Getting Pregnant with PCOS
The most common cause of female infertility is due to a failure to ovulate, and PCOS makes up 80% of these cases.
In this article, you will learn:
The problem with irregular or missing periods when you want to have a baby
How conventional methods for the management of PCOS can make your symptoms worse
How to restore a regular menstrual cycle without birth control pills
Strategies to balance your hormones and optimize your fertility so that you can get pregnant naturally even if you have PCOS
Why is conception difficult with PCOS?
One of the criteria that can make a PCOS diagnosis is irregular cycles, defined as those >35 days or having <9 periods per year.
Over half of women with PCOS have irregular menstrual cycles as a result of absent or delayed ovulation. High insulin and high testosterone levels are two of the most common reasons why ovulation is disrupted.
Infrequent ovulation decreases the number of opportunities for conceiving in a given year because without ovulation there is no egg released to be fertilized.
Irregular cycles can also make it difficult to know when ovulation will occur so you are more likely to miss your fertile window if you’re not tracking your cycle each day by monitoring your signs of fertility.
Decreased egg quality can also be an issue for women with PCOS. Lower quality eggs can affect follicle and embryo development and increase the risk for miscarriage. Inflammation, lower antioxidant status, obesity, and sleep disturbances are some factors that affect egg quality.
The good news? You can start ovulating on your own and get a regular period when you address the root causes of your PCOS and balance your hormones. There are so many nutrition & lifestyle factors that help to restore ovulation and improve the quality of your eggs.
The problem with hormonal birth control
When a woman is first diagnosed with PCOS by her doctor, she is often instructed to take birth control pills (or another form of hormonal birth control) to regulate her cycle and then told to come back when she is ready for a baby, where the main treatment would be medication to induce ovulation or IVF if those medications are not effective. These procedures can be very costly (especially if you don’t have insurance that covers fertility-related issues) and the success rates are not that great.
Hormonal birth control contains synthetic hormones that cause your body’s own natural hormone production to shut down. While this can be very effective at preventing pregnancy because it stops ovulation from occurring, the pill is not really regulating your cycle because the “period” you have while on the pill is simply just a bleed from the withdrawal of the synthetic hormones in the pill for that particular week. A true period comes about 14 days after ovulation.
Due to it’s ability to lower testosterone, hormonal birth control can be effective at decreasing some PCOS symptoms like acne, hirsutism, and male-pattern baldness. That being said, it’s really acting as a band-aid that is masking symptoms and isn’t getting to the root of why those symptoms, including irregular ovulation, are occurring in the first place.
There can be other issues with taking the pill for PCOS, as well. The pill has been shown to worsen insulin resistance, a problem that at least 80% of women with PCOS are already dealing with. Insulin resistance also leads to chronic low-grade inflammation.
Many women with PCOS already have inflammation and this is often a big cause of their symptoms. Birth control pills can alter the gut microbiome, causing an imbalance in the bacteria or yeast, leading to intestinal permeability and more inflammation.
Finally, the pill can cause deficiencies in many nutrients that are vital for thyroid function, a healthy menstrual cycle and pregnancy like vitamins C, E, B6, B12, folate, zinc, magnesium and selenium.
One thing I have observed in working with clients and hearing from many women with PCOS is that they were not aware that it was even possible for them to start ovulating regularly on their own and achieve a regular menstrual cycle without birth control. Many of these women just assumed that having PCOS meant their body was broken in some way and there wasn’t much that was in their control.
I want to assure you that this is most definitely not the case!
How to restore ovulation and get a regular period without birth control
There are numerous nutrition and lifestyle interventions that can help you get a regular period and improve your egg quality. Just imagine if you were ovulating regularly and had a period coming every 30 days or so, versus every 60 days or longer. Your chances of conceiving naturally would skyrocket!
This is possible for you. Here are some tips to get the needle — I mean your ovaries, moving in the right direction.
Improve insulin resistance and balance blood sugars
Most women with PCOS are insulin-resistant, and improving this condition is the most foundational thing you can do to restore a normal cycle. When there is too much insulin being produced by the pancreas, your ovaries will produce more testosterone, which halts ovulation.
Ensuring you are eating enough protein, fiber, and healthy fats alongside any carbohydrate food at meals and snacks will keep blood sugars more stable and lead to less insulin being pumped out. A good rule of thumb is to make 1/2 your plate non-starchy veggies, 1/4 protein, and the final 1/4 a carbohydrate source.
Good fiber sources include fruits and veggies, lentils, beans, whole grains, nuts and seeds. Aim for 35 grams of fiber each day.
Your individual carb tolerance depends on a variety of factors and may take some trial and error to figure out. A Registered Dietitian can help with this!
Regular exercise, especially strength training and walking are also great ways to make your cells more sensitive to insulin.
Eat enough calories and healthy fats
When diagnosed with PCOS, women are often told they need to lose weight. “Eat less and exercise more” is the common suggestion repeated by doctors and as a result many cysters implement very low-calorie, restrictive diets, often cutting out entire foods groups in an effort to lose weight. This often causes more harm than good. In most cases of PCOS, insulin resistance needs to be addressed before one will start to see weight loss.
Many of my clients come to me eating a very low number of calories each day, yet they are still not losing weight. Restrictive diets are very stressful on the body and can make PCOS symptoms worse. They can also slow your metabolism down and cause digestive issues.
Eating adequate calories sends a message to the brain that it is safe to ovulate and eating a wide variety of foods ensures good nutrient intake.
Healthy fats like those found in olive oil, fatty fish, avocados, nuts and seeds are needed for the absorption of fat-soluble vitamins and are used as building blocks for healthy hormones.
Focus on eating an anti-inflammatory, real food diet that includes plenty of anti-oxidant rich foods
Sugar, industrial seed oils, and highly processed foods can contribute to inflammation in the body and should be limited. A whole foods diet is nutrient-dense and contains the vitamins and minerals needed for healthy hormones.
Focus on anti-inflammatory foods such as fatty fish, fruits & vegetables, herbs and spices, and green tea. Fruits and veggies in particular are very high in anti-oxidants, which are needed to fight inflammation and promote good egg quality. Wild salmon, chia seeds, ground flax seeds, and walnuts are good sources of anti-inflammatory omega 3 fats.
Manage stress and optimize your sleep
We all have stressors in our life to varying degrees, but it’s our response to stress that matters most. High levels of stress can delay ovulation, contribute to more insulin resistance and inflammation, and lead to poor sleep. Meditation, deep breathing, and enjoyable exercise can all be great tools for stress management.
Sleep is crucial as it’s a time of healing and restoration. Aim for 7-9 hours of good quality sleep each night. You can optimize your sleep starting in the morning by exposing yourself to natural light upon waking.
Limiting caffeine after noon and avoiding blue light from electronics and screens 3 hours before bed time will help to lower the stress hormone cortisol and increase the sleep hormone melatonin (and melatonin is also a very important anti-oxidant that improves egg quality!). A dark, cool room is the ideal environment for quality sleep.
Smart supplementation
Incorporating a high quality prenatal will help you to replete nutrients that may have been depleted if you’ve taken hormonal birth control or have not eaten a very nutrient-dense diet over the past few months. It will also ensure that nutrient stores are optimized to support a growing baby. I suggest starting to take a prenatal vitamin 6-12 months before trying to conceive. I like this one (affiliate link) and this one because they are formulated with evidence-based doses and contain bio-available nutrients.
Magnesium can help improve insulin sensitivity, promote better sleep, calm the nervous system, and reduce inflammation. A dose of 200-400 mg a day is typically ok for most people. Magnesium glycinate is great for sleep and magnesium citrate can be helpful if you also have issues with constipation.
Vitamin D is often found to be low in women with PCOS. Deficiencies of this nutrient can lead to more insulin resistance, higher levels of androgens, and fertility issues. Ideally, you want to be getting this nutrient from the sunlight, but in many cases supplementation is warranted. Have your doctor check your vitamin D levels prior to supplementing.
Myo-Inositol is another supplement that has been found to be very effective for women with PCOS. Research indicates it can improve insulin sensitivity, help restore ovulation,and improve egg quality.
NAC (N-acetyl-cysteine) is an amino acid and powerful anti-oxidant that has been shown to restore ovulation and improve pregnancy rates. NAC can also reduce oxidative stress and inflammation, improve insulin sensitivity and aid in the detoxification of environmental toxins.
Always talk with your healthcare provider before starting supplements.
Conventional and functional lab testing to identify your PCOS root causes
Lab work can help identify your PCOS root causes and begin very targeted interventions. You may have high androgens, but do you know which ones are elevated? What is your degree of insulin resistance? How are your adrenal hormones impacting your PCOS?
In my nutrition practice I use both conventional blood work and functional lab testing such as stool tests, comprehensive hormone panels, and nutrient testing to help clients find their PCOS root causes. This data helps me to develop a personalized nutrition, lifestyle, and supplement protocol that is tailored to your individual needs.
Identifying Ovulation with Cycle Tracking
Tracking your menstrual cycle is the best way to identify your fertile window and confirm ovulation. It’s also a great way to improve body literacy and become familiar with what is happening in your body for each stage of your cycle.
A brief review of the menstrual cycle
The menstrual cycle is divided into 2 main phases: Follicular and Luteal.
The Follicular phase begins on Day 1 of your menstrual cycle, which is considered the first day of full flow and continues up until ovulation. In a 28-day cycle, ovulation would occur around Day 14. However, if you are having very long cycles, as is the case with many women with PCOS, then ovulation might be happening much later in the cycle for you.
The Luteal Phase begins immediately after ovulation and will continue until your next period arrives. The luteal phase will never be longer than 16 days unless you are pregnant.
So, the length of your menstrual cycle = the number of days from Day 1 of your period to the day before your next period starts.
While the goal is to increase your frequency of ovulation, it’s still possible to become pregnant even if you are only having a few periods a year. When you monitor for signs of fertility, you can better time your window for intercourse.
There are 2 main ways to track your cycle, and it’s best to use them together:
Basal body temperature (BBT)
Cervical mucus (CM)
Tracking Basal Body Temperature
BBT is a measure of metabolism and will increase when progesterone is being produced, which only occurs after ovulation.
By taking your BBT every morning and plotting it on a graph, you will be able to identify if/when ovulation has occurred for that particular cycle and know when you can expect your period to show up.
Ovulation can be confirmed when you have 3 temperature readings in a row that are at least 0.5 degrees or higher than the temperature reading the day prior to the initial increase.
Take your temperature first thing in the morning before you get out of bed each day, after a minimum of 4 hours of consecutive sleep.
Take your temperature first thing in the morning before you get out of bed each day, after a minimum of 4 hours of consecutive sleep.
Take your temperature at the same time every morning, if possible.
For the most accurate reading, leave the thermometer in place for 5-10 minutes before turning it on so that it warms up and stabilizes
There are many different charting apps available for download, where you can enter your temperature reading and it will plot the reading on a graph. I happen to use the app Kindara. Other options are My Days or Ovia.
There are also more technologically advanced options for monitoring your BBT. These all work a little differently and may be worth looking into if you decide to use BBT monitoring for fertility. I use the TempDrop and really like it!
Please note: Even if your sleep has been disrupted, it will still be useful to chart your temperatures because it will allow you to see how disruptions impact your temperature readings. Other things that might affect your temperature readings include:
illness
stress
alcohol consumption the night before
taking your temp after you've gotten out of bed
drinking liquids before taking your temp
travel/time zone changes
shift work or frequent night wakings
Cervical Mucus
As you approach ovulation, estrogen levels rise and with that you will notice an increase in cervical mucus. Around the time of ovulation, cervical mucus becomes an egg white consistency and this is the best predictor of ovulation.
In any cycle you are only fertile for about 5 days prior to ovulation and then about 12-24 hours after ovulation, so it’s important to time intercourse within this window if you want to conceive. Sperm can make a home in cervical mucus and survive for around 5 days, which is why you can be fertile for 5 days prior to ovulation.
Sometimes women with PCOS will notice an increase in cervical mucus, and then it goes away and comes back later in the cycle. This is because your body was gearing up to ovulate, but it wasn’t able to and is now trying again. If you notice that you had increasing amounts of CM but you didn’t get an increase in BBT, you did not ovulate yet. Keep an eye out for your CM to return so you can take advantage of that window!
In summary, cervical mucus is a predictor of ovulation and BBT helps to confirm it.
To learn more, I highly recommend the book Taking Charge of Your Fertility. It goes into great detail on how to track your cycle and use Fertility Awareness to avoid or achieve pregnancy.
Yes, you can get pregnant with PCOS.
It is important to talk to your doctor first if you decide you would like to come off birth control and work on getting a regular cycle using nutrition & lifestyle strategies.
When you you take a personalized approach to managing your PCOS, you can balance your hormones and get pregnant! Despite what you may have been told about your PCOS, your body is not broken and is capable of healing and ovulating on it’s own.
Be sure to leave a comment below and let me know what was most helpful for you in this article.
Are you wanting more support with balancing your hormones, getting a regular period, and optimizing your fertility? Let’s hop on a free introductory call together to discuss your case and how I can help you reach your health goals. Click HERE to apply for your free call.
Kate Netz, RDN, LD
Functional Dietitian
All information in this post is for educational purposes only and does not replace medical advice or diagnosis.
