How can individuals with Polycystic Ovary Disorder (PCOD) become pregnant?

How to Become Pregnant with PCOD

For women with PCOD who wish to conceive, start with weight loss and exercise, then use clomiphene citrate as first-line medication—approximately 80% will ovulate and half of those will conceive. 1, 2

Initial Approach: Lifestyle Modifications

Begin with weight control and regular exercise before any medication. 1 Even modest weight loss of just 5% of initial body weight significantly improves both metabolic and reproductive abnormalities in PCOD, including ovulation and pregnancy rates. 1, 3

• Weight loss should target a 30% energy deficit or 500-750 kcal/day reduction 3
• Exercise programs show positive effects even without weight loss 1
• These lifestyle changes must be implemented first, as they form the foundation of fertility treatment 1

First-Line Medical Treatment: Clomiphene Citrate

Clomiphene citrate is the recommended first-line pharmacological treatment based on strong evidence of effectiveness. 1, 2, 4

• Approximately 80% of PCOD patients ovulate with clomiphene, and half of those who ovulate will conceive 1, 2
• Start clomiphene on or about day 5 of the menstrual cycle 4
• Use the lowest effective dose, especially in PCOD patients who may be unusually sensitive to ovulation induction 4
• Treatment should not exceed 6 total cycles (including 3 ovulatory cycles) 4
• Properly timed intercourse in relationship to ovulation is critical—use basal body temperature charting or other ovulation detection methods 4

Important Safety Considerations with Clomiphene

• PCOD patients are at higher risk for ovarian hyperstimulation syndrome (OHSS) due to increased sensitivity to gonadotropins 4
• Start with the lowest recommended dose and shortest treatment duration for the first course 4
• Monitor for ovarian enlargement—if it occurs, do not give additional clomiphene until ovaries return to pretreatment size 4
• Watch for visual disturbances (blurred vision, floaters, photophobia)—these require immediate discontinuation and ophthalmologic evaluation 4
• Pelvic examination is necessary before each treatment course to check for ovarian cysts 4

Second-Line Treatment: Low-Dose Gonadotropins

If clomiphene fails, use low-dose gonadotropin therapy rather than high-dose protocols. 1, 2

• Low-dose therapy induces high rates of monofollicular development with lower risk of ovarian hyperstimulation 1
• This is particularly important in PCOD patients who have exaggerated responses to gonadotropins 4

Role of Metformin

Metformin improves insulin sensitivity and ovulation frequency, and appears safe during pregnancy, though its effects on early pregnancy outcomes are not fully established. 1, 5

• Metformin reduces insulin levels, which subsequently decreases ovarian androgen production 2
• It improves or maintains glucose tolerance over time in PCOD patients 1
• While metformin increases ovulation frequency, documentation on its effect in reducing miscarriage rates in early pregnancy is limited 1
• Stop metformin and any other teratogenic medications prior to pregnancy and do not restart until after breastfeeding is complete 1

Preconception Counseling and Monitoring

All women with PCOD attempting pregnancy should receive preconception counseling about increased pregnancy risks. 1, 6

• PCOD increases risk of early pregnancy loss, gestational diabetes, pregnancy-induced hypertension, and preterm birth 6, 7
• Screen for metabolic abnormalities before conception: fasting glucose, 2-hour glucose tolerance test, and lipid profile 2, 3
• These pregnancy complications occur independent of body mass index—even lean PCOD patients face increased risk 7
• Ensure thyroid disorders, adrenal disorders, and hyperprolactinemia are excluded or treated before starting fertility treatment 4

Common Pitfalls to Avoid

• Do not exceed recommended clomiphene dosage or duration—prolonged use may increase risk of borderline or invasive ovarian tumors 4
• Do not neglect metabolic screening even in normal-weight PCOD patients—they still face increased pregnancy complications 3, 7
• Do not use laparoscopic ovarian drilling as first-line therapy—its benefit and role remain undetermined 1
• Do not combine clomiphene with gonadotropins initially—there is no universally accepted standard regimen for combined therapy 4
• Do not ignore ovarian enlargement—this requires treatment cessation until ovaries return to normal size 4

Pregnancy Management Once Conceived

Women with PCOD who become pregnant require closer monitoring throughout pregnancy. 1, 6

• Monitor blood pressure, kidney function, and proteinuria regularly 1
• Prescribe low-dose aspirin from week 12 to week 36 to reduce preeclampsia risk 1
• Screen for gestational diabetes early, as PCOD significantly increases this risk 7
• Monthly urinalysis with treatment of asymptomatic bacteriuria 1