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PCOS and Fertility

Polycystic Ovarian Syndrome (PCOS) is the most common reason for irregular periods in women of child-bearing age.  These irregular periods can make conceiving a challenge, due to unpredictable (and sometimes, lack of) ovulation. The good news is that most PCOS can be treated successfully and women can restore regular periods with evidence-based lifestyle changes.

If you are looking to increase your chances of getting pregnant with PCOS, keep reading below as I share the steps backed by science and my experience in helping women with PCOS re-gain their regular periods.

PCOS Overview

PCOS is an inflammatory condition. In order to effectively treat PCOS, we need to take a personalized approach to reducing system-wide inflammation. In addition, the majority (around 70%) of women with PCOS have insulin resistance as an underlying cause.  The 30% without insulin resistance usually have PCOS driven by non-insulin related inflammation, stress/adrenals, or sometimes are misdiagnosed and actually have hypothalamic amenorrhea. 

Reducing inflammation, improving insulin resistance, optimizing nutrient intake, managing stress, and working to become more in touch with your body are integral pieces to re-gaining a regular menstrual cycle and increasing chances of natural conception.

A note about periods

Regulating your period is key to increasing your chances of getting pregnant with PCOS.  If your period is irregular, it is really challenging to pin-point ovulation.  Ovulation happens on only one day per month. Once egg is released, there is only a 12-24-hour window for fertilization before it disintegrates.  Because sperm can live for around 5 days in cervical mucous, a woman’s fertile window is considered to be around 5 days per month.

Most women will notice an increase in egg white cervical mucous (EWCM) around ovulation, due to a rise in estrogen.  Women with PCOS may actually have several patches of EWCM per month because their body keeps trying to gear up to ovulate but estrogen levels don’t rise high enough to stimulate a surge of Luteinizing hormone (LH) to trigger the release of the egg.

It should also be noted that most women with PCOS have higher levels of Luteinizing Hormone than other women, which makes the use of ovulation kits challenging.  Ovulation kits measure the rise of LH that usually occurs 24-36 hours before ovulation, but since women with PCOS have higher levels of LH in general, false positives are more likely.

The explanation above is simplistic, but here are a few actionable things you can do to start keeping track of your period (if you are getting one, keep reading below if you aren’t getting one at all):

1) Start tracking your period in some capacity, whether it be a period-tracking app like Flo or simply making note of it in your phone calendar.  By doing this you can start tracking how long your usual cycles are.

2) If your cycle is somewhat predictable, even if longer than 35 days, consider investing in a basal body thermometer and start tracking on a website like Fertility Friend.  A temperature spike takes place the day AFTER ovulation and your temperature will stay higher until your next period arrives (12-16 days later).  You can also start tracking your cervical mucous on the chart and see how things line up. 

3) Take notes on how heavy your period, any cramping, and how long the flow lasted. 

Now, let’s get into 5 things you can work on to restore a more regular menstrual period and increase your chances of getting pregnant with PCOS naturally.   

#1 Blood sugar balance

Blood sugar balance means more than avoiding carbs. It means balancing every meal and snack to include protein, healthy fats, and fiber. Carbs do not have to be completely avoided, but complex carbs from vegetables are preferred. Try not to include simple carbs like processed foods with added sugars in your diet.  It can be helpful to think of the 3 main macronutrients as being protein, fat, and fiber (instead of carbohydrate) because this highlights the importance of including complex carbs vs. simple sugars.

The second key with carbs is to avoid eating naked carbs, meaning eating carbs without adding in fat to slow the insulin response that leads to blood sugar imbalances. Healthy fats, like olive oil, coconut oil, avocado, ghee, nut butter, and nuts not only help balance blood sugar, they are important for hormone production as well.

There is no need to be extreme here and attempt the ketogenic diet or other very-low carbohydrate diets.  While some women will lose weight rapidly and improve insulin sensitivity on the ketogenic diet, I tend not to recommend it for women with PCOS who are trying to conceive for a variety of reasons, including:

1) It can be difficult to maintain long-term and there is very little research on if the ketogenic diet is safe during early pregnancy.

2) Temporary changes lead to temporary results.

3) There is a higher prevalence of eating disorders in women with PCOS and the highly restrictive ketogenic diet can be triggering for some (3).

Most women with PCOS do well when keeping carbohydrates at 100-150 grams per day or less (which is about 25-38% of total calories from carbohydrate when looking at a 1600 calorie diet).  but this is highly variable depending on a woman’s current height, weight, physical activity levels, and personal goals.  A shorter, inactive woman with severe insulin resistance is going to need less carbohydrates than a woman who is taller and doing cardio and strength-training 5 times per week. I would personalize this recommendation.

#2 Eat Nutrient Dense Foods

Eat a variety of nutrient-dense foods daily and don’t eat the same foods every single week.  Eat the colors of the rainbow and a combination of high quality animal proteins (like salmon and pastured eggs) and plant-based proteins like lentils, beans, and hemp seeds.  Leafy greens, cruciferous vegetables (broccoli, cauliflower, cabbage, and Brussels sprouts), and berries (which are lower in glycemic index than other fruits) should also make regular appearances on your menu.

#3 Gut Health

The root cause of PCOS often starts with inflammation, and inflammation often starts in the gut (where most of our immune system resides).

A healthy gut means removing food sensitivities, imbalance of bad bacteria (that influence our hormones as well!), and replacing fiber and nutrients for a healthy cell lining.

#4 Stress management

Stress and the stress hormone, cortisol, work directly on your brain, influencing whether your brain will secrete the necessary hormones (follicle stimulating hormone, FSH, and Luteinizing hormone, LH) to stimulate ovulation and thus, having your period after ovulation.

Real daily stress reduction, and better sleep will help reduce your cortisol and stop the interference of stress on your hormone balance.

To reduce stress, you might have to schedule a daily stress reduction technique into your day. Go ahead and set an alarm to remind yourself it’s time for you! Spend at least 15-20 minutes daily in self-care, whether it’s meditation, mindfulness, Yoga from home, a soak in Epson salts, or completely unplugging and sitting in a quiet room.  Also remember to take deep breaths throughout the day.

#5 Exercise (but not over doing it with HIIT)

Aerobic exercise is great to improve insulin sensitivity and strength training to build lean muscle mass can help give your blood sugar somewhere to go (other than being stored as fat or staying as blood as high blood sugar.)

High-intensity interval training (HIIT) has also been shown to improve insulin sensitivity (13), but if you are full go every day with high intense workouts, you’re not giving your body a chance to recover, and that leads to stress (see #5).

A good balance of aerobic, strength training, and restorative exercise like yoga will help improve insulin resistance and stress management.

In summary, if you want to increase your chances of getting pregnant with PCOS, focus on the following:

1) Identify and treat the root cause of your PCOS (insulin resistance, inflammation, adrenals/stress).

2) Start tracking your period in some capacity

3) Eat for blood sugar balance and add in nutrient-dense foods and appropriate supplements.

4) Manage stress & add appropriate exercise.

5) Optimize gut health.

To get started on your wellness journey to conception: CLICK HERE


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