Trying to conceive with PCOS

Polycystic ovarian syndrome (PCOS) is a complex metabolic, endocrine and reproductive disorder affecting around 1 in 10 women or people with ovaries of reproductive age. PCOS can impact many bodily functions, including your menstrual cycle, metabolism, heart health, skin health, sleep, mental health, and even your fertility. It's often a misunderstood and underdiagnosed condition, with 70% of women remaining underdiagnosed, leading to delays in treatment and management.

If you have PCOS and are trying to conceive (TTC), you might already know that it can sometimes make things a little more complicated to get pregnant, but it doesn’t mean pregnancy is out of reach. In fact, many people with PCOS go on to have healthy pregnancies, both naturally or with the right support of fertility treatment. The key is understanding how PCOS impacts fertility and what steps you can take to optimise your chances.

How is PCOS Diagnosed

You need 2 out of 3 criteria for a diagnosis. 

• Elevated androgens ("male " hormones), either identified through a blood test or clinical symptoms eg presence of acne, hair loss, or facial hair etc

• Irregular or absent menstrual cycles 

• 20 follicles or more follicles on one or both ovaries, or an ovarian volume equal or greater than 10ml or instead of a pelvic ultrasound, an AMH blood test could be used as an alternative way to identify polycystic ovaries.

And because it's a syndrome and you only need 2 out of 3 criteria for a diagnosis, not everyone will experience it in the same way. This means people can experience different symptoms, but also may need different management. So not every person who has PCOS will have the same treatment to manage it. It all depends on which criteria and symptoms you experience for your diagnosis.

How Does PCOS Affect Fertility

PCOS is a condition where your ovaries (and hormones) don’t always behave as expected. Common features include:

• Irregular or absent ovulation - making it harder to predict or identify your fertile window

• Elevated androgens - higher levels of androgens can interfere with follicle development and ovulation

• Insulin resistance - which can impact hormone regulation and ovulation

• Polycystic ovaries - lots of small follicles (not cysts) visible on ultrasound

  
  

Because ovulation may not happen every cycle (or at all, in some cases), it can take longer to conceive with PCOS. But importantly, PCOS does not mean you’re infertile...it just means your path to pregnancy may need more support. And there can still will be cycles where you do ovulate and release an egg, making conception possible.

Symptom & Fertility Management Strategies

Managing PCOS while TTC is about balancing your symptoms, supporting your hormones and ovulation, and optimising overall health. Here are some strategies:

Lifestyle Modifications

A healthy lifestyle should be the core focus for all people with PCOS, as this can have positive outcomes for general health, quality of life, emotional well-being, metabolic health, reproductive health and fertility, including egg and sperm health.

Nutrition

• Cut out alcohol, smoking, and recreational drugs

• Reduce caffeine.

• Adopt a balanced diet rich in whole foods. Focus on fruits, vegetables, whole grains, lean proteins, and healthy fats.

• Consider a low-glycemic index (GI) diet if you need help managing insulin levels.

  
  

Regular Exercise

• Incorporate regular physical activity into your routine. Aim for at least 150 to 300 min/week moderate-intensity physical activity or 75 to 150 min/week vigorous-intensity or an equivalent combination of both over the week

• Physical activity is any bodily movement that requires energy expenditure. It includes leisure activities that include physical activity (e.g. gardening or dancing), transportation (e.g. walking or cycling), occupational (i.e. work), household chores, playing games, sports or planned exercise, or activities in the context of daily, family and community activities. It doesn't have to be structured exercises!

• Benefits of exercise: Boosts mood, helps sleep, protects against chronic diseases and lowers the risk of cardiovascular disease, high blood pressure, type 2 diabetes, multiple cancers, dementia, anxiety, and depression, and strengthens bones.

• In terms of fertility: exercise improves oestrogen metabolism (sweating helps eliminate chemicals that can’t be excreted via kidneys or bowels), creates an anti-inflammatory response, improves circulation to pelvic organs, strengthens muscles and the pelvic floor and helps to align the uterus inside your pelvis and supports mitochondrial health (eggs power source important for fertilisation, development and implantation)

• The most important thing regarding exercise is ensuring you are doing an activity that you enjoy!

  
  

Stress Management

• Try not to stress about stress; studies are inconclusive on whether stress really does impact conception. Although the longer it takes to conceive, can increase your stress levels. It can be a vicious cycle!

• Stress may not prevent conception but it can cause issues with your menstrual cycle, delays in ovulation, shorten your luteal phase (second half of your cycle), increase inflammation, and negatively impact implantation

• Stress in men can reduce sperm, count, motility and morphology.

• Practice stress-reducing techniques like mindfulness, meditation, yoga and deep breathing exercises (if that is something you like doing) or do an activity that you find relaxing e.g reading. You can also seek support from a counsel or or support group if talking through your experience helps you more.

  
  

Sleep:

• Sleep is essential for restorative processes, healing and repair of the body. Its also important for regulating hormones, as hormones are made during the night and most people tend to ovulate overnight.

• Aim for 7-9 hours per night

• Sleep in usually underrated in terms of health, but lack of sleep can affect your physical and mental health.

• Sleep deprivation can increase your time to conceive, decrease how all hormones are made, decrease healing and repair in the body, impact ovulation and decrease in sperm production.

  
  

Endocrine-disrupting chemicals

• Are natural or human made chemicals in our environment that are similar to the molecular structure of your natural hormones and can interfere with your hormone system and how they function.

• The greater the exposure, the greater the negative effects on your menstrual cycle, sperm health and fertility.

• The good thing is you can make changes to reduce your overall exposure. Consider switching from plastic water bottles to stainless steel or glass, or opting for skincare and cleaning products that are free from harsh chemicals.

Weight Management

Weight can be a tricky topic for anyone with PCOS, as a lot of people struggle to lose weight. But also, not everyone with PCOS has weight to lose. So losing weight shouldn't be the first thing you do if you have PCOS, plus, restricting calories can actually make things worse.

• Rather, having a healthy lifestyle should be the first thing recommended to all women with PCOS.

• The reason a lot of doctors may discuss losing weight is because ovulation can be impacted due to an increase in body fat. Weight loss of 5-10% can help restore ovulation and reduce PCOS-related symptoms and increase your chances of conception.

• If you are struggling with changing your diet, making healthy choices or losing weight, don't be afraid to seek help from your doctor, dietician, nutritionist, psychologist, group support, personal trainer or exercise physiologist.

  
  

Fertility Supplements

• Certain supplements may help manage PCOS symptoms and support fertility, such as Inositol, folic acid, zinc, magnesium and Vitamin D.

• But always consult with your healthcare provider before starting any new supplements.

  
  

Tracking ovulation

• To improve your chances of becoming pregnant, you can keep track of your menstrual cycle and ovulation. You may find patterns or clues to help identify your fertile window and when to time sexual intercourse each month.

• Identifying mucus changes (mucus becomes slick and slippery, like raw egg white) or tracking basal body temperature can be useful to assess your menstrual cycle and work out when you are most fertile and if ovulation occurred.

• Be careful using LH testing kits, as people with PCOS tend to have naturally high LH and can get false positive readings.

Medical Treatments

• If you struggle with ovulation due to your PCOS, ovulation induction is a great starting treatment. Discuss fertility medications with your doctor, ensuring you also focus on a healthy lifestyle before starting treatment.

• Letrozole is the first-line treatment for TTC with PCOS, adjusting the dose as required. Followed by gonadotropin injections with ultrasound monitoring. The tricky thing with both these medications is getting the dose right, where you grow a follicle effectively but not too many follicles (we don't want to increase your risk of twins or multiples) . So sometimes it can take time to get the dosing right, but also why ultrasound and blood tests may be needed to monitor your response.

• If medications aren't effective, consider Assisted Reproductive Treatment (ART) options such as In Vitro Fertilisation (IVF). Consult with your fertility specialist to discuss the best course of action.

Chances of Conceiving with PCOS

• Many women with PCOS can and do conceive naturally, especially with lifestyle and cycle-tracking support.

• Others may need ovulation induction medications (like letrozole or clomiphene) to help the ovaries release an egg.

• If medications don’t work, assisted reproductive technologies like IVF may be recommended.

Trying to conceive with PCOS can feel frustrating when cycles are unpredictable and ovulation isn’t straightforward. But with the right support, education, and treatment if needed, pregnancy is absolutely possible.

But remember, you don’t have to navigate TTC alone. Whether you’re just starting out or already working with a clinic, My Fertility Nurse can help you understand your body, advocate for the right options for your journey, and guide you through your next steps.

👉 Ready to feel more in control of your fertility journey with PCOS? Book a free call with us today.

References

Helena Teede et al.. International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome 2023. Monash University. https://doi.org/10.26180/24003834.v1