PCOS - could it be affecting your fertility?
๐ช๐ต๐ฎ๐ ๐ถ๐ ๐ฃ๐๐ข๐ฆ?
PCOS (๐ฑ๐ฐ๐ญ๐บ๐ค๐บ๐ด๐ต๐ช๐ค ๐ฐ๐ท๐ถ๐ญ๐ข๐ต๐ช๐ฐ๐ฏ ๐ด๐บ๐ฏ๐ฅ๐ณ๐ฐ๐ฎ๐ฆ) is an endocrine disorder that affects roughly 10% of women in the UK, which is quite a lot when you think about it.
It's actually a group of symptoms - a syndrome - rather than a disease
Women with PCOS can have high levels of androgens (male hormones) which leads to infrequent or no ovulation, and low progesterone. This is why it can be tricky for women to conceive, because this affects the all-important quality of the eggs, the ability to conceive or knowing when you will conceive, and not having enough progesterone to support a pregnancy.
PCOS is different for each woman and is a complex interplay of genetics, disruption to your hormones, and other issues that tend to involve inflammation, excess insulin, high androgens (male hormones) and/or the use of hormonal contraceptives.
It also has longer term implications for metabolic health, so if you have irregular or no periods, it's worth investigating.
You don't have to have polycystic ovaries to have PCOS, and actually it's common for teens to have polycystic ovaries, long cycles and high insulin as their periods get established (๐ฃ๐ถ๐ต ๐ฏ๐ฐ๐ต ๐ง๐ฐ๐ณ ๐ญ๐ฐ๐ฏ๐จ๐ฆ๐ณ ๐ต๐ฉ๐ข๐ฏ ๐ข ๐บ๐ฆ๐ข๐ณ ๐ฐ๐ณ ๐ต๐ธ๐ฐ).
They are called cysts is because: normally you develop a few small follicles developing before ovulation, and one will become the dominant follicle and will ultimately be released from the ovary once it's ready: ovulated. However, in PCOS not one dominant follicle is selected, so you end up with many undeveloped follicles, which are called cysts. They will look different month to month, if you have this as part of your PCOS picture, because they will be reabsorbed and it will start again.
If you have PCOS, and you arenโt falling pregnant, the short answer is that your PCOS may be affecting your fertility.
๐
๐จ๐ซ ๐ญ๐ก๐ ๐๐จ๐ฅ๐ฅ๐จ๐ฐ๐ข๐ง๐ ๐ซ๐๐๐ฌ๐จ๐ง๐ฌ...
๐ High androgens (male hormones like testosterone) are typically high with PCOS, and insulin is often high too. Both interfere with egg quality. If the quality of your eggs arenโt top notch, they are less likely to fertilise or to stick once fertilised.
๐ Not ovulating or ovulating irregularly means either there is no egg available for conception, or you donโt know when it will be available to make sure the sperm can meet it.
๐ No or irregular ovulation means no empty follicle (corpus luteum, which produces progesterone) so you wonโt be able to produce the progesterone which is so necessary for supporting a pregnancy during the initial stages.
๐ Inflammation that often drives PCOS interferes with the delicate communication between hormones, and may worsen high insulin, which makes it all worse.
๐ Women with PCOS are more likely to suffer from low thyroid function, which exacerbates the situation.
Having described doom and gloom, I want to reassure you ๐ฉ๐ฅ๐๐๐ฌ๐ ๐ง๐จ๐ญ ๐ญ๐จ ๐ฐ๐จ๐ซ๐ซ๐ฒ - ๐๐ฅ๐ฅ ๐จ๐ ๐ญ๐ก๐ข๐ฌ ๐ซ๐๐ฌ๐ฉ๐จ๐ง๐๐ฌ ๐ฌ๐ฎ๐ฉ๐๐ซ ๐ฐ๐๐ฅ๐ฅ ๐ญ๐จ ๐๐ข๐๐ญ ๐๐ง๐ ๐ฅ๐ข๐๐๐ฌ๐ญ๐ฒ๐ฅ๐ ๐๐ก๐๐ง๐ ๐๐ฌ which can harmonise the levels of hormones and get them all produced, transported, attaching to the receptors and broken down appropriately.
But to understand whatโs driving your PCOS, you must talk to your GP about your concerns, ๐๐ฃ๐ ๐๐๐ฉ ๐ฉ๐๐จ๐ฉ๐๐...
Ideally, you need a thorough work up in blood testing that includes glucose & insulin (tolerance and fasting) and HbA1C, thyroid function, hormones, inflammation and more.
I also like to recommend the super DUTCH test which can show us more detail about these hormones as well as your cortisol pattern, which is incredibly helpful for putting the whole picture together.
Root cause
To resume and regulate your ovulation, improve your cycle and increase your chances of conceiving, it's paramount to identify what the root drivers and imbalances of your PCOS are.
๐๐ ๐๐ซ๐ ๐๐ฅ๐ฅ ๐๐ข๐จ๐๐ก๐๐ฆ๐ข๐๐๐ฅ๐ฅ๐ฒ ๐ฎ๐ง๐ข๐ช๐ฎ๐, so even though there are a large number of women with PCOS, the root causes vary hugely. So it's important to investigate the hormones and systems that aren't working well, peeling back the layers, to the root of it all.
These tend to be:
๐ฅ ๐๐ง๐๐ฅ๐๐ฆ๐ฆ๐๐ญ๐ข๐จ๐ง which is relevant to the other types but here it is the PRIMARY driver and may originate from digestive issues, environmental toxins, and foods you don't tolerate, plus other issues. You may experience significant fatigue, skin conditions and flares, joint pain, headaches
๐ฅ ๐๐ง๐ฌ๐ฎ๐ฅ๐ข๐ง ๐ซ๐๐ฌ๐ข๐ฌ๐ญ๐๐ง๐๐ Insulin normally rises and falls between meals, but if levels remain too high for too long and your cells stop responding to insulin, it leads to inflammation, impairs ovulation and triggers the production of more testosterone
Too much sugar, insufficient sleep, alcohol, an imbalance of gut bacteria, stress and more can lead to insulin resistance
You may carry excess weight, but not necessarily - you can still be normal weight and be insulin resistant
๐ฅ ๐๐๐ซ๐๐ง๐๐ฅ This type is driven by your stress response, and may have a genetic component making you more vulnerable to the negative effects of stress. There is also a link between high levels of stress during puberty, and adrenal PCOS, and endocrine disruptors
You will know this is relevant to you if all other parameters are normal but you have high DHEA-S in your blood, with other factors being ruled out
๐ฅ ๐๐จ๐ฌ๐ญ ๐ก๐จ๐ซ๐ฆ๐จ๐ง๐๐ฅ ๐๐จ๐ง๐ญ๐ซ๐๐๐๐ฉ๐ญ๐ข๐ฏ๐s interfere with the natural rhythm of your cycle in order to stop you getting pregnant. This can result in higher insulin, no ovulation and often an 'androgen' surge once you come off. The good news is that it tends to be temporary. If you were fine before going on hormonal contraceptives and you don't have insulin resistance, this type is more likely to be applicable to you.
I would add that close behind can be ๐๐ต๐๐ฟ๐ผ๐ถ๐ฑ ๐ถ๐๐๐๐ฒ๐, which also should be thoroughly checked over.
DIET
Eat the rainbow daily to benefit from a wide ranging and plentiful amount of antioxidants that can fight inflammation. Colourful vegetables should ideally fill half your plate. However, if youโre not used to eating so many vegetables, start by introducing one, then two, then three, to get your gut microbiome gradually used to eating more fibre. In time, you want to be eating 10+ different vegetables (and fruit) daily.
Balance your blood glucose by making sure you have a good portion (palm-sized) of protein and some fat every time you eat. Good sources of protein are the best quality your budget will allow, wild, grass-fed, organic and free-range meat, poultry and wild fish, organic eggs, fermented soya (tofu and tempeh), beans, lentils, yogurt, nuts and seeds, and fats are oily fish (salmon, mackerel, anchovies, sardines, herring), organic and free-range eggs, avocados, olives, olive oil, nuts and seeds.
Cook from scratch, using whole foods and avoiding or keeping to a minimum processed foods which are highly inflammatory.
Donโt avoid carbohydrates, just make sure they are complex and therefore low GI carbohydrates. Excellent options are those that are mainly plant based, such as beans like chickpeas (which are also good sources of plant protein), root vegetables, sweet potatoes, beetroots pumpkins and squash which provide lots of fibre and micronutrients too. Keep more starchy carbs such as rice, pasta and bread low but there is no need to avoid them if youโre eating them with protein and fat, and youโre eating lots of vegetables.
Include fruit but emphasise our native fruits from here in the UK, such as berries, apples, cherries, pears, quince and plums, and keep the sweeter, more tropical fruits such as mango, pineapple and lychees for less frequent occasions. Avoid dried fruit unless combining them with fat and protein such as dried apricots in a tajine.
Drink coffee if you are sure that you tolerate it well, i.e, that you donโt become jittery, wired, scattered and anxious, which are signs that coffee is not your friend. Make sure you buy organic to get the maximum dose of antioxidants and donโt drink coffee after midday, to make sure it isnโt interfering with your sleep (if you think you can have a coffee in the evening and it doesn't affect your sleep, youโre fooling yourself - it does). Ideally have one mug of great coffee with your breakfast, savour it, and leave it at that, choosing herbal teas such as green, verbena, spearmint and chamomile during the rest of the day. Please donโt immediately cut back your coffee if youโre a fiend - cut back gradually by swapping out half or a whole mug with decaf or green tea. You could suffer with terrible headaches and feel miserable if youโre not cutting back on coffee over a few weeks!
Avoid sugar as much as possible, especially if you have insulin resistance. Once your blood sugar is under better control you can have the occasional (once a month) pudding or piece of cake without it driving your PCOS in the same way. The less obvious sources of sugar are processed foods, yogurts, smoothies, energy balls. You may find that having more โcarbs' like rice and potatoes helps you to adapt to a less sugary diet as a temporary measure. If you need a sweetener, xylitol and stevia are good options.
Start the day on a protein-rich breakfast to get your blood sugar stable for the day. Eggs with veg are ideal!
Have an overnight fast of 12 hours as a minimum, but no more than 13/14 hours, especially if your PCOS is wholly or partly adrenal, as fasting for longer can drive adrenal dysregulation.