PCOS & Fertility

For most of us, PCOS is a lifelong chronic condition and symptoms can persist even after menopause. But even if we have PCOS for the duration of our lives, it’s important to understand that this condition does not necessarily impact us in the same ways throughout the years.

Just as life is not static, PCOS symptoms and triggers can morph over time. More importantly, our goals transform every time, and this has a large impact on how you may go about managing your symptoms.

You are reading this because you have indicated that you are thinking about starting a family or have been trying to conceive. We’ll be focusing on this since it’s your main goal, but we will also touch on other elements of balancing PCOS with your life such as interpersonal relationships and career.

In this article we’ll be focusing on questions like:

• Why does PCOS make it difficult for some women to conceive?
• What are different strategies for getting pregnant if I’m struggling with infertility?
• Once pregnant, what risks should I be aware of in having PCOS?
• How can I be most productive at work while having PCOS?
• How can I balance the lifestyle modification that comes along with managing a chronic condition with maintaining a social life?
• What are tips for opening up to friends and family about having PCOS?

PCOS and fertility

PCOS is known as being the leading cause of infertility in women (1). But fortunately, it’s also one of the most treatable. To start, we’ll be diving into why PCOS can lead to fertility trouble.

The primary reason that makes it difficult for people with PCOS to conceive is absent or irregular ovulation. This is one of the three Rotterdam diagnostic criteria to diagnose PCOS, and it is very common: studies show that on average, people with PCOS are not ovulating every month and on average they have fewer than 9 periods per year (2).

Since ovulation is needed for a sperm to fertilize an egg and people with PCOS are less likely to ovulate than the average female, this means PCOS puts you at a lower likelihood each month of conceiving. But, it is not just about ovulation itself occurring: what your hormones do post-ovulation, is also vital to maintain a healthy pregnancy.

Another side effect of PCOS can also make successful conception more difficult: a ”luteal phase defect” (3). This is when your luteal phase (i.e., the two weeks in between ovulation and your period) is shorter than normal because your body does not secrete enough progesterone. Progesterone is needed for proper uterine lining development, and inadequate levels can result in implantation issues and early miscarriage.

You can track your progesterone levels before conceiving and during your pregnancy. If testing suggests you have a luteal phase defect, a provider may prescribe a progesterone cream, or other supplementation. There are also certain foods you can eat to help boost progesterone levels.

Infertility treatment options

As mentioned, PCOS is one of the more treatable causes of infertility and people with PCOS can get pregnant. Depending on your timeline and preferences, you can leverage conventional treatments, holistic strategies, or a mix of both.

Conventional treatments

• Clomid: Clomiphene citrate (e.g., Clomid, Serophene) is a pill, generally administered orally for 5 days, that can help induce ovulation. This is prescribed to many people experiencing infertility that is due to a lack of ovulation. Some people experience side effects from clomiphene citrate while other bodies don’t; likewise, this drug is enough to help some families get pregnant while many still do not see success with it.
• IUI (intrauterine insemination): An IUI is a common first step that a fertility doctor may use in conjunction with Clomid before progressing to IVF. An IUI works by a doctor directly inserting sperm cells around your uterus during ovulation.
• IVF (In-vitro fertilization): While fertilization occurs internally with an IUI, with IVF it occurs externally. This procedure requires egg retrieval and possibly freezing depending on your timeline. With IVF, your fertility doctor will implant eggs with sperm from your partner or donor. He or she will then conduct an embryo transfer, which is the process of transferring the embryo to your uterus. IVF is an intricate process that requires a specific cadence of medication pre and post transfer to make sure your body is primed to carry the embryo. The entire process takes roughly 3 weeks.
• Progesterone supplementation: As mentioned, people with PCOS are at risk of a luteal phase defect which can make it difficult for an implanted egg to survive or result in early miscarriage. Be sure to speak with your doctor about monitoring your progesterone levels. It is possible he or she will prescribe a progesterone cream or some other method of supplementation.

Lifestyle interventions

• Nutrition: Whole, plant-based foods are key. In general, make sure you are adding loads of colorful vegetables and healthy fats to your plate. For many of us, high-quality protein sources and whole grains are also needed to optimize our fertility. Many sources may advocate specific meal plans like keto, paleo, or veganism. While we are not here to make recommendations, we cannot emphasize enough the power of personalization.
• Exercise: Any form of physical activity, all in moderation. Be sure to partake in a type of movement that works for you. For some of us that may mean yoga or light walking while others thrive on short HIIT sessions or running routines. You do you!
• Stress management: Stress management is key, especially if you are experiencing adrenal type PCOS, which is often spurred by high cortisol levels. Meditation and mindfulness practices can help here, as can making sure you are getting enough sleep, not overdoing it at the gym or at work, and maintaining healthy relationships with boundaries.
• Supplements: In general, it is recommended that you start a prenatal vitamin with the nutrients needed for proper fetal development such as folic acid. Some reports have noted certain foods or herbal supplements have medicinal-like properties that can help them manage their symptoms. If you are interested in this, working with a naturopathic doctor or other functional medicine practitioner can help point you in the right direction from an informed perspective.

PCOS pregnancy risks

PCOS oftentimes leaves women at a higher likelihood of having an at-risk pregnancy, although this depends on the severity: PCOS is a spectrum disorder, and minor cases are less risky than severe cases. That said, the following are important to be aware of for all women with PCOS:

• Luteal phase defect and miscarriages: Women with PCOS are at 3x higher risk of miscarriage (3). This is largely due to the aforementioned tendency to have a luteal phase defect, in addition to thyroid and prolactin disorders.
• As mentioned, be sure to ask your doctor if you need to be concerned about a luteal phase defect or thyroid or prolactin disorder. Particularly with low progesterone, supplementation can be quite effective.
• Insulin resistance and gestational diabetes: PCOS also leaves women at a higher risk for gestational diabetes, particularly for the majority of PCOSers who are insulin resistant. Gestational diabetes can cause a larger-than-normal fetus that requires a cesarean section delivery and also lead to low blood sugar and breathing trouble for newborn babies. That said, gestational diabetes is treatable and when controlled, it should not cause issues for mom nor baby.
• To minimize risk for gestational diabetes, you should keep track of your blood sugar before and during pregnancy, particularly if you already know that you have insulin-resistant PCOS. You can work with your doctor to determine what your target blood sugar levels.
• High blood pressure and preterm birth: Women with PCOS are at an increased risk of high blood pressure and subsequently more likely to develop a condition called preeclampsia. Preeclampsia is a sudden increase in blood pressure after the 20th week of pregnancy that can result in liver and kidney damage, and the most effective treatment is delivery. This often means a preterm birth and cesarean section.
• High blood pressure before pregnancy and gestational hypertension both can increase risk for preeclampsia. Eating a healthy diet that’s low in sodium, drinking at least 8 glasses of water per day, maintaining light activity, and practicing stress management techniques are all ways to keep blood pressure in control. In some cases, your provider may choose to put you on medication until you are far enough along to deliver safely.  

PCOS and productivity

Starting a family is a priority for you, but it’s not your entire life. If your career is important to you too, chances are you’re no stranger to seeking ways to optimize your productivity.

But what if our PCOS is having an impact on this? There are several common symptoms of PCOS that may take a toll on your productivity levels, for example:

• Brain fog
• Fatigue
• Anxiety and depression
• Insomnia

If you can’t think clearly or are too anxious or tired to find the motivation to actively participate in and excel at your job, it’s natural to feel frustrated.

Have you ever felt like any of the above symptoms were impeding your performance at work? If so, know you’re not alone: it can be helpful to even just recognize that your PCOS may be catalyzing these psychological issues. This awareness can be a helpful tool in and of itself.  

While reducing PCOS symptoms requires patience, in time you can manage the psychological symptoms that may be taking a hit on how you’re showing up to your job. If productivity is an issue for you, make sure to discuss this with your Pollie care team. There are a variety of lifestyle modifications your coach can help you with to tackle symptoms that are impeding your productivity. While Pollie does not currently prescribe pharmaceuticals, your care team can also help point you in the right direction if you are experiencing severe psychological symptoms that you think would benefit from medication.

Also, keep in mind that while you are trying to conceive, keeping stress low should be top-of-mind. This means that you may find relief in accepting that for this period of time, keeping yourself centered in order to start a family trumps doing everything you can to add to your plate at work.

It also may be worthwhile looking into career coaches or free online material to help manage difficulty concentrating or lack of motivation at work. This is also something your Pollie care team can help you find.

Managing your PCOS with interpersonal relationships

Relationships with both friends and romantic partners are a key part of life. Unfortunately, having PCOS can complicate both of these types of interpersonal relationships.

You may start to feel conflicted between giving your all to managing your PCOS and wanting to fully participate in your social life. For example:

• You know getting 8 hours of sleep per night is important for everyone, but especially people with PCOS. Regulating our circadian rhythm can help with re-balancing hormones, and wonky sleep schedules lend themselves to more hormonal disruption. But your group of friends likes to host dinner parties that go into the early hours of the morning, and you feel like you miss out on half the fun when you stick to your 10pm bedtime.
• Dairy aggravates your PCOS acne, and you recently learned that you are insulin-resistant and should stay away from starchy carbohydrates. This makes you a high maintenance participant at group dinners, and you find yourself saying “no” to social activities that don’t align with your dietary habits.

While in a perfect world, our friends and partners would magically change their behaviors and interests to suit our lifestyle needs, this is not realistic. Taking control of your PCOS in a sustainable way means finding treatment strategies that truly work for you now.

That said, it is also important to remember that your fertility journey is a temporary season of life with an unbelievable reward: starting your family. If you have chosen to go down this path, chances are that compromising on other areas of your life are well worth it to you. If you do choose to actively put your PCOS and fertility as your top priority, we recommend that you remind yourself that this too will pass, and in time you can adopt a more balanced lifestyle.

There is no denying it: it is difficult to manage trying to conceive with PCOS and simultaneously balance platonic and romantic relationships. But, it is possible with patience and experimentation.

Opening up to friends and family about PCOS

It is likely that you have heard of friends, family members, and colleagues who also have PCOS. With a condition that impacts 10% of the female population, this is an inevitability!

Opening up to people who you may know already have a diagnosis can be a great place to start if you are not yet ready to share with others. The same goes for trying to conceive: 1 in 8 couples struggle with infertility. There is a high likelihood that someone you are already close to has gone through a very similar journey. Leaning on them can be helpful for such a difficult time of life.  

We also recommend you share your experience with your Pollie support group. Opening up to people that you already know are struggling with the same condition can be a great first step to finding community support. If you are looking for more focused support around the infertility piece specifically, let your care team know. There are countless fertility communities that thousands of people have found strength and comfort in.

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