Tears of joy rolled down her cheeks as she watched her baby‘s heart beating strongly inside her womb during the ultrasound scan.
J, 32, was diagnosed with polycystic ovarian syndrome (PCOS) five years ago. When she consulted me, she had already been actively trying to conceive for the past 3 years. Initial failed treatment with traditional Chinese medicine (TCM) led her to explore assisted reproductive procedures. When she tried both IUI (intrauterine insemination) and IVF (in-vitro fertilization) unsuccessfully, she became depressed.
On examination, J had features of PCOS according to Rotterdam criteria. She was obese with a BMI of 33 and her menstrual cycle was irregular. It occurred every 37 to 60 days. Pelvic ultrasound examination revealed many small follicular cysts in both ovaries. A blood test confirmed elevated levels of male hormones. Her husband’s semen analysis was normal.
Preconception management of PCOS
J was advised that she had to reduce her weight in a gradual and sustainable way. This will be beneficial for her general as well as reproductive health. She had to change her lifestyle by adopting a low glycemic index diet and had to exercise, preferably daily. She was prescribed an anti-diabetic medication, metformin, in incremental doses to reduce insulin resistance and to restore ovulation.
Response to treatment
With the support and encouragement from her husband, J lost 8% of her body weight over 9 months and her menstrual cycle became more regular, occurring every 26 days to 32 days. The couple were overjoyed when her period was overdue and the pregnancy test was positive one year after treatment.
Management during pregnancy
Women with PCOS may face several challenges and risks during pregnancy. These include:
1. Increased risk of miscarriage
This is related to the hormonal and metabolic issues associated with PCOS.
2. Gestational diabetes (GDM)
The risk of GDM is higher in pregnant women with PCOS. This condition requires careful monitoring and management with a diabetic physician and paediatrician to prevent complications for both the mother and the baby.
3. Hypertensive disorders in pregnancy
The risk of hypertension during pregnancy (pre-eclampsia) is increased. Careful monitoring is important for optimal outcome for both mother and child.
4. Premature delivery
PCOS is associated with higher risk of premature birth which can lead to various neonatal complications.
Due to the increased risk of various complications, the likelihood of Cesarean section is higher. The baby can be small and growth restricted or larger than the average (macrosomia). As a result, the risk of admission of baby to neonatal intensive care unit (NICU) is increased.
J’s blood sugar and blood pressure were monitored closely during each antenatal visit. A balanced diet and regular exercise tailored to her pregnancy were prescribed to ensure adequate but not excessive weight gain.
Thankfully, J did not develop any of the obstetric complications mentioned. She had a spontaneous vaginal delivery at 38 weeks gestation. The baby girl was born weighing 3.2 kg with no complications.
Both the mother and child were discharged well on the 3rd day after delivery.
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