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As if all the other symptoms you deal with on a daily basis with PCOS weren’t enough, now you’re also learning that PCOS affects fertility? Unfortunately, having PCOS can not only affect your chances of getting pregnant, but also your chances for a healthy pregnancy.

In fact, PCOS is the #1 cause of ovulatory infertility in women (1).

The major reason for that is that women with PCOS do not ovulate regularly. That makes PCOS fertility less than optimal to start with.

Meaning that all those apps that help you track your cycle and guesstimate your ovulation at day 14 are pretty much useless for women with PCOS.

You can track your cycles yourself — I recommend using ovulation tests to PREDICT ovulation and using your basal body temperature to CONFIRM ovulation.

You can read more about how to track your cycles in this guest post by fertility expert Jenna McDonald.

But here’s a common scenario…

My client Amelia typically had long cycles and always had. We’re talking 60–80 day cycles here. When we first started working together, she said she would be great about peeing on all the sticks from around day 10 of her cycle to around day 21. Then she’d slack off and miss a few days. And without fail, 2-3 weeks after she stopped testing, her period would finally make an appearance.

Let’s back up a bit here…

What causes “late” periods is actually late ovulation. The average luteal phase for most women is consistently 14 days (2). So, predictably, 2 weeks after ovulation is when you can expect to get a period.

The problem with PCOS is that ovulation doesn’t happen right around that “perfect” cycle day 14. Which makes finding the fertile window difficult.

So What Can You Do to Improve Your Fertility with PCOS?

First things first: you’ve got to be ovulating. More about that in a moment…

And then you’ve got to be able to predict ovulation so that you can successfully time sex during the fertile window (~4 days before and the day of ovulation).

So, what are the keys to improving ovulation?

  • Reduce inflammation in the body. That means a diet high in anti-inflammatory fruits, veggies, fatty fish, and nuts.

  •  Improve insulin sensitivity. A real foods diet moderate in high-fiber carbs, regular exercise, inositol, vitamin D, chromium, cinnamon, and alpha lipoic acid can help with this.

  • Lower testosterone. High testosterone levels interfere with ovulation. Supplement choices depend on how soon you’re planning on getting pregnant. 1-2 Tbsp of flaxseed is a safe one to use around pregnancy, and has been shown to reduce testosterone in animal models (3). 

  • Rule out thyroid issues. Hypothyroid & PCOS go hand in hand, and low thyroid hormone is a common cause of menstrual irregularities (as well as early miscarriage). Get those numbers checked. Ideally, you want your TSH between 1–2, zero antibodies, and free T3 at or above 3.2. 

Pregnancy Risks with PCOS

Then once you get pregnant, chances of miscarriage are higher in women with PCOS—even with “lean PCOS” (4). 

You’re also at higher risk for gestational diabetes, high blood pressure and pre-eclampsia and other pregnancy complications such as induction of labor and C-section (5).

Fortunately, all those things you do BEFORE you get pregnant to lower your blood sugar and improve your insulin sensitivity, lower inflammation, and lower your testosterone levels also impact the likelihood of having a healthy pregnancy (6).

In other words, what you do NOW will benefit you and baby LATER. So, what are you waiting for?

Oh! I almost forgot to tell you what happened with Amelia…

About a month and a half after she started working with me, she had her first 28 day cycle without medication ever! And then 28 days later she had another one! Unfortunately, that third month, her period was late… but it was for a happy reason — she had gotten pregnant naturally!  We had improved her fertility with PCOS without medications! And without having to go through the emotional and financial strain of IVF! Needless to say, her fertility doctors were shocked! 

Be well!

Melissa Groves, RDN, LD

View my fertility services for PCOS here.

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IMPORTANT NOTE -> This information is provided for educational purposes and should not be construed as medical advice. Please consult with your healthcare practitioners before undertaking any changes in your diet or adding supplements. 

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