6 Steps To Get Pregnant With PCOS
By Clare Goodwin
Last updated: September 3, 2020
Pregnancy and PCOS are two things often associated with one another. Indeed, one of the first things that came out of my GPs mouth after she told me that I had PCOS was that I would struggle to get pregnant. My mind immediately skipped forward 10 years to me sitting on the couch with my husband crying over negative pregnancy tests, while all our friends were happily popping them out left, right, and centre.
The problem is, that’s where the education stopped. For the next few years, I believed that I would have trouble conceiving and that there was nothing I could do about it. I thought that the cysts were responsible for the PCOS and that as long as they were then then I was at their mercy.
This is absolutely not the case. Firstly, cysts have (almost) nothing to do with PCOS, they are merely an innocent bystander to the metabolic storm that’s going on in our bodies. Secondly, PCOS is reversible: pregnancy and PCOS is possible! Although it’s not easy for some, it all starts with understanding your PCOS.
Getting pregnant is way more technical than health courses make you believe. This is by no means an exhaustive list, but here are six steps that could help with pregnancy and PCOS.
1. Find out whether you are ovulating
Ovulation is when your ovaries release an egg. If unreleased, then the egg stays in the ovary as a half baked egg (or follicle). A ‘cyst’ is an accumulation of many of these, hence the name poly(many)cystic ovaries.
You can have polycystic ovaries and still ovulate, the cysts just mean that there have been instances in the past where you haven’t ovulated.
You can only get pregnant if your ovaries are releasing an egg that can meet with the sperm. Therefore, the other part of the equation is that there needs to be sperm in there before you ovulate. If you are waiting until you ovulate to call your husband/partner/lover for a conjugal visit, then you may have missed the window. The strongest sperm can live for as long as four days inside you, making the days before ovulation vital. An egg dies within 24 hours after ovulation, so keep that in mind too.
A study in my home country, New Zealand, surveyed 80 women seeking fertility treatment. They had all been trying for a baby for more than 2 years. They found that 74% of women had inadequate fertility awareness to get pregnant. This tells me that we might think we know how the birds and the bees work, but in actual fact, we probably need much more education.
Educating yourself on how to detect the signs of ovulation is your first step. You can find this out by measuring your temperature and cervical fluid. Lisa at Fertility Friday has a great podcast about how to do this.
2. If you’re not ovulating, then you need to find out why
If you’ve done step one and know you are not ovulating, then the next step is to understand why. A common misconception is that all women with PCOS are made equal – this is absolutely not true. There are many different ‘types’ of PCOS, depending on the root cause. I find that inflammation and insulin resistance are the most common, but for others it can be due to stress hormones and too much exercise, poor gut health, or simply from being on the pill for many years.
You need to understand your PCOS root cause in order to reverse it. For example, a low carb diet might help someone with insulin resistance, but it will make things much worse for someone with post-pill PCOS.
When it comes to pregnancy and PCOS, your type and root cause of PCOS can change how you approach getting pregnant. Read my article about the causes of PCOS for more information.
3. Treat inflammation
We now know that one of the major causes of PCOS is long-term inflammation. Inflammation affects almost all cells in our bodies. A few specific examples associated with PCOS are:
- Inflammation of the adrenal glands and ovaries causes increased testosterone levels, disrupting the normal menstrual cycle and ovulation.
- Brain inflammation causes resistance to leptin, our satiety hormone.
- Inflammation prevents our bodies from burning fat as a fuel source.
- Muscle cell inflammation causes resistance to insulin.
One of the first steps in reducing inflammation is removing any inflammatory foods from your diet. This is relevant to both PCOS women with and without insulin resistance, and also those who have so called ‘lean PCOS.’ Unlike a calorie/carb diet approach, the inflammation model recognises that food has a much wider impact on the body. The five most common problem foods are:
- All grains (not just gluten).
- Sugar, especially high fructose corn syrup.
- Industrial seed oils (canola, soy, sunflower, vegetable).
- Processed soy.
- Dairy – this might not be problematic for all women, but you cannot be certain unless you’ve been tested and/or tried removing it from your diet.
I’m not purporting that people with a normal, healthy metabolism need to remove all of these. Some people are fine eating their porridge and milk. But if you have PCOS, then it’s more than likely that you have some underlying inflammation and would be better off without these foods (at least in the short term). For more information, see my post about the best PCOS diet.
4. Treat your insulin resistance
Not all women with PCOS have insulin resistance, so if you don’t then you can skip this step. If you’re unsure, then get down to your GP and get tested as soon as possible.
Studies have shown that improving insulin resistance helps to reduce testosterone levels and body weight, and improve ovulation. This is why many women are prescribed Metformin to help with fertility. Metformin is a drug that claims to improve insulin sensitivity, but is actually not very effective for many women.
One alternative to Metformin is a very low carbohydrate (ketogenic) diet. Ketogenic diets have been shown to be very successful in improving insulin resistance, dropping weight, and reducing testosterone levels. The last point is particularly important as testosterone levels must be reduced in order for ovulation to happen.
5. Fix your gut
Our gut is home to 100 trillion microorganisms. This community of microorganisms is called the microbiome and has its good citizens and it’s not so desirable ones. Problems arise when there are too many of the bad and not enough of the good.
Studies have shown that PCOS causes us to have too few good bacteria and too many bad bacteria. There are many reasons why this is not good, but the most important are:
- Too much bad bacteria can cause insulin resistance and inflammation.
- It also increases the rate at which we absorb fatty acids and carbohydrates.
- Too much bad bacteria increases the storage of calories as fat.
As I mentioned above, insulin resistance and inflammation are intimately linked to testosterone levels and ovulation. This is why it’s so important that you address your gut health. I suggest introducing fermented foods into your diet and/or taking a good probiotic. For more information about gut health, read my post about whether bacteria is the secret to weight loss.
6. Stop killing yourself at the gym
Controversial, I know! But in actual fact, most women are doing too much high intensity exercise (especially cardio) and not enough low intensity activity. If you’re heading off to an early morning spin class, run, or aerobics class, only to sit at your desk all day, then you’re doing it all wrong.
This type of high intensity cardio actually increases stress hormones. Stress hormones are produced by our adrenal glands, which are also responsible for 20-30% of our bodies production of androgenic hormones. Androgens include testosterone and are responsible for most of our PCOS symptoms, such as acne, hair growth, and ovulation problems.
If you’d like more information about the sort of exercising you should be doing, then read my article about the best exercise for PCOS.
Still No Luck?
If you’ve completed all of these steps and continue to have trouble getting pregnant then you might need some additional supplementation. They could also be a hidden cause for why you are not ovulating or not able to reverse your PCOS. This could be anything, from an undiagnosed thyroid condition or a gut infection, to environmental toxins. I often find that my clients just need some fine tuning in all of these areas. If you would like some personal help then please don’t hesitate to reach out.