Managing PCOS When Trying to Conceive
Trying to conceive when you have been diagnosed with PCOS can be an emotional rollercoaster (trust me, I’ve been there!). Maybe your doctor has told you it’s unlikely to happen naturally, or that it will take you longer to get pregnant, what ever has been said, it’s usually not very confidence building or supportive in such an already potentially stressful time (especially if you’ve been trying for a while). What if I told you, that you can absolutely fall pregnant naturally with PCOS, and there is so much we can do to support you through this journey.
How Do I Know If I’m Ovulating?
The difficulty with PCOS and conception is figuring out when and if you are ovulating, as this can vary greatly month to month with irregular cycles, and some month’s there may not be a successful ovulation (don’t stress, this can be perfectly normal depending on what’s going on). Knowing the exact ovulation time each month can help to reduce stress and pressure around timing of intercourse, and also empower you by increasing knowledge around your cycle. If you have insulin resistance (commonly seen with PCOS) it’s also important to address and manage this ideally before trying to conceive as it can increase the risk of gestational diabetes and impact egg quality. Of course there are certainly things we can do to manage insulin resistance throughout a pregnancy as well.
How to Track Ovulation Without Algorithms
I know menstrual tracking apps are very popular and can be a great starting tool to understanding your cycle, but often they are not as accurate as they seem (e.g., not everyone ovulates on day 14! Especially if you have PCOS). To gain a more accurate understanding of your cycle and when ovulation occurs (and your ‘fertile window’), I’d highly suggest going old school and manually tracking it (feel free to email me for a free menstrual tracking chart). But if you are adamant about using an app, my choice would be Temp Drop (no affiliation).
Temperature and cervical mucus tracking through out the menstrual cycle helps us to more accurately determine when and if ovulation has occurred, and also if there is potentially any thyroid involvement interfering with fertility.
What we want to focus on, is getting a healthy ovulation occurring each month, and regulating specific hormones (e.g., progesterone, testosterone, leutinising hormone and follicle stimulating hormone) so that this can occur, while also supporting optimal egg quality. Lucky for us, there are some amazing herbal and nutritional medicines that help us do this (see below).
Optimising Diet for PCOS
Of course, diet and lifestyle are huge players in managing PCOS and overall wellbeing. But we will talk more about optimising nutrition for fertility in another post. For now, we’ll keep some basic nutritional foundations
Consume a diet of fresh fruit and vegetables, complex carbohydrates, fibre, good quality protein, and healthy fats.
Avoid or go low sugar. Fresh fruit is fine, aiming for <25g fructose per day
Avoid simple carbohydrates such as white bread, white pasta, white rice, biscuits, cakes, pizza, burgers, chips, and soft drinks
Avoid trans-fats, deep-fried foods, and oxidised fats (rancid oils, smoked oils)
Revisit your portion sizes
Consider the glycaemic index of foods
Managing Emotional Wellbeing
In terms of lifestyle, managing stress and making sure you are getting plenty of quality down time is so important to maintain a healthy cortisol response and hormonal balance. Whatever activities you enjoy doing that you find relaxing, make sure to prioritise these throughout your day/week. Allowing yourself extra down time and surrounding yourself with trusted and supportive friends/family can be so helpful throughout the ebbs and flows of TTC and pregnancy.
Every person that comes to me with PCOS presents slightly differently, and so will receive individualised treatment depending on the underlying driver of their PCOS and their goals (e.g., to conceive, to regulate their cycle, to balance blood sugar, to reduce signs of androgen excess), so this doesn’t mean you should be taking every one of these recommendations, but at least you’ll be aware of how many beautiful options there are aside from Metformin and the pill.
Nutritional Medicine
Myo-inositol: Comparable to Metformin in many studies. Helps to regulate the menstrual cycle, reduce total testosterone, increase sex hormone binding globulin, and reduce fasting glucose and insulin. Overall, a really good supplement for PCOS regardless of if you’re trying to conceive or not. Read more: https://doi.org/10.1186/s12958-023-01055-z.
N-Acetyl Cysteine: Acts as an antioxidant and supports ovulation. Studies have shown supplementation with NAC has found to significantly improve pregnancy and ovulation rates (PMID: 25653680)
Berberine: Can help lower fasting glucose, post-meal glucose, hemoglobin A1c, and even LDL and triglyceride levels making it an important consideration for those with insulin-resistant PCOS.
Vitamin D: Vitamin D has been shown to be correlated to insulin resistance. Maintenance levels of vitamin D can be achieved by 20minutes of sunshine on bare skin three times weekly. This is a worthy marker to test to ensure levels are optimal. The goal is >70nmol/L in Winter and >100nmol/L in Summer. Supplementation depends on what your levels are to start with. If sunshine is inadequate, a maintenance dose of 1000IU may be recommended.
Zinc: Can help to reduce hirsutism (excess hair growth) and acne by lowering androgens while also working to lower insulin levels.
Chromium: Chromium is required for the uptake of insulin into our cells and can help to reduce sugar cravings. Dietary sources include egg yolk, beef, and shellfish. Consult your practitioner for individual supplement dosage recommendations.
Magnesium: Magnesium is a key nutrient prescribed in insulin resistance, as deficiency impairs insulin secretion. Increase your consumption of leafy green vegetables, whole grains, and nuts. If supplementing, try for a magnesium bisglycinate (consult your practitioner for dosage).
CoQ10: Acts as an antioxidant and supports energy production in the oocyte.
Herbal Medicine
Peony & Licorice: This blend in the right ratio helps to inhibit ovarian testosterone synthesis and increase aromatase activity to support oestrogen levels, a really great blend for PCOS.
Tribulus: Helps to reduce LH and restore optimal LH:FSH ratio.
Saw palmetto: Anti-inflammatory and helps to reduce androgens.
Goat’s Rue: The active compound in Goat’s rue is called galegine, modern studies of galegine actually led to the creation of metformin (medication used to lower insulin levels).
Coleus: May assist with weight loss and reduce blood pressure in those with cardio metabolic symptoms arising from insulin resistance.
If you would like individualised support for hormonal, fertility, preconception, pregnancy or the post-natal period, you can book in a discovery call or initial session with me here
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