How to navigate PCOS and Fertility?

September is PCOS Awareness Month, so let's talk about it. PCOS (polycystic ovary syndrome) is a common hormonal disorder that affects women, particularly during their reproductive years, and is a leading contributor to fertility issues. The World Health Organization (WHO) estimates that approximately 8-13% of women of reproductive age are affected by PCOS globally, yet it remains misunderstood and underrepresented. Read on to learn more about PCOS, how to navigate fertility with this condition, and what lifestyle changes and supplements can improve fertility with PCOS. 

What is PCOS?

PCOS is a hormonal condition that affects how the ovaries function, often disrupting the menstrual cycle, ovulation and fertility. 

Key features of PCOS: 

• Hormonal Imbalance PCOS involves an excess production of androgens, which are often referred to as "male hormones," although they are present in both males and females. Elevated androgen levels can disrupt the normal menstrual cycle and lead to symptoms such as acne, excessive hair growth (hirsutism), and hair loss
• Irregular Menstrual Cycles Individuals with PCOS often experience irregular or missed periods due to anovulation (lack of ovulation). This can lead to difficulties in conceiving, making PCOS one of the leading causes of infertility
• Polycystic Ovaries The name "polycystic" refers to the presence of many small fluid-filled sacs (follicles) in the ovaries, which may be visible on ultrasound. However, not all individuals with PCOS have these cysts, and their presence is not necessary for diagnosis

Common Syptoms of PCOS include: 

• Irregular or absent menstrual periods
• Excessive body or facial hair
• Acne or oily skin
• Weight gain, particularly around the abdomen
• Thinning hair on the scalp
• Skin tags or dark patches on the skin

The exact cause of PCOS remains unclear, but several factors may contribute:

• Genetics: A family history of PCOS can increase the likelihood of developing the condition.
• Insulin Resistance: Many individuals with PCOS exhibit insulin resistance, which can lead to higher insulin levels and contribute to increased androgen production.
• Obesity: Being overweight can exacerbate symptoms and increase insulin resistance.

Diagnosis

Diagnosis typically involves a combination of medical history evaluation, physical examination, and tests such as blood tests to measure hormone levels and ultrasounds to assess ovarian structure. According to diagnostic criteria, at least two out of three features—irregular periods, elevated androgen levels, and polycystic ovaries—must be present for a diagnosis.

Management and Treatment

PCOS is a chronic condition that requires ongoing management. Early diagnosis and a tailored treatment plan can help mitigate its effects and improve quality of life for those affected. While there is no cure for PCOS, various treatment options can help manage symptoms:

• Lifestyle Changes: Weight management through diet and exercise can significantly improve symptoms.
• Medications: Hormonal contraceptives can regulate menstrual cycles and reduce androgen levels. Other medications may include anti-androgens for hair loss and acne or insulin-sensitizing agents like metformin.
• Fertility Treatments: For those seeking pregnancy, treatments may include ovulation-inducing medications or assisted reproductive technologies.

How does PCOS affect fertility?

Ovulation Issues: The primary way PCOS affects fertility is by disrupting normal ovulation. Women with PCOS often have irregular or absent menstrual cycles due to hormonal imbalances, particularly elevated levels of androgens (male hormones). This hormonal imbalance can prevent follicles on the ovaries from maturing and releasing eggs regularly. Anovulation (lack of ovulation) or oligoovulation (infrequent ovulation) makes it difficult to conceive, as there are fewer opportunities for fertilization to occur.

Hormonal Imbalances: PCOS involves several hormonal disruptions that can affect fertility. Elevated insulin levels can increase androgen production, further disrupting the menstrual cycle. High levels of luteinizing hormone (LH) relative to follicle-stimulating hormone (FSH) can interfere with follicular development and ovulation. These hormonal imbalances can also affect the quality of eggs produced.

Endometrial Issues: The hormonal imbalances in PCOS can lead to a thickened uterine lining, which may not develop properly to allow for implantation of a fertilized egg. This can increase the risk of early miscarriage even if conception occurs.

Metabolic Factors: Insulin resistance, common in PCOS, can negatively impact fertility and increase the risk of pregnancy complications. Being overweight or obese, which is common in women with PCOS, can further reduce fertility. 

Impact on Conception and Pregnancy: On average, women with PCOS take longer to conceive compared to women without the condition. PCOS is associated with a higher risk of certain pregnancy complications, including gestational diabetes, preeclampsia, and premature delivery.

Despite these challenges, it's important to note that with proper management and treatment, many women with PCOS can conceive and have healthy pregnancies. Things like lifestyle changes, weight management, and medical interventions can significantly improve fertility and pregnancy outcomes for women with PCOS.

Key Lifestyle Changes that Can Improve Fertility

There are several lifestyle changes that can help improve fertility for women with PCOS. Remember that it’s not all or nothing. You can slowly implement these changes into your daily routine and see what works for you. 

Diet & Nutrition

1. Follow a low-glycemic index diet with complex carbohydrates, fiber, and anti-inflammatory foods.
2. Consider adopting a Mediterranean diet, which is rich in vegetables, fruits, whole grains, lean proteins, and healthy fats.
3. Reduce intake of processed foods, sugary drinks, and foods high in saturated fats.

Exercise & Movement

1. Engage in regular physical activity, aiming for at least 150 minutes of moderate-intensity exercise per week.
2. Include both aerobic exercises and strength training in your routine.
3. Minimize sedentary time and increase daily movement.

Physical Health

1. If overweight, aim to lose 5-10% of body weight, which can significantly improve ovulation and menstrual regularity.
2. Work with a nutritionist or dietitian to develop a sustainable weight loss plan if needed.

Stress Management

1. Practice stress management techniques like meditation, yoga, or deep breathing exercises.
2. Ensure adequate sleep, aiming for 7-9 hours per night.
3. Consider taking melatonin before sleep to potentially improve oocyte quality and sleep patterns.

Other

1. Quit smoking and limit alcohol consumption.
2. Monitor blood sugar levels regularly, as PCOS can affect insulin production and glucose metabolism.
3. Consider working with a fertility specialist to explore medical treatments alongside lifestyle changes.

By implementing these lifestyle modifications, women with PCOS may improve their overall health, hormone balance, and fertility outcomes. It's important to consult with healthcare providers to develop a personalized plan that addresses individual needs and medical history.

What Supplements Can Help?

Supplements are a great way to supplement and enhance your overall physical and mental health, and they can also assist with specific fertility goals. Here are some supplements that have shown some promise for helping with PCOS-related fertility challenges, though more research is still needed in some instances: 

1. Inositol: Several studies have found inositol supplements may help improve ovulation, menstrual regularity, and pregnancy rates in women with PCOS. It appears to work by improving insulin sensitivity.
2. Omega-3 fish oil: Some low quality evidence suggests omega-3 supplements may benefit women with PCOS, though more research is needed.
3. CoQ10: There's some evidence that CoQ10 supplements may improve fertility outcomes for women with low ovarian reserve, which can occur with PCOS.
4. Vitamin D: While evidence is mixed, some studies suggest vitamin D supplementation may be beneficial if a deficiency is present.
5. Probiotics: Early research indicates probiotics may help improve hormonal balance and reduce inflammation in PCOS, but more studies are needed.
6. N-Acetyl Cysteine (NAC): Some studies have found NAC may help lower testosterone levels, improve insulin resistance, and boost fertility in women with PCOS.
7. Berberine: Limited research suggests berberine may help improve fertility and insulin resistance in PCOS patients.

It's important to note that supplement quality and effectiveness can vary widely. Always consult with a doctor before starting any new supplements, especially when trying to conceive. Lifestyle changes, like the suggestions above, remain the first-line recommendations for improving fertility with PCOS.

Sources

1. World Health Organization. "Polycystic Ovary Syndrome (PCOS)." WHO, accessed September 25, 2024. https://www.who.int/news-room/fact-sheets/detail/polycystic-ovary-syndrome
2. U.S. Department of Health & Human Services. "Polycystic Ovary Syndrome." Office on Women's Health, accessed September 25, 2024. https://www.womenshealth.gov/a-z-topics/polycystic-ovary-syndrome.
3. Legro, R. S., and N. Arslanian. "Polycystic Ovary Syndrome: Current and Emerging Treatments." National Institutes of Health (NIH), accessed September 25, 2024. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7789031/.
4. Goodarzi, M. O., et al. "Polycystic Ovary Syndrome: A Review." Human Reproduction Update 12, no. 6 (2006): 673–684. https://academic.oup.com/humupd/article/12/6/673/625165?login=false.
5. Rubin, K. H., and G. Glintborg. "PCOS and Metabolic Dysfunctions." National Institutes of Health (NIH), accessed September 25, 2024. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9867443/.
6. Nyu Langone Health. "Lifestyle Changes for Polycystic Ovary Syndrome." NYU Langone Health, accessed September 25, 2024. https://nyulangone.org/conditions/polycystic-ovary-syndrome/treatments/lifestyle-changes-for-polycystic-ovary-syndrome.
7. National Institutes of Health (NIH). "PCOS and the Role of Supplements." NIH, accessed September 25, 2024. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9710389/.
8. Grem Journal. "Improving Fertility in Women with Anovulatory PCOS." GREM Journal 4, no. 2020. https://gremjournal.com/journal/04-2020/how-to-improve-fertility-in-women-with-anovulatory-polycystic-ovary-syndrome-pcos/.
9. Medical News Today. "PCOS and the Symptoms of Infertility." Medical News Today, accessed September 25, 2024. https://www.medicalnewstoday.com/articles/326560.