Polycystic ovary syndrome (PCOS) affects 1 in 10 women globally, making it the most common endocrine disorder in women of reproductive age.
Whilst a PCOS diagnosis doesn’t mean you can’t conceive naturally; it can make it harder and take longer. However, there is LOTS you can do in terms of diet and lifestyle to manage symptoms and to get pregnant with PCOS. Keep reading for more!
But first, what exactly is PCOS?
Polycystic ovary syndrome (PCOS) is a common endocrine disorder that’s characterised by a wide range of symptoms, including irregular menstrual cycles, elevated levels of male hormones (or androgens), insulin resistance, and multiple follicular cysts on the ovaries. PCOS increases the risk of infertility, obesity, type 2 diabetes, and cardiovascular diseases.
Diagnosis is based on the presence of at least two out of the following three criteria:
(1) irregular menstrual cycles or anovulation
(2) high levels of androgen hormones or clinical signs of hyperandrogenism (such as hirsutism)
(3) polycystic ovaries detected on ultrasound scan
However, the diagnosis may vary depending on the physician's clinical judgment and interpretation of the diagnostic criteria, which is where it can feel like a confusing diagnosis for some!
Several genetic and environmental factors are known to contribute to the development of PCOS, making it a complex disorder to understand and manage. Research has identified various mutated genes (known as genetic polymorphisms) and epigenetic modifications (when lifestyle factors affect genes) that may predispose women to PCOS. Environmental factors such as obesity, insulin resistance, and exposure to endocrine-disrupting chemicals have also been linked to an increased risk of PCOS.
How Does PCOS Affect Fertility?
PCOS affects fertility in several ways.
Firstly, the high levels of androgens in women with PCOS can cause irregular ovulation, or the absence of ovulation altogether. This means that eggs may not be released from the ovaries, making it difficult to conceive. Studies have shown that almost half of women (46% to be precise!) with PCOS experience anovulation (not ovulating).
Secondly, high levels of insulin in women with PCOS can lead to insulin resistance, which affects the body's ability to regulate blood sugar levels. In fact, studies show that a whopping 80% of women with PCOS had insulin resistance compared to only 17% of women without the condition. Insulin resistance is associated with an increased risk of infertility, and studies have shown that women with PCOS are more likely to have insulin resistance. Insulin resistance can also affect the production of sex hormones, including oestrogen and progesterone, which are essential for a healthy reproductive system.
In addition to the hormonal imbalances caused by PCOS, there are also structural and functional changes in the ovaries that can affect fertility. The small cysts that develop on the ovaries can interfere with ovulation and the release of eggs. Studies have shown that women with PCOS are more likely to have a reduced ovarian reserve, or a lower number of viable eggs in their ovaries.
All these factors contribute to the decreased fertility in women with PCOS. However, there is LOTS we can do to support fertility with PCOS, keep reading for how to get pregnant with PCOS…
Right, here's why you are really here: How To Get Pregnant With PCOS!
There are several things you can do to improve your fertility if you have PCOS.
Balance Blood Sugar Levels
Due to the increased risk of insulin resistance in women with PCOS, balancing blood sugar levels is key! There are several ways to do this but a simple one would be to follow the low glycaemic index (GI) diet principles. You don't have to cut out all carbs at all, making some simple swaps like choosing wholegrains instead of white grains would be a good place to start. For example, swapping out any white rice or white bread for brown rice or wholegrain varieties. Consuming low GI fruit also helps. For example, berries, citrus fruits and kiwi's are all low GI options. This will help to improve insulin sensitivity and support ovulation, and therefore improve fertility. I also like to use blood glucose monitors to track my client’s levels, so we can have a more personalised approach as insulin resistance can behave differently person to person. Ensuring your plate is balanced with the right amount of veg, carbs, protein to healthy fats and the order in which you eat foods can also help - vegetables first, then your proteins and wholegrains.
The Mediterranean Diet
Several studies have highlighted the role of a healthy diet in improving fertility in women with PCOS. Numerous studies have shown that a Mediterranean-style diet high in monounsaturated fatty acids (MUFAs) improved insulin sensitivity and lipid profiles among overweight women with PCOS. Women following the Mediterranean diet also have better ovulation rates and improved fertility. Essentially, it’s a whole food diet, containing lots of colour, fibre, healthy fats from olive oil, oily fish and nuts and seeds as well as a little meat and poultry. Take a look at my FREE recipe bundle to help support you to consume in line with the Med diet principles.
Maintain a Healthy BMI
Although PCOS doesn’t always correlate to a high BMI (there is a more lean type of PCOS), maintaining a healthy BMI can help to improve symptoms of PCOS in a few ways. Firstly, losing weight can help to reduce insulin resistance, which is a common problem in women with PCOS and can lead to several health problems, including obesity, heart disease, and diabetes. Secondly, losing weight can help to reduce inflammation. Inflammation is a natural immune response that helps to protect the body from infection. However, chronic inflammation can damage cells and tissues. Thirdly, losing weight can help to improve fertility. In women with PCOS, excess weight can interfere with ovulation, the release of an egg from the ovary. This can make it difficult to get pregnant. Studies have found that women with PCOS who lost weight had improved menstrual cycles, lower testosterone levels, and a higher chance of ovulation. Weight loss also improved insulin sensitivity and women had a lower risk of developing type 2 diabetes.
Exercise Regularly
Exercise can help women with PCOS improve fertility in a number of ways. Firstly, exercise can help to improve insulin sensitivity by increasing the number of insulin receptors on cells. This allows cells to take in more glucose from the blood, which helps to lower blood sugar levels. Secondly, exercise can help to reduce inflammation by increasing the production of anti-inflammatory proteins. This helps to protect cells and tissues from damage. Exercise can also help to improve ovulation. When women with PCOS lose weight, they are more likely to ovulate and have regular menstrual cycles. A number of studies have shown that exercise can help women with PCOS improve fertility. For example, one study found that women with PCOS who exercised regularly were more likely to get pregnant than women with PCOS who did not exercise regularly. Another study found that women with PCOS who exercised regularly had a higher chance of ovulation than women with PCOS who did not exercise regularly.
Here are some tips for exercising if you have PCOS:
- Start slowly and gradually increase the intensity and duration of your workouts - a 10 minute walk after each meal can work wonders for your blood sugar levels. Start small and build up to 45 minutes of training 3 times per week. On other days, aim for 30 minutes of walking per day.
- Choose activities that you enjoy and that are appropriate for your fitness level. Low intensity aerobic exercise is more effective at weight loss than high intensity work outs, such as walking, running, swimming, or cycling. Strength training is particularly good to help build lean muscle, such as lifting weights or using resistance bands. Yoga or Pilates use gentle body weight exercises that support lean muscle gain and have the added bonus of improving mood and mental health.
Exercise can be a great way to improve your overall health and well-being, and it can also help you improve your fertility if you have PCOS. If you are not sure how to get started with an exercise program, talk to a certified personal trainer. Listen to your body and stop exercising if you feel any pain. Be kind to yourself.
Stress and Sleep
Stress can have a negative impact on fertility in women with PCOS. Sleep is important for overall wellbeing, health, and fertility. Both stress and poor sleep can lead to changes in hormone levels, which can make it difficult to ovulate. Additionally, both can lead to weight gain, which is another risk factor for infertility in women with PCOS. There are several healthy ways to manage stress and sleep, keep reading for more tips:
- Exercise is a great way to reduce stress and improve overall health (see above).
- Relaxation techniques, such as yoga, meditation, and deep breathing, can help to reduce stress and improve sleep too. Walking in nature has been shown in studies to redcue feelings of stress and anxiety.
- Spending time with loved ones can help to reduce stress and improve mood. Laughing releases endorphins, our feel good hormones, which can therefore help to reduce stress.
- Aim for 7-8 hours of sleep each night. Achieve this by truly winding down in the evening. We are all guilty of scrolling past 9pm, so turn all devices off or pop them on flight mode so that you aren’t tempted to scroll. The blue light emitted can reduce melatonin production (the sleepy hormone), which can impact sleep quality.
Studies used/references:
Escobar-Morreale, H. F., et al. (2000). The complex interaction between sex hormone-binding globulin and insulin resistance in women with polycystic ovary syndrome. Clinical endocrinology, 53(2), pp. 185-191.
Moran LJ, et al. (2009). Effects of Exercise on Pregnancy Rates in Women with Polycystic Ovary Syndrome, Fertility and Sterility.
Moran LJ, et al. (2011). Effects of Lifestyle Modification on Reproductive Outcomes in Women With Polycystic Ovary Syndrome, Fertility and Sterility.
Setiawan, V.W. et al. (2020). Polycystic ovary syndrome in African American women: a population-based study. J Clin Endocrinol Metab, 105(2), pp. 471- 479.
Taher, J. et al. (2021). Ethnic variation in polycystic ovary syndrome: an intersectional approach. J Investig Med, 69(3), pp. 619-624.
Teede, H. J., et al. (2010). Endocrine and metabolic consequences of polycystic ovary syndrome: a concise review. Hormone research in paediatrics, 73(4), pp. 249-256.
Teede, H.J. et al. (2018). Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Hum Reprod. 33(9), pp. 1602-1618.
Wildman RP, et al. (2011). Effects of Exercise on Ovulation in Women with Polycystic Ovary Syndrome, The Journal of Clinical Endocrinology and Metabolism.
Wildman, R.P. et al. (2012). Effects of Weight Loss on Insulin Sensitivity and Risk of Type 2 Diabetes in Women With Polycystic Ovary Syndrome. The Journal of Clinical Endocrinology and Metabolism.
Yu, Y,.et al. (2021). The association between environmental endocrine disrupting chemicals exposure and polycystic ovary syndrome: a systematic review and meta-analysis. Environ Health, 20(1), pp. 15.