Trying To Get Pregnant With PCOS
Trying to get pregnant with a PCOS diagnosis can be a very challenging, emotional, and stress-driven time. There are some of us that get pregnant easily with PCOS, and then there are others, where month after month, nothing seems to be changing.
It can be exceptionally disheartening when we turn to the internet, and social media for support, only to see many ‘PCOS experts’, doctors, naturopathic doctors, nutritionists, and so on talk about how they were able to fall pregnant naturally with PCOS. It probably makes you feel like there’s some missing piece, or this secret that you’re not in on. Worse – it probably makes you feel like you’re doing something wrong.
I’m here to set the record straight for all of you trying with PCOS! There is no secret you’re missing out on, there is nothing you are doing wrong. The truth is that PCOS is the leading cause of infertility in women and this means it is generally more challenging to conceive with PCOS. However, it’s also the condition most amenable to treatment, meaning we have the most options that are likely to yield benefit.
Today, I’m taking you through ALL of the steps to go through if you’ve started on your PCOS fertility journey (this includes if you just started thinking about trying too!), so you can feel confident that you’re on the right track.
Step 1: Understand the Obstacles
As much as I wish this were not the case, there are obstacles to conception with PCOS. Here are the major obstacles we need to consider with PCOS:
anovulation
This is the barrier that gets the most attention, because it is also a diagnostic criteria of PCOS. Many individuals with PCOS have a hard time ovulating naturally. Some individuals with PCOS ovulate inconsistently, others ovulate every month, and on the furthest end of the PCOS spectrum, there are some individuals who don’t ovulate naturally at all.
Ovulation is obviously essential to becoming pregnant. If we don’t ovulate, we can’t get pregnant. If delayed or absent ovulation is something you experience, this is the first place we need to start.
poorer egg quality
Interestingly, women with PCOS tend to have a higher ovarian reserve, and in women with PCOS undergoing IVF, egg retrieval rates tend to be much higher compared to control groups. Sadly, quantity does not equate to quality. In these same studies, we have found that although egg numbers are high, many of these eggs tend to be immature and of poorer quality, leading to lower fertilization rates.
reduced endometrial receptivity
Last, but not least women with PCOS also tend to exhibit reduced endometrial receptivity AKA implantation failure. Recently, a number of investigations have exhibited altered endometrial receptivity during the implantation window. There are many theories as to why this happens – insufficient estrogen and progesterone exposure, excess exposure to androgens and insulin, and possibly even progesterone resistance. Unfortunately, we don’t know why this happens for sure, and this is the obstacle we know the least about.
Step 2: Take a Deep Breath
Now that you know the obstacles, let’s take a deep breath. Remember, it is not impossible to conceive with PCOS. You can get there. In fact, just because you have PCOS, there’s no reason why you shouldn’t be able to conceive.
Before you even start trying, let’s start the practice of mindfulness, of being in a good headspace, and of being aware of our reaction to stress. Basically, take some long, deep breaths whenever life, the prospect of trying, or not being pregnant yet feels overwhelming to you.
Step 3: Take Stock of Your Cycle Health & PCOS Status
Now, for my favourite step – take stock of your cycle health and PCOS status so you’re going into this from a place of knowledge. Similar to going into an exam having studied and therefore knowing (at least some of) the answers, going into trying prepared, and armed with knowledge can be helpful. Taking stock of your cycle health, and PCOS health will help us to identify where your specific barriers lie, and, where we need to focus our efforts moving forward. For anyone with PCOS trying to conceive, I like to understand the following:
insulin & blood sugar levels
Fasting glucose and fasting insulin are essential for taking stock of your PCOS status. Many individuals with PCOS exhibit high fasting insulin, and HOMA-IR levels (clinically validated score of insulin resistance). This matters because when insulin is elevated this can delay or prevent ovulation, it reduces egg quality, and as mentioned above, exposure to high insulin is a proposed mechanism by which implantation failure occurs. Basically, testing this is a must.
hormone levels
Understanding where your hormone levels are when trying with PCOS can be very helpful. As mentioned above underexposure or overexposure to certain hormones can alter endometrial receptivity in the implantation window. It also can be a main cause of delayed or absent ovulation. In my practice, I always like to see FSH, LH, estradiol, total and free testosterone, DHEA, and post-ovulatory progesterone (if ovulation is occurring).
nutrient levels
Most notably I’m talking about Vitamin D. Vitamin D is an essential vitamin in PCOS. Adequate Vitamin D levels have been associated with better PCOS parameters including inflammatory markers, insulin control, hormone levels, and egg quality. Vitamin D also plays a crucial role in endometrial receptivity!
ovulation tracking
At-home ovulation tracking can be an inexpensive and effective tool for individuals with PCOS trying to conceive. At the very basic level, it gives us information as to whether or not you’re ovulating. If you are ovulating, it allows us to see if you ovulate consistently, or if ovulation is delayed or inconsistent. For example, it’s not uncommon for individuals with PCOS to ovulate at different times of their cycle each month. Some cycles you might ovulate on cycle day 14, and other cycles it might be on cycle day 20, making it very challenging to appropriately time out intercourse. Getting a grasp on your ovulatory patterns will help you to understand when to try, but also provide you with a deeper understanding of your body’s ovulatory signs. That way even if you do ovulate inconsistently, you know what it feels like when it happens, and therefore can better time out intimacy.
assessing for comorbid conditions
Last but not least, we need to rule out comorbid conditions. A comorbid condition is the presence of one or more additional conditions, often co-occurring with a primary condition. In the context of fertility, I’m talking about hypothyroidism and endometriosis co-occurring with PCOS specifically.
These two conditions occur at much higher rates in women with PCOS, compared to women without. Both of these conditions also have fertility implications. Understanding whether or not these conditions are simultaneously present will help us determine if additional barriers to fertility exist. It will also help us determine the best course of treatment for you that takes all your conditions into account!
Step 4: Get a PCOS-Fertility Support Plan in Place
Once you have an understanding of your hormone status, PCOS status, and what your unique barriers might look like, we can start enacting change. When it comes to fertility, I truly believe a multi-modal approach works best. My favourite combination of modalities for PCOS fertility include:
PCOS-friendly diet & lifestyle modifications
Stress management strategies such as CBT
Targeted supplements & herbs (prescribed by a fertility-focused, or PCOS-focused Naturopathic Doctor)
In some cases, bioidentical hormones (also prescribed by a fertility-focused, or PCOS-focused Naturopathic Doctor, or Reproductive Endocrinologist)
Lastly, fertility and cycle support acupuncture
For many of my PCOS patients trying to conceive, in addition to working with a Naturopathic Doctor, I always recommend finding a good therapist and acupuncturist to help support you on this journey.
Step 5: Take Another Breath & Be Open to the Possibilities
Finally – take another deep breath. Trying to conceive with PCOS may be challenging, but it’s certainly not impossible. For some individuals with PCOS, it might be a lot easier than you expected. For others, it might be a longer journey that requires more intervention. In any case, be open minded to all the possibilities and options available to you – because there are lots of them! And if you’re confused with which approach to take, that’s exactly what we’re here for.
Ready to make a change?
If you’re hoping to learn more about getting pregnant with PCOS, you can check out our info pages on PCOS and fertility, or book a complimentary consult with one of our fertility-focused Naturopathic Doctors (myself or Dr. Clinning!).
With loving compassion,
Dr. Alessia Milano, ND