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Case History

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Image not available. A woman attends your clinic. She has been trying to conceive for six months. She is known to have polycystic ovary syndrome (PCOS) and has a body mass index (BMI) of 37 kg/m2. She comes to see you because she feels that at 34 years of age, 'time is not on her side'. Her partner is 35 years old and is fit and well.

What general lifestyle advice would you give her?

What advice specific to her PCOS and weight would you give her?

What treatments may be appropriate for her?

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Background

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What general lifestyle advice would you give her?

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Smoking
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Image not available. Women who smoke are known to have reduced fertility and therefore advice and information about smoking cessation programmes should be offered. Even passive smoking may be associated with delayed conception. The relationship between male smoking and fertility is unclear although it is associated with reduced semen parameters.

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Alcohol and recreational drugs
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It is known that excessive alcohol can damage the developing fetus. There is no strong evidence regarding alcohol intake pre-conception. However the United Kingdom Department of Health recommends women who are trying to conceive drink no more than one or two units of alcohol, once or twice a week.1 Excessive alcohol is known to affect semen quality but its effect is reversible. Recreational drugs are known to affect fertility potential. Marijuana and cocaine can affect ovulatory function. Cocaine and anabolic steroids may also affect semen quality.

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Medications
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There is evidence that non-steroidal anti-inflammatory drugs (NSAIDs) inhibit ovulation.2 Drugs including thyroxine, antidepressants, asthma medication and tranquillizers may also increase the risk of anovulatory infertility.3

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Supplements
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Folic acid supplementation does not increase chances of conception, but a dose of 400 μg daily pre-conception should be recommended to all women who are trying to conceive. This is because it has been shown to reduce the incidence of neural tube defects.

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Vitamin supplements do not affect the chances of pregnancy but it should be remembered that women who are trying to conceive or who are pregnant should avoid high doses of vitamin A which is teratogenic.

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In women with a normal haemoglobin level there is no evidence that iron supplementation is either beneficial or harmful. Advice regarding a balanced diet should be offered.

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Exercise
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General advice regarding exercise, especially during pregnancy, should be offered. Maternal benefits of exercise may be both physical and psychological.4 Women who exercise in pregnancy may be less likely to develop some pregnancy complications such as swelling, varicosities and fatigue. Women who exercise more also experience less anxiety, stress and depression. Women with pregnancies complicated by medical conditions should consult their medical team for advice specific ...

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