Best age to get pregnant with PCOS, precautions and unusual symptoms

Polycystic ovary syndrome (PCOS) is a condition that affects a female's ovaries work and is characterized by a hormonal imbalance. PCOS affects up to 13% of females in their reproductive age, and around 70% remain undiagnosed. There is no cure for this condition, but proper treatments can improve symptoms.

Although PCOS affects fertility, in itself it does not prevent pregnancy. You can get pregnant with PCOS, but there are certain precautions and factors to consider, including age. Now, when is the best age to get pregnant if you have PCOS? Let’s get it sorted.

What does PCOS have to do with age and fertility?

It is true that people with PCOS can have a harder time getting pregnant. This is because of the high male androgen hormone production caused by this syndrome. The prevalence of this hormone disrupts the menstrual cycle and ovulation, making it trickier to conceive. Both PCOS and older age in tandem can make the journey more challenging. 

For a pregnancy to happen, fertilization needs to occur during your fertile window. And here are the two issues. First, PCOS can cause irregular cycles, when ovulation is hard to track. It might not even occur during certain cycles or not occur at all. And if ovulation is not happening, conception is not biologically possible. 

Egg count

An egg is produced by your ovary every month during the ovulation phase (fertile window), expecting to be potentially fertilized. But the number of eggs that a female body produces during her lifetime every month is not unlimited and it decreases with time. 

A female fetus has around 6 to 20 million eggs (oocytes) in their ovaries, but the number is decreased even by the time the baby is born – a newborn girl has between 1 million and 2 million eggs left. This decrease continues throughout her whole life, and a young adult would have about 4000,000 eggs left – about 10,000 of them would die every month before puberty. 

A more rapid decline starts at around age 37-38. Only around a thousand eggs survive by the time a woman reaches menopause.

This means that combining the two factors – irregular ovulation or a lack of ovulation caused by PCOS and a steady decline in egg supply as a woman ages – makes it twice trickier to get pregnant. Besides that, additional PCOS symptoms, such as high sugar levels, high blood pressure, among others, don’t help either. It also makes sense to consider a partner’s health and fertility, since sperm quality and quantity also play a role in a successful fertilization and can also be affected by aging, according to some studies.

Menopause 

The average age of menopause, when the menstrual cycle stops completely, is around 50 years. However, different people reach menopause at different times – some earlier, and some later, around 55. The earliest perimenopause signs, although rare, might start as early as 35 years old in some people. However, there was one curious study that explored a tendency of an increased reproductive lifespan in the US female population. It says that from 1959-1962 to 2015-2018 years, the age of a natural menopause in females increased from around 48 years to up to 50 years. Meanwhile, the reproductive life span increased from 35 to 37 years. Putting it simply, an increased lifespan with certain factors, such as use of oral contraceptives, was linked to later menopause and longer reproductive ages.

That being said, egg numbers decrease every year, which is natural and normal. Thus, experts consider 20s to mid-thirties an optimal age to get pregnant with PCOS for those who wish to have babies. And it is not just because of the number of eggs, but also because of their quality and the overall person’s health. It might also take a number of cycles to conceive.

Pregnancy with PCOS success rate by age

But what do statistics say about the chances to conceive while managing PCOS? 

One study examined the likelihood of spontaneous (natural) conception in different age groups. It was observed that it was twice as easy to conceive for women in their 19-26 in comparison to females in their 35-39. The study says that the reduction in fertility was greatest in women in their late 30s and early 40s.  

Another study revealed that 58.3% of females with PCOS from a control group conceived naturally after managing their lifestyle and diet. 

Besides, certain fertility treatments for people affected by PCOS can increase the chances of getting pregnant. For example, a study found that around 80% of females with PCOS successfully ovulated after being treated with the drug called clomiphene citrate. And half of them got pregnant naturally within six months.

Sometimes, a doctor can recommend In Vitro Fertilization treatment. According to research, your chances of getting pregnant with PCOS can be around 20% to 40% with IVF. Notably, according to this study, females over 35 years old or overweight have a lower chance of conceiving.

Difference between PCOS and pregnancy symptoms

According to the three international guidelines, there are several specific symptoms for diagnosing the syndrom. One of these diagnostic criteria requires a patient to have 2 out of 3 symptoms to be diagnosed with PCOS:

• High testosterone or symptoms of high testosterone (male patterned hair loss, facial hair, etc.);
• Irregular ovulation and irregular cycles/lack of ovulation;
• Ovaries with numerous cysts, visible on ultrasound.

Sometimes, it is possible to confuse PCOS symptoms with early pregnancy signs. For example, sugar cravings and weight gain, hair loss – these PCOS symptoms can be easily taken for a pregnancy and vice versa. 

Moreover, certain medications like metformin, which is prescribed to treat PCOS, can also cause symptoms similar to pregnancy – vomiting, nausea, metallic taste in the mouth. Progesterone treatment, on the other hand, can cause swollen breasts, mood swings and fatigue, which are also typical for a pregnant woman. 

Having irregular menstrual cycles with PCOS makes it difficult to understand if you're pregnant or skipped your period because of the syndrom. A simple pregnancy test can clear that up. 

To tell PCOS and first trimester pregnancy symptoms apart, listen to your body and notice very typical pregnancy signs (if you are sure they are not caused by medications). Among these symptoms are feeling fatigue due to higher hormone progesterone levels, swelling and tender breasts, sensitivity to smell, and frequent need to urinate. As soon as you start to experience these symptoms – take a pregnancy test. Usually, it will show the results two weeks after sex.

There is no magic trick to guess if it’s a PCOS or a pregnancy sign, but if you notice anything unusual and suspicious – consult your doctor. There are also no specific symptoms of pregnancy with PCOS, however, it is possible to confuse those two conditions.

Unusual pregnancy symptoms with PCOS

Besides some standard PCOS symptoms described above, there are some of them that can be quite unusual. The thing is, they can also signify pregnancy. Some of such symptoms are:

• Low vitamin D – one of the most common symptoms in pregnant women. The deficiency among pregnant females is quite a common thing, even for those living in sun-rich countries. On the other hand, low vitamin D can be a PCOS symptom in non pregnant women.
• Skin tags – although more rare than others, it can be a symptom for pregnant people and people with PCOS.
• High cholesterol (over 200 milligrams/deciliter) – can be observed in pregnant people in their first trimester of pregnancy. However, this is also a common sign for PCOS.

These are just some of the peculiar symptoms that a pregnant woman can notice while at the same time having PCOS. It’s important to consult a doctor to define what exactly is going on.

Precautions during pregnancy with PCOS

You might also wonder what precautions to take during pregnancy with PCOS. With this syndrome, a pregnant woman might be at risk of complications during her pregnancy. In that case, experts recommend certain lifestyle management:

• Monitoring sugar level and insulin resistance;
• Sticking to a healthy diet;
• Keeping a healthy body mass index (BMI);
• Physical activity (150 min/week moderate or 75 min/week vigorous intensity exercise, as per clinical recommendations).

However, keep in mind that general recommendations might not fit your specific case. It is crucial to discuss your lifestyle and health corrections with a doctor if you are trying to get pregnant or already pregnant while managing PCOS. 

A baby, whose parent is having PCOS, can also be at certain health risk factors. That’s why it is necessary to consult an expert to define individual health management and ensure a healthy pregnancy and a baby.

Final Verdict

There is no universal "best" age to get pregnant with PCOS. However, considering the data from scientific studies and biological factors, experts recommend getting pregnant with PCOS before mid 30th.

It can be hard to tell the difference between PCOS and pregnancy symptoms, because these two conditions can have similar signs due to hormonal fluctuations. Some unusual pregnancy symptoms can also be easily confused with PCOS signs. A pregnancy test and an ob-gyn appointment can help clear it up.

It is crucial to be aware of the risks associated with PCOS and pregnancy and take precautions during pregnancy with PCOS. Make sure to consult your doctor to determine risk factors and specific for your body options for a successful conception and pregnancy.

‍

References

”Polycystic ovary syndrome”, https://www.who.int/news-room/fact-sheets/detail/polycystic-ovary-syndrome

“Unifying theory of adult resting follicle recruitment and fetal oocyte arrest”, https://www.sciencedirect.com/science/article/pii/S1472648315003582

“Comprehensive review on the positive and negative effects of various important regulators on male spermatogenesis and fertility”, 

https://pmc.ncbi.nlm.nih.gov/articles/PMC9884832/ 

“Prevalence of Polycystic Ovary Syndrome Phenotypes Using Updated Criteria for Polycystic Ovarian Morphology”, https://pmc.ncbi.nlm.nih.gov/articles/PMC4126218/ 

“Pregnancy Outcomes in Women with PCOS: Follow-Up Study of a Randomized Controlled Three-Component Lifestyle Intervention”, https://pmc.ncbi.nlm.nih.gov/articles/PMC9867443/#:~:text=Conception%20resulting%20in%20live%20birth,total%2C%2058.3%25%20conceived%20spontaneously 

‍