Getting Pregnant with PCOS: Tips for those TTC

Understanding PCOS and its impact on fertility

Polycystic Ovary Syndrome (PCOS) is an endocrine disorder that affects millions of people worldwide. It is characterized by the presence of cysts on the ovaries, irregular menstrual cycles, and high levels of androgens. PCOS can have a significant impact on fertility, making it challenging to conceive with this condition.

One of the primary reasons for infertility with PCOS is the inability to ovulate regularly. Ovulation is the release of an egg from the ovary, which is necessary for conception. Due to hormonal imbalances, people with PCOS may have infrequent or absent ovulation, reducing their chances of getting pregnant.

In addition to irregular ovulation, PCOS can also lead to other fertility-related issues such as insulin resistance and inflammation. These factors further contribute to the difficulty of conceiving with PCOS. Understanding the impact of PCOS on fertility is crucial for taking the necessary steps to improve your chances of getting pregnant.

Factors affecting fertility with PCOS

Several factors can affect fertility with PCOS. Understanding these factors can help in finding effective solutions and improving your chances of conceiving.

• Hormonal Imbalance: PCOS is primarily characterized by hormonal imbalances, particularly high levels of androgens such as testosterone. These imbalances can disrupt the normal ovulation process and make it difficult to conceive.
• Insulin resistance: Many people with PCOS also experience insulin resistance, which means their bodies have trouble using insulin effectively. Insulin resistance can lead to difficulties in regulating blood sugar levels and can also interfere with ovulation.
• Excess weight: Not everyone with PCOS will experience this symptom yet it is often associated with PCOS. Carrying excess weight has the potential to disrupt hormone levels and make it more difficult to conceive. Those with PCOS trying to conceive are often advised to lose 10-15% of their body weight to improve fertility outcomes, however the increased fertility is likely contributed to the lifestyle modifications rather than the weight itself.
• Inflammation: Chronic inflammation is often present in people with PCOS, and it can affect fertility by disrupting the delicate balance of hormones and interfering with the ovulation process.

Additional factors include age, smoking, and activity level. Dietary factors that can impact fertility are diets high in saturated and trans fats, high animal protein diets, diets that are high on the glycemic index, and deficiencies of vitamin D. Understanding these factors can help you make informed decisions regarding your fertility journey and take steps to address these issues.

PCOS and its impact on reproductive hormones

PCOS can impact several fertility hormones, leading to difficulties with ovulation and fertility. Here are some of the key fertility hormones affected by PCOS:

1. Follicle-Stimulating Hormone (FSH): FSH plays a crucial role in the development and maturation of ovarian follicles, which contain the eggs. In PCOS, the elevated levels of androgens can disrupt the normal FSH secretion and response, leading to an imbalance in follicle development and irregular or absent ovulation.
2. Luteinizing Hormone (LH): LH is responsible for triggering ovulation, the release of a mature egg from the ovary. In PCOS, LH levels may be higher than normal or the ratio of LH to FSH can be disrupted. This imbalance can prevent ovulation or result in the development of multiple follicles that fail to release eggs.
3. Insulin: Insulin is a hormone that regulates blood sugar levels. Women with PCOS often have insulin resistance, which means their bodies have difficulty using insulin effectively. Insulin resistance can lead to increased insulin levels in the blood, resulting in higher androgen production by the ovaries. Elevated androgen levels can disrupt normal hormonal balance and hinder ovulation.
4. Anti-Mullerian Hormone (AMH): AMH is a hormone produced by developing follicles in the ovaries. In PCOS, the presence of multiple small cysts on the ovaries is associated with higher levels of AMH. Elevated AMH levels can indicate increased follicle activity but can also contribute to irregular ovulation and difficulties with fertility.
5. Estrogen and Progesterone: Estrogen and progesterone are key reproductive hormones involved in the menstrual cycle and the preparation of the uterus for pregnancy. In PCOS, the imbalanced hormone levels can affect the regular production and release of these hormones, leading to irregular or absent menstrual cycles and difficulty in achieving and maintaining a pregnancy.

It’s important to note that PCOS affects individuals differently, and the specific hormonal imbalances can vary from person to person. Additionally, hormonal imbalances associated with PCOS can have broader impacts on various aspects of health beyond fertility. If you have PCOS and are concerned about your future desires to conceive or are currently experiencing struggles with fertility, it is recommended to consult with a healthcare professional for proper treatment options. To evaluate your fertility and hormonal status. These tests can help identify underlying issues related to PCOS and guide appropriate treatment options. Here are some common lab tests that you can request:

Hormone Panel:

• Follicle-Stimulating Hormone (FSH): Measures the level of FSH, which helps assess ovarian function.
• Luteinizing Hormone (LH): Evaluates LH levels, which are involved in ovulation.
• Estradiol: Assesses estrogen levels during the menstrual cycle.
• Progesterone: Measures progesterone levels to confirm ovulation.

Anti-Mullerian Hormone (AMH): Measures the level of AMH, which reflects the number of remaining eggs in the ovaries. Elevated AMH levels are often associated with PCOS.

Androgens:

• Testosterone: Assesses the level of testosterone, an androgen hormone that is frequently elevated in PCOS.
• DHEAS (Dehydroepiandrosterone sulfate): Evaluates the level of DHEAS, another androgen hormone that may be elevated in PCOS.
• Androstenedione 
• DHT

Thyroid Function Tests:

• Thyroid-stimulating hormone (TSH): Measures TSH levels to evaluate thyroid function.
• Free T4 (thyroxine) and Free T3 (triiodothyronine): Assess the levels of thyroid hormones.

Glucose and Insulin:

• Fasting Glucose: Measures blood glucose levels to screen for insulin resistance and diabetes.
• Fasting Insulin: Evaluates insulin levels to assess insulin resistance, which is common in PCOS.

Lipid Profile: Assesses cholesterol and triglyceride levels, which can be affected by PCOS-related metabolic changes.

Remember, the specific tests ordered may vary depending on your individual needs and the preferences of your healthcare provider. These tests, along with a comprehensive medical history and physical examination, can help your healthcare provider determine the most appropriate treatment plan for your fertility concerns associated with PCOS.

download this free lab sheet

Tips to improve fertility with PCOS

While getting pregnant with PCOS may present unique challenges, there are several empowering tips that can increase the chances of successful conception. Here are some tips for you to consider:

1. Follow a balanced diet: A healthy, balanced diet is essential for managing PCOS and improving fertility. Focus on whole foods, such as fruits, vegetables, lean proteins, and whole grains as much as possible. Depending on your needs, limiting highly processed foods, sugary beverages, and foods high in saturated fats can help improve fertility outcomes.
2. Manage insulin levels: Since insulin resistance is common in PCOS, it is crucial to manage insulin levels effectively. This can be achieved through dietary modifications, such as pairing high-fiber foods with lean proteins and healthy sources of fats. Ensure to eat on a regular basis and avoid skipping meals, especially breakfast.
3. Stay active: Regular exercise can help regulate hormone levels, improve insulin sensitivity, and promote ovulation. The type of exercise, duration, and frequency all depends on the individual. There are other factors to consider such as physical limitations and mobility. Some exercises to consider are yoga, resistance training, going for walks, swimming, or cycling.
4. Reduce stress: High levels of stress can disrupt hormones and interfere with fertility. It is not possible to eliminate stress but incorporating stress-reducing activities into your daily routine can make a positive impact on your ability to conceive. Some ideas that help reduce stress are journaling, meditation, or deep breathing exercises.
5. Sleep: Sleep plays an important role in fertility, and disruptions in sleep patterns can potentially impact a person’s ability to conceive. Those living with PCOS are also at increased risk for conditions such as sleep apnea. If you are experiencing sleep disturbances it is advised to discuss this with your healthcare provider. Ways that you can work on sleep improvements at home are adhering to a consistent sleep schedule, creating a sleep-friendly environment with cool temps, comfortable bedding, and low lighting. You may also find that you will need to limit any activities that stimulate you prior to bedtime.

By implementing these tips, you can take control of your fertility journey and increase the chances of getting pregnant.

Increasing PCOS fertility with nutrition

A healthy, balanced diet plays a crucial role in improving fertility with PCOS. But, what does that actually mean? Here are some of the best fertility diet tips for PCOS:

• Focus on complex carbohydrates: Choose whole grains, such as quinoa, brown rice, and oats. Complex carbohydrates have a lower glycemic index and can help regulate blood sugar levels. To save time and fuss, opt for frozen or microwave versions of these grains and easily add them to your dishes.
• Reduce trans fats: Trans fats can promote inflammation, impact insulin resistance and disrupt hormones that have an effect on fertility. It is common to find trans fats in fried or fast foods, baked goods, refrigerated dough products, margarine, and some snacks.
• Eat red meats in moderation: Red meat is a source of saturated fats and cholesterol, but also packed with nutrients like B vitamins, zinc, and iron. While you don’t have to eliminate red meats from your diet, you may see benefits from eating them in moderation. Shop for lean sources of protein, such as chicken, turkey, fish, and legumes. Protein is essential for hormone production and can support healthy ovulation.
• Increase plant proteins: Plant proteins are naturally lower in saturated fats plus they add more fiber into the diet which can help to improve insulin resistance. If you’re not a fan of plant proteins, such as beans, you can try different variations such as bean based pastas.
• Increase fiber intake: Fiber-rich foods, such as fruits, vegetables, and whole grains, can help regulate insulin levels and improve fertility. Aim for at least 25-30 grams of fiber per day. Another great tip is to ensure that you’re also hydrating adequately when increasing fiber to help reduce the chances of having digestive symptoms.
• Increase antioxidants: While increasing your fruits and vegetables you will likely also increase your antioxidants. PCOS is associated with increased oxidative stress that can impair reproductive function and egg quality. Antioxidants help to reduce oxidative stress and improve fertility outcomes. Shop for produce such as blueberries, strawberries, artichokes, or experiment with spices such as cinnamon, clove, and turmeric. 
• Increase MUFAs: Monounsaturated fatty acids (MUFAs) help to improve egg quality, insulin response, manage inflammation, and support hormones for fertility. You can add MUFAs into your diet by incorporating avocado or avocado oil, olives and olive oil, peanuts, chia and flax seeds into your dishes. Also you can incorporate sources of healthy fats into your diet with fatty fish like salmon, mackerel, or anchovies.
• Swapping some dairy for full fat varieties: Full fat dairy for improved fertility in those with PCOS is a topic of discussion with further research being needed. Some of the research currently available suggests that there are benefits of including some full fat dairy into the diet. While individual responses may vary, full fat dairy has shown fertility improvements in those with PCOS by improving egg quality, higher rates of ovulation, and improved follicular development. You may find it easier to only swap certain dairy products like yogurts and cottage cheese or milks if you drink them.
• Switching to decaf: Caffeine and its impact on fertility in those with PCOS is another ongoing topic. More research is needed to conclude definitely the role of caffeine in PCOS fertility. Considerations for caffeine and fertility is that it may affect fertility by interfering with normal ovulation and menstrual cycles. However, the evidence is mixed, and the specific effects on those with  PCOS are not yet well-defined. Caffeine can potentially affect hormonal balance by stimulating the release of stress hormones like cortisol. Chronic stress and elevated cortisol levels can disrupt hormonal regulation, including the reproductive hormones involved in ovulation and fertility. If you are always stressed and relying heavily on caffeine to get you through the day, you may consider swapping some of your caffeinated beverages for decaf. 
• Stay hydrated: This one may seem simple, but its important and easy to overlook. Drinking an adequate amount of water throughout the day to support overall health and promote optimal fertility.

By following these PCOS fertility diet tips, you can create a nourishing environment within your body and enhance the chances of getting pregnant.

Improve PCOS fertility with exercise

Regular movement is an essential component of managing PCOS as well as improving fertility. Regular physical activity can help regulate hormone levels, reduce insulin resistance, and promote ovulation. Here’s how exercise can empower you on your journey to getting pregnant with PCOS:

• Hormone regulation: Exercise can help balance hormones, including insulin and androgens, which are often imbalanced in people with PCOS. Regular physical activity can promote hormone balance, leading to improved fertility.
• Insulin sensitivity: Exercise improves insulin sensitivity, allowing the body to use insulin more effectively. This can help manage insulin resistance, a common issue in those living with PCOS, and enhance fertility.
• Stress reduction: Physical activity is known to reduce stress levels and improve overall well-being. By incorporating exercise into their routine, people with PCOS can manage stress, which can have a positive impact on fertility.

When incorporating exercise into your routine there are some considerations. The time spent outside of your exercise needs to support the type of exercise you are engaging in. Ensure that you are well nourished, allowing your body to rest and recover, and managing stress the best you can. Oftentimes those with PCOS get caught up on which exercise is the best, all modalities of exercise have its benefits but what makes the biggest difference is how you respond to that specific method of physical activity.

The activity that you choose needs to be enjoyable and leave you feeling better not worse. A great tip when it comes to movement is consider the types of activities that you enjoyed in your childhood. Did you used to ride bikes? Maybe you would prefer cycling. Were you the kid who was always outside? You might benefit from taking walks in nature or hiking. Lastly, exercise is as diverse as the bodies that perform them. It is important to consider personal limitations when it comes to physical activity. You may experience limited mobility, lack of access to safe spaces, or have a challenging schedule. Find the movement that suits you and your life the best. 

If you’re still confused on where to start, check out my services where I offer personalized fitness plans that suit your needs and abilities.

Fertility treatments for PCOS: options and considerations

While lifestyle modifications can significantly improve fertility, some may need additional help in their journey. Various fertility treatments are available for those living with PCOS, each with its own considerations. Here are some available fertility treatments for PCOS:

• Ovulation induction: Ovulation induction involves using medications, such as clomiphene citrate or letrozole, to stimulate ovulation. These medications can help regulate the menstrual cycle and increase the chances of getting pregnant. Prior to initiating these ovulation stimulating medications, your healthcare provider may suggest starting with the medication metformin, which is an insulin sensitizing drug that can improve insulin response and ovulation. For some, a combination of these medications may be advised.
• Intrauterine Insemination (IUI): IUI is a procedure where ovulation stimulation medications are prescribed and once the follicles reach the desired size, the healthcare provider will perform an insemination procedure. IUI is a less invasive and more affordable fertility treatment compared to more advanced techniques such as in vitro fertilization (IVF).
• In vitro fertilization (IVF): IVF is a fertility treatment option that involves retrieving eggs from the ovaries, fertilizing them in a laboratory, and transferring the embryos back into the uterus. IVF has high success rates but is a more invasive procedure and expensive making it not accessible for everyone.
• Laparoscopic ovarian drilling: This surgical procedure involves making small holes in the ovaries to reduce androgen production and stimulate ovulation. It is typically reserved for those who have not responded to other forms of treatment.

It is essential to discuss these options with a healthcare professional or a fertility specialist to determine the most suitable treatment approach based on your individual circumstances. Factors such as age, overall health, and previous treatment history can influence the choice of fertility treatment.

Natural ways to improve fertility

In addition to medical interventions, several natural options can complement the efforts to increase fertility with PCOS. Many people living with PCOS are eager to learn natural ways to help improve their chances of conceiving. These options can be used alongside lifestyle modifications and fertility treatments to enhance the chances of getting pregnant, but it is always advised that they are discussed with your qualified healthcare provider. Here are some natural fertility options to consider:

• Acupuncture: Acupuncture is an ancient Chinese therapy that involves inserting thin needles into specific points on the body to promote balance and well-being. Some studies suggest that acupuncture may help regulate menstrual cycles and improve fertility in women with PCOS. 
• Herbal supplements: Certain herbal supplements, such as myo-inositol, have been traditionally used to support hormonal balance and improve fertility. It is crucial to consult with a healthcare professional before incorporating any herbal supplements into your routine. We will discuss supplements that support fertility later in this article.
• Stress management techniques: Chronic stress can negatively impact fertility. Engaging in stress management techniques, such as mindfulness meditation, yoga, or deep breathing exercises, can help reduce stress levels and promote fertility.
• Emotional support: Dealing with fertility issues can be emotionally challenging. Support from family, friends, or support groups are often vital for those experiencing fertility struggles. Seeking the care of a qualified mental health practitioner is an exceptional way to achieve support, understanding and encouragement as well as addressing any potential stressors such as past or current traumas.
• Routine monitoring: Working closely with a healthcare provider who specializes in PCOS and fertility will likely initiate routine monitoring, but you can start this at home before seeking fertility support. Begin tracking your menstrual cycles, signs and symptoms of ovulation, and hormone levels. This can also help your fertility specialist identify potential issues and guide the appropriate interventions or treatment options.

It is essential to remember that natural options may not have the same level of scientific evidence as medical interventions. Therefore, it is crucial to approach natural options with an open mind and consult with healthcare professionals, such as fertility specialists or reproductive endocrinologists, before incorporating them into your fertility journey. Every individual with PCOS is unique and treatment options along with their results may vary.

Tracking with PCOS & why its important

For those with PCOS, tracking ovulation becomes even more critical in the journey to getting pregnant. If you are currently not ovulating (anovulation) your ovulatory status can change by implementing the tools shared in this article and tracking your status can help you to see these improvements. Ovulation tracking helps to identify when you are most fertile and can time intercourse accordingly. There are numerous ways to track your ovulation with apps, journals, or in the notes section of your smartphone. You can even download our PCOS Tracker to get you started. Here are some methods to track ovulation with PCOS:

• Ovulation predictor kits (OPKs): OPKs detect the surge in luteinizing hormone (LH) that occurs before ovulation. These kits can help pinpoint the most fertile days in your menstrual cycle, but they are not always correct for those with PCOS. It is common for those with PCOS to baseline levels of elevated LH which can make it challenging to detect LH surges. Those with PCOS may also experience irregular cycles, multiple LH surges in a single cycle, or anovulatory cycles that need to be considered before investing in OPKs as these experiences will likely lead to inaccurate results.
• Basal body temperature (BBT) charting: BBT charting involves taking your temperature every morning before getting out of bed and recording it on a chart. A rise in temperature indicates that ovulation has occurred. This is a simple yet highly effective way to track ovulation for those living with PCOS.
• Cervical mucus monitoring: Changes in cervical mucus throughout the menstrual cycle can indicate when ovulation is approaching. Fertile cervical mucus is typically clear, stretchy, and resembles raw egg whites.
• Cervical height monitoring: PCOS can affect impact hormones and menstrual cycles, which also affect cervical height, so this method should never be used as a standalone indicator of ovulation. Cervical height refers to the position of the cervix within the vagina, which changes throughout the menstrual cycle. Generally, during the fertile window the cervix tends to be higher, softer, and more open to allow easier passage for sperm. After ovulation, the cervix tends to be lower, more firm, and closed. This is observed by inserting one or two fingers into the vagina to feel for the cervix, which resembles a small round donut. Tracking cervical height is most effective when used along with other methods of ovulation tracking, such as BBT and cervical mucus monitoring.
• Ultrasound monitoring: Transvaginal ultrasound scans directly visualize the development of ovarian follicles and the release of eggs, providing more accurate information about ovulation. This isn’t monitoring you would do at home as it must be suggested and ordered by your healthcare provider, but it is great to keep track of the results if you obtain ultrasound monitoring.

By tracking ovulation, you can maximize the chances of getting pregnant by identifying your fertile window and timing intercourse accordingly.

Supplements to consider when trying to conceive with PCOS

I know you’re curious about supplements and how they can play a supportive role in improving fertility with PCOS. While it is essential to consult with a healthcare professional before starting any supplements, here are some of the supplements that can help boost fertility:

1. Inositol: Inositol is a naturally occurring compound that can help improve insulin sensitivity and regulate menstrual cycles. It is available in both myo-inositol and D-chiro-inositol forms.
2. Prenatal: Good quality prenatal vitamins contain essential nutrients that support reproductive health and hormone balance. By taking prenatal vitamins, you can ensure that your body has sufficient levels of these important nutrients that can help optimize fertility. This is an especially important supplement for those who may find that they are lacking nutrients in their daily diet.
3. Omega-3 fatty acids: Omega-3 fatty acids, such as those found in fish oil, have anti-inflammatory properties and may help regulate hormones and improve fertility.
4. Coenzyme Q10: Coenzyme Q10 is an antioxidant that can support egg quality and overall reproductive health. It may be particularly beneficial for those over 35 years of age.
5. Vitamin D: Vitamin D deficiency is common in people with PCOS and may have a negative impact on fertility. Supplementing with vitamin D can help address this deficiency and support reproductive health.
6. Melatonin: Melatonin is commonly known for its ability to improve sleep, and while sleep does have positive impacts on fertility this isn’t the only benefit that melatonin has to offer. Melatonin also supports fertility with its antioxidant effect, improving insulin sensitivity, and supports the release of FSH and LH.

It is important to note that supplements should not replace a healthy diet and lifestyle modifications. They should be used as a complementary approach under the guidance of a healthcare professional.

Explore these supplements and more in our shop page. 

Coping with the emotional challenges of infertility and PCOS

Dealing with infertility while living with PCOS can take a toll on your emotional well-being. It is essential to recognize and address the emotional challenges that may arise during this journey. Here are some strategies to coping with the emotional aspects of PCOS infertility:

• Seek support: Connect with others who are going through similar experiences, whether through support groups, online forums, or counseling. Sharing your feelings and experiences can provide comfort and validation.
• Practice self-care: Prioritize self-care activities that bring you joy and help you relax. This can include hobbies, exercise, spending time with loved ones, or engaging in activities that promote mental and emotional well-being.
• Communicate with your partner: Open and honest communication with your partner is crucial during this time. Express your feelings, fears, and hopes, and work together as a team to navigate the challenges of infertility.
• Consider professional help: If the emotional challenges become overwhelming, seeking professional help from a therapist or counselor who specializes in infertility and PCOS can be beneficial.

Remember that it is normal to have ups and downs during this journey. Give yourself permission to feel the emotions that arise and be gentle with yourself throughout the process.

Seek out the success stories

Hearing success stories of those who have successfully gotten pregnant with PCOS can provide hope and motivation. While every person’s fertility journey is unique, knowing that others have overcome similar challenges can be empowering. Seek out stories of those who have successfully conceived with PCOS through online forums, support groups, or books. These stories can serve as a reminder that it is possible to achieve your dream of becoming a parent, even with PCOS.

This is Desiree, a past client. When she came to me she was at a loss for what to do. Her PCOS was impacting her life and not in a good way. She was on birth control but knew she wanted to come off of it and try conceiving. We worked hard on managing her stress, getting her blood sugar balanced, and improving her health. Desiree felt empowered to talk to her provider about discontinuing her birth control. She was surprised to find that all of the work we did while she was on birth control helped her body transition smoothly. Her periods were regular and she was ovulating. Even more shocked, Desiree quickly became pregnant.

If you need help navigating your PCOS, let’s work together. Take a look at my services.

Final thoughts on getting pregnant with PCOS

Getting pregnant with PCOS may present unique challenges, but with the right knowledge, support, and lifestyle modifications, it is possible to increase the chances of successful conception. Understanding the impact of PCOS on fertility, addressing factors that affect fertility, and following these empowering tips can empower you on your journey to getting pregnant.

Remember to consult with healthcare professionals and fertility specialists to develop a personalized approach that suits your individual needs. Stay positive, stay informed, and believe in your ability to unlock fertility and create the family you desire.

Sources: PMID: 36353235  PMID: 17329264  Additional sources