If you have PCOS, you may have found it took some time to conceive or you’ve been hoping for pregnancy for several months, leaving you wondering about the potential miscarriage risks linked to your condition. The early stages of pregnancy can often be overwhelming, marked by the fear that things might not go as planned.
In this article, we’ll explore why women with PCOS face a higher risk of miscarriage and the preventive steps you can take to give yourself the best chance of enjoying a smooth and stress-free pregnancy.
PCOS and Miscarriage: What Are the Risks?
First, let us reassure you: PCOS is not synonymous with infertility, despite what you may have heard. Most women with PCOS will go on to conceive and deliver healthy babies! (Source).
Irregular Cycles
Nevertheless, PCOS is a manifestation of hormonal imbalance, and it is true that affected women will take longer to conceive. This is mainly due to the fact that women with PCOS often have very long and irregular cycles.
However, PCOS is a manifestation of hormonal imbalance, and it’s true that affected women may take longer to conceive. This is mainly because women with PCOS often have very long and irregular cycles.
If your cycles last 2, 3, 4 months or more, you naturally have fewer opportunities to conceive each year compared to a woman with regular cycles. A 28-day cycle provides about 12 or 13 chances to conceive annually, while a woman with PCOS may only ovulate 3 or 4 times a year, depending on the individual case.
Egg Quality
Another source of fertility issues in women with PCOS is related to egg quality. Research has shown that women with PCOS often produce eggs of lower quality (source). This is due to disruptions in egg maturation: rather than following a smooth process of about two weeks, the follicular phase in women with PCOS can be prolonged, with several unsuccessful attempts at ovulation.
Eggs are also exposed to higher androgen levels than those in women without PCOS, further affecting their quality.
Additional Challenges
Other factors that can increase the risk of miscarriage include:
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Hypothyroidism, which is often associated with PCOS
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Inflammation
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Vitamin and mineral deficiencies, more commonly found in women with PCOS (notably vitamin B9, which is very important in preventing miscarriage and malformations).
If you’ve experienced one or more miscarriages, please don’t blame yourself: you are not at fault ❤️🩹. It’s also worth remembering that 30% of infertility cases have a male-related cause. Your partner should feel empowered to seek further tests, such as a semen analysis, and adopt a healthy lifestyle as well.
What Can Be Done to Minimise the Risk of Miscarriage?
Lowering Insulin Resistance
If you’re insulin resistant (about 70% of women with PCOS are), then this is certainly the first area to focus on. Excess insulin interferes with the secretion of pituitary hormones, lowering FSH and increasing LH secretion—this is the main reason behind irregular cycles.
Insulin also reduces SHBG: this is a hormone that binds oestrogen and testosterone. When SHBG levels drop, free testosterone increases in your bloodstream, leading to symptoms of hyperandrogenism and damaging the follicles.
➡️ Hyperinsulinaemia is responsible for many of the ovarian dysfunctions seen in women with PCOS, which is why it’s crucial to address it.
Key principles to follow:
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Adopting a low glycaemic index diet (see more about PCOS-adapted diets)
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Limiting blood sugar spikes throughout the day
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Choosing the right supplements to stabilise blood sugar (Sugar Balance is perfect for this ♥︎)
Improving Egg Quality
An egg takes three months to develop.
Ideally, you should begin preparing for pregnancy by working on improving your egg quality as early as possible.
Optimising egg quality starts with your diet: you’ll want to increase your intake of healthy fats (especially omega-3s), limit processed and inflammatory foods, prioritise complex carbohydrates, and ensure you’re consuming enough protein and fats. Think of a diet similar to the traditional Mediterranean style—that’s what a fertility-friendly plate looks like!
You should also focus on maintaining good overall health: ensuring you get quality sleep (7-8 hours minimum), managing stress, and incorporating regular physical activity into your daily routine.
Additionally, certain supplements have a significant positive effect on egg quality. Ovastart, which contains both inositol and folic acid (vitamin B9), is a great option.
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Inositol works on insulin resistance while supporting egg maturation. It’s also a powerful antioxidant that improves egg quality (source).
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Vitamin B9 is essential before pregnancy to prevent birth defects and reduce miscarriage risk. However, many women do not properly absorb the folic acid often prescribed by doctors. We recommend opting for methylated B9 (such as Quatrefolic®, found in Ovastart).
Other vitamins and minerals are also vital for fertility, especially since women with PCOS are at a higher risk of deficiencies. Vitamin D, iodine, zinc, and B12 are particularly important—consider consulting a professional trained in micronutrition for tailored advice.
And don’t forget to involve your partner in these lifestyle changes, as they will benefit him as well!
Protecting Your Body from Inflammation
PCOS is often accompanied by low-grade chronic inflammation, which can have consequences for the fluid surrounding the follicles (source). This inflammation worsens insulin resistance and can impair egg quality, so addressing it is essential.
It’s often difficult to identify low-grade inflammation as there may be no obvious symptoms (such as a fever). However, biological tests can detect it, such as a high-sensitivity CRP test (hs-CRP). Be sure to specify this, as it’s much more precise than a standard CRP test. Don’t hesitate to discuss this with your doctor.
To reduce inflammation, you can:
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Prioritise an anti-inflammatory diet by avoiding ultra-processed foods, alcohol, and refined sugars.
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Consider food intolerance tests with your doctor, which may reveal sensitivities to eggs, dairy, gluten, etc.
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Take care of your gut, as your microbiome plays a key protective role against inflammation. Supplements like glutamine can help with this.
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Supplement with omega-3s, known for their anti-inflammatory effects (source), especially if your diet lacks sufficient omega-3 sources (like oily fish and vegetable oils such as flaxseed, rapeseed or camelina). Our Omega-3 supplement is specifically formulated for women with PCOS, offering an optimal EPA/DHA ratio and one of the lowest possible ToTOX indices..
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Consider supplementing with omega-3s, whose anti-inflammatory effects are well-known (source). This is especially important if you consume few dietary sources of omega-3s (fatty fish, vegetable oils like rapeseed, flaxseed, camelina...). Our supplement Omega 3 is specifically formulated for women with PCOS with a studied EPA/DHA ratio and one of the lowest possible ToTOX indices.
Check Your Progesterone Levels
Progesterone deficiency is very common among women with PCOS and is both a cause and a consequence of the condition. However, progesterone is a key hormone in pregnancy (the term itself means "pro-gestation").
Progesterone helps maintain the uterine lining until the embryo implants. When levels are too low, the post-ovulation phase may be too short, or you might notice spotting (small amounts of bleeding), indicating that the uterine lining is beginning to shed. This makes it difficult for the embryo to implant, and often, the pregnancy ends before you’re even aware of it.
Once implantation occurs, progesterone is essential throughout the pregnancy. In the first trimester, it’s produced by the corpus luteum (a scar left by the ovulated egg). Later, the placenta takes over and begins producing large amounts of progesterone for the remainder of the pregnancy.
Progesterone deficiency in the first trimester is a frequent cause of miscarriage, but it can be avoided. To determine if you have this issue, there are two options:
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If you're planning to conceive, request a progesterone test at the lab 7 days after ovulation. (If you’re unsure how to track your cycle, check out this article.SOURCE MANQUANTE) Your level should be around 15 ng/ml. If it’s significantly lower, seek help from a professional (such as a gynaecologist or a naturopath specialising in fertility).
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If you find out you’re pregnant, ask for a progesterone test alongside your Bhcg test (if you're planning on having one). In early pregnancy, progesterone levels should be at least 15-20 ng/ml. If your levels fall short, contact your gynaecologist, who may be able to support your pregnancy with progesterone supplements.
In the UK, you don’t need a prescription for these tests (though you’ll need to pay for them yourself at an average cost of £30 to £50),
Ensuring Your Thyroid Health
Scientific studies show that PCOS and hypothyroidism are closely linked: women with PCOS are three times more likely to develop autoimmune thyroid conditions 🥵 (with Hashimoto's thyroiditis being the most common).
Hypothyroidism is a significant cause of miscarriage or complications during pregnancy (source). If you're trying to conceive or have already experienced one or more miscarriages, you should request a comprehensive thyroid assessment from your GP.
This can sometimes be tricky, as doctors often only request a TSH test initially. However, your TSH levels could be normal, while other thyroid values might not be.
Here’s what a full thyroid panel should include:
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TSH (should be < 2.5 mUI/l when planning or in early pregnancy)
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T3 and T4, reverse T3
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Thyroid antibodies
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Iodine deficiency check, ideally through a 24-hour urinary iodine test
Again, you can request these tests without a prescription, but a full panel like this may be costly.
If you discover that your results are less than ideal, or if your TSH exceeds 2.5 mUI/l, seek advice from your gynaecologist. Many women benefit from mild thyroid treatment during pregnancy to prevent potential complications.
We hope this article has provided you with some valuable insights to help you ensure a healthy pregnancy.
Miscarriage can be a traumatic and guilt-inducing experience, which should never be overlooked. Remember, one of the primary causes of miscarriage is chromosomal abnormalities in the embryo, which cannot always be prevented.
