Getting Pregnant With PCOS

Polycystic ovary syndrome (PCOS) is the most common reason for anovulatory infertility (when an egg isn't released from the ovaries). But having PCOS doesn't mean that you can't get pregnant.

PCOS could make it harder to conceive because lack of ovulation is at the core of this condition. Without any egg for sperm to fertilize, there can be no pregnancy, but I've seen first-hand how lifestyle changes can normalize ovulation and improve the chances of getting pregnant. In this article, I'll share exactly why PCOS impacts fertility and what steps you can take to regain hormone balance naturally.

What is PCOS?

PCOS is the most common endocrine disorder, affecting 5 to 10% of women of reproductive age. There's unlikely just one cause of PCOS, as it's linked to a combination of genetics, environmental, and lifestyle factors like diet and exercise.

People with PCOS have hormone imbalances that lead to symptoms like irregular or missing periods, acne, infertility, hair loss, and in some cases, weight gain. Higher than average androgens, primarily testosterone (yes, women have testosterone, too), throws off the balance of other hormones like estrogen, insulin, and progesterone. 

Metabolic health issues, especially insulin resistance, may also show up with PCOS, making it a problem for heart health and weight concerns. Insulin resistance could also increase testosterone production in the ovaries, which only worsens things.

Symptoms of PCOS 

Symptoms of PCOS can look different for each person, and there are actually multiple types of PCOS. Insulin resistance is present in up to 70% of PCOS cases, but other signs and symptoms include:

• Acne
• Facial hair
• Mood swings or depression
• Heavy periods
• Irregular or missing periods
• Hair thinning
• Weight gain
• Infertility
• Breast tenderness

Despite the name, PCOS doesn't always automatically mean there are cysts on the ovaries. In fact, what once was thought to be cysts has been shown to be follicles, lots of them, as the body attempts to ovulate. To be diagnosed with PCOS, you must have two out of three of the following symptoms:

• Lack of ovulation, which usually shows up as irregular or missing periods
• High androgens on lab testing or based on symptoms
• Polycystic ovaries on ultrasound

Since irregular cycles and acne are typical during puberty, it can take time to get the PCOS diagnosis, and it's often missed in adolescents. Instead of diving deeper into root causes, it’s common that providers prescribe a woman the birth control pills to control symptoms. 

But once the pill is stopped, symptoms resume. Sometimes, the pill is discontinued in anticipation of becoming pregnant. Unfortunately for many women, this may be the first time they learn they have PCOS and that becoming pregnant isn’t as easy as their doctor, teachers, or parents made it out to be.

Is infertility common with PCOS? 

As I shared earlier, PCOS is the most common cause of anovulatory infertility, but it does not mean you can't get pregnant. Understanding why PCOS can impact your fertility and how you can rebalance your hormones is a critical step.

How does PCOS affect fertility?

Our hormones control our menstrual cycle. For people with PCOS, hormone balance is altered, impacting the menstrual cycle and ovulation.

Hormone Imbalances

Aside from elevated testosterone, women with PCOS often have higher luteinizing hormone (LH), lower follicle-stimulating hormone (FSH), lower progesterone levels, and sometimes higher estrogen (although it can be lower too). LH triggers egg release from the ovary, and FSH stimulates egg growth. All are essential for ovulation, as you'll see below.

These hormone imbalances manifest as irregular or missing periods from lack of ovulation.

In addition, if insulin levels are rising (which can happen with insulin resistance), this hormone can stimulate the ovaries to increase production of testosterone, which interferes with fertility.

Ovulation 

The primary reason PCOS causes infertility is that it interferes with regular ovulation. Ovulation is when an egg is released by the ovary. Right before ovulation, estrogen spikes and then your LH surges which triggers the release of the egg, and estrogen, which has been steadily rising, drops quickly.

With PCOS, hormone imbalances impact the normal release of eggs. If cysts are present on the ovaries, they can also produce LH without ovulation. Without ovulation, pregnancy can't happen because there's no egg to fertilize.

Irregular periods

Irregular periods are a result of anovulation (missed ovulation). If you aren't ovulating, you’re unlikely to get a period at all. If ovulation is sporadic, your periods will also be sporadic. And you may even have periods that only come a few times a year. Generally, going more than 35 days between periods is considered longer than expected and can be a sign of PCOS.

As an aside, if your periods are heavier than usual, PCOS could be the culprit, but make sure to have your practitioner look closely to rule out other possible underlying reasons like fibroids, endometriosis, hypothyroidism or estrogen dominance.

Mental health 

While not necessarily a direct cause for infertility, it's worth mentioning that if you are dealing with PCOS or infertility and experience depression or anxiety, you are absolutely not alone.

Having PCOS increases the risk for mental health concerns—about 40% of women with PCOS also have depression. At the same time, the stress and emotions involved with infertility can take a significant toll on mental health. 

Weight management 

Both insulin resistance and increased weight may make it harder to get pregnant, with or without PCOS. However, one study found that weight loss of 5 to 10% of body weight can improve reproductive health outcomes and insulin sensitivity.

Rather than focusing on weight alone, I invite my patients to look at how they can build a nutrient dense diet and muscle mass. These are two things that can improve insulin sensitivity, hormones, inflammation and fertility. And they are far less frustrating than watching a number on the scale and prevents the “just eat right and exercise” rhetoric from discouraging progress. Weight management in PCOS is much more complicated than calories in and calories out. 

I have a free meal plan and recipe guide to help support you on bringing in the nutrients that support your hormones.

Is PCOS fertility treatment possible? 

Having PCOS does not mean you can't get pregnant, but if you are struggling or want to make healthy changes before trying to conceive, you can take steps to support your hormones, health, and chances of conceiving on your own.

Lifestyle changes to help ovulation and regulate your period

Since the primary reason for infertility with PCOS is anovulation, balancing the hormones needed to regulate your cycle and support ovulation is foundational. 

It can be challenging to track if your cycle is irregular, but looking for ovulation signs to better understand your body is an excellent place to start. (I wrote this article for tips on how to do it.)

Often, a doctor will prescribe birth control pills as a primary way to regulate hormones with PCOS, but of course, that's not going to help if you want to get pregnant. Working directly with someone who understands how to support PCOS and fertility is ideal, but there are many lifestyle changes you can start now on your own.

It's now recognized that diet, exercise, and other health habits should be “first-line treatments” for people experiencing infertility with PCOS as they can help address weight, blood sugar imbalances, and testosterone levels.

Here are my top tips:

Consider hormone balancing supplements. 

Many supplements support ovulation and the menstrual cycle if you have PCOS. While I go into them in more detail in this article, some of my top choices are inositol, vitex, and N-Acetyl-Cysteine (NAC).

Inositol helps with blood sugar and hormone balance while also supporting ovarian health. Vitex can be especially beneficial for hormone balance because it could increase progesterone while keeping testosterone at healthy levels. NAC is an antioxidant that has been shown to improve ovulation and pregnancy rates.

Research also suggests that women with PCOS who also have low vitamin D, benefit from supplementation, as it may improve reproductive function. It's always a good idea to get your vitamin D levels tested and optimize levels as needed.

For more fertility focused supplements, watch the video at the end of this post.

Build a nutrient dense diet. 

No one specific diet pattern is right for every person with PCOS, so the best diet is the one that is sustainable and makes you feel good. There are specific foods for PCOS like antioxidants, polyphenols, and fiber from fruits, vegetables, and complex carbs. These foods are also natural fertility boosters.

Fundamentally, blood sugar balance is vital for PCOS. It helps with hormone balance and insulin sensitivity. While low-carb can be tempting, it's not always the right choice for everyone (read more about low-carb diets and PCOS here).

There are other ways to balance blood sugar without going low carb if it doesn't fit your lifestyle. Taking steps to make sure to pair your carbs with healthy fat, fiber, or protein can slow down the digestive process that contributes to blood sugar spikes.

If you aren't sure where to start, I've created a free hormone-balancing kit with a lot of helpful information about diet, including a 7-day meal plan to guide you.

Find joy in movement. 

Moving your body regularly can help decrease androgens and improve insulin sensitivity, which can help with ovulation. Physical activity is also a mood enhancer and stress reliever. Walking, dancing, swimming—anything that gets your heart pumping can help.

Check your alcohol intake. 

Alcohol can be a complex topic depending on your personal choices. For some people, alcohol is a needed stress reliever at the end of the day, and for others, it's easy to avoid. There are a couple of things to consider about alcohol if you have PCOS. 

First, the type of alcohol matters. High sugar beverages used as mixers aren't great for blood sugar balance because they spike blood sugar. But further, if you are trying to become pregnant, drinking could interfere. A study found that more than four drinks a week could negatively affect your cycle, hormone levels, and how often you ovulate.

If you are trying to conceive, it may be a good idea to examine your intake of alcohol, whether you have PCOS or not. You can read more about alcohol and your hormones here.

Work on stress management. 

I know that health experts telling you to work on stress may start sounding like a broken record, but it really is that important. Stress impacts every area of health and directly affects your hormones. If you have PCOS, you don't need cortisol coming in and adding even more problems to the mix.

Even five or ten minutes a few times a day can help so much. The internet is filled with apps, videos, and more to guide you through meditations, breathing exercises, or gentle stretching. Find something that helps you get in touch with your body and pay attention to something as simple as your breath. You may be shocked at what a difference it can make.

Should I pursue IVF?

In vitro fertilization (IVF) is a great option for some people looking to conceive. It is generally recommended that after 1 year of unsuccessfully trying to conceive if your in your early thirties or younger (6 months if you’re mid-thirties and above) that you seek care from a fertility specialist. They may recommend you pursue IVF or they may offer you the same suggestions above while you investigate with further testing.

The good news is, you can employ the same suggestions above to support your health and it can even make IVF more successful in some cases. 

Getting pregnant with PCOS is possible

PCOS could affect your fertility, but you can absolutely still become pregnant. A targeted approach to hormone balance that includes supplements, diet, movement, and stress management can make such a difference.

If you are struggling with PCOS symptoms or infertility, please don't be afraid to reach out to a healthcare practitioner who can help you get on track.

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