As doulas, we are non-medical supports. However, as birth workers, we are seen as knowledgeable professionals. We cannot give medical advice, but we can provide general education on getting pregnant with PCOS.
Many people will see you as a source of information and general questions about conception, pregnancy, birth and more. Potential clients, friends, etc. might ask you about getting pregnant with PCOS.
PCOS is polycystic ovarian syndrome. A common reproductive health condition which impacts reproduction as well as general health and quality of life.
People with PCOS need to see a qualified healthcare provider to manage and treat this condition. However, you can provide information and support as they navigate getting pregnant with PCOS.
What Is PCOS?
Polycystic ovarian syndrome is a condition which impacts hormones.
The ovaries of one with PCOS produce excess male hormones, particularly testosterone. These male hormones are androgens.
If a midwife or doctor suspects PCOS, they will check androgen levels. They will also typically order an ovarian ultrasound.
PCOS tends to run in families and to date, most research suggests insulin resistance as a leading cause.
While you may hear PCOS is seen with a high BMI, PCOS can occur regardless of one’s weight. One can have insulin resistance regardless of BMI or weight.
Some symptoms of PCOS include the following:
- Irregular periods – especially long, anovulatory cycles
- Infertility – often from not ovulating regularly
- High levels of male hormones
- Balding – particularly male patterned baldness
- Acne
- Excess hair growth
- Chronic pelvic pain
- Polycystic ovaries – lots of ovarian cysts and often enlarged ovaries
- Apple-shaped obesity – excess weight around the middle, and difficulty losing the weight.
There is not one test to diagnose PCOS. Usually, it’s diagnosed when a blood test shows elevated male hormones and insulin levels, and polycystic ovaries are seen on ultrasound.
While PCOS can be challenging, there are many ways to treat the health complications and associated infertility. There are several ways for getting pregnant with PCOS.
Is Natural Conception Possible With PCOS?
The simple answer is yes, you can naturally get pregnant with PCOS. The more complex answer is it depends on several factors. There are many treatment options to get pregnant with PCOS, including natural treatment options.
Some prefer to avoid or limit medical and surgical procedures. We often see PCOS with insulin resistance. So, in some cases, natural remedies help correct PCOS and increase the frequency of ovulation.
The World Health Organization (WHO) recommends dietary and lifestyle changes regardless of fertility status, as PCOS is linked to metabolic and cardiovascular health. However, as the body changes with diet and lifestyle, fertility may improve in some bodies.
Dr. Gillian Lockwood, from the IVI Midland fertility clinic, found dietary changes increased her patients’ likelihood of conception by a fifth. Her results were published in a recent study.
Major dietary changes can be difficult, but even reducing or eliminating processed carbohydrates could have a drastic impact on PCOS. As a doula, you can help clients understand the impact diet and exercise can have on their overall health.
It is important to note that dietary changes may not be enough for many with PCOS. As a doula, you should provide this information only when asked about conceiving naturally with PCOS. It is rarely helpful to provide unsolicited advice about diet or lifestyle if one is already undergoing fertility treatment with a healthcare provider.
What Supplements Help With PCOS
As a doula, you are not qualified to recommend any specific supplements. Your language when educating clients is important. If someone asks you about supplements you can respond with something such as, “Some people find taking vitex their PCOS symptoms improve. You can discuss this with your midwife or doctor to see if it’s safe for you to try.”
If a person is already undergoing any fertility treatment, taking even the safest supplements could interact with their treatment.
It’s ideal clients work with a healthcare provider qualified and knowledgeable in recommending supplements. As a doula you can simply provide general information about what some individuals find helpful.
Some with PCOS find the following supplements helpful:
- Alpha-lipoic acid – to reduce insulin resistance
- Cinnamon – aids in insulin resistance
- Vitamin D
- Ashwagandha
- Vitex – a common supplement for regulating hormones and menstrual cycles
- Black Cohosh – aids in ovulation
- CoQ10 – improves egg quality and improves ovulation
- L-Carnitine – improves ovulation.
In addition to supplements, some women find acupuncture helpful in regulating hormones and stress.
What Medications Are Used For Getting Pregnant With PCOS?
Depending on the severity of symptoms, time trying to conceive, age, and other factors, many with PCOS seek medical help to conceive.
Some common medications include:
- Metformin – treats insulin resistance which can aid in regulating your cycle and ovulation
- Clomid – can increase the likelihood of ovulating and therefore pregnancy. It does increase the chance of conceiving multiples
- Letrozole – similar to Clomid
- Injectable gonadotropins – to trigger ovulation, less common as there’s an even higher increased risk of multiples compared to oral medication.
Choosing between only treating the PCOS itself with natural treatment and medication is a very personal decision. As doulas, it is important to never judge the decision a client makes in treating PCOS and overcoming (IUI).
Surgical Treatments For PCOS
Some with PCOS will have short surgical procedures to remove large cysts as needed. Others opt for surgery to treat PCOS and associated hormonal imbalances.
One surgical option is an ovarian wedge resection. This surgery reduces the size of ovaries that become overgrown from cysts. The change in ovaries has an impact on hormone levels and ovulation.
With the use of more fertility medications, and the fact it can sometimes be treated with diet and lifestyle changes, wedge resection isn’t extremely common today for getting pregnant with PCOS.
IVF For Getting Pregnant With PCOS
It is not uncommon to use IVF for getting pregnant with PCOS. If someone has been trying to conceive for a while, used other treatments, is over age 30, etc., IVF may be the right choice for them.
If a client comes to you and asks about IVF, you can encourage them to get a second opinion if they are not certain about moving forward. As you saw about, there are less invasive options.
For those who opt for IVF, doula support can be vital as it is a physically and emotionally challenging process. You can encourage them to be an active participant in the decision making process, as well as encouraging them to practice self-care.
Remind them to discuss the benefit and risk of all their options with their provider. Those with PCOS may be at an increased risk of a serious complication known as ovarian hyperstimulation syndrome (OOHS). However, many doctors alter medications and treatment plans to reduce this risk.
While you cannot provide specific medical advice, you can use this information to be a source of knowledge and support for your clients.
If you want to be even more of a support, consider the Perinatal Nutrition Educator course. With that knowledge, you can support your clients with PCOS in making nutrition and lifestyle changes.
Author: Aliza Juliette Bancoff
Aliza Juliette Bancoff is a well-known doula and doula trainer who has been providing doula services to families for over a decade. She is the founder of Main Line Doulas, a doula group providing doula support in the great Philadelphia area for the last decade, the International Doula Institute, which provides online doula training and lactation training and certification programs and the International Breastfeeding Institute which provides lactation training and certification. She is the co-founder of United Birth, a company devoted to increasing access to doulas across the country to make the perinatal time safer both physically and emotionally. “Every birthing person deserves access to quality doula support. And we are working to make that a reality across the country. The work we are doing to get doulas to every birthing person will decrease the black infant and maternal mortality rate significantly by 2030.” Says Bancoff. Aliza is known for her compassionate and empowering approach to doula work, and she has been featured in numerous media outlets, including United Nations Maternal Health Report, Parent Magazine, CafeMom, theBump and many more. Aliza's journey into doula work began when she gave birth to her first child and felt a strong calling...