Dr. Joshua,

I’m 29, and I have a ten-year history of endometriosis, a recent diagnosis of mild PCOS, and a slightly heart-shaped uterus. A laparoscopy in December 2005 demonstrated scattered areas of endometriosis; these were subsequently removed. Although I’m not quite ready to conceive (approaching that point, though), I’m concerned about my chances of being able to do so and carry my baby to term.

I’m doing everything I can to prepare my body for pregnancy — eating a healthful diet, exercising regularly, maintaining a weight that is considered ideal for my height, and taking a prenatal vitamin daily. In your experience, do the conditions mentioned in the paragraph above (particularly the combination of the three) significantly interfere with conception and a subsequent successful pregnancy? Are fertility treatments typically needed and, if they are, are they generally effective in cases such as mine?

I appreciate your time and consideration, and I look forward to reading your response.

An already-anxious prospective mommy

Dr. Joshua’s Answer

Thank you for sending in your question. I’m happy that you are maintaining a healthy lifestyle and watching your weight - these are some of the key elements in the management of PCOS. Endometriosis and polycystic ovary syndrome both increase the risk of infertility and miscarriages, but succesful pregnancy is possible. Fertility treatments exist and may lead to succesful pregnancy. One interesting field of research in PCOS currently is the use of adul-onset diabetes drugs (metformin) as part of the fertility treatment in PCOS. This is sill an experimental treatment, but has showed some promising results. One problem is that the safety of metformin in pregnancy has not been established.

On a more personal note to you, I’d say that at 29, the time for you to start making babies is now. You have an increased risk of infertility, and after the age of 30, a woman’s fertility starts going down significantly even in the absence of PCOS or endometriosis. I don’t know what your life situation is, but in my opinion, the sooner you start trying to get pregnant, the better - sometimes it takes years before a succesful pregnancy occurs (again, this is true even in the absence of PCOS/endometriosis), and at this point you don’t want any extra delays. Good luck!