Miscarriage Risks in Women with Polycystic Ovary Syndrome

Is polycystic ovary syndrome (PCOS) associated with an increased risk of miscarriage?

Last June, I conceived naturally but unfortunately miscarried at 12 weeks.
The doctor mentioned that polycystic ovary syndrome (PCOS) increases the risk of miscarriage (the embryo pathology showed no abnormalities).
After that, I took ovulation medication and Utrogestan, but I experienced bleeding as soon as I became pregnant (even with progesterone injections, there was no improvement).
Subsequently, I had an ectopic pregnancy and had to undergo a left salpingectomy.

1.
Given my situation, should both partners undergo chromosomal testing?
2.
On November 9th, the United Daily News published an article about polycystic ovary syndrome, stating that one should take progesterone for 1-1.5 months to maintain a normal menstrual cycle and prevent endometrial hyperplasia.
Is the following regimen correct? Take Utrogestan for 10-12 days (after each meal) until menstruation occurs.
(If I want to maintain a normal 30-day cycle, should I start taking Utrogestan on day 15 of the cycle for 10-12 days until menstruation occurs?) Is there a chance for natural ovulation with this approach? These past two years have been really tough in my pursuit of having a child.
Is it really that difficult to become a mother with polycystic ovary syndrome? Thank you, doctor, for taking the time to respond!

GRACE, 30~39 year old female. Ask Date: 2000/11/16

Dr. Wang Hanzhou reply Obstetrics and Gynecology

Polycystic ovary syndrome (PCOS) does not make it that difficult to conceive.
If there are 2-3 instances of fetal demise or miscarriage, both partners' chromosomes can be examined.
As for whether to take Utrogestan, please closely consult with your physician.

Reply Date: 2000/11/16

More Info

Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder that affects many women of reproductive age. It is characterized by irregular menstrual cycles, excess androgen levels, and polycystic ovaries. Women with PCOS often face challenges related to fertility, and unfortunately, they may also experience a higher risk of miscarriage compared to women without this condition.

In your case, having experienced a miscarriage at 12 weeks of pregnancy, it is understandable to be concerned about the implications of PCOS on your fertility and the risk of future miscarriages. The fact that your doctor indicated that PCOS can lead to an increased risk of miscarriage is consistent with current medical understanding. The hormonal imbalances associated with PCOS can affect the uterine environment, making it less conducive to sustaining a pregnancy.

1. Chromosomal Testing: Given your history of miscarriage and the subsequent complications, it may be advisable for both partners to undergo chromosomal testing. This can help identify any genetic factors that might contribute to miscarriage or fertility issues. While PCOS itself is not a genetic disorder, it can have hereditary components, and understanding both partners' genetic backgrounds can provide valuable insights into your reproductive health.

2. Use of Utrogestan: Regarding the use of Utrogestan (progesterone), it is often prescribed to help maintain the uterine lining and support early pregnancy, particularly in women with a history of miscarriage or those with irregular cycles. Your understanding of the dosing schedule seems appropriate; however, it is crucial to follow your physician's specific recommendations. The typical approach is to start taking progesterone after ovulation and continue until the expected onset of menstruation. If you are trying to maintain a 30-day cycle, starting on day 15 and continuing for 10-12 days could be beneficial, but this should be confirmed with your healthcare provider.

3. Natural Ovulation: The use of progesterone does not directly induce ovulation; rather, it helps to stabilize the uterine lining after ovulation has occurred. If you are looking to enhance your chances of natural ovulation, your doctor may recommend ovulation induction medications, such as Clomiphene Citrate or Letrozole, which can help stimulate ovulation in women with PCOS.

4. Managing PCOS: Managing PCOS effectively often involves lifestyle changes, including maintaining a healthy weight, regular exercise, and a balanced diet. These changes can help regulate menstrual cycles and improve insulin sensitivity, which is often impaired in women with PCOS. Additionally, medications such as Metformin may be prescribed to help manage insulin levels and improve ovulatory function.

5. Emotional Support: The journey of trying to conceive, especially with the added challenges of PCOS and previous miscarriages, can be emotionally taxing. Seeking support from counseling or support groups can be beneficial in navigating the emotional aspects of fertility challenges.

In conclusion, while PCOS can complicate the journey to motherhood, many women with this condition do successfully conceive and carry pregnancies to term. It is essential to work closely with your healthcare provider to develop a personalized plan that addresses your specific needs and concerns. Regular monitoring, appropriate medical interventions, and lifestyle adjustments can significantly improve your chances of achieving a healthy pregnancy. Remember, you are not alone in this journey, and there are resources and support available to help you along the way.

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