Trying To Get Pregnant With PCOS
We originally posted this blog in November 2021, but as is always the case in medicine, new and exciting information and research gets published every month. As such, we wanted to update all of our PCOS followers out there on the most up to date information on trying to get pregnant with PCOS!
First off, we understand that trying to get pregnant with a PCOS diagnosis can be a very challenging, emotional, and stress-driven time. PCOS is the leading cause of infertility in women and this means it is generally more challenging to conceive with PCOS. However, our goal is to help dispel your concerns around conceiving with PCOS, as individuals with PCOS actually tend to respond quite positively to fertility interventions – both naturopathic and conventional, and have fantastic treatment outcomes!
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 Stock of Your Cycle Health, Metabolic Health & PCOS Status
Now that we understand the obstacles, it’s time to take stock of your cycle health, your metabolic health, and your PCOS status so you’re going into this from a place of knowledge. Understanding these pieces 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:
METABOLIC HEALTH
Insulin & Blood Sugar Levels
Fasting glucose and fasting insulin are essential for taking stock of your PCOS status. Many individuals with PCOS have high fasting insulin levels, and insulin and glucose dysregulation. 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. As such, testing insulin and glucose levels are a must.
Lipid Levels
In 2022, a retrospective study looking at PCOS patients undergoing fertility treatments found that patients with higher total cholesterol levels had poorer outcomes to ovarian stimulation. Specifically, it was found that a total cholesterol level of 5.20 mmol/L or greater significantly reduced the live birth rates in IVF/ICSI in PCOS patients. While we’re unsure if treating elevated cholesterol levels in PCOS specifically helps to improve fertility outcomes, given this updated research, I always recommend testing lipid levels when assessing fertility in PCOS.
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!
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 3: Get a PCOS-Fertility Support Plan in Place
Once you understand your hormone status, metabolic status, and PCOS barriers, we can create a customized fertility plan for you. 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)
Ongoing cycle monitoring at home
Lastly, fertility and cycle support acupuncture
Step 4: Be Open to All Possibilities
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