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with Jane Harrison-Hohner, RN, RNP and Laura Corio, MD

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Thursday, February 17, 2011

PCOS & Pregnancy Risks: Miscarriage, Infertility, and More

I really want a baby!

Have you been told that you might have polycystic ovarian syndrome (PCOS)? If so, were you at all worried that you might not be able to have a baby? Many women know that PCOS can prompt unwanted facial hair growth, acne, and irregular periods. Additionally PCOS can make it difficult to conceive, increase rate of miscarriages, and increase the risk for type 2 diabetes. Here at the WebMD Women’s Health Community we have been getting increasing numbers of posts from women stating they are desperate for a baby, yet have been unable to conceive because they have PCOS.

In honor of these women, let’s examine the latest information on PCOS and pregnancy. Important questions to address would include:

  • How do I know if I have PCOS?
  • How do I know if PCOS is the cause of my inability to get pregnant?
  • What treatments might help me?

How do I know if I have PCOS?

Traditionally we have stated that the incidence of PCOS in women of childbearing age is between 5-10%. The definition of what constitutes PCOS has changed over the past two decades. In 1990 the National Institutes of Health defined PCOS as:

1. Irregular or absent periods

2. Increased male hormone levels (i.e., acne, facial hair)

3. No other health condition which could be causing the symptoms

In 2003, specialists in PCOS from the Eastern Society for Human Reproduction and Embryology and the American Society for Reproductive Medicine met together. Their consensus statement, issued from Rotterdam, put forward a different definition for PCOS:

A woman could be considered to have PCOS is she had any two of these characteristics:

1.  Irregular, or absent periods

2.  Increased male hormone levels

3.  Multiple small ovarian cysts (“string of pearls”) visualized on pelvic ultrasound

Using this second definition, a recent study of 728 Australian women by March and colleagues (2010) found an incidence of PCOS of about 18%!  If the earlier NIH criteria were applied to these same women, the incidence of PCOS was about 9%. This group of women aged 27-34 were selected from birth records of a single maternity hospital. Of these community based women identified as having PCOS, some 70% did not have a prior diagnosis of PCOS.

While there are some methodology problems with this study (e.g., not every subject consented to having the ultrasound exam of their ovaries) I really like this study for two reasons. First, it really highlights the differences in incidence depending upon which definition of PCOS is used. Second, it suggests that the incidence of undiagnosed women may be much higher than we had imagined.

Next: How do I know if PCOS is the cause of my inability to get pregnant?

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Posted by: Jane Harrison-Hohner, RN, RNP at 9:57 am

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