PCOS: How it Affects Fertility

Sep 21, 2020
Fertility Dietitians

Who wants to hear all about PCOS and fertility??

Well you came to the right place! In this episode, Caitlin and Sophia dive in to the #1 most common cause of fertility struggles in women: PCOS

So… what is it?

PCOS is an endocrine problem, meaning it is a hormone imbalance. It used to be thought of as a gynecological problem, but as science has advanced we now know PCOS goes beyond female sex organs.

Dietitians like us actually cannot diagnose PCOS, though both Caitlin and Sophia often have women come to them for fertility help, and when we send them back to their doc for some testing it’s discovered that they DO have PCOS.

PCOS is diagnosed using certain criteria (Rotterdam Criteria), and it’s more of a culmination of signs and symptoms. The symptoms your doctors typically look for are:

  • Cystic ovaries – ovaries with multiple cysts diagnosed with ultrasound
  • High androgens – Testosterone, DHEA-S, Androsterone, etc. elevated higher than normal for women
    • Excess body hair
    • Male pattern baldness
  • Lack of/delayed ovulation – your cycles are very irregular and ovulation is rare or absent

Caitlin was a mere teen when she was diagnosed with PCOS, and when she innocently asked her doc what this meant, his cold reaction was “PCOS is the #1 reason women can’t get pregnant”. Which, by the way, is a HORRIBLE thing to say to anyone, let alone a teenager!

**If you only take one thing away from this episode, let it be know that PCOS is NOT an infertility diagnosis! If left untreated, PCOS can certainly impact fertility; but PCOS is very treatable! This diagnosis does not mean you will never be a mom!!!!!**

Treating the factors that influence PCOS greatly increase your chances of getting pregnant!

So, what if you simply suspect you may have PCOS?

  • Cycles longer than 35 days
  • Acne
  • Hair loss
  • Body hair growth
  • Difficulty losing weight
  • Excess weight around your belly

How does PCOS affect fertility?

If you’re ovulating every 28-30 days or so, you’ll have roughly 12 chances to get pregnant in a year. If you, someone with PCOS, only ovulates every 50-60 days, you will have far less chances to get pregnant in a given year.

Why does this occur?

Almost always, the root cause of PCOS has something to do with insulin resistance. In simple terms, this means your body doesn’t manage your blood sugar well. Insulin is a hormone that moves the sugar/fuel in your blood into your body’s tissues and cells. Insulin resistance is where your body stops listening to the message of insulin, requiring your body to crank up the volume on insulin to get the job done. This causes ovaries to get overstimulated, increasing testosterone and other male hormone levels; causing many of the symptoms of PCOS

Brains are greatly affected too. Your brain has glands that make hormones that control ovulation. In healthy bodies, your brain makes a surge of luteinizing hormone (LH) and follicle stimulating hormone (FSH) just before ovulation. In bodies with PCOS, these hormones kick into high gear far too frequently as your body tries and tries to ovulate. This is why it’s so helpful to get lab work done so we can address exactly what is happening with each of these hormones.

Brains also make a hormone called prolactin. When prolactin is at its best, it helps nursing moms make milk for their babies. Part of the overstimulation of the ovaries and brain that come with PCOS cause your brain to make too much prolactin. High prolactin is good if you’re nursing a baby because it also tells your ovaries not to ovulate, since your body is still sustaining the life of the baby you’re nursing. However, if you have PCOS and your prolactin is too high, this hormone holds off ovulation and makes it harder to become pregnant.

Estrogen is also higher in many women with PCOS. This, again, can be because your body is trying and trying to ovulate. Estrogen can also be too high due to excess body fat, a piece of the cruel cycle of PCOS. Estrogen being too high is particularly problematic when it comes to the hormonal rhythm of ovulation. When estrogen dominates other hormones (like progesterone), many of the symptoms of PMS/PCOS are amplified. Migraines, cramps, anxiety, heavy bleeding, etc. are all symptoms of high estrogen to progesterone.

The last noteworthy hormone of PCOS is cortisol, the stress hormone. This hormone causes blood sugar to rise and thwarts the function of insulin, making your body naturally more insulin resistant. This is great if you’re in the midst of a bloody battle; not so good if you’re overwhelmed by the daily stress of life. While we cannot change the stressors that occur in your life, we do help each of our patients manage stress and react to stress differently.

These hormones are why both Caitlin and Sophia both do functional hormone testing as a part of their practices! We want to target your specific symptoms and root causes! No two women are the same, and there is no way to say simply by looking at symptoms what each of your hormones are doing.

This is also why advice from medical professionals that sounds anything like “lose some weight” is so infuriating! It’s not only unhelpful, but it’s psychologically damaging. Remember, one of the symptoms of PCOS is excess weight in the midsection. So, it’s not helpful to be told the very symptoms you’re there to address is same as the treatment.

** Cue Sophia rant about doctors telling women to lose weight **

Another great test to run is an insulin assay. This includes a 2 hour glucose tolerance test and measuring insulin markers like the Homa-IR test

These labs we all mentioned are tests that Caitlin and Sophia use all the time in our practices! However, this is not a comprehensive list of all the hormones and tests to look at with PCOS. Even if you have done all this testing, and you still can’t figure out what’s up; don’t give up! There are more stones to overturn and Sophia or Caitlin are poised and read to help you get some answers!

What could happen if you go to the OB/GYN and say you want to get pregnant with PCOS

  • Get a full panel of labs on varying dates of your cycle
  • Your doc might give you Metformin (glucophage) and are told to come back in a few months if you’re not pregnant
  • Your doc might also give you Clomid (clomiphene) or letrozole to try and trigger ovulation

You might also be simply told to lose 10% of your bodyweight… which is not helpful, as we’ve established.

Stay tuned to next week’s episode where we talk about REAL LIFE SOLUTIONS to PCOS fertility struggles! Tune in and be amazed.

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