Can You Get Pregnant with PCOS?

If you’ve been diagnosed with polycystic ovarian syndrome, or have some of the symptoms, you might be wondering whether you can get pregnant with PCOS. It’s true—a common side effect of PCOS includes fertility issues and trouble conceiving. But, there’s a lot that can be done to prepare for trying to conceive and to increase your odds of getting pregnant (not to mention, managing those pesky PCOS symptoms), including small lifestyle changes and supplement support.

PCOS, also known as polycystic ovarian syndrome, is a hormonal disorder affecting more than 20% of reproductive-aged females. To be diagnosed, you need to meet 2 of the 3 Rotterdam Criteria, which include:

• An ultrasound showing multiple cysts on the ovaries
• Signs of high androgen hormones (high testosterone or other androgenic hormones upon lab work, or signs and symptoms of high testosterone like acne, hair loss, or unusual hair growth)
• Irregular, infrequent, or absent menstrual cycles

PCOS itself doesn’t cause infertility. But some of the side effects of PCOS—primarily insulin-resistance and anovulation—can make conception more difficult. Irregular, infrequent, or absent menstrual cycles can make ovulation either unpredictable or non-existent. This is called anovulatory infertility, and it affects 70 to 80% of those with PCOS. Fertility treatment options for PCOS are predominantly centred around treating ovulation (more on this below).

At the root of PCOS-related hormonal dysfunction is insulin resistance. Insulin resistance happens when the body doesn’t respond to the hormone insulin as effectively, often due to genetic and lifestyle factors. The results can be weight gain, increased inflammation, and hormone imbalance, all of which can affect ovulation and the ability to get pregnant.

• LH increases → insulin resistance contributes to elevated LH, which overstimulates the ovaries and contributes to excess androgen production
• Testosterone increases → elevated insulin levels signal the ovaries to produce more testosterone, which shuts off ovulatory mechanisms
• High testosterone → May lead to lower estrogen levels, which disrupts ovulatory signalling
• Progesterone decreases → because insulin resistance often disrupts ovulation, progesterone—which is only produced after ovulation—tends to be low. Low progesterone is also associated with increased risk of miscarriage in PCOS

In most cases, the effects of insulin on LH, testosterone, estrogen, and progesterone are treatable, and even reversible, with the right interventions.

Fortunately, PCOS is strongly influenced by external factors, like diet, lifestyle, and environment. Even small changes can have a positive impact on, not just PCOS symptoms, but your chances of conceiving, too. In fact, lifestyle interventions are the first-line treatment option for females with PCOS. This is because around 75% of females with PCOS have some degree of insulin resistance, which responds well to intervention.

Diet and nutrition are at the core of PCOS management and fertility success. Most with PCOS can benefit from a low glycemic diet and increasing dietary fiber. Combined, these strategies help to lower insulin levels, which can help restore ovulation. This can be as simple as swapping white bread for whole-grain bread, or cereal for rolled oats. It also means including more non-starchy vegetables(think: zucchini, cucumbers, arugula, and peppers) and reducing starchy vegetable intake (like potatoes, cooked carrots, and peas). Emphasizing good-quality lean protein sources and healthy fats at every meal is also important to keep PCOS hormones balanced and insulin in check.

It’s a common belief that the solution to PCOS symptoms is to just lose weight. While it’s true that even a 2 to 5% weight reduction can help improve menstrual cycle regularity and fertility, losing weight can be challenging as a result of insulin resistance, and it’s not always necessary because even lean individuals can be insulin resistant. This is when working with a practitioner, like a naturopathic doctor, can help. Bloodwork, like fasting insulin and the insulin-glucose challenge test, can provide insight into the degree of insulin resistance and the causes associated with it (hint: it’s not just diet). Other ways to improve insulin resistance include managing stress, getting enough sleep, improving gut health, and regular exercise.

• Eat a whole-food diet
• Manage stress
• Prioritize sleep
• Improve gut health through diet and probiotics
• Regular exercise

Metformin, a pharmaceutical insulin sensitizer and first-line treatment for PCOS, can help lower circulating insulin in cases where insulin resistance has increased HbA1C (a marker of long-term glucose management). On its own, Metformin can take more than 6 months to re-stimulate ovulation, which is one reason why it’s best to start managing PCOS symptoms sooner rather than later.

On the flip side, medications such as clomiphene and letrozole work more quickly to induce ovulation, making them appealing if you want to get pregnant sooner rather than later.

Inositol, a B-vitamin-like compound, is known to be as effective as metformin at improving symptoms in individuals with PCOS. Like metformin, it works by improving insulin sensitivity, which helps restore ovulation and a regular menstrual cycle. (Fun fact: even though the body makes inositol on its own, those with PCOS tend to use and excrete more of it, making them deficient. Read more about the benefits of inositol for PCOS here.)

Not only is there a clear link between Vitamin D deficiency and insulin resistance, but improving Vitamin D status has also been shown to positively impact cardiometabolic and hormonal parameters in women with PCOS.

A 2020 study showed that taking 600 mg of CoQ10 daily helped improve ovulation rates (by 325%) and pregnancy rates (by 464%) in those with PCOS who were also dealing with infertility.

N-Acetyl-Cysteine (an amino acid, also known as NAC) not only improves PCOS insulin resistance but live birth rates, too.

PCOS is a disorder that requires lifelong management. Which means the diet and lifestyle strategies implemented to improve symptoms need to be continued to prevent symptoms from coming back.

The good news is, the sooner you start, the sooner you’ll see hormonal and metabolic benefits, which is important since unmanaged PCOS can lead to cardiovascular disease, type 2 diabetes, endometrial cancer, and more. So, whether TTC is currently on your radar or not, managing your PCOS can–and should–start right away. Because your period is like a monthly report card, tracking cycles and ovulation is an amazing biomarker of your overall health. Managing symptoms with the goal of improving ovulation rates before trying to conceive can increase the odds of successfully conceiving.

It’s possible to get pregnant with PCOS without having to pursue PCOS fertility treatments! By maintaining a healthy weight, consistently eating a healthy insulin-supporting diet, and working on other lifestyle factors (like exercise, stress management, and incorporating the right supplements), ovulatory cycles and a healthy pregnancy are possible.