PCOS: 6 Ways to Support Fertility
Roughly 6-10% of women struggle with a condition called PCOS (polycystic ovary syndrome). PCOS is a collection of hormonal imbalances that affect a woman’s menstrual cycle by disrupting ovulation. It also causes other signs and symptoms related to hormonal imbalance and predisposes women to a number of health issues later in life, such as cardiovascular disease, diabetes, and endometrial cancer. Because of its detrimental effect on ovulation, PCOS can make it very difficult for a woman to become pregnant and is estimated to be responsible for about 20-30% of infertility cases. In this article, we explore the complex subject of PCOS-related infertility and talk about ways the condition can be managed naturally to provide the best possible odds for a successful conception and healthy pregnancy.
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What is PCOS?
PCOS is not a disease, but a collection of signs and symptoms related to hormone imbalance. The condition has multiple potential diagnostic criteria, but consensus has not been reached in the medical community on which of the following medical signs must be present (and in what combination) in order to officially diagnose PCOS. The criteria that can be considered are:
Irregular or absent periods– oligo- or anovulation
Evidence of excess of male hormones (androgens)– either observed or measured
Bilateral polycystic ovaries– multiple immature follicles found on each ovary via ultrasound
Exclusion of other conditions that could cause irregular periods and/or androgen excess
It is important to note that polycystic ovaries alone are NOT enough to diagnose PCOS, as research shows that up to 25% of healthy women will present with polycystic ovaries on an ultrasound. There are also other non-PCOS diagnoses that may explain irregular cycles and hyperandrogenism, which is why neither of these should be used alone as a justification for a PCOS. Thus, the most accurate way to diagnose PCOS appears to be a combination of ovarian dysfunction and hyperandrogenism with the exclusion of other health issues that may provide an alternative explanation.
Although there is no single accepted cause for PCOS, evidence suggests several factors that may play a role in its development, including:
Each woman will present with a unique set of factors that may have contributed to her PCOS, as well as a unique combination of the symptoms listed below. This is what makes PCOS difficult to accurately diagnose and treat.
What Are the Symptoms of PCOS?
There are several symptoms that women with PCOS may experience, most of which are directly related to androgen excess. The most common symptoms are:
Irregular or absent periods
Obesity
Hirsutism (abnormal growth of hair on the face or body)
Infertility
Severe acne
Depression
Loss of scalp hair
How Does PCOS Cause Infertility?
The primary way PCOS causes infertility is through overproduction of male hormones (androgens), which disrupts normal ovarian function and ovulation. This can happen through a number of biochemical pathways and it is not completely clear in the research how the disorder develops in all cases. However, there is ample evidence to suggest that insulin resistance and abnormal LH levels are involved. PCOS is also associated with high rates of inflammation and oxidative stress, which can cause infertility through decreased egg quality and disrupted implantation.
Insulin Resistance
Insulin resistance is present in about 60-80% of PCOS cases, and appears to play a role in the development of PCOS for many women. When the ovaries are exposed to high levels of insulin from the bloodstream, they begin to alter their hormone production in favor of male hormones (androgens), which disrupts normal ovulation and can lead to infertility. Insulin resistance often contributes to weight gain and obesity in PCOS, but it is possible to be insulin resistant at a normal weight.
Increased LH and Abnormal LH/FSH Ratio
The menstrual cycle and ovulation are regulated by two hormones produced by the pituitary gland in the brain: follicle stimulating hormone (FSH) and luteinizing hormone (LH). FSH and LH must be properly balanced in order for normal ovulation to occur. In a large majority of women with PCOS, LH is either inappropriately elevated or is out of balance with FSH. Elevated LH can both be caused by and contribute to androgen excess, which will disrupt ovulation. Also, an imbalance between FSH and LH does not allow follicles to fully mature, making a woman unable to ovulate or produce progesterone.
Inflammation and Oxidative Stress
Research has begun to show a clear association between PCOS and inflammation and oxidative stress in the body. Oxidative stress is a state of imbalance between free radicals and antioxidants that can lead to tissue damage and inflammation. Oxidative stress has been shown to have a negative effect on egg quality, as well as cause problems in the uterine environment that prevent proper embryo implantation. Also, oxidative stress can both cause and be caused by insulin resistance, leading to excess androgen production and disrupted ovulation.
Conventional Treatment Options
Currently, there are only a handful of conventional treatments available for infertility caused by PCOS. Most women are told that they have little to no chance of becoming pregnant naturally and are steered toward fertility drugs and other treatments, which may have significant negative side effects. Here is a list of possible interventions for infertility with PCOS:
Clomiphene citrate (Clomid or Serophene) – used to induce ovulation
Letrozole (Femara) – used to induce ovulation
Metformin – used to increase insulin sensitivity which may restore ovulation
Ovarian drilling – destroys androgen-producing tissue in the ovaries
Injectable FSH/LH – used to induce ovulation
IVF
6 Ways to Support Fertility Naturally
Change your diet
If you have PCOS, one of the most effective changes you can make is to avoid sugar, soda and sweetened beverages, and refined carbohydrates in your diet. Consuming these foods spikes your blood sugar and can quickly lead to insulin resistance, which we know contributes to hormone imbalances, inflammation, and weight gain in PCOS. A very large study has shown that women who consume more quickly digested (refined) carbohydrates are significantly more likely to experience anovulatory infertility. Studies on dietary interventions for PCOS have shown that even a moderate reduction in carbohydrates in the diet has a positive impact on insulin sensitivity. Another important “food” to avoid is trans-fat, which has been shown to impair insulin sensitivity and cause numerous health problems. If it says “hydrogenated” or “partially hydrogenated” on the label, do not eat it.
Your goal should be to focus on getting most of your carbohydrates from non-starchy vegetables, low glycemic fruits, and occasional small servings of starchy vegetables, whole grains and legumes. You should also aim to consume balanced amounts of quality proteins and healthy fats, which will help keep your blood sugar and insulin levels stable. Buy organic produce to avoid endocrine-disrupting pesticides and try to source animal products that have not been given hormones or antibiotics. Working with a qualified nutritionist to construct a diet that is right for you can help immensely.
Get enough (but not too much) exercise
Studies have shown numerous benefits to exercise for PCOS. Exercise improves insulin sensitivity, ovulation, and weight loss in women with PCOS and has also been shown to reduce inflammatory markers associated with the condition. However, too much exercise can be stressful to the body and lead to endocrine imbalance and worsening of PCOS symptoms. Aim to get at least 30 minutes of exercise per day at an intensity that is appropriate for your body type and fitness level. Avoid activities that result in prolonged physical stress or exhaustion.
Reduce your stress and get enough sleep
PCOS is an endocrine disorder and few things have a more negative impact on the overall endocrine system than stress and lack of sleep. Excessive stress can contribute to blood sugar dysregulation and insulin resistance, which can drive increased androgen production. It is also important to point out that stress can cause your adrenal glands to produce more androgens, contributing further to hormone imbalances and cycle issues. Managing stress is an important step to normalizing insulin and hormone levels throughout the endocrine system.
Women with PCOS have also been shown to exhibit sleep disturbances. Lack of sleep affects the body’s stress levels and metabolism (think insulin) and can also contribute to inflammation and immune system problems, all of which are harmful to fertility. Focus on getting at least 7 hours of uninterrupted quality sleep each night.
Avoid endocrine disruptors
Endocrine disruptors are chemicals that alter hormone balance in the body and have been found to be harmful to fertility in many different ways. Scientific evidence is now showing that one endocrine disrupting chemical in particular, BPA (bisphenol A), may play a significant role in PCOS. Multiple studies have shown higher BPA levels in women with PCOS and this study demonstrated that elevated BPA levels were associated with greater insulin resistance and higher levels of male hormones. BPA has been shown to specifically affect the cells in the pancreas that produce insulin and can thus impact insulin levels and function in the body.
You can avoid BPA by:
Avoiding the use of plastic – particularly for any item that comes into contact with food or drink
Avoiding contact with thermal receipt paper
Reducing/eliminating canned food from your diet or purchasing only BPA-free cans
Although BPA has the strongest scientific evidence for its impact on PCOS, there are many other endocrine disruptors that can affect hormone levels and fertility. The best policy is avoidance. For a list of chemicals to avoid and tips on how to reduce your exposure, visit the Environmental Working Group webpage on endocrine disruptors.
Optimize your vitamin D levels
Research has shown that there is a high prevalence of vitamin D deficiency in women with PCOS and that supplementing with vitamin D could improve glucose metabolism, insulin resistance, and menstrual frequency. Vitamin D (along with other nutrients) may also be able to improve inflammation, oxidative stress, and hormonal markers in PCOS. For more information on the importance of vitamin D for fertility and how to ensure you are getting enough, check out this post.
Consider other supportive supplements
There are several supplements that have been shown to be helpful for reducing symptoms of PCOS and helping to correct the hormone imbalances that lead to infertility. Because PCOS is a complex condition and each woman will present with different signs and symptoms, you should work with a qualified natural healthcare practitioner to help you determine which supplements may be right for you. Not everyone will respond the same way to supplements and some supplements may be contraindicated for some women, so it is best not to self-medicate. That said, here is a list of supplements with scientific evidence supporting their use for PCOS:
Inositol (myo-inositol and d-chiro-inositol)
Several different herbs (licorice, peony, black cohosh, vitex, cinnamon)
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