Understanding PCOS: A Mother's Experience and Questions

Question
Hello,
I just read your answer to a readers question about ovarian cysts.  You told her that they did not effect her friend's ability to become pregnant nor did the cysts affect the pregnancy.  

I am a 28-year old mother of one daughter.  My doctor diagnosed me with PCOS.  I did not have this condition with my first pregnancy.  It was after my daughter was born and I took a birth control shot that I seemed to develop this condition.  After the birth of my daughter and the taking of this shot I continued to bleed vaginally for over 6 months straight.  My stomach swelled and was sore to the touch.  The doctor handling my post-pregnancy said this was all normal, but when I returned to the care of my own doctor she said these were classic symptoms of PCOS and sure enough ultrasounds found many small cysts all over  my ovaries.  She prescribed Glucaphage (Metaphormin) and the cysts subsided.  I have been  taking this medication for 4 years now.  I was able to get pregnant last year for a second time, but went off the Metaphormin once I realized I was pregnant (I was afraid it would hurt the baby).  I did this without discussing it with my doctor.  I ended up miscarrying in my 9th week.  It came out intact and I was able to bring it to the lab.  There was nothing wrong with my baby, the sac, nothing.  My doctor later told me that I should not have gone off of the Metaphormin, that in cases like mine, it can help to sustain the pregnancy.  If cysts on the ovaries have no effect on pregnancy, then why is there so much research involving PCOS and pregnancy and that some many women with this syndrome cannot carry to term?  I was confused by your answer to the woman asking about her friend.  It seems so at odds with my own experience and research.  

Answer
There is a differency between simple ovarian cysts (even multiple) and PCOS. We have been having much success with the use of Metformin in the treatment of PCOS and it can, indeed, be continued during pregnancy. Sometimes, we use metformin in addition to Clomid to induce ovulation in a woman who is trying to conceive.  However, cysts by themselves do not cause infertility or menstrual irregularity such as bleeding. The risk of miscarriage is 15-20% of every pregnancy. There is nothing you can do to cause a miscarriage and there is nothing you can do to prevent a miscarriage. The metformin may have helped sustain your pregnancy, but your stopping of the metformin did not cause the miscarriage at 9 weeks. PCOS has been causing difficulties in conception for years, but unless there is a concommitant condition (antiphospholipid syndrome, autoimmune defect, corpus luteum defect, progesterone deficiency, etc) most PCOS patients can come to term once they conceive. The cysts do  not interfere with the pregnancy.  In the absence of PCOS, simple (or even complex) ovarian cysts do not effect the pregnancy.