Up to 10% of reproductive-aged women have Polycystic Ovarian Syndrome (PCOS).
Firstly, PCOS comes with higher risks for heart disease, diabetes type 2, and uterine cancer.¹ Secondly, women with PCOS are at higher risk for anxiety, depression and abnormal lipid levels.¹ But overall, women should also be aware of how PCOS impacts their fertility.
- Irregular menstrual cycles (skipping periods)
- Abnormal male patterned hair growth or excessive hair growth
- Many cysts or follicles on the ovaries (more than usual, only seen on ultrasound)
- Elevated levels of testosterone (assessed by bloodwork)
- Cystic acne
(You don’t have to have all the above symptoms, only 2 out of 4 to is enough to diagnose PCOS.)
In fact, many women with PCOS may show no external symptoms. Many go through their lives without realizing something was wrong with skipping periods. Women with PCOS tend to gain weight. Yet, there is something called “skinny PCOS,” where weight gain is not an issue.
When do women figure out they have PCOS?
Many women first notice difficulty conceiving due to their skipped periods. The lack of menstrual cycles can be because of skipped ovulatory cycles. This means women with PCOS may not ovulate 12 times per year. And essentially, less ovulatory cycles means fewer chances to conceive.
Further complicating matters, PCOS causes abnormal hormone levels. This results in high levels of estrogen, low levels of progesterone, and an increased body mass index. Hormones in disproportion make it harder to achieve and continue a pregnancy.
But, it’s not all doom and gloom.
Good News! Studies show that women’s PCOS symptoms improve with age, and in fact, may no longer have PCOS once menstrual cycles stabilize. This can increase the number of pregnancies women can have later in life. However, women should not consider this a way to defy aging ovaries. No one can defy age! Women with PCOS tend to have falsely high anti-müllerian hormone (AMH) level, but are still just as prone to decreased fertility with age.²
So, What can you do?
Attempt to get pregnant early in your reproductive years for at least 1 year. Then, if not pregnant, you still have time to receive help from your medical provider. More information on what “help” is below.
Step 1: Tests
If you have any of the above symptoms (especially skipped periods), request blood work. Ask for levels of testosterone, anti-müllerian hormone, prolactin level, lipids, thyroid stimulating hormone (TSH) level, and DHEA.
Step 2: Diet and Exercise
If you have elevated levels of testosterone and those PCOS symptoms I listed above, consider a ketogenic diet. Also, consider an exercise regimen to lose 7-10% of BMI to improve regulation of ovulation.³ Ketogenic diets reduce the risk of diabetes because of intentional low carbohydrate intake. Ketogenic diets improve HDL levels (good cholesterol) and simultaneously lower LDL (bad cholesterol). In most people, it stabilizes weight.4
Step 3: Supplements
As I mentioned in my article, Top Fertility Supplements That Actually Improve Fertility, there are some limited studies that show an improved effect on fertility for women with PCOS.5 These supplements include maca root for low progesterone, vitamin D3 supplementation for period regulation, omega 3s to balance lipids, vitamin C and vitamin B12 to act as antioxidants. Additionally, you can take royal jelly, spirulina, and bee pollen for additional fertility improvement!
Ovasitol by Theralogix. This supplement can reduce insulin resistance and metabolic syndrome. You can use my Provider Referral Code (PRC) 101505 for a discount. Take at your own risk, this is not medical advice.
STEP 4: How to know if you’re ovulating?
- Receive a monthly period,
- Test positive on ovulation predictor kit strips,
- Have egg white cervical mucus for 2-4 days a month or
- Have decreased basal body temperatures followed by elevated temperatures in the morning, then you’re probably ovulating.
- Furthermore, blood testing can further confirm if you cannot detect ovulation on your own. (Sometimes ovulation predictor kits do not work for women with PCOS.)
Step 5: Help
So, if 6 months to a year goes by without conception, please request help from a medical professional. Your OB/GYN, nurse practitioner, or clinician might order a few months of metformin or clomiphene (Clomid). Metformin is used for insulin resistance and to improve your own sensitivity to insulin production. Your regular OB/GYN can order clomiphene (Clomid) that you can take by mouth while you try to conceive from home.
Lastly, if 3 months of metformin or Clomid is not successful in inducing more regular periods and pregnancy, ask for further help from a reproductive endocrinologist.
The Big Guns
Reproductive endocrinologists (REs) can track your ovaries for follicle maturity. They can stimulate ovulation and can help you time intercourse better. You can opt to have an intrauterine insemination (IUI) along with the metformin and clomiphene. If this does not lead to pregnancy, injectable stimulation meds may be necessary.
Still, Plenty of women get pregnant on their own
Most importantly, don’t give up. I have many patients conceive without much help. It is dependent on the individual. Interestingly, the syndrome can vary in severity related to testosterone levels and symptoms. So, please have patience with yourself. If you ovulate less, it may take longer for you to hit your timing right.
PCOS means you are ovulating at random. Take action through diet, nutritional supplements, and regular healthy habits. This will encourage your body to regularly ovulate so you can have at least 12 chances a year to get pregnant.
Did you get pregnant with PCOS? Tell me your story below!
¹Cooney, L. G., & Dokras, A. (2018). Beyond fertility: Polycystic ovary syndrome and long-term health. Fertility and Sterility,110(5), 794-809. doi:10.1016/j.fertnstert.2018.08.021
²Ziegler, D. D., Pirtea, P., Fanchin, R., & Ayoubi, J. M. (2018). Ovarian reserve in polycystic ovary syndrome: More, but for how long? Fertility and Sterility,109(3), 448-449. doi:10.1016/j.fertnstert.2017.11.027
³Mavropoulos, J.C., Yancy, W.S., Hepburn, J., and Westman, E.C. The effects of a low-carbohydrate, ketogenic diet on the polycystic ovary syndrome: a pilot study. Nutr Metab (Lond). 2005; 2: 35
4Dashti, H. M., Mathew, T. C., Hussein, T., Asfar, S. K., Behbahani, A., Khoursheed, M. A., Al-Sayer, H. M., Bo-Abbas, Y. Y., … Al-Zaid, N. S. (2004). Long-term effects of a ketogenic diet in obese patients. Experimental and clinical cardiology, 9(3), 200-5.
5Unfer, V., Carlomagno, G., Dante, G., & Facchinetti, F. (2012). Effects of myo-inositol in women with PCOS: A systematic review of randomized controlled trials. Gynecological Endocrinology,28(7), 509-515. doi:10.3109/09513590.2011.650660
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