The greatest worry for most women with Polycystic Ovarian Syndrom is whether they would be able to get pregnant naturally. I know so many women who have tried naturally to get pregnant but wanted to give up after years of disappointment. While IVF is considered safe in the hands of professionals, there are some possible health effects to be aware of, including ovarian hyperstimulation syndrome. This is an excessive response to taking the medicines (especially injectable gonadotropins) used to make eggs grow. It can lead to bloating, nausea, swelling of the abdomen, or severe blood clots, shortness of breath, abdominal pain, dehydration, and vomiting.
The good news is most women with PCOS don’t need IVF treatment to conceive a baby. Most women with Polycystic Ovarian Syndrome can get pregnant easily by making diet and lifestyle changes. But let’s start with
What is Polycystic Ovarian Syndrom (PCOS)?
PCOS is a hormonal condition that affects about one in 10 women in their childbearing years. Women with PCOS have higher levels of insulin and androgens (male-type hormones) than other women. This hormonal imbalance can cause a range of symptoms and affect fertility. PCOS can also be a risk factor for pre-diabetes, gestational diabetes, and type 2 diabetes.
What are the symptoms of PCOS?
PCOS can cause
- irregular or no periods
- taking longer to fall pregnant
- increased risk of some pregnancy complications
- weight gain
- problems losing weight
- increased risk of diabetes
- excess hair growth on the face, stomach and back
- hair loss from the head
How is PCOS diagnosed?
At least two of the following must be present for PCOS to be diagnosed (2):
- Multiple small follicles or cysts on the ovaries (seen on an ultrasound)
- Clinical evidence of elevated androgen levels (high levels of male-type hormones)
- Menstrual problems (lack of or irregular periods)
- 70% of women with PCOS are undiagnosed.
PCOS and insulin resistance
Up to 80% of women with PCOS have insulin resistance. This occurs when the body’s cells can’t respond properly to insulin. Insulin is an important hormone for regulating blood glucose levels. When insulin resistance occurs, the pancreas needs to make more and more insulin to manage blood glucose levels.
Insulin resistance is a risk factor for pre-diabetes, gestational diabetes (diabetes during pregnancy), and type 2 diabetes. Women with PCOS are up to seven times more likely to develop type 2 diabetes than women without PCOS.
How to find out if you are insulin resistant
Most popular in clinical settings is the fasting glucose-to-insulin ratio. Unfortunately, this only gives information about one moment in time and may fail to detect insulin-resistant subjects. A recent study suggested that oral glucose tolerance testing is more sensitive than the glucose-to-insulin ratio in the detection of impaired glucose tolerance in adolescents with PCOS. (1) Also, a woman with PCOS may test negative for insulin resistance when young and thin but develop it with time. If you have tested negative for insulin resistance you may want to double-check the method used.
What are your options to get pregnant naturally?
PCOS symptoms are treatable naturally which includes infertility. In women with PCOS, the hormonal imbalance interferes with ovulation. If you don’t ovulate, you can’t get pregnant.
How to check if you are ovulating
Understanding your menstrual cycle is going to be a crucial element to determine whether you are ovulating. The length of the menstrual cycle varies from woman to woman, but the average is to have periods every 28 days. Regular cycles that are longer or shorter than this, from 21 to 40 days, are normal. The “period” usually lasts between 3–7 days.
The menstrual cycle is controlled by hormones. In each cycle, rising levels of the hormone estrogen cause the ovary to develop and release an egg (ovulation). The womb lining also starts to thicken.
In the second half of the cycle, the hormone progesterone helps your uterus to prepare for the implantation of a developing embryo.
The egg travels down the fallopian tubes. If pregnancy doesn’t occur, the egg is reabsorbed into the body. Levels of estrogen and progesterone fall and the womb lining come away and leave the body as menstrual flow.
The time from the release of an egg to the start of a period is around 10 to 16 days. So if you assume your ovulation occurs on day 14 you might have missed the chance to get pregnant.
Once a woman starts her periods, 1 egg develops and is released during each menstrual cycle. After ovulation, the egg lives for 24 hours. Pregnancy happens if a man’s sperm meet and fertilise the egg. Sperm can survive in the fallopian tubes for up to 7 days after sex. A woman can’t get pregnant if ovulation doesn’t occur.
Calendar or rhythm method
If you have regular periods, you can work out, over several months, when you should avoid sex. Remember, you are fertile for the week before you ovulate and for a few days afterward. This method can be quite unreliable. It’s not suitable for women who have irregular periods and therefore not the best for most women with PCOS.
Your resting temperature rises slightly after you ovulate. This method involves taking your temperature with a basal thermometer before you get up every day. You need to take it in your vagina, rectum, or mouth (choose either or). This method isn’t very accurate because your temperature can be affected if you sleep in, drink alcohol, or are stressed. But while tracking the basal body temperature during multiple menstrual cycles cannot actually predict when you are going to ovulate, it can help to establish a pattern. You will then be able to understand when you are likely to ovulate.
If you chart your cycle, you may know that progesterone’s rise is indicated by the jump in your basal body temperature that follows ovulation. Progesterone is key to fertility and a lasting pregnancy. If the temperatures go back down, progesterone has dropped, which means either the period has arrived and that cycle has ended, or a miscarriage has occurred.
The Cervical Mucus method or Billings method
Cervical mucus is secreted by glands found in and around the cervix. It changes during the month. Right after your period, your vagina may feel quite dry, then around the time of ovulation, the mucus becomes clear and stretchy, like raw egg white. After you have ovulated, it becomes thicker and cloudier. You can use these changes to work out when you ovulate. Fertile cervical mucus is a clue that ovulation is coming. Your vaginal discharge is fertile when it resembles raw egg whites.
Please note this method isn’t suitable if you have abnormal bleeding from your vagina if you have inflammation in your cervix or vagina, or if you’re taking some medicines, including antibiotics, antihistamines, or thyroid medicines, which can change your cervical mucus. Getting sexually aroused or having semen in your vagina can make it harder to tell what your mucus is like.
The position and texture of your cervix changes during your menstrual cycle. Cervical position tracking can be used throughout the month to help you to predict your most fertile windows. Done right it can let you know when ovulation is about to occur, or even indicate whether you’re pregnant.
Checking the cervical position takes some practice. A good time to try it is after a bath or shower:
- Wash your hands well (and don’t forget to trim your nails)
- Sit on the toilet or squat or stand with one leg on the edge of the bathtub. Use the same position each time you check your cervix.
- Gently insert one or two fingers into the vagina. Feel for the cervix – located in the upper front or top.
With practice, you will start to notice the changes your cervix goes through during monthly cycles. Because every woman’s cycle is different, including the lengths of each different phase, it may take several cycles before you get to know your body. Some women are squeamish about checking during bleeding (including me) and wait until the menstrual flow stops. But if you don’t mind – go for it.
All three methods above by themselves are not very accurate but combined they can tell you very well when you ovulate. The symptothermal method uses observation of a combination of two or more signs of fertility including temperature, cervical mucus secretions, and changes in the cervix, to calculate fertile times of the cycle. You take your temperature in the morning and examine your cervical mucus at night to work out when it’s safe to have sex. You can also watch for various other symptoms that show you are ovulating. These include some pain like period pain, spotting, and tender breasts. Combining these different methods makes fertility awareness more accurate.
Ovulation Predictor Kits (OPKs)
OPK’s (sometimes referred to as LH kits) are used to detect the rise of the ovulation hormone, luteinising hormone (LH) 24-36 hours prior to ovulation. LH is the hormone that triggers the release of an egg from the ovary and after the hormone surge ovulation usually occurs 24-36 hours later. Many women find themselves in a stick-peeing frenzy, timing bathroom breaks at work to try to catch that elusive LH surge.
If you have Polycystic Ovarian Syndrome (PCOS) you are likely to have high levels of LH at other times of the month and this produces ‘false positives’ leading to confusion over when to try and get pregnant (6). This is why I recommend to safe yourself the trouble and money for the OPKs.
Blood Tests, Transvaginal Ultrasound, and
Elevated progesterone levels in the blood usually are associated with ovulation. A blood test to measure progesterone can be performed about one week before the anticipated onset of the next menstrual period. The LH surge occurs just before ovulation. LH levels in the blood or urine can be measured to predict when the follicle is mature and ready for ovulation.
Follicular growth can be measured with ultrasound.
Progesterone, a natural ovarian hormone, helps prepare the endometrium to receive an embryo. An endometrial biopsy is occasionally used to determine if a woman has ovulated and if the endometrium has been adequately stimulated with progesterone.
All methods have their pros and cons attached. You need to decide which method of ovulation detection is best for you.
In my own journey to health, pregnancy, and motherhood I found it invaluable to understand my body and its language. Our bodies constantly communicate with us. By paying attention I learned to listen, adjust my behaviour accordingly, and was able to finally find healing and peace within me.
I advise all my clients to lower their carbohydrate intake, amid a growing body of evidence linking such foods to impaired fertility especially when in women with PCOS. A recent study found that women with PCOS who started and kept a low-glycemic index diet had their menstrual cycles become more regular. (7)
Please understand carbohydrates are not the enemy, and some complex carbs can be helpful in maintaining a healthy weight. But many women with PCOS find that consuming a normal amount of carbohydrates can lead to weight gain. However, when some of the refined carbs in the diet are replaced with healthy fats, studies have shown that women with PCOS can see improved insulin levels and reduced body fat.
When following a high fat, low carb diet it’s important that the carbs being reduced are refined carbs like white bread, white pasta, and sugary cereals. These carbs should be replaced with healthy fats like avocado, oily fish, and olive oil to boost insulin regulation.
No, I’m not going to ask you to work your butt off each and every day. The most important part is to get moving. Move your body, no matter how. You don’t have to do vigorous exercise to be healthy but you do have to move your body in one way or another. There is no one size fits all solution. You might have heard that HIIT workouts are no good for you but some women with PCOS do just fine with it. Go for a walk, dance, lift weights, run, do yoga, do whatever makes you happy.
I recommend doing whatever physical movement you like in the first 3/4 of your menstrual cycle (in a regular cycle this means up to day 21) but to slow down at this point. Opt for a gentle movement like pilates, yoga, walks.
Midway through your luteal phase progesterone should be at its peak in your cycle. Progesterone is an extremely important hormone for sustaining a pregnancy. It has to maintain the uterine lining to ensure that your uterus is a friendly environment for an embryo to implant. Too much stress which includes too much exercise can make your body produce a stress hormone in the adrenal gland called cortisol to help it cope and respond. The body prioritises defense from stress over just about everything, including fertility. So the production of the stress hormone literally robs the body of progesterone and therefore of a pregnancy.
Magnesium is an essential ingredient for both cortisol and progesterone, but, as described above, the body prioritises the production of cortisol. Magnesium can be used to replenish the progesterone lost to cortisol.
A lack of magnesium actually sends the body into more stress. Having low levels of magnesium is believed to be an underlying cause of anxiety.
It can be difficult to know if you are deficient in Magnesium because most of the body’s Magnesium is stored in your bones and soft tissue, leaving only 1% of it in your blood. Women who are low in magnesium levels are thought to be more likely to have polycystic ovary syndrome (PCOS). (8)
Magnesium can help improve insulin sensitivity and if taken at night, reduce fasting blood glucose levels (8). Improving insulin resistance may help improve several PCOS symptoms, such as irregular periods, excess facial or body hair, oily skin, and weight gain.
The recommended dosage is 350-400g. You can get magnesium in foods like leafy greens, fish, nuts, and seeds as well as in oral supplements and Epsom salt baths. The vast majority of people do not meet the RDI for magnesium through food though. There are many types of magnesium supplements. The ones that are best absorbed and are more bioavailable include magnesium aspartate, glycinate, citrate, lactate, and chloride forms. Magnesium oxide and magnesium sulfate are generally not absorbed as well. (9)
Do not take magnesium if you have a heart problem called “heart block” or any kidney problems or kidney failure.
Fertility Massage Therapy is a deep, yet gentle and non-invasive therapy that works by bringing the organs within the abdominal area back into alignment, releasing pressure and strengthening the surrounding muscles and ligaments.
Physical touch taps into the nervous system and can release feel-good chemicals in the brain, increase circulation and lymph flow, bring awareness of the body and self, improve sleep, aid digestion, and provide stress relief. Blood flow to the uterus and ovaries helps with reproductive function.
Most programs on infertility I looked at cover diet, lifestyle, and vitamins but ignore the role that the mind plays in blocking conception. But this is the most important factor to consider and work on, in order to have a baby.
Changing your thinking can change your life in all aspects but in particular in your fertility journey. Our body is set up to mirror what is happening in our minds. Your body will act in ways that match your thinking which means your body responds to the images you make in your head and constantly works to meet that image. As longer you are on the trying to conceive train as more challenging it is to support your mind in a constructive way.
Your mindset plays the most important part of your journey to motherhood and in your whole life. You won’t be able to stick to healthy living if you do not change the way you think about it. If you do not support your body mentally on its healing journey you may never experience healing. Yes, it is that important.
If we change the way we think we change our lives.
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(1) Palmert M.R., Gordon C.M., Kartashov A.I., Legro R.S., Emans S.J., Dunaif A. Screening for abnormal glucose tolerance in adolescents with polycystic ovary syndrome. J Clin Endocrinol Metab. 2002; 87: 1017-1023
(2) Zawadzki J.K., Dunaif A.; Diagnostic criteria for polycystic ovary syndrome.; in: Dunaif A. Givens J.R. Haseltine F. Merriam G.R. Polycystic ovary syndrome. Blackwell Scientific Publications, Cambridge, MA1992: 377-384
(4) World Health Organization multicenter study on menstrual and ovulatory patterns in adolescent girls. II. Longitudinal study of menstrual patterns in the early postmenarcheal period, duration of bleeding episodes and menstrual cycles. World Health Organization Task Force on Adolescent Reproductive Health. J Adolesc Health Care 1986;7:236–44. [PubMed]
(8) Sharifi, F., Mazloomi, S., Hajihosseini, R., Mazloomzadeh, S. (2012 Jan). Serum magnesium concentrations in polycystic ovary syndrome and its association with insulin resistance. Gynecol Endocrinol. ;28(1):7-11.
(9) National Institutes of Health. Office of Dietary Supplements. Magnesium fact sheet for health professionals. Updated October 11, 2019.