What is the Best Age to get Pregnant with PCOS?

While polycystic ovary syndrome (PCOS)  is known to cause painful and irregular periods, it can also have other effects on a woman's health. Not only does PCOS  increase the risk of type 2 diabetes, miscarriage, and heart disease, but it can also make it harder to get pregnant. And as a woman ages, the chances of getting pregnant with PCOS become even more difficult.

While a healthy pregnancy for women with polycystic ovary syndrome is possible, it’s important to pay attention to a few important factors as you try to conceive. So, what is the best age to get pregnant with PCOS? We sought advice from four fertility experts to provide a comprehensive answer to this question, if PCOS worsens with age, and explain the four types of PCOS and their respective causes.

What is PCOS?

Polycystic ovarian syndrome (PCOS) is caused by an imbalance in the female hormone system, according to the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). Women and girls of reproductive age are primarily affected by this symptom, and weight gain, acne, irregular menstrual cycles, and excessive facial and body hair are some of the common symptoms. In addition to raising blood sugar levels, PCOS can lead to other problems like insulin resistance and enlarged ovaries with cysts.

How are PCOS and Pregnacy Linked? 

PCOS can make it hard to get pregnant and can lead to complications during pregnancy, such as an increased chance of miscarriage, gestational diabetes, and preterm birth, according to the NICHD.

Successful pregnancies with polycystic ovary syndrome are possible, and with medical supervision, women can undergo fertility treatments to increase their likelihood of getting pregnant. Women can also make simple lifestyle changes (for example, weight loss if at risk for obesity) to help improve their chances of conceiving naturally.

What is the best age to get pregnant with PCOS?

Because PCOS has direct impacts on reproductive health, Dr. Ilana Ressler, a board-certified reproductive endocrinologist at Illume Fertility, recommends aiming to get pregnant before the age of 35, citing the natural decline in both egg quantity and quality as women age.

"While the decrease in egg supply typically becomes noticeable in the mid-30s, fertility declines and conceiving becomes increasingly challenging as a woman grows older," Dr.Ressler tells Today's Parent. "Once a woman is in her 40s, most eggs are no longer healthy, and by her mid-40s, there are usually no more healthy ones."

However, Rachael Jones, MSN, APRN, FNP – VP, family nurse practitioner, and Clinical Client Strategy at WIN Fertility Benefit Management Solutions, suggests that the ideal age for pregnancy with PCOS is still very personal. "It can differ based on individual factors such as overall health, fertility status, and PCOS symptoms," she explains. "That is why close collaboration with healthcare providers is crucial for women with PCOS to optimize their fertility and manage potential pregnancy risks at various ages."

Does PCOS fertility get better with age?

According to Jones, some studies suggest that PCOS symptoms can improve after the age of 40 as testosterone levels start to balance out. "Women with PCOS tend to have a higher anti-mullerian (AMH) level indicating a higher reserve of eggs at more advanced ages than women without PCOS. However, age-related changes in the quality of eggs may still be a factor. The bottom line is that although women with PCOS may have a higher quantity of eggs after 40 than women without PCOS, the increased propensity of abnormal embryos may still be a factor and cause issues with fertility past the age of 35."

Does PCOS get worse as you age?

Dr. Caitlin Dunne, MS, FRCSC, Reproductive Endocrinologist and Reproductive Specialist with The Pacific Centre for Reproductive Medicine in Vancouver suggests that there are serious complications of PCOS that get worse over time.

"For example, women with PCOS are more likely to develop diabetes, heart disease, sleep apnea, and depression," says Dunne. "Those women who have very infrequent periods (more than two to three months apart) are at significantly increased risk of endometrial cancer. That’s why doctors need to take a multidisciplinary approach to address all of a patient’s risk factors."

What are the 4 types of PCOS?

Jones explains that there are four types of polycystic ovary syndrome. "These include insulin-resistant PCOS, inflammatory PCOS, post-pill PCOS (which is linked to birth control), and adrenal PCOS," she says.

Insulin-resistant PCOS

Jones says this is the most common type of PCOS and occurs with high insulin levels in the body that cause androgens, like testosterone, to be produced in higher quantities. "With higher circulating blood sugar levels, the body will produce more insulin which further exacerbates the problem, so the key here is to follow a healthy diet low in carbs and rich in protein and healthy fats," explains Jones. "If you have noticed feeling thirsty frequently, weight gain, and brain fog, along with longer and irregular menstrual cycles, this might be the type of PCOS you have."

Inflammatory PCOS

"If you have noticed frequent headaches, what appears to be issues with itchy skin that may be skin allergies, or frequent infections along with longer and irregular menstrual cycles this might be the type of PCOS you have," explains Jones. "Reducing stress in your life and changes in your diet such as reducing consumption of gluten, and adding supplements, if indicated by your doctor, may help."

Post-Pill PCOS

This kind of PCOS, according to Jones, is frequently transient and can happen if you quit taking oral contraceptives suddenly after using them for a while. She says, "You might experience irregular periods, or not get a period for a few months, as well as acne, and overgrowth of hair. This kind of PCOS can usually be resolved with a healthy lifestyle that includes nutritious food, exercise, and low stress.

Adrenal PCOS

Jones adds that a high level of stress can also cause this kind of PCOS."The high stress in this case increases the level of DHEAS (which plays a big role in the production of testosterone and estrogen production)," she explains. "A healthy lifestyle, as well as relaxation methods like mindfulness meditation and adequate sleep, may help with this kind of PCOS."

FAQs

How does age affect the quantity and quality of eggs in women with PCOS?

Age can impact both the quantity and quality of eggs in women with PCOS, which also happens to women without the condition, says Jones. She further explains that PCOS-related hormonal imbalances, such as heightened hormonal levels (androgens) and insulin resistance, may indirectly influence egg quality by disrupting normal egg development and increasing oxidative stress in the ovaries.

Despite these challenges, many women with PCOS can still achieve conception through appropriate management and treatment. This highlights the importance of seeking guidance from a healthcare provider specializing in reproductive health for personalized support and care.

What role do hormonal imbalances play in determining the best age to get pregnant with PCOS?

Hormonal imbalances linked to PCOS can affect the optimal timing for pregnancy in many ways. According to Jones, "Initially, irregular menstrual cycles and ovulation issues may hinder fertility, making conception more challenging during younger, typically more fertile years," she says. "However, as women with PCOS age, the natural decline in fertility may exacerbate these challenges."

Additionally, Jones states that high levels of androgen hormones and insulin resistance can affect the quality of eggs and increase the chances of pregnancy problems like gestational diabetes and pre-eclampsia, especially as a person gets older.

Are there specific considerations for women with PCOS who want to delay pregnancy until later in life?

Jones suggests that freezing eggs can be a good option for women with PCOS who want to delay having children. However, she warns that these women are more likely to experience Ovarian Hyperstimulation Syndrome (OHSS), which can lead to swollen and painful ovaries during egg freezing or IVF. To manage this, women will require close monitoring by a doctor throughout the cycle, with adjustments to medication dosages as necessary.

What are the success rates of fertility treatments for women with PCOS in different age groups?

According to Dr. Robles, MD, Fertility Expert and Obstetrician-Gynecologist at Columbia University Fertility Center, the success rates of fertility treatments (IVF) for women with PCOS vary in different age groups. "For women under 35, the success rate is about 15 to 18 percent per ovulation induction or intrauterine insemination (IUI) cycle and around 50 to 55 percent in an in vitro fertilization (IVF) cycle," he explains.

"As women get older, the success rates decline, with about a two to five percent decline in IUI cycles and a five. 10 percent decline in IVF success rate for each two-to-three-year age bracket above 35. After 40, the success rates range between 15 to 25 percent for an IVF cycle, and after 42, the rates are about 10 percent or less."

Experts

• Rachael Jones, MSN, APRN, FNP – VP, family nurse practitioner and Clinical Client Strategy at WIN Fertility Benefit Management Solutions
• Dr. Ilana Ressler, a Reproductive Endocrinologist at Illume Fertility, is Board-Certified in Both Obstetrics & Gynecology and Reproductive Endocrinology and Infertility
• Dr. Caitlin Dunne, MS, FRCSC, Reproductive Endocrinologist and Reproductive Specialist with The Pacific Centre for Reproductive Medicine in Vancouver
• Dr. Alex Robles, MD, Fertility Expert and Obstetrician-Gynecologist at Columbia University Fertility Center