Polycystic Ovary Syndrome (PCOS) is a common hormonal disorder characterized by hormonal imbalances, irregular periods, and often the development of small cysts on the ovaries. When considering gestational surrogacy, the immediate concern is whether a PCOS diagnosis automatically prevents participation. While it does not lead to automatic disqualification, it requires a stringent medical review. A woman with PCOS who has previously carried a healthy, full-term pregnancy without major complications is often still considered a viable candidate for a surrogacy journey.
How PCOS Impacts Initial Surrogate Screening
The initial screening process for a potential surrogate with PCOS focuses heavily on assessing and stabilizing metabolic health, which is frequently impacted by the syndrome. A significant number of women with PCOS also experience insulin resistance, a condition where the body’s cells do not respond effectively to insulin. This metabolic component is a primary area of concern for fertility clinics during the pre-approval phase.
Surrogacy agencies and fertility doctors require a potential surrogate to demonstrate a stable, well-managed health baseline before proceeding. Strict body mass index (BMI) requirements are enforced, with many clinics setting an upper limit, often around 33 kg/m², because obesity can significantly worsen insulin resistance and overall health risks. Candidates must undergo detailed laboratory testing to evaluate their current blood sugar control and cardiovascular health metrics. Uncontrolled insulin resistance or significant hormonal imbalances that complicate the embryo transfer process are grounds for exclusion.
Specific Pregnancy Risks for Surrogates with PCOS
A history of PCOS introduces several heightened medical risks once a pregnancy is established. The most significant concern is the increased likelihood of developing hypertensive disorders, such as pregnancy-induced hypertension and preeclampsia. Studies indicate that women with PCOS face up to a fourfold higher risk for preeclampsia, a serious condition involving high blood pressure and organ damage.
The metabolic dysfunction linked to PCOS also substantially elevates the risk of gestational diabetes mellitus (GDM). Impaired glucose tolerance is more frequent in pregnant women with PCOS, requiring careful monitoring to prevent complications for both the surrogate and the developing fetus. There is also a greater chance of requiring a cesarean section and an increased risk of the baby being born small for gestational age (SGA). Furthermore, the hormonal environment of PCOS necessitates specialized protocols for preparing the uterine lining, or endometrium, for the embryo transfer, ensuring it is receptive enough to support implantation.
Medical Management and Enhanced Monitoring
Due to the heightened risks associated with PCOS, surrogates with the condition are placed on an enhanced monitoring schedule throughout the pregnancy. Active surveillance for GDM is intensified, often including earlier and more frequent glucose tolerance tests to detect blood sugar issues promptly. This enhanced monitoring involves more frequent medical appointments and testing compared to surrogates without PCOS.
Heightened monitoring of blood pressure is also instituted to quickly identify any early signs of preeclampsia or gestational hypertension. In some cases, medication such as Metformin may be recommended before and during the pregnancy to help manage underlying insulin resistance and improve the overall metabolic profile. A comprehensive, multidisciplinary care team—including a reproductive endocrinologist, a high-risk obstetrician, and a nutritionist—collaborates closely to manage diet, weight gain, and any emerging complications, ensuring the safest possible journey to term.