How To Get Pregnant With PCOS
If you have recently been diagnosed with polycystic ovary syndrome (PCOS), or you have been trying to conceive for some time, please know that you are not alone. PCOS is one of the most common hormonal conditions affecting women of reproductive age, and while it can feel overwhelming, it is also very responsive to the right care.
Many women with PCOS go on to conceive naturally, and for those who need a little more support along the way, there are a range of options available to them. Preparing your body for conception invovles a combination of cycle awareness, reducing inflammation, and addressing the underlying drivers of PCOS through evidence-based nutrition, lifestyle, and naturopathic care.
This path can feel uncertain at times. Having someone walk alongside you can make all the difference. Our practitioners at Floralia Wellness have supported many women through the complexities of PCOS and fertility, and they would be honoured to help you feel more informed and more hopeful about the path ahead.
Why PCOS makes it harder to conceive
To understand why PCOS causes difficulties with conception, it helps to look at what's happening hormonally and why this prevents the normal sequence of events your body needs to go through each cycle to release an egg.
Irregular ovulation and anovulation
In a healthy menstrual cycle, a follicle develops and releases an egg in the middle of the cycle. However, in PCOS, the process does not always unfold as expected. You may ovulate in some months and not in others, or you may go through several months without ovulating altogether, a phenomenon referred to as anovulation. This is the main reason why conceiving with PCOS can be challenging, as there is nothing for the sperm to meet.
Your body may still produce discharge that resembles a period, even though you have not ovulated, which makes it difficult to know whether you're ovulating without further monitoring.
Insulin resistance and its effect on your hormones
A considerable number of women with PCOS are also insulin-resistant, and that's irrespective of whether or not they are overweight. This resistance causes your body to produce more insulin. Increased insulin has two important effects on your hormones and your fertility. One is that it causes your ovaries to make more androgens. The second is that it disrupts the normal messages your brain and ovaries use for ovulation.
High insulin levels will also reduce your levels of sex hormone-binding globulin, which means that your bloodstream will have more free testosterone in it. This is a hormonal state in which follicle stimulating hormone cannot function well, and this will prevent your eggs from developing. If you are unsure whether insulin resistance is a contributing factor in your case, it may be worthwhile getting hormone testing done and working with a practitioner who is experienced in interpreting what these results mean.
How excess androgens disrupt egg development
One of the hallmarks of PCOS is high levels of androgens, which can impact the development of eggs. When androgen levels are too high, eggs develop in the ovaries, then stop before they mature enough to ovulate. This is what gives a polycystic ovary its name, because these eggs develop cysts and were not mature enough to ovulate.
This hormonal imbalance also affects the quality of eggs that do ovulate. Even if ovulation takes place, egg quality may be affected by the presence of elevated androgen levels.
Signs PCOS may be affecting your fertility
The most common sign is irregular or absent menstrual cycles, which reflect the underlying pattern of irregular ovulation or anovulation. Other symptoms may also serve as an indicator. Excessive hair growth on your face and body, hair thinning on your head, oily skin, and weight gain around your abdomen are all symptoms of PCOS and may affect your fertility.
If you have been trying to conceive for six months or longer and have irregular menstrual cycles, this warrants further investigation through blood tests and an ultrasound. Many of these symptoms are also present in other hormone disorders, so working with someone who understands PCOS makes a meaningful difference. At Floralia, our team of naturopaths who specialise in PCOS can help you make the connection between your symptoms and any fertility challenges you are experiencing.
Lifestyle changes that can restore ovulation
Many lifestyle changes can support your body to ovulate naturally. This is often a good place to start, as the potential impact on your hormone levels is considerable.
Why losing even 5 to 10 per cent of body weight helps
It is not about being at a specific weight. Scientific studies have shown that losing 5 to 10 per cent of your weight is enough to help restore regular ovulation in women with PCOS. This equates to a weight loss of about four to eight kilograms if you weigh 85 kilograms. Fatty tissues are metabolically active, and they affect the level of insulin and inflammation in the body. These two in turn affect your hormones. Losing weight can reduce the level of insulin, which lowers androgens and allows the ovulation cycle to begin. However, losing weight does not apply to everyone with PCOS. Lean PCOS, where the person is already quite lean, requires a very different approach.
What to eat to support hormone balance
When it comes to eating patterns for PCOS, the general advice is to eat in a way that supports hormone balance by including foods that help to regulate blood glucose levels and minimise the insulin spikes that can contribute to the hormonal imbalances present in PCOS. This means eating at regular intervals throughout the day and including adequate amounts of high-quality protein and healthy fats with all your meals.
Swapping to or incorporating more low-GI foods, like vegetables, legumes, wholegrains, nuts, and seeds, is a good place to start. When eating carbohydrates, including a good source of protein and healthy fats helps to slow down the absorption of carbohydrates into the blood system. This in turn helps you to maintain stable insulin levels throughout the day. Our naturopaths and clinical nutritionists at Floralia Wellness can help patients to create customised eating plans. The personalisation of this matters, as everybody interacts with food differently, and things like insulin levels and body composition can shape what is advised.
Movement that helps (without adding stress)
Incorporating movement is a valuable support for fertility issues related to PCOS, especially where insulin resistance and inflammation are present. However, not all movement has the same effect.
Engaging in high-intensity activity every day of the week can actually increase cortisol levels. A combination of moderate-intensity activities such as walking and swimming, combined with resistance training two to three times per week, appears to have the most supportive impact on insulin resistance and androgen levels.
Tracking your cycle when ovulation is unpredictable
Standard ovulation tracking methods require a relatively predictable cycle. Ovulating with PCOS is not predictable. When your cycles vary between 35 and 90 days, any app that uses average cycle lengths to calculate your fertile window will quickly become unreliable.
Basal body temperature (BBT) tracking will confirm that ovulation has occurred, but it will not be able to give you advanced notice that it will occur. A sustained increase in body temperature will only occur after the fact. Ovulation predictor kits (OPKs) test for the surge of luteinising hormone that causes ovulation. This is a better predictor of ovulation. However, with PCOS, it is common for baseline LH levels to be elevated, which may result in false positives.
The most reliable approach is to combine methods. Using OPKs in conjunction with observing your cervical mucus and basal body temperature methods will give you a more comprehensive picture. If your menstrual cycles are long or irregular, your GP or fertility specialist may be able to use blood tests and ultrasound scans to detect when ovulation is approaching. It requires more work than it does for women with a regular menstrual cycle, but it gives you facts instead of assumptions.
Medical fertility treatments for PCOS
At Floralia, we take time to understand the root causes of your symptoms, addressing any underlying lifestyle factors that may be contributing to your fertility challenges. If your lifestyle changes have not induced ovulation, or if you have been trying to conceive for a reasonable period without success, your doctor or healthcare provider may recommend fertility treatment. PCOS is responsive to ovulation induction therapy, and many women with PCOS conceive after first- or second-line treatment.
Ovulation induction with Letrozole or Clomiphene Citrate
Letrozole is currently considered the first-line medication for ovulation induction in PCOS patients. It acts by temporarily suppressing the levels of oestrogen, thus prompting the brain to release more follicle stimulating hormone that induces the development of the egg. Clomiphene citrate has been shown to act similarly and has been used for several decades. More recent studies have shown that letrozole produces higher rates of ovulation and pregnancy in PCOS patients.
Both of these medications are taken orally for a period of five days at the beginning of your cycle, and your response is monitored through an ultrasound scan. The international guideline for the treatment of PCOS, published in 2023, recommends letrozole as the first-line pharmacological treatment of choice for infertility in women with PCOS, while clomiphene citrate, along with metformin, is recommended as a second-line treatment.
Metformin for insulin-resistant PCOS
Metformin addresses the insulin resistance that contributes to hormonal imbalance in PCOS. By supporting your body's ability to better manage insulin, metformin may help lower your androgen levels and support the return of normal ovulation. Metformin is commonly used in combination with letrozole or clomiphene citrate, particularly in cases where your blood tests show raised insulin and glucose levels.
Gonadotrophin injections
If oral medication has not been effective, gonadotrophins are hormone injections that stimulate the ovaries to develop eggs. Because they are a stronger form of stimulation, close monitoring through blood tests and scans is important to reduce the risk of multiple pregnancies or ovarian hyperstimulation.
Laparoscopic ovarian surgery
Ovarian drilling is a surgical procedure in which small holes are made in the surface of the ovary to reduce the amount of androgen-producing tissue. It can support regular ovulation in some women, though it is generally considered after lifestyle changes and medication have not been able to achieve the desired result.
When IVF becomes the right next step
In vitro fertilisation (IVF) may be considered if other treatments have been unsuccessful, or if there are additional factors that are affecting your ability to conceive naturally, such as blocked fallopian tubes or male factor infertility. IVF does not require ovulation because eggs are retrieved directly from the ovaries after they have been stimulated. Women with PCOS can have an exaggerated response to IVF stimulation, so the protocol is usually tailored to reduce the risk of ovarian hyperstimulation syndrome.
Your healthcare provider will be able to guide you in the right course of action based on your symptoms and history, taking into consideration your previous response to treatment modalities. A recent evidence review has reaffirmed that letrozole has superior efficacy in ovulation and live births compared to clomiphene citrate in PCOS, supporting the current approach of progressing from oral agents to IVF therapy where needed.
Naturopathic support alongside conventional treatment
This is where Floralia Wellness sits in your fertility picture. Naturopathic medicine complements what you are already doing with your fertility specialist and medical treatment plan to support the underlying metabolic and hormonal influences that may not be entirely covered by conventional treatments.
While your specialist manages the ovulation induction or IVF process, your Floralia naturopath works on what is happening in the background. This involves creating a personalised treatment protocol that incorporates specific herbal medicines, supplements and lifestyle changes that work cohesively to improve your insulin sensitivity, reduce inflammation in the body, support egg quality, and help you be in the best possible state to respond to what your specialist is doing. Floralia supports the foundations of your fertility. You can learn more about how this works on the fertility naturopath page.
Herbal medicine for hormonal balance and ovulation
Herbal medicine for women's hormonal balance and ovulation support has a long tradition of use by practitioner-grade herbalists, and some herbs have clinical evidence to support their use in PCOS. Peony and liquorice combinations have been shown to help reduce androgens in women with PCOS, and vitex (chasteberry) may assist with balancing progesterone and supporting more regular menstrual cycles.
Selecting and dosing herbal medicine is not a matter of choosing something from a health food store shelf. The herbs and amounts required will be specific to your hormonal profile and need to be checked against any other medicines you are taking. At Floralia, your blood test results and your response to treatment are always taken into account.
Inositol and other targeted nutrients
Myo-inositol and D-chiro-inositol have emerged as two of the most studied nutritional therapies in PCOS in the past few years. They function as insulin sensitisers, and their mechanism is different from that of metformin. Studies have confirmed their efficacy in improving ovulation rates and reducing androgens with improved egg quality. The combination of myo-inositol and D-chiro-inositol is key. A 40:1 ratio is the natural balance in the body and the one most commonly used in clinical trials.
In addition to inositol, other nutritional therapies that may be used by Floralia practitioners include zinc (important for the metabolism of androgens), vitamin D (often low in PCOS patients and associated with poorer fertility outcomes), omega-3 fatty acids (to address inflammation), and N-acetyl cysteine, a nutrient that has shown promise in improving ovulation in combination with clomiphene citrate. These nutritional therapies will be tailored to what your blood work and your body actually need, not what is given in a general prescription.
How integrative care works with your fertility specialist
Floralia works alongside your fertility specialist or your doctor so that your care is coordinated and not contradictory. For instance, if you are just about to begin an IVF cycle, your naturopathic doctor will modify your herbal and nutritional support so that it does not interfere with your medication and supports your response to the stimulation drugs.
Integrative care allows for the use of natural and conventional medicine with practitioners who understand the role of the other.
Pregnancy risks to prepare for with PCOS
While getting pregnant is the ultimate goal, PCOS also increases the risk for pregnancy complications.
Gestational diabetes and blood pressure monitoring
Women with PCOS are more prone to gestational diabetes and hypertension during pregnancy, which are associated with the underlying insulin resistance that is characteristic of the condition. Babies born to women with PCOS are more likely to be large for gestational age, which increases the chance of needing a caesarean delivery.
Health checks during pregnancy help to identify these complications early, so they can be managed well. A meta-analysis of over 106,000 pregnancies found that even if age and BMI are matched, the higher risk of gestational diabetes, pre-eclampsia, and caesarean section persists, confirming that PCOS is indeed a risk factor.
Ways of reducing your risk before you conceive
The best time to reduce your risk is before you conceive. Improving your insulin sensitivity through diet, exercise, and supplementation can go a long way in reducing your risk of developing gestational diabetes. Reaching a healthy weight before conception can also reduce your risk of high blood pressure and pregnancy complications.
This is one of the strongest arguments for preconception care. Three to six months of preparation can change the entire trajectory of your pregnancy. Floralia's pregnancy clinic helps women through this transition from preconception into antenatal care, especially with regard to PCOS-related risks.
When to see a fertility specialist
If your periods are irregular, it is a good idea to see a fertility specialist if you have not conceived within six months of trying. If your periods do not exist, you do not have to wait six months. The sooner you get a diagnosis, the sooner you'll understand what is happening with your body, and the more options will be available to you.
Your doctor may recommend that you have your fallopian tubes checked, which rules out any other causes of your infertility, aside from your PCOS. A fertility specialist is best placed to carry out any blood tests required to determine your condition, and if you have PCOS, it is a good idea to explore your options sooner rather than later. This is because your age is a factor in how successful your fertility treatment is.
