Best Age to Get Pregnant With PCOS: An Expert Reviewed Guide

●   This article has been reviewed by an expert in reproductive medicine

As if the acne, excess body hair, and risk of serious medical conditions weren't enough, PCOS can also severely compromise your fertility.

On top of  that, finding information about the best age to get pregnant with PCOS is tough.

I've always battled to figure out how polycystic ovary syndrome (PCOS) will affect my fertility. I'm not alone - one study published in the Human Reproduction Open journal suggests women with PCOS have several questions about pregnancy and PCOS but struggle to find current, reliable information from healthcare providers and other sources.

Common questions are:

• What’s the best age to get pregnant with PCOS?
• Does PCOS fertility get better with age?
• How many months does it take to get pregnant with PCOS?
• How can I increase my chances of getting pregnant with PCOS?

Fortunately, scientists have been studying the relationship between age and fertility for decades. In this guide, we’ll look at what the latest research says about these questions.

While I hope this article is helpful to you, it’s not a substitute for medical advice. It’s essential to talk to your gynaecologist or health care provider when you’re ready to get pregnant

 What’s the best age to get pregnant with PCOS?

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The best age to get pregnant with PCOS, according to several scientific studies, is under 35 years old, particularly under 45.  While age is a key factor, there are other aspects that may influence the best time to get pregnant for you. Conceiving naturally may be easier when you're younger. But you may not be financially or mentally ready for motherhood.

That being said, there's no denying what several studies suggest: fertility drops and pregnancy complications increase for all women after 35. Age-related fertility declines are even steeper after age 40.

When it comes to polycystic ovary syndrome specifically, PCOS is a leading cause of infertility. Pregnancy and childbirth may be challenging during PCOS due to:

• Lack of ovulation
• Irregular periods
• Gestational diabetes
• Preterm birth
• Hypertension 

At the root of most of these fertility and pregnancy issues is insulin resistance.

Before we dive into PCOS-specific data about age and fertility, let’s review some of the research on the best age to get pregnant for all women.

Age impacts fertility and pregnancy

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According to an analysis of 41 studies into age and fertility, age affects both female and male fertility. Notably, egg and sperm quality declines with age. For women, there’s a “marked decrease” in fertility from the mid to late 30s, reports the paper.

Another study published in the Medical Science Monitor compared delivery data of 4796 pregnant women. Researchers found older women have a higher risk of postpartum haemorrhage, where a woman experiences heavy bleeding after birth. Researchers attribute this connection to changes in the elasticity of the soft birth canal and “worsening of uterine contraction” as we age.

Preterm birth is another possible complication as we age, finds BMC Pregnancy Childbirth. Placental pathologies, which are abnormalities in the placenta, and low progesterone levels could contribute to preterm birth among older women -  progesterone levels drop as we age. Progesterone supplementation has helped to prevent preterm birth, explains researchers.

Now let’s look at the problems women with PCOS may face during pregnancy.

Polycystic ovary syndrome and pregnancy

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PCOS is tied with insulin resistance, a condition that may interfere with ovulation regardless of age. As Fiona McCulloch, writes in 8 Steps to Reverse Your PCOS, insulin resistance affects fertility in a number of ways:

“High levels of insulin cause the ovaries to make too much testosterone…increased androgens are a central factor in PCOS. They stall ovulation and create hirsutism, acne, and hair loss.”

In other words, excess testosterone may cause anovulation, when the ovary does not release an egg.

Research shows that anovulatory fertility is a major reason for infertility. PCOS, in turn, is a major cause of anovulatory fertility.

In one study that examined data from 3552 deliveries to women with PCOS and 88,273 deliveries from women without PCOS, women with PCOS were at higher risk for pregnancy-induced hypertension, preeclampsia and eclampsia, preterm labor, and extended neonatal hospital stay. Pregnant women with PCOS also had a 51% greater risk of gestational diabetes.

However, a paper published in Minerva Obstetrics and Gynecology 2022 said the association of PCOS with a higher risk of pregnancy complications is “controversial”. That’s because there’s too much variability across studies.

 “This variability is found in the diagnosis and clinical presentations of PCOS, and can be influenced by prepregnancy circumstances and therapies as well as particular population and environmental features.”

Nonetheless, because of the connection between PCOS and insulin resistance, researchers recommend closer follow-ups during pregnancy for women with PCOS.

As mentioned, age isn’t the only thing to consider when having a baby. In truth, there is no universally best age. Many factors should be considered when thinking of the best age to get pregnant, notes Medical News Today. These factors may include money, career, or support system.

Age does affect the ability to get pregnant, though, reports the American Society for Reproductive Medicine. Women cannot have a baby after menopause and older men may produce less healthy sperm.

If you’re older than 35, you might consider assisted reproductive technology (ART) to increase your chance of conceiving successfully. This could involve using donor eggs or embryos.

Today, having a baby later has become more common than ever before.

Birth rates are falling for women in their 20s. On the other hand, the number of women having babies after 35, even after 40, is rising across the world.

According to Statista, the average age of mothers in the United Kingdom has increased from 27.7 in 1991 to 30.7 in  2019.

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In the United States, birth rates dropped for women under 35 and increased for women in their early 40s, per the U.S. Department of Health and Human Services.

When I was 38, I fell pregnant once more. I already had two children, 8 and 5. I had my son at 30 and my daughter at 34. With my first, I was living on a diet of red wine and fast food when I fell pregnant. By 34, things were better but not by much - I was still eating a diet high in processed foods and simple carbs.

My third pregnancy was different. At 38, I was healthier than I'd ever been.

I'd completely changed my diet, restricting carbs and added sugars. I was also taking several hormone-balancing supplements. Another lifestyle change I made was to start exercising regularly. Exercise helps to reduce stress, a common factor in PCOS, and it also helps to regulate hormones.

I was getting regular periods for the first time in my life. So much so, that I knew exactly which day I conceived.

The third time around I had deep knowledge about how to manage my PCOS and consulted regularly with a healthcare provider who specialised in hormone health. I found strength in knowing that my body was doing its best to give me a healthy pregnancy.

Does PCOS fertility get better with age?

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Age-related fertility problems appear to be less pronounced in women with PCOS.

In one study, published in the journal Frontiers in Endocrinology, researchers compared fertility outcomes between women with PCOS and those without. They found that fertility declines at a slower rate for women with PCOS.

The paper points to studies that suggest tests to check a woman’s ovarian reserve, anti-Mullerian hormone (AMH) level and antral follicle count (AFC), show a slower decrease in women with PCOS.

“Other studies have further shown that a small portion of women experience improvements in the symptoms and signs of PCOS after the age of 40 years, such as the improvement of irregular menses and hirsutism and a decline in androgen levels.

According to the Journal of Clinical Endocrinology & Metabolism, most “clinical features” of PCOS get better as women age.  As a result, women may experience relief from some PCOS symptoms. Irregular menstrual cycles improve and male hormone levels drop, and women with PCOS may go through menopause at a later age.

Despite this, researchers maintain that insulin resistance can lead to infertility and can still persist as women with PCOS age.

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How can I increase my chances of getting pregnant with PCOS?

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Diet and lifestyle factors can increase your chances of getting pregnant with PCOS. Once you improve insulin resistance and balance blood sugar levels, you'll boost your odds of having a baby.

The Obstetrician & Gynaecologist advises improving a patient’s overall health as a first-line treatment before moving on to other therapies to induce ovulation.

Women who are overweight are more likely to experience infertility and other pregnancy complications, so it’s important for women with PCOS to maintain a healthy weight before trying to conceive.

And although insulin resistance is often associated with weight gain, a paper published in the Journal of Diabetes & Metabolic Disorders finds that women with lean PCOS could also have insulin resistance.

 “Hormonal, metabolic and haematological profiles were altered in lean women with PCOS compared to healthy counterparts…Insulin resistance seemed inherent in PCOS independent of obesity.”

One paper investigated fertility treatment options for women with PCOS and found a healthy diet could counter the impact of PCOS on fertility.

 “A low-calorie diet with adequate nutritional intake and healthy food choices have improved fertility outcome in PCOS by significantly improving insulin sensitivity”

Eating a diet moderate in carbs and polyunsaturated and monounsaturated fats, high in fiber and lean protein reduces insulin levels and delivers “maximum benefits”.

Studies show pregnancy rates are also higher when couples time their intercourse around peak fertility times.

Apart from natural treatments, drugs are also prescribed to improve fertility. One popular medication is metformin, a drug prescribed to help treat type 2 diabetes. According to the Medical Hypotheses journal, metformin is prescribed for women with PCOS for their entire pregnancy.

“Several studies examining the effects of Metformin during pregnancy reported a lower pregnancy loss, reduced gestational diabetes and no increased risk for birth defects, however, several more recent studies also raised concerns about its safe use.”

Finally, assisted reproductive technologies, like IVF treatment, can also help you conceive.

When I was diagnosed with PCOS at 24, the gynaecologist told me not to delay pregnancy for too long and sent me on my way.

I was lost and confused. I had no idea that PCOS was causing my acne and irregular menstrual cycle or that I could manage the hormonal disorder through better lifestyle habits. I didn't know I was at risk of developing serious illnesses further down the line.

Then, more than a decade later, I saw a specialist who confirmed that PCOS was the root cause of my skin problems and irregular periods.

Since learning about my condition, I've made a lot of changes to my lifestyle in an effort to manage it better. I've restricted processed foods and refined sugar, increased my exercise routine, and sought out advice from experts on how to best take care of myself. And I've found that all of these changes have been helpful in managing my PCOS and improving my fertility.

How many months does it take to get pregnant with PCOS?

Most healthy couples will conceive before one year of timed intercourse - having sex during your fertile window, reports the Frontiers in Endocrinology. Many women will get pregnant within six months. If you’ve addressed any hormonal imbalances and are ovulating regularly, this timeframe will apply to you too.

But if you're having problems with your metabolic health, you may find it harder to conceive.

In one study, researchers compared time to conception between women with metabolic syndrome and those without. They found women with metabolic syndrome took about a month longer to conceive.

The American Society of Reproductive Medicine and The American College of Obtetricians and Gynecologist recommend women with PCOS should be screened for metabolic syndrome.

Getting pregnant with polycystic ovary syndrome

PCOS is one of the most common hormonal disorders among women of reproductive age. But it turns out you can conceive with PCOS, as long as you adopt a healthy lifestyle and keep your hormone levels in check.

With the right treatment, your periods will become regular and you’ll restore ovulation. I know I did, and you can too.

Image credit: Photo by freestocks on Unsplash