Good question. Yes and no. Yes, because if woman has no ovulation and she go to gynecologist and doctor will do the stimulation, the probability to have twins is increased because quite often during the stimulation we have one or two follicles, sometimes even three so, this may increase the chance to have twins but PCOS per se does not increase the chance to have twins pregnancy.
Good question. Yes and No. Yes – because if woman has no ovulation and she go to gynecologist and doctor doing the stimulation, the probability to have twins is increased because quite often during the stimulation we have one or two follicles, sometimes even three, so this may increase the chance to have twins but PCOS per se, does not increase the chance to have twin pregnancy.
PCOS should not increase the risk of twins if managed correctly. However, PCOS patients typically have very high levels of AMH, so we must proceed with caution when stimulating them for treatment. Therefore, we adjust the protocol to aim for 1 maximum 2 follicles. By following this approach, the risk of twin pregnancy should be similar to that of other patient groups.
There is no direct correlation between multiple pregnancy and the pathology of polycystic ovarian disease or syndrome but we need to understand, that polycystic ovarian patients have got a high egg reserve which means, the number of eggs in their ovaries naturally is very very high and some people would argue that the controlling mechanism of ovulation and the hormones which are produced from the brain which is FSH and LH which control the ovulation so, that access might be differently set in polycystic ovaries patients and that can sometime lead to two eggs or more than one egg released in a natural cycle or they are more sensitive to the fertility treatment and that can release more than one egg and that can end up in multiple pregnancies.
So yes, polycystic ovarian patients would have more chances of multiple pregnancy but probably not because of the underlying problem of disease but possibly because of the extra treatment which we give them for ovulation induction or other assisted conception treatment. The probability of having multiple pregnancy get higher in these in this group of patients.
I would say it depends on how they’re being treated. If a woman with Polycystic Ovarian Syndrome is starts to ovulate simply because she’s been dieting and exercising and she’s lost weight through that way, then her chances of getting twins is just as as high as any other woman who doesn’t Polycystic Ovarian Syndrome – it’s about one percent.
However, if a woman with Polycystic Ovarian Syndrome is using clomiphene or tamoxifen tablets to try and get her to ovulate, she does have a higher risk of getting twins or triplets. Her risk of twins with taking the most common tablet which is clomiphene is about 10 percent and the risk of triplets, is about one percent. Now this risk can be reduced if by having what we call follicle tracking during the cycles that she’s using these tablets – some people use injections like FSH for women who don’t ovulate with the tablets and need an FSH injection in order to make them ovulate, but that using the injections even increases the risk of twins even higher to anywhere between 15 to 20 percent.
There’s also something called ovarian drilling, laparoscopic ovarian drilling which is quite invasive because it means taking a patient to the theater, putting out sleep and putting a camera through her belly button and then with a diathermy. We call it ovarian drilling but it’s actually burning a few holes about four holes in each ovary and with this the women are able to start ovulating on their own without any medication. Now, with these women, their chances of twins is just as high as women who do not have Polycystic Ovarian Syndrome – it’s about one percent, so it really depends on the type of treatment and of course, if you go down to IVF, it depends on how many embryos are put back in. So, if you’re under the age of 35 and your doctor puts two embryos back in at embryo transfer, your risk of twins, if you become pregnant is about 40 percent. Whereas, if you just have one embryo put back in, your risk of twins is one percent which is again, the same as any other woman who doesn’t have Polycystic Ovarian Syndrome.
PCOS doesn’t itself increase your chances of twins, however some fertility treatments that you might have as a result of your PCOS, could increase your chances of twins. Although it is actually not good to have a multiple pregnancy, therefore with infertility treatments we try very hard to ensure that you don’t have a multiple pregnancy as the risks associated with having a multiple pregnancy include things such as miscarriage, problems during delivery and problems with the babies being born early so there are a lot of risks associated with this. So whilst PCOS itself doesn’t increase your risk, there is always a risk of fertility treatments and stimulating ovaries that could have a twin pregnancy but in the medical profession we try very hard to limit that risk.
