulation.

These symptoms vary from one woman to another and are not always present at the same time, in particular because they depend on the intensity of the disease and the hormonal imbalance.

How to be diagnosed with PCOS?

If you have any doubts about whether you have PCOS, especially because you are unable to get pregnant, it is important to consult your doctor.

🖐️ Whether or not you are diagnosed with PCOS, if your couple is having difficulty conceiving a child, the possibility of endometriosis will be considered and you will undergo various examinations.

The Rotterdam criteria

After having been debated for a long time, the diagnosis of PCOS has been based on the three Rotterdam criteria since 2014. To be said to have PCOS, you must present at least two of the three Rotterdam criteria among:

• Clinical hyperandrogenism (hirsutism, acne, androgenic hair loss) or biological (abnormally high testosterone levels).
• Menstrual cycle disorders, with rare or absent ovulation (oligo-anovulation or anovulation). The Rotterdam criteria established that cycles shorter than 21 days or longer than 35 days were considered dysovulatory.
• Large ovarian volume (greater than 10 mL and without the presence of a cyst or dominant follicle) and/or a significant number of small follicles detected during a vaginal ultrasound.

Diagnostic exams

There are three examinations to make the diagnosis of PCOS:

• Hormonal assessment: this assessment takes stock of the levels of different hormones (FSH / LH, androgenic hormones, etc.). Several blood samples are taken at different times of the menstrual cycle to study their evolution;
• Pelvic and/or abdominal ultrasound: ultrasound is a contested examination because its results are often inconclusive. It can make it possible to study the size of the ovaries which can enlarge (1.5 to 3 times the “normal” size) in cases of PCOS;
• Laparoscopy: as for endometriosis, laparoscopy is an examination that is authentic due to its precision, although it is more invasive (it is a surgical procedure). It consists of observing the interior of the abdominal cavity, the uterus, the ovaries and the fallopian tubes. It makes it possible to observe the significant ovarian activity linked to the disease (large ovarian volume and large number of small follicles).

What causes PCOS?

The origin of the hormonal imbalance leading to PCOS is, still today, not clearly identified. It is considered to be multifactorial.

The two most convincing factors are:

• Genetics: Around twenty PCOS predisposition genes have been identified. However, they only explain the occurrence of PCOS in less than 10% of cases. In addition, family history (presence of the disease in women in the family, particularly close ones) exposes a woman to a 30% increase in the risk of developing the disease.
• Environmental: Endocrine disruptors (these substances that we find today in nature, in our food, in our cosmetic products or even in our clothing) could play a role in the appearance of the disease. However, no evidence and no link between endocrine disruptors and the occurrence of the disease have been established to date.

Can PCOS be cured?

Currently, there is no treatment and definitive solution to cure PCOS. However, different treatments exist to slow down its progression, alleviate its symptoms and live as best as possible with PCOS.

How can this impact my fertility?

PCOS is also the leading cause of infertility in France. It can therefore impact your fertility . The disruption of fertility in a person with PCOS most often depends on the severity of the disease and the number of symptoms affecting it.

Here are the elements that can affect your fertility:

• Irregular menstrual cycle: People with PCOS often have irregular menstrual cycles. This makes it difficult to determine the time of ovulation and therefore the optimal time to have sex in order to conceive. Monitoring the menstrual cycle solely through applications that “count the days” thus appears insufficient for conceiving;
• Poor egg quality: The eggs produced by the ovaries may have impaired quality in women with PCOS. This can reduce the chances of conception and increase the risk of miscarriage. In this case, your doctor may consider IVF to promote the selection of good quality eggs;
• Anovulation: In PCOS, the ovaries often produce eggs irregularly or may not produce eggs at all. Because ovulation is necessary for conception, you may experience difficulty conceiving. In this case, your doctor may consider treatment to trigger ovulation;
• Hormonal Imbalance/Hyperandrogenism: PCOS is associated with high levels of male hormones (androgens) such as testosterone. This can disrupt the hormonal balance necessary for ovulation and fertility;
• Insulin resistance: Many women with PCOS have insulin resistance, meaning their cells have trouble properly using insulin, a hormone that regulates blood sugar. Insulin resistance can negatively affect fertility by disrupting the levels of other hormones involved in ovulation and menstrual cycle regulation;
• Metabolic syndrome: PCOS is often associated with other medical conditions, such as obesity, high blood pressure, and high cholesterol levels, which are grouped under the term metabolic syndrome. These conditions can also have a negative impact on fertility.

I can't get pregnant and I think I have PCOS: what should I do?

It is also possible that the name PCOS appeared to you when you were already embarking on a baby project. Faced with failures month after month, you have started to conduct your first research and you are considering that PCOS could be the culprit of your difficulties. How to do ?

Step #1: Talk to a doctor about your doubts

Have you been trying to get pregnant for several months without success? We can only recommend that you consult your doctor and your gynecologist on this subject: familiar with your medical file, they will be able to answer your questions.

We also urge you not to be too impatient: according to INED, it takes seven months on average to become pregnant . In their survey published in 2010, after a year of trying, 97% of couples managed to have a child. If after two years and despite regular sexual intercourse without contraception, the couple cannot conceive, we speak of infertility.

Step #2: Go through the diagnosis and fertility testing phase

In cases of infertility and difficulty conceiving, doctors offer different tests. PCOS and endometriosis are two common diseases and often cited to explain infertility. They are both considered, while your companion is also required to do tests (in particular a spermogram to assess the quality of his sperm).

If the diagnosis is made, you will enter into the follow-up of the people diagnosed – see the next part. Otherwise, other avenues will be sought.

I have PCOS and I want to get pregnant, what should I do?

If you have been diagnosed with PCOS and want to get pregnant as soon as possible or soon , you may be worried that you will encounter difficulties. We will take you through the steps to increase your chances of getting pregnant despite PCOS.

Step #1: Consult your doctor

If you have PCOS and have follow-up carried out by your gynecologist and an endocrinologist (doctor specializing in hormones), we can only recommend that you consult them when stopping your contraception and starting your project. baby.

Depending on your medical profile, your age and the severity of the illness and your symptoms, the professional will advise you. He will generally have the choice between two paths:

1. Invite you to try to get pregnant naturally , most often with a deadline (usually one year). If beyond this limit it does not work, he will check that your PCOS is indeed the cause of your difficulties by ruling out other causes and will offer you solutions to get pregnant in an assisted manner. Several solutions exist.
2. Invite you to enter directly into a process to get pregnant in an assisted manner , especially if you and your partner are older and if the disease is more severe. The goal: not to waste time.

Step #2: Try to get pregnant naturally

We want to reassure you, it is completely possible to get pregnant naturally despite PCOS. And this, even very quickly! To put all the chances on your side, here are some great practices and good lifestyle habits that you can put in place.

• Adopt a healthy lifestyle: sleep well, have a balanced and varied diet, drink enough, play sports, avoid stress and anxiety, limit alcohol, tobacco or even stimulants... you know what it is a healthy lifestyle. The better your lifestyle, the greater your chances of getting pregnant.
• Track your cycle using apps: period tracking apps also and above all allow you to track ovulation. However, having sex in the days surrounding your ovulation will necessarily increase your chances of getting pregnant naturally! Record information about your periods each month and the apps can give you information about your ovulation.
• Track your cycle using your basal temperature: your body's basal temperature changes depending on the time of your cycle. These very precise temperature variations can help you identify your fertile period. However, if you have PCOS and your cycles are very irregular, the applications alone may not help you know your ovulation. Taking your temperature almost daily with a basal thermometer will help you better identify it!

• Track your cycle using symptomothermy: due to PCOS, it is possible that your menstrual cycle is completely irregular with chaotic ovulation. In this case, menstrual cycle tracking apps will struggle to help you. As for the basal temperature, the method can be tedious. Other more encompassing solutions will perhaps speak to you more, this is the case of symptomothermy . This method consists of accumulating knowledge on all the symptoms of your cycle so as to be able to predict your ovulation simply by knowing your body. At Gapianne, we have recently been working with Alix, from Magic ovaries, to help you navigate all of the symptoms and thus increase your chances of getting pregnant.
• Track your cycle using ovulation tests: like pregnancy tests, there are ovulation tests that work in the same way and according to the same principle. They detect the presence of hormones linked to ovulation and can help you better identify this precise moment.
• Regulate your hormones to increase your fertility: herbal medicine consists of treating yourself through plants. These act on our hormones and consuming specific food supplements and herbal teas can help restore your hormonal balance when planning a baby.

✴️ Be careful though: herbal treatments can interact with medications you are taking. If you are taking treatment to boost your fertility, seek advice from your doctor and/or pharmacist before supplementing with herbal products.

• Increase your chances with a fertility cup: the fertility cup is a silicone cup which is used to keep your partner's sperm in your vagina, once the latter has ejaculated inside you. Simply place the cup in your vagina and keep it for up to an hour after sexual intercourse: this way, three times more sperm enter your vagina. The advantage of this device is that it is hormone-free and will not interact with any treatments you are taking elsewhere.

❤️ Disclaimer: Because we are all different and health is sometimes also a question of (bad) luck, we would like to remind you here that everything is not completely in your hands and you are not responsible . It is possible that you put all of these tips in place without getting pregnant and it is possible that you do not put any of them in place and that you get pregnant... These practices are only tools to increase your chances, they are in no way guarantees.

Step #3: Test for other causes of infertility

If, unfortunately, it was not possible for you to get pregnant naturally at first, it is then customary to consider specific treatments to increase the chances.

However, before starting this type of treatment, it is necessary to ensure that there are no other factors causing infertility, in addition to your PCOS, and in particular in your partner ( sperm abnormalities, for example). Indeed, this could modify therapeutic management.

Step #4: Implement specific treatments

Once other causes of infertility have been excluded, your referring doctor will be able to deploy a battery of tools, examinations and treatments to support you in your baby project. If we know the name in vitro fertilization (or IVF), it is not the only one to be used!

• Ovulation induction: This is a medical process used to stimulate the ovaries to produce and release an egg as part of fertility treatments or to regulate menstrual cycles.
• Laparoscopic ovarian drilling: This is a surgical procedure used to treat certain cases of polycystic ovarian syndrome (PCOS), especially for people in whom the disease is advanced to the point that ovulation induction does not work.
• Intrauterine insemination (IUI): Also known as artificial insemination, it is an assisted reproduction technique used to help couples having difficulty conceiving naturally. It can be used in addition to ovulation induction.
• In vitro fertilization (IVF): IVF is a medically assisted reproduction technique in which an egg is fertilized by a sperm outside the body of the menstruating person, in a laboratory. The fertilized eggs are then implanted in the uterus, previously prepared by different treatments.

These different methods all have in common that they help you get pregnant. They are mostly invasive (injections, heavy and recurring treatments, surgical interventions) but can allow you to accomplish your baby project. According to the National Institute of Demographic Studies (INED), 71% of couples engaged in IVF became parents within 8 years of starting this course: 41% thanks to IVF, 11% thanks to adoption and 12% naturally.

Advice and testimonials from women who have become pregnant with PCOS

Personal history with PCOS

When were you diagnosed with PCOS?

I was diagnosed when I wanted to have a child, when I stopped taking the pill in 2014, that is to say at 27 years old.

What were your main symptoms?

I had no cycle or very irregular one. Of course I couldn't get pregnant. At first I was patient. I had seen a gynecologist years ago... I should have understood at that time if the doctor had explained it to me, but I was young (18 years old), I had taken the morning after pill and it all seemed very far. Damage…

Journey to Conception How long did you try to conceive before you succeeded?

I went through different stages of treatment… until artificial insemination. We made several attempts. The whole journey took 2 years / 2 and a half years.

Have you had fertility treatments? If yes, which ones ?

I have amnesia of names… but almost all of them, up to the daily stimulation injection and insemination.

Management of PCOS

How did you manage your PCOS symptoms before and during your attempt to conceive?

Wrong.

In addition to the psychological suffering and the multiplicity of heavy hormonal treatments which have an effect on morale, I had acne... I felt useless, ugly, depressed, I isolated myself... I cried a lot. Nobody was talking about this at the time. But I found two solutions:

I trained in reflexology and natural health: I met people, it did me good, I was surrounded, advised… I learned, I understood how the body worked with courses in anatomy, physiology... I had the impression of moving forward, of learning despite the fact that I was stagnating and staying in my job to be able to honor all the medical appointments...

I went to see a psychologist but I wasn't ready to open up, she directed me towards mindfulness meditation: Christophe André entered my life, when he was not at all known in the time !

And finally, I found a group of lyrics… which was very precious to me. My partner agreed to experience this with me and it also reassured him a lot to see the state of feverishness of the other women, that it was normal... that I was not going crazy. That I needed support, sharing... we were very united, it strengthened us a lot even if we don't have the same sensitivity, so it's not always easy to understand each other.

I finally changed gynecologists because it is very important to have confidence and to feel understood. Let there be a match. We must not persist with someone who does not reassure us, with whom we do not feel good or confident.

Have you made any diet or lifestyle changes to improve your chances of conception?

No, I compensated a lot... my diet was comfort food... that is to say very fatty and sugary, which is counterproductive... but we do what we can...

I was a little more careful with alcohol in certain phases of treatment but nothing much more.

Challenges and Solutions What were the biggest challenges you faced in your fertility journey?

Juggling schedules, honoring appointments, blood tests, etc.

And manage these hormones… with the moral impact that that has.

Support and resources What type of support (medical, family, community) have you found most helpful?

The community. Medicine is dysfunctional because it separates things of the body and those of the mind: we are very poorly equipped to “experience” the treatments.

Family life is also difficult because it is complex to understand what the other person is going through and the “don’t think about it anymore and it will happen” sometimes reinforces isolation. but communication within the couple is essential and if it works, it allows us to be united, to stick together.

Finally, paramedicine and alternative alternative medicine really allow you to escape and reconnect.

Are there any specific resources or tips you would recommend to other women with PCOS? To surround yourself with people who have had this experience, just to understand that it's normal to have very disturbed morale while injecting so many hormones...

Experiences with healthcare

How have you worked with your healthcare team to manage your PCOS and fertility?

Do you have any specific advice on communicating with healthcare professionals? I found it very difficult to understand them. I did an MRI, for example, without understanding a word... I had to go and train myself in anatomy and physiology (as part of my two-year training in reflexology) to understand their language . Time is limited at each appointment, for them as for us, it's difficult not to feel lost, we quickly let ourselves be carried away and that has a dehumanizing side.

Emotions and mental well-being

How did you deal with the emotional and mental aspects of the design process with PCOS? Not very good but it strengthened my relationship.

Do you have any recommendations for mental wellbeing during this journey? Talk, surround yourself with people who are going through the same struggle, above all, don't isolate yourself, take care of yourself.

Retrospective and advice

Looking back, is there anything you would have done differently?

I would surround myself differently, sooner, I would have found another gynecologist sooner to evolve in a gentler and more confident environment and I would have fewer expectations of my sisters and mother who were ultimately very deprived.

What advice would you give to a woman with PCOS who is trying to conceive?

Just to understand that her mind is disturbed, that she doesn't become sad or depressed, that the power of hormones is crazy and that she remains full of life and vitality. Do not seek comfort in those around you who do not understand… who are not equipped to support. Look for testimonials, people who are in the same situation, and open up. And organize yourself to face it.

For my part, I carried out this journey without telling the office, I was cheating... I was hiding my appointments etc. It was easier to say that I had been drunk the day before rather than that I had cried before arriving at the office because my umpteenth pregnancy test was negative... I don't know if it would have been better to say that say. It wasn't a time when this would have been accepted, my boss was a misogynist and I didn't want to share this with my team but maybe it's a reflex from the past, I don't know what is the better. I preferred to keep it in my secret garden. I held on all day, and sometimes burst into tears when I left the office. But hey, it was worth it and it allowed me to organize myself. We must create the personal and professional framework that allows us to honor all medical commitments. You have to manage your time. For the record, my pregnancy had to rebalance certain things and above all, with PCOS (4 in my case) we become more fertile the older we are. Infertility is caused by our inability to produce viable eggs due to ovarian overactivity. So as the ovarian reserve decreases over time, this slowly compensates... we become more fertile, we are more able to complete the process. It’s the revenge of PCOS.

I got pregnant during my first cycle after stopping the pill to conceive my second child.

Sources:

Inserm, Polycystic ovary syndrome (PCOS): a common disorder, leading cause of female infertility, 2019: https://www.inserm.fr/dossier/syndrome-ovaires-polycystiques-sopk/

Inserm, Infertility: difficulties in conceiving from multiple origins, 2019: https://www.inserm.fr/dossier/infertilite

Ministry of Health and Prevention, Report on the causes of infertility: towards a national strategy to combat infertility, 2022: https://solidarites-sante.gouv.fr/IMG/pdf/rapport_sur_les_causes_d_infertilite.pdf

Hope Association for Polycystic Ovary Syndrome (Esp'OPK), Nat'OPK: natural methods and/or alternative medicine!, 2018: https://www.esp-opk.org/post/nat-opk-des- natural-methods-and-or-soft-medicine

Deuxiemeavis.fr , PCOS, 2021: https://www.deuxiemeavis.fr/pathologie/sopk