As soon as you google PCOS, alarm bells about fertility issues start ringing. However, it's important to understand that PCOS is not a definitive diagnosis of infertility. Whether pregnancy is on the horizon now (or for later), many of my patients come to me with a lot of questions about the topic. It's Canadian Infertility Awareness Week 2023, so it's the perfect time to cover PCOS infertility.
Anovulatory and/or irregular cycles mean that you're not ovulating, not ovulating regularly, and/or it's difficult to pinpoint when you're ovulating.
Insulin resistance in which the body's blood sugar regulation system is impacted can lead to inflammation, interfere with ovulation, increase testosterone, and impair proper placental development. You can read my blog post on insulin resistance here.
Elevated androgens like testosterone, DHEA, and androstenedione can lead to impaired ovulation, feed back into insulin resistance, and contribute to inflammation.
Vitamin D deficiency is very common in PCOS and can impact implantation, carrying to term, insulin resistance, and more.
Thyroid issues, especially Hashimoto's disease (autoimmune thyroid disorder), is common in PCOS. Thyroid dysfunction and autoimmunity both can interfere with ovulation, worsen cyclicity, affect metabolism, and contribute to inflammation.
There are other factors as well including a dysregulated stress response, mental health components of PCOS, fatty liver (more on that here), generalized inflammation, body composition, and more.
You might now be thinking that those are a lot of factors to consider. Aaaand, you're right. BUT, we can work on these!
There are many ways to support PCOS infertility. This can be done naturally, conventionally, and with a combo approach.
Some people with PCOS might need assisted reproductive technology like medication, IVF, or IUI, especially with advanced maternal age, structural reproductive tract issues, sperm-related issues, but people with PCOS can get pregnant without these.
Here are some natural PCOS treatment considerations for fertility purposes:
Food & Nutrition: Focus on balanced meals that have protein, fat, and carbs. Food restriction is common in PCOS and should be avoided — we need food to have healthy menstrual cycles. Lots of plant foods and a diverse complement of fruits and veggies are important for fibre, vitamins, minerals, and antioxidants. Part of this is also consuming omega-3s in your diet or in supplement form.
Supplements like inositol and NAC (n-acetyl cysteine): These help improve insulin resistance, decrease androgen levels, and increase ovulation rates and cycle regularity. NAC has an added bonus of being a potent antioxidant that is supportive of fertility in general (as well as decreasing risks of ovarian hyperstimulation syndrome (OHSS) with fertility meds and helping with the maintenance of pregnancy). Inositol has the added benefits of improving general fertility parameters as well as thyroid function in hypothyroidism.
Melatonin: Even though this is associated with sleep (rightfully so!), it is emerging as a potent adjunct in fertility care. Melatonin is a potent antioxidant that is proving to be useful in PCOS for improving symptoms, and it also helps with endometrial receptivity at conception time.
Exercise: There's a lot of PCOS exercise misinformation out in the world. The most important thing to remember is that some exercise and movement is better than none. A combination of strength/resistance and cardio helps improve general health and fertility as well as insulin resistance. Incorporating forms of exercise you enjoy is a great place to start.
Lifestyle: Work on stress management, get good sleep, build in rest and recovery, and address your mental health.
Vitamin D: The sunshine vitamin has roles in general fertility like implantation but also healthy pregnancy outcomes. Since deficiency is common in PCOS, testing and then addressing those levels is prudent.
As always, please consult with your healthcare team to ensure that any supplements or treatments are appropriate for you. If you're looking to add in a PCOS naturopath (anywhere in Ontario virtually, in person in Newmarket), I accept a few new patients every month.
