PCOS and pregnancy: understand, support, and optimise

Polycystic ovary syndrome is a complex endocrine condition that affects ovarian function. The PCOS is a common hormonal disorder, affecting between 6% and 13% of women of reproductive age. 

It is characterised by a combination of two out of three criteria: 

• irregular or absent ovulation (severely disrupted menstrual cycles)
• hyperandrogenism (excess of male androgenic hormones)
• multifollicular ovaries visible on ultrasound (multiple follicles)

This condition results from a multifactorial interaction between genetics, environment, and lifestyle. Women with a family history of PCOS are at greater risk. Insulin resistance also plays a central role, promoting excess androgens and disrupting normal ovulation. This hormonal imbalance chronic condition impacts overall metabolism, which explains the frequent association between PCOS and being overweight, or even obesity.

The symptoms of PCOS vary widely, but primarily affect the menstrual cycle and physical appearance. Women with the condition often experience irregular cycles, with irregular or absent periods, or a lack of ovulation. Clinical signs of hyperandrogenism may also be present, such as acne, hirsutism (excessive hair growth on the face and body) and sometimes androgenetic alopecia.

On a metabolic level, PCOS is often associated with insulin resistance, increasing the risk of developing type 2 diabetes or cardiovascular conditions.

Beyond the hormonal aspects, this condition also affects mental health: anxiety, body image issues and depression are more common in women with PCOS. The link between PCOS and pregnancy therefore sits within a broader health picture that should be considered from the moment you start trying to conceive.

PCOS is the most common cause of ovulatory infertility. Due to the chronic anovulation it induces, women often have difficulty conceiving spontaneously. Approximately 50% of women with PCOS have primary infertility, and 25% have secondary infertility.

Despite this, the majority of women affected can successfully have a positive pregnancy test with appropriate support. 

Simply regulating menstrual cycles and inducing ovulation can often help make it easier to become pregnant. 

It is important to note that even in the presence of severe PCOS, the chances of conception exist, but require specialist follow-up. IVF is not mandatory. The earlier the condition is managed, the better the outlook. Therefore, PCOS and pregnancy do not mean negative pregnancy test, but require an individualised approach.

Improving your chances of conception with PCOS relies on several complementary approaches. The first step is to make lifestyle changes. Even moderate weight loss (5 to 10%) can be enough to restore spontaneous ovulation. 

Diet also plays a central role: a diet low in fast-release sugars and rich in fibre, lean proteins and healthy fats helps to regulate blood sugar and insulin levels. 

At the same time, regular physical activity, even moderate, improves insulin sensitivity. 

You may also consider taking a pcos supplement to support your fertility. For example, supplements inositol pcos, at a dose of 4g per day, are a highly effective treatment for promoting ovulation, oocyte and embryo quality, regulating the cycle and hormones, and increasing fertilisation rates. We detail all its benefits in the article inositol benefits. 

In addition, our food supplement to get pregnant Ovo+ is compatible with PCOS and contains Coenzyme Q10 and NAC, which are beneficial for increasing the chances of conception. PCOS can be characterised by a ovarian reserve low, or even defects at the level of the oocytes. Coenzyme Q10 in supplements is particularly beneficial when you are looking how to improve oocyte quality. 

If these changes are not enough, treatments may be considered: ovulation induction with medications such as clomiphene or letrozole, or even metformin to correct insulin resistance. Finally, if these medications are unsuccessful, assisted reproductive technologies (IVF, etc.) offer effective options. So, while PCOS and pregnancy are sometimes spontaneously incompatible, solutions exist to restore fertility.

Once pregnant, a woman with PCOS requires closer monitoring. This condition increases the risk of complications during pregnancy, including: 

• early miscarriages,
• premature birth,
• intrauterine growth restriction,
• gestational diabetes,
• pre-eclampsia.  

These risks are linked to the particular hormonal and metabolic environment of women with PCOS. Recent studies also suggest that elevated AMH and androgen levels may influence the hormonal programming of the baby, particularly in girls, increasing their risk of developing PCOS in turn.

This underlines the importance of close medical supervision from the very start of pregnancy. The aim is to safeguard both the mother's health and that of the child, whilst limiting the long-term effects of the condition on future generations.

Pregnant women with PCOS are at increased risk of gestational diabetes due to chronic insulin resistance. This condition can appear as early as the first trimester and requires early screening. It is essential to manage it promptly to avoid foetal complications such as macrosomia or neonatal hypoglycaemia. 

High blood pressure, and even pre-eclampsia, are also more common, even in women with a normal BMI. These complications require close monitoring with regular blood pressure checks, urine tests and growth scans. With personalised follow-up, it is possible to prevent a large proportion of these complications and achieve a delivery without major issues.

Treatment of PCOS during pregnancy focuses primarily on preventing complications. Metformin may be continued during pregnancy if it was introduced beforehand, as it reduces the risk of gestational diabetes and miscarriage.

Adopting a healthy lifestyle is paramount: a balanced diet, regular exercise, quality sleep, and stress management are the cornerstones of prevention. Taking a pregnancy food supplement multivitamin can also be helpful and may be recommended. 

Close medical monitoring is essential, often coordinated between an obstetrician-gynaecologist, an endocrinologist, and a midwife. 

Tailored birth preparation, taking into account the specific risks associated with PCOS, will help you approach labour with confidence. Finally, psychological support may be offered to help manage anxieties related to this so-called "high-risk" pregnancy.

PCOS and pregnancy is not an inevitable dead end. Despite the challenges, the majority of women affected can conceive and carry a pregnancy to term with appropriate care. The keys to success lie in early diagnosis, a healthy lifestyle, targeted treatments and multidisciplinary support. By seeking reliable information and surrounding themselves with competent professionals, women with PCOS can experience a fulfilling journey into motherhood.