“Polycystic Ovarian Syndrome (hereinafter referred to as “polycystic”) is a roadblock for expectant mothers to prepare for pregnancy ~ I am often asked by patients, “I am polycystic, is it only possible to do IVF?” So, how difficult is it to get pregnant with polycystic ovaries, let’s take a look today. Q. Why is it difficult to get pregnant with polycystic? A, regular ovulation is a necessary condition for normal pregnancy. In polycystic patients, irregular ovulation or even no ovulation, poor follicular quality, coupled with hormonal imbalance in the body, resulting in decreased acceptance of embryos by the endothelium, and so on, these factors can lead to a decrease in the pregnancy rate. Q. Is the doctor going to give me ovulation stimulation? Will it lead to premature ovarian failure? A. As mentioned above. Since polycystic patients have ovulation problems, the natural conception rate is relatively low if they go along with the natural course of events. Therefore, we will give the patient ovulation induction. In a normal woman, there are about 8-10 follicles entering development at the same time in one cycle, usually only one follicle becomes the “dominant follicle” and eventually develops to maturity, and the rest of the follicles will not be able to escape the fate of atresia. Our ovulation stimulation is to pull these follicles that will be atretic back to the growth team, so that they have the opportunity to grow, not the future follicles used up early, so it will not affect the ovarian reserve, will not lead to premature aging. Q. Will ovulation pills or ovulation injections affect my body? Will it affect the baby? A. Ovulation pills or injections may cause multiple births and ovarian hyperstimulation syndrome, so these medications should be used with caution under a doctor’s supervision, and attention should be paid to the use of ultrasound to monitor follicular development and lining. Nowadays, the main oral ovulation drugs we use are clomiphene and letrozole, and the ovulation injection is HMG (short for “urinary prophylaxis”), which have been used for many years, and the data from various aspects proved that these ovulation drugs don’t increase the incidence of fetal malformations. Q. I have taken two cycles of Clomiphene and two cycles of Letrozole, but my follicles are not big, around 8mm, and there are many small follicles, what’s wrong? A. Generally speaking, before ovulation induction, polycystic patients should review the basal state of the body and metabolism, such as whether they are overweight or not, and whether there is insulin resistance, which may cause the patient’s insensitivity to conventional ovulation drugs leading to failure of ovulation induction. If the above abnormalities exist, weight should be lost and medication should be taken. Rushing to promote ovulation without adjusting the basic state is often the result of a desire for speed. Q. I want to prepare for ovulation, but the doctor said I am too fat and want me to reduce my weight, but I can’t reduce my weight, can I apply for IVF directly? A. The answer is no. The obesity of polycystic patients is mainly central obesity, and the fat mainly accumulates in the visceral organs of the abdominal cavity, which will cause the whole body to be in an inflammatory activation state, leading to insulin resistance, hyperandrogenemia, sparse ovulation or anovulation, and also greatly increase the risk of hyperlipidemia, diabetes mellitus and cardiovascular diseases. Weight loss restores ovulation, and thus menstruation, in about 80% of patients, increasing the chances of natural pregnancy and reducing diabetes and cardiovascular disease. Therefore, in the latest PCOS China Diagnostic and Treatment Guidelines released in January 2018, it is clearly stated that lifestyle intervention is the preferred basic treatment for PCOS patients, especially for PCOS patients with combined overweight or obesity, and that lifestyle intervention should be carried out prior to and/or accompanying drug therapy. This applies to all obese polycystic patients, especially expectant mothers who are trying to conceive. I often tell obese polycystic patients in my clinic that they must resolve to lose weight, not only because obesity is unattractive, but also because it has affected their health. Obesity will not only lead to increased probability of failure of ovulation promotion, even if pregnant, but also prone to overweight during pregnancy, gestational hypertension, diabetes, etc., affecting the health of the baby. Weight loss is not only for the sake of one’s own health and better conception of the next generation, but more importantly, in the process of weight loss, the patient can recognize the mistakes of his original lifestyle (such as love of high-fat and high-sugar food, do not love exercise, etc.) and correct them, so that he can maintain a healthy lifestyle in the future, thus benefiting himself for life and also benefiting his own next generation. Therefore, whether it is natural conception or IVF, there is no getting around the important part of weight reduction. A significant number of patients with polycystic conditions can conceive naturally as long as they are properly adjusted and there are no other infertility factors in combination. A few patients need to resort to IVF techniques. It is not possible to choose IVF just because you don’t want to lose weight. Q. What should polycystic patients pay attention to after pregnancy? A. Early pregnancy should pay attention to the prevention of miscarriage, because the chance of miscarriage in polycystic patients is 2-3 times higher than that of normal women. During pregnancy, the risk of gestational diabetes and high blood pressure increases, so you should pay attention to controlling weight gain, and if you find that your blood glucose is elevated, you should adjust your diet and control your blood glucose under the guidance of your doctor. For more information, see the article “What should I do if I have diabetes during pregnancy?”, which mentions recommendations for weight gain during pregnancy, and of course, you should pay attention to maintaining your exercise habits during pregnancy, see the article “Exercise during pregnancy”. After giving birth, we should pay attention to our own weight changes, maintain a balanced diet, and regularly review the metabolic status of blood lipids and blood glucose for long-term management.