Is PCOS affecting your ability to conceive?

By Dr. Liz Dalglish, ND

Trying to get pregnant can be a huge stress on people who struggle with infertility. Roughly 16% of couples in Canada experience infertility, which has doubled since the 1980s.¹ For every 10 cases of infertility, 4 of them are due to women.¹ There are different root causes behind why a woman is infertile but one common cause relates to whether a woman’s cycle is regular.^1,2

Polycystic ovarian syndrome (PCOS) is a metabolic disorder that often presents as a women’s health and infertility concern. An estimated 1.3 million women between the ages of 15 to 44 are affected.^1,3 Most people find out if they have PCOS in their 20s and 30s when they try to get pregnant, are not able to conceive and investigate why with their medical doctor or physician.³ People of all races can be affected with PCOS and people who have female first-degree (e.g mother, sister, aunt) relatives are more likely to have PCOS.¹

People with PCOS often have hormonal imbalances, specifically altered insulin sensitivity and elevated androgens (e.g. testosterone and DHEAs).⁴ These hormonal imbalances can cause someone with PCOS can have a number of symptoms, including but not limited to: 

• hirsutism (excess hair growth on the face, chest, and other areas of the body)
• thinning hair on the scalp,
• acne on the face, chest and upper back,
• weight gain or difficulty losing weight,
• darkening of skin around the groin, neck, and 
• irregular menstrual cycles. ⁴

Cysts can be found on both ovaries if a person with PCOS undergoes a pelvic ultrasound.⁴

Due to the aforementioned hormonal issues, people with PCOS struggle to conceive because their cycles are often irregular and it is a challenge to determine when, or even if, they are ovulating. Cycle irregularity means that the length of time between day 1 of one period and day 1 of the next period is inconsistent. Ovulation is the point of your cycle when an egg is released from the ovary. Ovulation usually occurs at day 14 in a cycle that is 28 days in length. If your cycle length changes, determining when ovulation occurs is difficult, as it might not be right in the middle of your cycle length. Furthermore, hormonal imbalances can prevent you from ovulating as the chemical signal to release the egg is inconsistent or insufficient. If you don’t ovulate (i.e. the egg doesn’t release from the ovary), you won’t be able to get pregnant. Ultimately, timing when to have sex is difficult in people with PCOS if your cycles are irregular and if you aren’t sure you are ovulating properly.  

The good news is PCOS is a treatable condition and people with PCOS can become pregnant! Different treatments work for different people, so consulting your healthcare practitioner is always a good idea to determine what would work best for your particular case. 

There are several naturopathic treatments that can help people with PCOS trying to conceive. We will highlight three for you: inositol, berberine, weight management, and acupuncture. 

Inositol is a derivative of a B-vitamin and can be made naturally in the body from glucose. Supplementation of inositol in women with PCOS helps to reduce androgens and insulin.^5,6 There hasn’t been a study produced that specifically looks at women with PCOS taking inositol to reduce rates of miscarriage, but overall this supplement helps those with PCOS and could be recommended by your healthcare practitioner to regulate your menstrual cycle and promote ovulation.

Berberine is a phytochemical that can be found in different plants and works on the pathway similar to Metformin. Berberine helps to manage blood glucose and reduce insulin resistance, which is a key cause of PCOS. This phytochemical can be supplemented and has been shown to help women with PCOS conceive and also promotes live birth rates and reduce miscarriage similar to that of Metformin.^7,8

Weight management is an interesting topic in PCOS and fertility. A modest reduction of 5-10 lbs. seems to improve hormone levels enough to lower risk of miscarriage, regardless of your starting weight.⁷ According to the research, as long as the weight loss occurs, it doesn’t matter what your ratio of protein to fat to carbohydrate is, as long as you are consistently eating the same way for six months.⁷ Recommendations can be tricky as there is some thought that addressing the insulin resistance in people with PCOS can help with a lower carbohydrate diet. Discussing your options with your healthcare practitioner is best when making dietary changes for PCOS in order to maximize your benefits without stressing about what foods to eat. 

Acupuncture can assist with managing a person’s stress levels when trying to get pregnant. It has been shown to benefit those who are getting transfer acupuncture the day of an in vitro fertilization procedure.⁹ The treatment can be administered before or after the embryo transfer and could help to improve pelvic blood flow and endometrial wall thickening. There is a low level of evidence showing that if could improve ovulation rates in women with PCOS.¹⁰

Questions about PCOS and how it affects your fertility?

Talk to your healthcare practitioner or book an appointment with one of our NDs who would be happy to answer your questions about PCOS!

References

1. Government of Canada. Fertility. 2019. Retrieved from https://www.canada.ca/en/public-health/services/fertility/fertility.html 
2. US Department of Health and Human Services. 2019. Polycystic Ovarian Syndrome. Retrieved from https://www.womenshealth.gov/a-z-topics/polycystic-ovary-syndrome#17
3. Canadian Socio-economic Information Management System (CANSIM). Population by sex and age group: Statistics Canada, 2007.
4. Lujan ME, et al. Diagnostic Criteria for Polycystic Ovary Syndrome: Pitfalls and Controversies. J Obstet Gynaecol Can. 2008 Aug;30(8):671-679. doi: 10.1016/S1701-2163(16)32915-2.
5. Salehpour S, et al. A Potential Therapeutic Role of Myoinositol in the Metabolic and Cardiovascular Profile of PCOS Iranian Women Aged between 30 and 40 Years. Int J Endocrinol. 2016;2016:7493147. doi: 10.1155/2016/7493147. Epub 2016 Aug 25.
6. Moran LJ, et al. Dietary composition in restoring reproductive and metabolic physiology in overweight women with polycystic ovary syndrome. J. Clin. Endocrinol. Metab. 2003 Feb;88(2):812-9
7. Robertson J. Carrying to Term: A Practical Guide to Reducing your Miscarriage Risk. First Choice Books. Victoria BC. 2018.
8. An Y, et al. The use of berberine for women with polycystic ovary syndrome undergoing IVF treatment. Clin Endocrinol (Oxf). 2014 Mar;80(3):425-31. doi: 10.1111/cen.12294. Epub 2013 Aug 9
9. Hullender Rubin LE, et al. Acupuncture and in vitro fertilisation research: current and future directions. Acupunct Med. 2018 Apr;36(2):117-122. doi: 10.1136/acupmed-2016-011352. Epub 2018 Feb 10
10. Jo J, et al. Acupuncture for polycystic ovarian syndrome: A systematic review and meta-analysis. Medicine (Baltimore). 2017 Jun;96(23):e7066. doi: 10.1097/MD.0000000000007066.