Supporting Fertility in PCOS
For many of my patients, one of the first thoughts that arise after a diagnosis of PCOS is if they will be able to get pregnant. Despite what you may have been told, a diagnosis of PCOS does not automatically mean you will struggle with fertility. PCOS is a complex condition that presents quite differently from one person to the next. Some with PCOS conceive easily with little to no intervention. While others can struggle for many years to get pregnant. In my experience treating hundreds of patients with PCOS, the vast majority do get pregnant with the right treatment and carry a healthy baby to term!
Whether you’re just starting along your PCOS and fertility journey, or if you’ve been trying to conceive for some time, there is so much you can do to support your fertility both alongside fertility interventions such as IUI and IVF or on its own.
In my practice, I focus on three main goals to help my patients with PCOS get pregnant and reduce the risk of miscarriage. These goals are to:
Support and monitor ovulation
Optimize egg quality
Encourage healthy implantation
Support & Monitor Ovulation
The biggest barrier that people with PCOS face when it comes to fertility is irregular cycles and a lack of consistent ovulation. In fact, 80% of anovulatory infertility cases are due to PCOS (1).
Approximately 75-85% of those with PCOS have oligomenorrhea, defined as infrequent or irregular periods (2). If you are experiencing cycles longer than 35 days, shorter than 21 days, or if your cycles vary more than 5 days from one cycle to the next you want to work on monitoring and supporting more regular ovulation as your primary goal.
To support regular ovulation, you first need to understand what your specific barriers to ovulation are. In some people with PCOS, insulin resistance, inflammation and metabolic health issues are the biggest factors preventing regular ovulation. In others, an unregulated nervous system and dysregulated cortisol are the drivers. In yet others, the presence of elevated male hormones (androgens) and elevated LH hormone is blocking regular ovulation. And in many, it’s a combination of these factors.
Detailed lab work can be easily run to understand what your specific ovulation barriers are. Once you have a clear picture of your ovulation barriers, you can begin working on a diet, lifestyle, supplement and in some cases medication plan to get you ovulating more regularly.
Optimize Egg Quality
Although research is conflicting, we have seen evidence that PCOS can impact the quality of the growing eggs and embryos (3). Like ovulation, the presence of insulin resistance, inflammation and high androgens can impact the quality of the developing eggs (3). Alongside working on these factors, making sure we’re supporting egg quality as much as possible is the second biggest consideration to focus on when supporting fertility in those with PCOS.
We can support and optimize egg quality by moving towards a diet that is low on the glycemic and insulin index and high in colourful and polyphenol-rich foods. We can work on regular movement, focus on stress management, reduce alcohol and smoking and even certain chemicals in our environment we know can impact egg quality. Outside of these foundational dietary and lifestyle changes, there is a large range of nutraceuticals that we know can positively impact egg quality including CoQ10, PQQ, NAC and melatonin to name a few.
Encourage Healthy Implantation
The third consideration is to support the healthy implantation of the embryo. We know that those with PCOS have a significantly higher risk of miscarriage than those without the condition (4), but we also know there is a lot we can do to reduce this risk.
Research has found that the development of the placenta which is essential for blood flow and nutritional support to the growing embryo can be altered in women with PCOS (5). This healthy placenta formation is impacted by insulin levels, androgen levels and inflammatory levels. We can significantly influence all these risk factors with targeted diet, lifestyle, supplement, and medication support.
In my practice, I also commonly use progesterone therapy in the first trimester to try and reduce miscarriage risk in many of my patients with PCOS.
Looking For More Fertility Support?
Understanding how to optimize your fertility, reduce miscarriage risk and support yourself for the healthiest pregnancy and postpartum period in PCOS is incredibly important. Naturopathic medicine has many tools that can support you along your hormonal health, PCOS, and fertility journey. You can read more about our approach to PCOS or fertility, and reach out to the clinic if you have any questions!
References:
1. Degner, K., Magness, R.R. and Shah, D.M. (2017) “Establishment of the human uteroplacental circulation: A historical perspective,” Reproductive Sciences, 24(5), pp. 753–761. Available at: https://doi.org/10.1177/1933719116669056.
2. Harris, H.R. et al. (2017) “Abstract 2293: Oligomenorrhea, polycystic ovary syndrome, and risk of ovarian cancer histotypes, evidence from the Ovarian Cancer Association Consortium,” Cancer Research, 77(13_Supplement), pp. 2293–2293. Available at: https://doi.org/10.1158/1538-7445.am2017-2293.
3. Parker, P.B. et al. (2020) “Polycystic ovary syndrome is associated with increased aneuploidy rate,” Fertility and Sterility, 114(3). Available at: https://doi.org/10.1016/j.fertnstert.2020.08.138.
4. Pan, M.-L., Chen, L.-R. and Chen, K.-H. (2021) “The risk of subsequent miscarriage in pregnant women with prior polycystic ovarian syndrome: A nationwide population-based study,” International Journal of Environmental Research and Public Health, 18(16), p. 8253. Available at: https://doi.org/10.3390/ijerph18168253.
5. Kelley, A.S., Smith, Y.R. and Padmanabhan, V. (2019) “A narrative review of placental contribution to adverse pregnancy outcomes in women with polycystic ovary syndrome,” The Journal of Clinical Endocrinology & Metabolism, 104(11), pp. 5299–5315. Available at: https://doi.org/10.1210/jc.2019-00383.
6. Degner, K., Magness, R.R. and Shah, D.M. (2017) “Establishment of the human uteroplacental circulation: A historical perspective,” Reproductive Sciences, 24(5), pp. 753–761. Available at: https://doi.org/10.1177/1933719116669056.