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Pregnancy & PCOS: Your Treatment & Management Options
Contrary to popular belief, having polycystic ovary syndrome (PCOS) does not guarantee that you will struggle with infertility. Even though PCOS is a common cause of anovulatory infertility (where there is no release of an egg by the ovary), a handful of women can still become pregnant and carry their baby to term without any medical treatment or intervention.
Nevertheless, research investigating PCOS fertility rates has shown that women with this condition are at higher odds of experiencing infertility than women who don’t have it. For instance, one study conducted demonstrated that more than 70% of participants with PCOS reported infertility, which was 15 times higher than participants who had no diagnosis of this condition. 
While PCOS makes it harder to conceive, massive leaps in medical research have paved the way for various treatments and procedures which can improve your fertility and boost your chances of conceiving.
What Can I Do If I Wish To Conceive?
Understandably, if you have this condition and wish to get pregnant, you may bear some doubts and concerns about your fertility.
When you’re ready, encourage yourself to seek professional advice from a trusted healthcare professional to clarify them. This article will highlight some PCOS fertility treatment options you can discuss with your treating doctor, along with their risks and benefits.
In Malaysia, clomiphene and gonadotrophin injections are frequently used in PCOS fertility treatment. 
Treatment Options For Infertility In PCOS
Clomiphene citrate is an oral fertility medication usually recommended as the first choice of treatment to improve fertility in women with PCOS. This medication functions by increasing the production of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) in the body, thus, encouraging the release of an egg (ovulation).
This medication is administered as an oral tablet for five days per cycle. If ovulation is not achieved, then the dose can be increased for subsequent treatment cycles. Common side effects of clomiphene include dizziness, headaches, and nausea, vomiting, and pelvic pain. 
Metformin is another oral medication that can be used alone or combined with clomiphene to treat infertility. This medication is commonly prescribed if clomiphene has failed to produce the desired outcomes.
While metformin is commonly utilized as an antidiabetic agent, research has also deemed it a possibly effective treatment for anovulatory infertility in women with PCOS.  Some side effects commonly associated with metformin use include diarrhoea, bloating, gas, constipation, and stomach upset.
Letrozole is yet another oral medication that may induce ovulation in women with PCOS. It is commonly utilized only when clomiphene has failed to stimulate ovulation after at least three treatment cycles (clomiphene resistance). [5, 6]
However, this medication’s primary indication is, in fact, treating breast cancer. Hence, it is only prescribed to tackle anovulation under a specialist’s recommendation and supervision.
Letrozole may lead to adverse effects such as hot flushes, night sweats, nausea, and vomiting.
These injectable synthetic hormones are a viable option if pregnancy is yet to be achieved with oral medications. Clomiphene and letrozole are usually trialed before injectable gonadotropins. The reasons linked to this practice include cheaper costs, fewer side effects, and ease of administration through the oral route. 
Injectable gonadotropins act to stimulate ovulation and subsequent pregnancy. Some side effects linked to this treatment include abdominal discomfort, nausea, and vomiting.
The main concerns associated with injectable gonadotropin use are ovary enlargement, which leads to abdominal pain and the formation of a multiple pregnancy (such as twins or triplets) .
In Vitro Fertilization (IVF)
IVF is usually one of the final options for treating infertility in PCOS but is rarely required. If deemed necessary, your fertility specialist will help you determine the type of IVF treatment protocol best suited for you. 
Infertility can heave the heaviness of shame, despair, and disappointment on a person’s shoulders. However, you do not have to bear the weight of this alone. Seeking the advice of a professional, such as a fertility specialist, fertility coach, or healthcare provider, can set your steps in the right direction and ensure you are supported emotionally and mentally.
Women with PCOS can get pregnant, and this is made all the more possible with the host of PCOS fertility treatment and management options available. Nonetheless, before commencing on any supplement or medication, it is always best to seek your healthcare professional’s advice to ensure it’s best and safe for you.
Author: Jasmine Chiam (Bachelor of Pharmacy, Honours)