However, some experts believe that a TSH level of 2.5 indicates a person at risk of hypothyroidism who might even be experiencing some early symptoms, she said.
To see if a slightly underperforming thyroid gland could still affect fertility, Fazeli and her colleagues reviewed the cases of 187 couples with unexplained infertility. They also analyzed information on 52 couples in which the men had an extremely low sperm count, using them as a control group, for comparison.
Nearly 27 percent of women in the unexplained infertility group had a TSH level in the high-normal range of 2.5 or greater, compared with 13.5 percent of the women in the male-factor infertility group, Fazeli said.
The next step in research will be to see whether giving women supplements to boost their thyroid hormone levels will make a difference, Fazeli said.
Doctors already test for thyroid levels in pregnant women and treat them as necessary, said Dr. Tomer Singer, director of reproductive endocrinology at Lenox Hill Hospital in New York City.
“We pretty much implement treating patients with thyroid supplements when they have TSH greater than 2.5 because we know during pregnancy it’s been shown by several studies that the baby’s brain development can be affected if the patient hasn’t been treated for hypothyroidism,” said Singer, who wasn’t involved with the study.
“This is along the same lines,” he said. “Now, patients who are trying to conceive should be treated, and if they’re not treated, that in and of itself can be a contributing infertility cause.”
On the other hand, doctors might need to focus on the health problems that are causing low thyroid levels because those might be the true culprit behind infertility, said Dr. Alan Copperman, director of reproductive endocrinology and infertility at the Mount Sinai Health System in New York City. He also wasn’t part of the study.
“Is this in fact a person with health issues as exhibited by not enough thyroid hormone circulating? Is this a person with immune issues? Or is this background noise?” Copperman asked. “I don’t know we’ve yet answered that question. If the finding is real, it could just be a surrogate marker for other health issues.”
The new study was published online Dec. 19 in the Journal of Clinical Endocrinology & Metabolism.
- Can Hypothyroidism Impact Your Fertility?
- Testing for Hypothyroidism
- Hypothyroidism and Fertility
- Hypothyroidism and Pregnancy
- Preparing for a successful pregnancy with a thyroid condition
- Thyroid Disease in Pregnancy: What to Know
- Hashimoto’s Thyroiditis and PCOS: Is There a Connection?
- I got pregnant with no menstrual cycle!
- The hCG test was wrong!
- You have to have an abortion!
- Pregnancy after a Thyroid Scan
- Motherhood is the best thing in the world
- After birth my polycystic ovaries were gone!
- How To Get Pregnant With PCOS – The 11 Things You Need To Know
- 6. Don’t Make This Preconception Treatment Mistake With Clomid
- 7. Consider Taking Myo-Inositol
- 8. Implement A PCOS Fertility Diet No Matter Which Path You Choose
- 9. Make Exercise Part Of Your Weekly Routine
- 10. Implement Stress Management Techniques
- 11. Don’t Lose Hope – PCOS Pregnancy Success Stories
Can Hypothyroidism Impact Your Fertility?
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When your thyroid gland isn’t making enough thyroid hormone, it can have a serious effect on every organ in your body — including your reproductive system.
This means hypothyroidism may make it difficult to conceive if you’re planning on having children. A study published in August 2015 in the Journal of Pregnancy found that women with hypothyroidism were less likely to become pregnant — and more likely to take longer to become pregnant — than women without the condition.
That’s because women with hypothyroidism may not ovulate or ovulate with any regularity, “and you have to ovulate to get pregnant,” says Ingrid Rodi, MD, a gynecologist and reproductive endocrinologist at UCLA Medical Center in Santa Monica, California.
Hypothyroidism can affect fertility in men as well, according to the Thyroid Foundation of Canada. Although hypothyroidism is less common in men, those who do have an underactive thyroid may have low libido and low sperm count, according to a review of research published in November 2013 in Frontiers in Endocrinology in November 2013.
Additionally, hypothyroidism can lead to fatigue in both men and women. “When you’re fatigued, you may not have much sex,” Dr. Rodi says. “It’s harder to get pregnant when you’re not having much sex.”
Here’s what you can do if you’re planning on having children and think you may have hypothyroidism.
Testing for Hypothyroidism
If you’re experiencing symptoms of hypothyroidism — fatigue, increased sensitivity to cold, constipation, dry skin, weight gain, muscle weakness, and heavier than normal or irregular menstrual periods in women, among others — you should get tested for the condition.
A simple blood test can reveal whether your thyroid gland is functioning normally. The test measures the amount of thyroid stimulating hormone (TSH) in your bloodstream, and high levels suggest hypothyroidism, according to the American Thyroid Association.
So, should you be tested for hypothyroidism before you try to conceive? Rodi believes so, especially because more women are waiting until they’re older to become pregnant. “The older you are, the more chances you have of acquiring hypothyroidism,” she says. “The thyroid is a particularly sensitive organ and fails particularly frequently.”
Hypothyroidism is one of the many common conditions that your doctor can test for as part of a pre-pregnancy health check, according to the American Pregnancy Association, noting that it’s better to identify and treat health issues before conception. A conversation about pre-pregnancy testing is especially warranted if thyroid health problems run in your family, the British Thyroid Foundation says.
Women who have difficulty getting pregnant or who have had miscarriages previously should be tested, says Salila Kurra, MD, co-director of the Columbia Adrenal Center at NewYork-Presbyterian Hospital/Columbia University Medical Center in New York City.
Hypothyroidism and Fertility
Hypothyroidism can be easily treated, and once you get your thyroid levels back to a normal range, you can become pregnant, Rodi says. Treatment involves taking synthetic thyroid hormone in pill form. Though it may take a few months to determine the proper amount of hormone for you, once you and your doctor determine your optimal dosage, “you should be feeling yourself again and be able to conceive,” she notes.
When hypothyroidism is the reason for infertility, taking thyroid medication will enable most women to conceive, from as soon as six weeks after treatment, according to a study published in February 2015 in the IOSR Journal of Dental and Medical Sciences. The study also pointed out that many women who have a problem conceiving may have no apparent symptoms of hypothyroidism and only slightly elevated TSH levels, making it all the more important to have a TSH blood test if you’re having a hard time getting pregnant and don’t know why.
Another study found that treating hypothyroidism with medication not only improved conception rates, but also reduced miscarriages early in pregnancy, which can happen as a result of untreated severe hypothyroidism. Those results were published in January 2015 in The Obstetrician & Gynaecologist.
Hypothyroidism and Pregnancy
Once you conceive, it’s important to continue to monitor your thyroid hormone levels throughout your pregnancy. Your doctor may need to adjust your medication dosage to keep your TSH under control.
“You need to be tested periodically during pregnancy,” Rodi says. Typically, that means about three times, she adds.
Most of the time, mildly low thyroid hormone levels won’t affect the fetus or the pregnancy, Rodi says. However, she notes, severe hypothyroidism “can be associated with a number of bad outcomes, including miscarriage and fetal death.” Thus it’s critical to continue taking your medication throughout your pregnancy — but rest assured that there’s no harm in it to you or the baby, according to Rodi.
If you have any concerns about your thyroid function while pregnant or trying to become pregnant, talk to a reproductive endocrinologist or an obstetrician/gynecologist trained in fertility and hypothyroidism, Dr. Kurra advises.
Preparing for a successful pregnancy with a thyroid condition
If you have an undiagnosed thyroid condition it may make it difficult to conceive and can potentially cause some problems during pregnancy. So if there is any family history of thyroid problems; or you have an irregular menstrual cycle; or it has taken more than 6 months to conceive you may want to check for any potential symptoms on these patient advice sheets and consider getting tested.
If you’ve already been diagnosed with a thyroid condition, there’s no reason why you shouldn’t have a healthy pregnancy and baby. However, it’s important to let your doctor know a few months in advance of trying for a baby so that you can work together to optimise your outcomes before and during pregnancy.
If you think you’ve conceived before taking the advice of your GP don’t panic. Your risk of complications will only be slightly higher than usual. Just let them know as soon as possible.
Before conception it’s currently recommended that your TSH (thyroid stimulating concentration) should ideally be kept in the lower half of the reference range (between 0.5 and 2.5 mU/L) as this has been associated with a lower risk of miscarriage.
During the first trimester (12 weeks), the healthy brain development of the foetus is very much dependent on the mother’s thyroid hormones so careful monitoring is advised. During pregnancy your levels should ideally be kept below 2.0 mU/L which may require a dose adjustment in your medication in order to mimic the body’s natural increase of thyroid hormones by as much as 50%.
For women with an underactive thyroid (hypothyroidism) it‘s perfectly safe to take Levothyroxine during pregnancy and it’s not unusual for your dose to be increased by between 25 to 50 mcg daily at this time.
With regard to women with an overactive thyroid (hyperthyroidism), Propylthiouracil (PTU) is usually considered the preferred drug in early pregnancy as it is less likely to cross the placenta than carbimazole (CMZ). However, it is often changed back to carbimazole in later months as there have been rare reports of liver toxicity in young children.
Regular blood tests should be taken throughout pregnancy with TSH levels being measured monthly to keep your thyroid levels as required.
If you have normal thyroid function, your need for iodine increases during pregnancy so you will still be recommended to have prenatal vitamins that will typically include iodine, folic acid and vitamins D and B12.
Supplements and Levothyroxine
If you are prescribed supplements which include iron, calcium or are taking Gaviscon you should wait three to four hours before or after your levothyroxine as they can affect absorption. This applies to your prenatal vitamins if they contain iron or calcium too. There is no need to take additional iodine if you are already taking Levothyroxine.
Graves’ disease and pregnancy
Men are advised to wait for 4 months before fathering a child if they have had radioiodine treatment. Women are advised to wait for 6 months before becoming pregnant after radioiodine treatment.
Although your thyroid function may be normal on Levothyroxine after being successfully treated by surgery or radioiodine, there may still be Graves’ disease antibodies in the blood (called the TSH receptor antibodies) even if your condition is well under control.
These antibodies can cross the placenta and cause temporary symptoms of Graves’ disease in the baby during the second half of pregnancy and for up to 2-3 months after delivery.
By measuring the level of this antibody early in the pregnancy you can be guided as to whether this is likely to be a problem in your pregnancy. The heart rate and growth rate of the developing baby in the womb can also indicate if there is a potential problem.
I hope you found this helpful. Please read my next post about morning sickness and pregnancy – you might be surprised to learn that this is endocrine related.
Although every effort is made to ensure that all health advice on this website is accurate and up to date it is for information purposes and should not replace a visit to your doctor or health care professional.
As the advice is general in nature rather than specific to individuals Dr Vanderpump cannot accept any liability for actions arising from its use nor can he be held responsible for the content of any pages referenced by an external link
Thyroid Disease in Pregnancy: What to Know
The thyroid diseases—hyperthyroidism and hypothyroidism—are relatively common in pregnancy and important to treat. The thyroid is an organ located in the front of your neck that releases hormones that regulate your metabolism (the way your body uses energy), heart and nervous system, weight, body temperature, and many other processes in the body.
Thyroid hormones are particularly necessary to assure healthy fetal development of the brain and nervous system during the first three months of your pregnancy since the baby depends on your hormones, which are delivered through the placenta. At around 12 weeks, the thyroid gland in the fetus will begin to produce its own thyroid hormones.
There are 2 pregnancy-related hormones: estrogen and human chorionic gonadotropin (hCG) that may cause your thyroid levels to rise. This may make it a bit harder to diagnose thyroid diseases that develop during pregnancy. However, your doctor will be on the look-out for symptoms that suggest the need for additional testing.
However, if you have pre-existing hyperthyroidism or hypothyroidism, you should expect more medical attention to keep these conditions in control while you are pregnant, especially for the first trimester. Occasionally, pregnancy may cause symptoms similar to hyperthyroidism; should you experience any uncomfortable or new symptoms, including palpitations, weight loss, or persistent vomiting, you should, of course, contact your physician.
Untreated thyroid diseases during pregnancy may lead to premature birth, preeclampsia (a severe increase in blood pressure), miscarriage, and low birth weight among other problems. Therefore, it is important to talk to your doctor if you have had a history of hypothyroidism or hyperthyroidism so you can be monitored before and during your pregnancy, and to be sure that your medication is properly adjusted, if necessary.
Symptoms of Hyperthyroidism & Hypothyroidism While Pregnant
Symptoms of hyperthyroidism may mimic those of normal pregnancy, such as an increased heart rate, sensitivity to hot temperatures, and fatigue. Other symptoms of hyperthyroidism include the following:
- Irregular heartbeat
- Heightened nervousness
- Severe nausea or vomiting
- Shaking hands (slight tremor)
- Trouble sleeping
- Weight loss or low weight gain beyond that expected of a typical pregnancy
Symptoms of hypothyroidism, such as extreme tiredness and weight gain, may be easily confused with normal symptoms of pregnancy. Other symptoms may include:
- Difficulty concentrating or memory problems
- Sensitivity to cold temperatures
- Muscle cramps
Causes of Thyroid Disease in Pregnancy
Hyperthyroid disease—The most common cause of maternal hyperthyroidism during pregnancy is the autoimmune disorder Grave’s disease. In this disorder, the body makes an antibody (a protein produced by the body when it thinks a virus or bacteria is present) called thyroid-stimulating immunoglobulin (TSI) that causes the thyroid to overreact and make too much thyroid hormone.
Even if you’ve had radioactive iodine treatment or surgery to remove your thyroid, your body can still make the TSI antibody. If these levels rise too high, TSI will travel through your blood to the developing fetus, which may cause its thyroid to begin to produce more hormone than it needs. So long as your doctor is checking your thyroid levels, both you and your baby will get the care needed to keep any problems in check.
Hypothyroid disease—The most common cause of hypothyroidism is the autoimmune disorder known as Hashimoto’s thyroiditis. In this condition, the body mistakenly attacks the cells of the thyroid gland, leaving the thyroid without enough cells and enzymes to make enough thyroid hormone to meet the body’s needs.
Diagnosis of Thyroid Disease in Pregnancy
Hyperthyroidism and hypothyroidism in pregnancy are diagnosed based on symptoms, physical exam, and blood tests to measure levels of thyroid-stimulating hormone (TSH) and thyroid hormones T4, and for hyperthyroidism also T3.
Treatment of Thyroid Disease in Pregnancy
For women who require treatment for hyperthyroidism, an antithyroid medication that blocks production of thyroid hormones is used. This medication—propylthiouracil (PTU)—is usually given during the first trimester, and — if necessary, methimazole can be used, after the first trimester. In rare cases in which women do not respond to these medications or have side effects from the therapies, surgery to remove part of the thyroid may be necessary. Hyperthyroidism may get worse in the first 3 months after you give birth, and your doctor may need to increase the dose of medication.
Hypothyroidism is treated with a synthetic (man-made) hormone called levothyroxine, which is similar to the hormone T4 made by the thyroid. Your doctor will adjust the dose of your levothyroxine at diagnosis of pregnancy and will continue to monitor your thyroid function tests every 4-6 weeks during pregnancy. If you have hypothyroidism and are taking levothyroxine, it is important to notify your doctor as soon as you know you are pregnant, so that the dose of levothyroxine can be increased accordingly to accommodate the increase in thyroid hormone replacement required during pregnancy. Because the iron and calcium in prenatal vitamins may block the absorption of thyroid hormone in your body, you should not take your prenatal vitamin within 3-4 hours of taking levothyroxine.
Updated on: 04/27/18 Continue Reading Thyroid Gland Overview View Sources
- NIH. National Institute of Diabetes, and Digestive and Kidney Diseases. Thyroid disease and pregnancy. Available at: www.niddk.nih.gov/health-information/endocrine-diseases/pregnancy-thyroid-disease. Accessed April 24, 2018.
- Alexander AK, Pearce EN, Brent GA, et al. 2017 American Thyroid Association Guidelines for Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum. Thyroid. 2017;27(3):315-389.
- De Groot L, Abalovich M, Alexander EK, et al. The Endocrine Society. Management of Thyroid Dysfunction in Pregnancy and Postpartum: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2012;97(8):2543-2565.
Hashimoto’s Thyroiditis and PCOS: Is There a Connection?
Both experts had similar responses to the overall finding of the study, that is, that it is clear that Hashimoto’s thyroiditis occurs in many women who have PCOS.
“An association between autoimmune thyroid disease and a polycystic ovary syndrome phenotype has been often – but not universally – found, so the suggestion of an increased prevalence of Hashimoto’s thyroiditis in patients with polycystic ovary syndrome is not surprising,” Dr. Angell tells EndocrineWeb.
Dr. Skugor concurs. “The population studied comes from a fertility clinic, and since both conditions—PCOS and autoimmune thyroiditis—impair fertility, and it is more likely for both metabolic diseases, which have a genetic link, to be found in these patients,” he says.
Managing Your Health when Diagnosed with Both Conditions
According to Dr. Urich and his team, their findings matter because the data comes from “the largest single cohort examined to date.” Therefore, the results are of value, as they underscore the importance of screening women for autoimmune thyroiditis, especially in patients concerned about their fertility,2 according to the authors.
“In summary, a 3-fold increase in the prevalence of autoimmune thyroiditis, and hypothyroidism in women with PCOS appears to be established. And, the presence of both PCOS and Hashimoto’s thyroid disease seems to worsen the impact on metabolic, cardiovascular, and reproductive outcomes,”2 the authors wrote.2
So if you have polycystic ovary syndrome and are being evaluated for infertility, be sure ask your physician about your risk for comorbid conditions, in particular, Hashimoto’s (autoimmune) thyroiditis.
According to the experts, patients seeking reproductive evaluations for difficulty in getting pregnant are often screened for both polycystic ovary syndrome and hypothyroid disease because of their known impact on sex hormones and fertility.
“An important question for these women—does treatment with thyroid hormones improve fertility in women with autoimmune thyroiditis?” Dr. Skugor tells EndocrineWeb. He recommends directing future research to this issue, particularly as several studies suggest the value of thyroid hormone is beneficial during fertility treatment.5,6
“Additional studies are needed to elucidate how Hashimoto’s thyroiditis and PCOS are associated and the mechanisms connecting them,” Dr. Angell suggests. “Both PCOS and autoimmune hypothyroid disease have been associated with less successful fertility, and understanding the particular outcomes for patients with these conditions and the ideal treatment in these patients warrant further study.”
Last updated on 04/15/2019 Continue Reading Hashimoto’s Thyroiditis: My Journey Back to Health View Sources
2Ulrich J, Goerges J, Keck C, Muller-Wieland D, Diederich S, Janssen OE. Impact of Autoimmune Thyroiditis on Reproductive and Metabolic Parameters in Patients with Polycystic Ovary Syndrome. Exp Clin Endocrinol Diabetes 2018;126:198-204.
3British Thyroid Foundation. Your Thyroid Gland. http://www.btf-thyroid.org/ index.php/thyroid. Accessed May 7, 2018.
4Hadley M. Endocrinology. Upper Saddle River, NJ: Prentice Hall; 2000.
I got pregnant with no menstrual cycle!
I had polycystic ovaries and was under birth control for six years. “Since you don’t have a period, it’s difficult for you to get pregnant and have a child,” my gynecologist had said. At that time I had stopped taking the pill for two and half years and had free intercourse with my husband for six months, almost every day, or every other day. My period came all of a sudden after 4 months and only once. And so in the beginning I didn’t realize I was pregnant. I hadn’t menstruated for three months. And then I only had one single drop of black blood for one day and I conceived! And never saw any blood ever since. I conceived a child with no period!
The hCG test was wrong!
I had had an hCG test with another doctor, and had come out with a wrong result. I have a thyroid condition and I had a thyroid scan. As soon as I did the scan, I started vomiting. On the first couple of days, I thought it was the Thyroid scintigraphy. But the vomiting wouldn’t stop. So here I was taking the hCG test once again two weeks later. There had been a lab mistake. I was pregnant.
You have to have an abortion!
I go to my gynecologist, I’m telling him I’d had a thyroid scan, he examines me and finds that indeed I was pregnant. He closes the monitor, so I wouldn’t be able to see the baby, and turns to me and says: “We need to arrange for the abortion.”
My eyes are full of tears. Because I had the thyroid scan and the scan drug had entered in my system (something like radioactive iodine), he said that the child would be affected. As we learned in the process, the amount of radiation was the same as when you put the mobile phone to your ear. I had a feeling that the child as healthy as could be. Whatever it is, I want to go ahead and have a nuchal translucency, I said. “I will not take that risk,” says the gynecologist. “Either you have an abortion, or go find another doctor.”
Pregnancy after a Thyroid Scan
I looked for another obstetrician and found Dr Paraschos. I emailed him the thyroid test results and asked him what I should do from then on. We set up an appointment after 2 days. After he examines me, he goes, “In taking over now, and there’s no way anything happens to the child!” He just saw me quite often, to check the baby’s development. Every week we had an ultrasound, whereas normally, I would have had it once a month. After we did the NT and saw everything was OK, I calmed down.
Motherhood is the best thing in the world
I felt complete. I cannot describe this feeling. Amazing moments, very strong emotions. And to think the other gynecologist wanted me to have an abortion! And now I see my boy and say: “Dude, you’re a joy to us all!”
After birth my polycystic ovaries were gone!
I kept my child. I heard not my mind, but my heart. After giving birth I now have a normal period. And I do not have PCOS anymore. Birth helped with the thyroid, too. It got smaller.
During pregnancy every 45 days I was tested for my thyroid levels. Since the 8th month my thyroid reached normal levels. “To stay there, it is advisable to keep taking the pills,” my doctor told me. Anyway, pregnancy eventually changes everything. Pregnancy hormones do wonders.
How To Get Pregnant With PCOS – The 11 Things You Need To Know
Once your eggs have been collected, they are then fertilized either by introducing your partner’s sperm and letting the little swimmers do their thing, or by injecting a single lucky sperm directly into the egg – a process known as intracytoplasmic sperm injection (ICSI). This last step is an optional technology which greatly increases fertilization rates and helps overcome shortcomings in your partner’s fertility. This is something my husband and I opted for the second time around after so few of my eggs fertilized during my first cycle.
Once the eggs are fertilized they are then grown for a few days under carefully controlled lab conditions before either being placed back into your uterus as a “fresh embryo transfer”, or being cryogenically preserved for a later date in what’s known as a “frozen embryo transfer”.
The last IVF technology worth a quick mention here for anyone concerned about getting pregnant with PCOS is PGS testing or pre-implantation genetic screening. As the name suggests, this involves checking to see if an embryo has a normal set of genes before going ahead and putting it back in your uterus. This can make one of the biggest possible differences to your chances of success.
But just to be clear on this technology, women with PCOS have been shown to have a normal risk for chromosomal abnormalities (Luo et al. 20173) so a decision to undergo PGS should be made for other reasons.
In my case, PGS took my IVF success rate probability from 35% per transfer to 70% which essentially halved the chances of an early miscarriage. PGS is super expensive though, so it’s not for the faint hearted and as my successive failed cycle’s show it’s still no guarantee of success.
6. Don’t Make This Preconception Treatment Mistake With Clomid
Putting the principles of Step #5 into practice, here’s some essential knowledge for anyone that’s advised to go on birth control before starting a clomid cycle:
A recent survey revealed many obstetricians and even reproductive endocrinologists have major knowledge gaps when it comes to PCOS (Dokras et al. 201714).
As a result of this gap many doctors will incorrectly prescribe the birth control pill as a short term preconception treatment. The idea behind this thinking is that the pill will suppress the over-production of androgens, which in theory should then also kick-start ovulation when you then stop taking them.
The problem with this approach is that it’s based on outdated science.
Recent research has shown that taking birth control for four months in preparation for fertility treatment may in fact do more harm than good. Preconception birth control not only has no benefit to your chances of ovulation, but it also worsens metabolic health and may potentially be detrimental to your fertility (Legro et al. 201515; Legro et al. 20168).
As I mentioned earlier, rather than mess around with birth control ahead of taking clomid, it’s been clearly shown that taking a four month break to improve your diet and lifestyle makes it far more likely that you’ll successfully fall pregnant if and when you eventually proceed with your fertility treatments (Legro et al. 20168).
Randiann Tokeshi would be the first to agree with these scientific findings. After three unsuccessful rounds of clomid, two IVF cycles, and a first trimester miscarriage, Randiann felt defeated and fell into depression. Her faith was restored however, after taking part in my free 30 Day PCOS Diet Challenge where she began applying the principles of a PCOS fertility diet. Over a six-month period, she lost 45 pounds and finally decided to give clomid another try. Two cycles later, her six-year journey through heart-breaking infertility had finally ended with the blessing she had longed for.
Randiann gave me permission to use this touching message she posted in my PCOS Support Facebook Group.
During every free 30 Day PCOS Diet Challenge, I see many women struggling with the idea that an answer as simple as dietary change can lead to such powerful results. My hope is that this disbelief will diminish as the latest research is more widely disseminated and we hear more from inspiring women like Randiann.
7. Consider Taking Myo-Inositol
After having been through IVF twice, with a nearly disastrous outcome the first time (see my journey to overcome PCOS and infertility) one of the things I wish I had known before starting IVF, was how useful the supplement myo-inositol is. This is another nugget of information, the most well informed PCOS fertility patients should know about.
Myo-inositol is a safe and affordable supplement that has been shown to increase egg quality and reduce the risk of ovarian hyperstimulation syndrome when doing IVF (Papaleo et al. 200916; Ciotta et al. 201117).
Myo-inositol has also been shown to be more effective than birth control at regulating our ovarian function (Ozay et al. 201618), and appears to be better than metformin for boosting pregnancy rates in women with PCOS (Raffone et al. 201019).
One of the most popular inositol supplements for women with PCOS is the product Ovasitol by Theralogix. This supplement contains a combination of two types of inositol, with myo-inositol being the main ingredient. Ovasitol is widely promoted for helping you to get pregnant with PCOS, and this certainly seems to be well supported by science.
Here’s where I differ from other people about this product though. While Ovasitol is clearly a good supplement, even after allowing for the smaller recommended dosage, it’s three times more expensive than a regular myo-inositol supplement.
For women with PCOS that are only interested in boosting their fertility, this well-marketed product does not appear to be significantly better over the long term than it’s cheaper, myo-inositol only alternative. This is actually spelled out in the results of the most commonly cited study, it’s just that this fact is conveniently omitted by promoters of the product (Nordio and Proietti 201220).
While I’m not a fan of self-prescribing anything besides food and exercise, if you were to take myo-inositol, doses of 4000 mg per day are commonly prescribed for the treatment of PCOS infertility. This dose also appears to improve insulin resistance in pregnant women with gestational diabetes (Regidor et al. 201621; Corrado et al. 201122; D’Anna et al. 201223).
You can read more about myo-inositol for fertility here.
8. Implement A PCOS Fertility Diet No Matter Which Path You Choose
While diet changes are listed as #8 on this list, they are actually the MOST important step you can take towards a successful PCOS pregnancy.
At the top of this article I explained the mechanisms by which our hormone imbalances mess-up our ovulatory cycle and that it all begins with high androgens, inflammation, and how our cells respond to glucose. With this in mind, it makes perfects sense that we can reverse these negative effects by being more selective about the foods we eat.
Two women, Alisha P and Bianca K, are perfect examples of what’s possible when implementing the right kind of PCOS diet plan to get pregnant.
Despite having spent nearly two years struggling with infertility, Alisha P was not happy about the idea of taking clomid and metformin to help her ovulate. Instead she chose to join my 10 Week Program and after starting what would become a dramatic change to her diet and lifestyle, Alisha went from having no energy to feeling fantastic. She lost 30 pounds, her skin cleared up, her hormone blood tests started coming back normal, and she regained a normal period after not having one for 8 months. The best part though, was that within months of starting this transformational change, Alisha fell pregnant naturally just the way she’d always hoped for.
You can read Alisha’s full story here.
Bianca K on the other hand discovered the power of a PCOS diet after she was told that since she needed to lose weight but couldn’t, bariatric surgery was her best option for starting a family. After taking part in my free 30 Day PCOS Diet Challenge, Bianca cancelled her appointment with the surgeon, and went on to do things her own way. After losing 30 pounds by learning how to make PCOS friendly meals, Bianca was able to fall pregnant naturally and is now a mother to a beautiful son.
You can read her full story in her own words here.
So, what does a diet geared towards fertility for women with PCOS actually look like in practice?
First, as I’ve already mentioned, a PCOS fertility diet has us eliminating pro-inflammatory foods like vegetable oils and sugar. Other foods that trigger our immune system can also make a big difference to our fertility as I describe more here.
We can also choose foods that promote a slow rise and fall of our blood glucose levels, which help us avoid the cascading events that mess with our ovaries. This is by far one of the most powerful levers to pull. Many women report getting their first period in years when they get started on the meal plans I provide during my free 30 Day PCOS Diet Challenge or by using my free 3 Day PCOS Meal Plan.
Rather than eat foods that spike your blood sugar levels, it’s better to nourish yourself with foods that sustain you across the day.
By directly addressing your insulin response in this way you’re treating your infertility at a basic level rather than applying another band-aid solution. Instead of taking a drug to alter your hormones, you’re eating in a way that lets your body do so naturally providing a long term solution with benefits that go well beyond just getting you pregnant.
By treating your PCOS with food you lower your chances of miscarriage, and the likelihood of developing gestational diabetes, or preeclampsia. You’ll breastfeed better, your baby will be healthier long-term, and if you’re blessed with a girl, you’ll lower the chances of passing on your PCOS diagnosis to her (Tata et al. 201824).
If you’re just getting started on your family now, treating your PCOS with food also means you’ll be far better prepared when it’s time for baby number two, three, or four.
From a general health perspective, the right PCOS diet helps you achieve and maintain a healthy body weight, improves both your cardiovascular and metabolic health, and lowers the risk of liver disease, and endometrial cancer which are generally elevated in women with PCOS (Glintborg et al. 201745).
PCOS friendly food really has a lot going for it…
If I’ve managed to convince you that dietary change really is a kick-ass solution and you’re ready for action, make sure to read my comprehensive PCOS diet blog. In this ultimate beginner’s guide, I provide a thorough description of how to do a PCOS diet correctly, in 13 simple steps.
While these 13 steps are definitely simple to understand, when it comes to applying them, they can be a little overwhelming at first. This is exactly why I created my free 30 Day PCOS Diet Challenge. This free program makes it fun and easy to put all these good ideas into practice. As well as weekly meal plans, recipes, and shopping lists, the Challenge also includes video lessons and a vibrant online community to cheer you on.
I run the Challenge four times a year, which means there’s a good chance we’re starting one soon. If the timing isn’t right though and you want to get started today you can still take action by downloading my free 3 Day PCOS Diet Meal Plan. This 15-page ebook includes some of my most popular PCOS recipes as well as an accompanying shopping list and further information on beating PCOS through dietary intervention.
I also have a PCOS Diet Cheat Sheet you can stick on your refrigerator door as a prompt. This handy list summarizes a PCOS fertility diet on a single page using over 180 example foods. It also includes accompanying notes with a bunch of other information I’m sure you’ll find useful.
One of the important things to keep in mind when applying a PCOS friendly diet is that you don’t need to count calories or restrict your energy intake in anyway, even if losing some weight is included in your fertility plan. With the right changes to what you eat, excess body fat can be naturally eliminated without the need to worry about how much you’re eating.
If you’ve spent the last decade dieting, then I know this can sound like crazy-talk. But for people that begin losing weight sustainably for the first time in their lives, while still eating large and filling meals, the fact that this is possible at all is the best kind of crazy. If there’s one thing I’ve learned from being a part of a well-informed and determined PCOS community, it’s that for women that are nutrient deficient, sometimes eating more is actually the secret to losing body fat.
9. Make Exercise Part Of Your Weekly Routine
Like the right PCOS diet, exercise is another powerful way we can directly improve our reproductive potential (and neuro chemistry too) without taking drugs (Hakimi et al. 201725).
For example, it’s been shown that for women with PCOS, progressive resistance training can reduce insulin resistance (Cheema et al. 201426) as well as lower testosterone and free androgen levels (Thomson et al. 200827; Miranda-Furtado et al. 201628).
From what I understand, the way this works is that when we work out, we’re actually increasing the density of mitochondria, the cellular organs that power our muscles. More mitochondria in our muscle cells make them more sensitive to insulin, and the more sensitive they are to insulin, the better our hormone balance.
Aerobic exercise is also known to have a powerful effect at improving insulin sensitivity, but what’s even more interesting is its effect on inflammation – another root cause of many PCOS symptoms and health risks. This too has been well documented by science (Covington et al. 201629).
All of this should be of great interest to women with lean type PCOS as much as it is to women with more classical PCOS symptoms looking to lose weight. By reducing androgen levels, ovarian function is directly improved and this means better baby-making potential, whether or not you are wanting to lose weight.
This is saying nothing for the fact that exercise is one of the cheapest, safest and most effective way to help with stress management – the third key pillar to a PCOS friendly lifestyle. Put simply, exercise is awesome for both PCOS and fertility.
10. Implement Stress Management Techniques
Many people mistakenly ignore the psychological impact of infertility on reproductive function. This is fairly understandable given the research is fairly anecdotal still, and most people have become accustomed to stressful lifestyles where we’re pushed to our limits all the time.
But if you’ve ever felt anxious after a strong cup of coffee, or depressed after a boozey night, then you’ll have an appreciation for the link between our emotional state and our hormones. Our physiology affects our mental state, and our mental state affects our physiology with the link of course being our hormones.
While coping with stress is important for anyone’s good health, it’s particularly important that women with PCOS take care of their emotional wellbeing. Especially if you are trying to get pregnant.
Studies have shown that women with PCOS have elevated levels of the hormone cortisol when subjected to stressful situations (Benson and Arck 200930). Not only does this reduce our capacity to cope with stress well, but it also causes fat to accumulate on our stomachs and thighs, promotes insulin resistance, and markedly increases our probability of suffering from heart disease (Black 200331; Pasquali 200632; Koertge 200233).
For anyone trying to conceive, cortisol is the enemy which is why despite the obnoxiousness, there’s actually something to that “just relax” advice. In a world first, US researchers managed to demonstrate the link between stress and fertility status. After controlling for confounding factors such as female age, race, income, and the use of alcohol, caffeine and cigarettes, a two-fold increased risk of infertility was observed in women that had the highest bio-markers of stress (alpha-amylase) compared to those who were the most chilled-out (Lynch et al. 201434).
The interventions that I have always found most useful when trying to conceive (which I generally like to group as “self-care” therapies) include cognitive behavioral therapy, mindfulness meditation, and the practice of self-compassion. Relaxation exercises are also fantastic for acute stress and insomnia, and certain essential oils can be a great help too (see my free 5 Day Essential Oils for PCOS course for more information).
By practicing self-care in a methodical, disciplined way, we can actually attenuate our hyper-sensitive cortisol levels and have a small but real effect on our chances of falling pregnant.
Self-care really is one of the best things you can do for yourself if you’re trying to get pregnant with PCOS.
11. Don’t Lose Hope – PCOS Pregnancy Success Stories
Motivation is the secret sauce that makes all of these powerful lifestyle changes work. So let me give you a taste of what’s possible with another couple of inspiring examples of women that have taken this approach seriously and fallen pregnant as a result:
From the time she was 17, the only way Hanna would ever get her period was to be on birth control. But by the time she was ready to start her family, the problem came to a head for her and she became serious about taking better care of her PCOS.
She started doing short workouts that included a progressive resistance training program designed specifically with PCOS in mind. As I mentioned above, this type of exercise has been shown to be highly effective at restoring hormone balance in women with PCOS. But perhaps more importantly, Hanna also made the dietary changes she learned during my free 30 Day PCOS Diet Challenge. While this sounds almost too good to be true, her periods returned astonishingly quickly and within a few months she was happily pregnant.
You can read more about Hanna’s success story here.
Nellsy was another woman, who was able to overcome four years of infertility simply by changing her diet. Over the course of a full year following her participation in my 30 Day Challenge, Nellsy worked hard to quit sugar and to follow all of my dietary principles as best she could. With time, a PCOS friendly diet became second nature to her, she lost weight, and she was rewarded with the birth of her gorgeous rainbow baby after a healthy natural pregnancy.
Nellsy is now an enthusiastic advocate for the power of dietary change to overcome PCOS and infertility and was happy to let me share this inspiring post she wrote shortly after giving birth.
While Hanna, Nellsy, and the other women I’ve mentioned above may sound like extreme cases, the fact of the matter is that I’ve now lost count of the number of women with PCOS that I’ve seen fall pregnant after taking part in my free 30 Day PCOS Diet Challenge.
Even for me personally, despite all the medical treatment I went through, in the end, it was a low carb, nutrient dense, anti-inflammatory diet that restored my period for the first time since puberty and finally led to me falling pregnant naturally.
While the scientific evidence is extremely compelling, it’s my personal experience and the success of all these other women around me that makes me so optimistic whenever I meet someone facing PCOS and infertility.
Whether you pursue assisted reproduction, or you want to keep doing it the old fashioned way, by sticking to a PCOS friendly diet, by doing the right kind of exercise, and by proactively managing your stress, you are going to greatly increase your chances of getting pregnant with PCOS.
So if you’re ready for action, then come and join me for my next free 30 Day PCOS Diet Challenge.
And if you are pumped after reading this and don’t want to wait for the next live Challenge to start, then make sure to download this free 3 Day PCOS Meal Plan and this fridge-friendly PCOS Diet Cheat Sheet.
Having kids really is all it’s cracked up to be and you totally deserve every ounce of joy that they bring.
Wishing you the best of luck in your journey to that BFP!
Kym Campbell is a Health Coach and PCOS expert with a strong passion for using evidence-based lifestyle interventions to manage this disorder. Kym combines rigorous scientific analysis with the advice from leading clinicians to disseminate the most helpful PCOS patient-centric information you can find online. You can read more about Kym and her team here.
Dr. Jessica A McCoy, Ph.D
This blog post has been critically reviewed to ensure accurate interpretation and presentation of the scientific literature by Dr. Jessica A McCoy, Ph.D. Dr McCoy has a master’s degree in cellular and molecular biology, and a doctorate in reproductive biology and environmental health. She currently serves as a University professor at the College of Charleston, South Carolina.
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Dr. Sarah Lee, M.D
This blog post has also been medically reviewed and approved by Dr. Sarah Lee, M.D. Dr. Lee is a board-certified Physician practicing with Intermountain Healthcare in Utah. She obtained a Bachelor of Science in Biology from the University of Texas at Austin before earning her Doctor of Medicine from UT Health San Antonio.
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