PCOS Treatments When Trying to Get Pregnant

If you have PCOS and are taking medications to improve your chances of falling pregnant, it is crucial to rely on the expertise and experience of a qualified fertility specialist, who can monitor closely the effect of the tablets and/or injections. This is because women respond differently to the medications and injections.

Some women may not respond to a certain medication at all, or may just take longer to respond. Others may respond immediately and grow a healthy egg or two in the same cycle, ready to ovulate. Some women may over-respond, ovulating multiple follicles that could result in a multiple pregnancy. The aim is to ovulate one follicle, although two and maybe even three follicles might be accepted. There is also a risk of hyperstimulation, when the ovaries make too many follicles.

As a result, if you are taking meds or injections for ovulation, you should be monitored closely to ensure there is an adequate response and that this response is safe. If you’re not getting a good response from the medication, a different type of medication can be tried. If you’re getting an excessive response, and are at risk of having multiple pregnancies, a different treatment plan may be required. This is because a multiple pregnancy is very high-risk, with a much higher possibility of miscarriage and preterm babies.

Medications for ovulation

The tablets that are commonly prescribed for ovulation include Letrozole, which is commonly known by its trade name Femara. In the simplest terms, Femara is a medication that blocks the enzyme that tells the body to convert testosterone to estrogen. This triggers the body to produce a hormone called FSH, which is short for follicle stimulating hormone. This hormone tells the follicles (the little sacks containing the individual eggs) to grow and get ready to ovulate. Femara is more likely to stimulate the growth of one follicle versus multiple follicles. One of the very few side effects could be dizziness.

An alternative option might be Clomid, Fertomid or as it is called in medical terms, clomiphene citrate. In very simplified terms, this medication blocks the brain’s estrogen receptors, so it produces more follicle stimulating hormone (FSH), which stimulates more follicles to grow eggs. Clomid does tend to make more follicles grow, so there is a higher chance of having a multiple pregnancy. Some women also experience side effects such as hot flushes, headaches and moodiness.

Another medication that may be prescribed is Metformin, which is usually used to manage insulin levels. Metformin is not as effective as Clomid or Femara, but it may help with ovulation if you have PCOS. Your fertility specialist might also add Metformin in addition to Clomid or Fertomid.

Whether your fertility specialist prescribes Clomid or Femara for you, the tablets cannot be taken at any time – there is a window period during your cycle when it can be taken. Usually, for maximum benefit, a course of these tablets start on day 3 of your cycle, and is taken for five days. Usually on about day 11 of your cycle, an ultrasound will be arranged to monitor how you have responded and how many follicles (in which the little eggs grow) there are. The ideal is just one and certainly no more than three follicles should be acceptable to prevent the risk of multiple pregnancies.

If the response is acceptable, your fertility specialist will provide further medication to trigger ovulation. This medication starts maturing the egg/s and getting them ready to ovulate. The timing must be right, because if a follicle is still too small, the egg inside will be immature, and it may fail to ovulate and can also not be fertilized.

This process takes between 34 and 38 hours, so you will ovulate in around 36 hours. Because the time of ovulation is known, you will be able to have intercourse at the time you are ovulating, increasing your chances of falling pregnant significantly. Similarly, if an artificial insemination is required, it can be planned to fall within this time of ovulation.

If the response is not acceptable, your fertility specialist may recommend waiting a few more days, after which a new strategy may be implemented, such as adding in a few injections to boost the process, or to try again on the next cycle with only injections.

The injections are usually only a further step if the medication did not achieve the results. This is both because it is more expensive and time-intensive with self-administered injections and more scans, and also because it is very effective.

With the injection option, the treatment should start off at a low dose. You inject yourself every day for a few days, and your fertility specialist will also give you injections before beginning the scans.

The self-administered injections are designed to allow you to set the dose and has a tiny needle that is really not painful.

The other risk is that these injections are very effective and might see you with five or six growing follicles. In that case, switching over to IVF treatment should be considered seriously. If that is not an option, abandoning the cycle is highly recommended because the risk of having a multiple pregnancy is three times higher.

Further treatment options

These treatments are very effective to address ovulation as a crucial aspect of achieving a natural pregnancy. However, even with healthy ovulation, pregnancy is not guaranteed.

It is also important to remember that PCOS may not be the only fertility issue you may have as a couple. In as many as a third of fertility cases, there are more than one contributing factor.
As such, your fertility specialist will also check for other potential problems such as sperm quality, endometriosis or blocked fallopian tubes among many others possible contributing factors. Fortunately, all of these can be addressed through the range of fertility treatments available today.

We offer all these latest and most effective fertility treatments at Cape Fertility, and we believe in making quality fertility treatment affordable, while always striving for higher success rates.

Your next step to getting the right treatment for you for PCOS when trying to fall pregnant is simply to contact our team of fertility specialists by clicking here…

At Cape Fertility, we value each individual patient and we look forward to providing you with our signature individualised and personalised care!