PCOS is the most common cause of anovulatory infertility; 90–95% of anovulatory women seeking treatment for infertility have PCOS. An anovulatory cycle is a menstrual cycle in which ovulation, or the release of an egg from the ovaries, does not occur. PCOS is a disorder with a combination of reproductive and metabolic characteristics. Women may learn they have PCOS only after seeking infertility treatment. Underproduction of estrogen and overproduction of testosterone by the ovaries can result in the tiny cysts on the surface of the ovaries (polycysts), hair and skin conditions.
In fact, PCOS the most common endocrinological disorder in women of reproductive age. The most common reproductive symptoms of PCOS are high production of male hormones, menstrual irregularity, anovulatory infertility, and pregnancy complications. Diagnosing and managing PCOS is important to restore fertility, decrease symptoms, and prevent future complications that can develop.
Although significant progress has been made towards developing diagnostic criteria for PCOS, the optimal treatment for infertility of women with PCOS is still unknown. There have been various studies conducted involving lifestyle modifications, pharmaceutical agents, and cognitive behavioral therapy – and the first line of treatment.
Hormone Control and Fertility
Controlling PCOS symptoms and hormone levels is your best strategy for improving fertility for PCOS. There is not a one-size-fits-all approach when it comes to diet, fertility, and PCOS. Work with your dietitian to create a balanced, high quality, whole food, high fiber PCOS Diet that meets your needs. A well-balanced diet (with adequate nutritional intake and healthy food choices) has improved fertility outcome in PCOS by significantly improving insulin sensitivity.
It’s also important to adopt healthy eating patterns in addition to building individual meals – eat smaller meals at more frequent intervals to help balance blood sugar and regulate insulin levels. Studies show that eating more frequently improves insulin sensitivity in women with PCOS – and produces lower peak insulin responses after meals. Improved insulin sensitivity helps your body maintain hormone balance/levels conducive to reproduction.
Insulin appears to disrupt all components of female reproduction. Your ovaries are reproductive tissues that are sensitive to insulin – which is why controlling insulin with PCOS is so important. Insulin lowers your blood sugar by storing the glucose in cells – as a result, the cells become more resistant to the constant insulin and need a stronger insulin cue to be signaled to reduce blood sugar levels.
On the other hand, high insulin levels also tell the ovaries to make more testosterone, which can interfere with normal reproductive processes. Women with PCOS also have elevated androgen levels (high androgens are a key marker of PCOS). High androgen levels interfere with the development of your eggs and the regular release of your eggs, also known as ovulation.
Androgens are often referred to as male hormones, but these hormones are present in both men and women. They are vital to normal reproductive function. Excessive androgen production by ovaries as well as from adrenals contributes to hyperandrogenism. Most women with hyperandrogenism have PCOS. Excess male hormones such as androgens and/or testosterone cause irregular periods and absence of ovulation, which makes it difficult to get pregnant. Therefore, controlling and balancing your hormone levels is so important when it comes to fertility and can increase the chance of pregnancy.
Weight Loss and PCOS Fertility
Achieving weight loss will increase your chances of becoming pregnant. Studies suggest that women with PCOS can become pregnant once their PCOS is well managed. Exercise and dietary regulation are important components of lifestyle modification – both have demonstrated significant improvement in cardiovascular risk factors and reproductive dysfunction in women with PCOS. Regular exercise has incredible benefits that go way beyond weight loss for women with PCOS.
Including movement into your daily activities can help reduce insulin resistance, especially when paired with anti-inflammatory foods. Along with a balanced diet, regular physical activity can help with many issues and health concerns that surround PCOS by decreasing androgen levels, improving insulin sensitivity and assisting with weight-loss.
In addition to helping mitigate PCOS symptoms, weight loss can help facilitate pregnancy, decrease pregnancy risk, and lower miscarriage prevalence. Even modest weight loss of 2%–5% total body weight may restore ovulation, improve the reproductive hormonal profile, and achieve an improvement in insulin sensitivity. Lifestyle changes and weight management are recommended as the first line of treatment for PCOS. These activities improve hormonal disturbances and prevent future reproductive and metabolic conditions – we prefer them to weight loss medication because you won’t have any negative side effects.
With that said, during preconceptual counseling, it is important that women work with their doctors to identify risk factors for reproductive failure. Correct any issues/risks prior to fertility treatment. Achieving weight loss prior to infertility treatment improves ovulation rates in women with PCOS. Obesity is also common in women with PCOS and is linked to fertility treatment failures. Obesity is also associated with anovulation, pregnancy loss and pregnancy complications.
Get in the Right State of Mind
Behavioral therapy can also help improve fertility. Studies show that weight management program outcomes (in women with PCOS) improved when their treatment regimens included behavioral and psychological strategies such as goal setting, self-monitoring, cognitive restructuring, problem solving, and relapse prevention.
PCOS symptoms can also severely affect body image and psychological health -depression is associated with reduced quality of life related to polycystic ovary syndrome symptoms. Depression can also negatively impact the motivation required for efforts for self-care, which may make PCOS symptoms (fatigue, acne, weight-gain) worse.
Physical activity, meditation, yoga, eating a balanced diet are all examples of self-care. Therefore, these treatment activities can significantly improve your ability to manage PCOS.
Methods such as pharmacological options and IVF are routinely offered at fertility centers. Metformin is an effective treatment for anovulatory infertility amongst women with PCOS. Metformin works by improving the sensitivity of tissues to insulin, which results in a reduction of insulin levels throughout the body. However, there are some side effects associated with metformin treatment such as nausea, bloating, abdominal pain, diarrhea, anorexia and metallic taste – however, slower release Metformin is associated with fewer side effects. Medication can help; however, lifestyle modifications like diet, exercise, and behavioral therapy are the first line of treatment.
If you have recently become pregnant, our team can help you refine your nutrition goals during pregnancy. We build specific nutrition plans for helping moms-to-be improve their habits and food choices during pregnancy.
How to Get Started
Having PCOS does not mean you can’t get pregnant. PCOS is one of the most common causes of infertility in women - but guess what? It’s treatable! In general, living a healthier lifestyle with a balanced diet, regular movement, less stress and medications (if necessary) will improve your fertility. Working closely with your doctor and dietitian is important to make sure you have the knowledge to manage symptoms and increase your odds of pregnancy.