Pregnancy and PCOS: 5 expert tips for increasing your fertility
By now, you probably know that getting pregnant can be more challenging when you have PCOS. Trying for a baby can be frustrating and upsetting, especially when friends or people on social media keep popping up with pregnancy announcements that seem like conception happened on the first try.
Firstly, remember that everyone has their own challenges in their journey to parenthood. But it’s also important to know that people with polycystic ovary syndrome can convenience naturally, and there are loads of positive pregnancy and birth stories from people with the condition out there.
The main reason people with PCOS struggle with fertility is because their eggs turn into cysts in the ovaries and aren’t released into the uterus where they can be fertilised.
'It can be harder for people with PCOS to get pregnant because of the high levels of hormones like insulin and androgens', says Alex Okell, a registered associate nutritionist and founder of non-diet education hub The PCOS Collective. 'This impacts the likelihood of ovulation. If you aren't ovulating, then conception isn't possible.'
Lifestyle changes are some of the most common and effective ways to manage the condition and, by supporting your hormone levels, you increase the chances of a menstrual cycle and ovulation. Here are some simple places to start.
Focus on nutrition
Eating a nutritious diet can help with regulating periods, improving ovarian function and balancing hormones. Remember that this will look different for everyone, but research shows that low GI diets (that is diets that avoid spiking blood sugar with high fibre and protein) are shown to reduce testosterone and other symptoms of PCOS.
'Focus on adding in foods rather than removing them,' says Okell. 'Ensure you are eating enough, eating regularly and getting a good variety of carbohydrates, fats and proteins to help with blood glucose management, which in turn improves insulin levels. To help lower androgen levels, try boosting your protein intake, particularly if you are vegan or vegetarian. You may find it helpful to focus on your omega-3 intake too, by eating more oily fish, flaxseeds, chia seeds and walnuts, for example, to help with the chronic inflammation associated with PCOS.'
Omega-3 has also been linked with supporting fertility. In a study from 2022, researchers found that women taking omega-3 supplements were more than two times more likely to conceive in a given menstrual cycle.
A paper from Reproductive Biology and Endocrinology in 2018 found that omega-3 fatty acid may improve insulin resistance and decrease total cholesterol in people with PCOS.
Current advice from the NHS is to get enough omega-3 from food by having one portion of oily fish a week (around 140g). Be wary of eating too much fish that may contain pollutants and fish oil supplements that can be high in vitamin A, both of which can be harmful during pregnancy.
For more information, read the NHS guide or talk to your doctor.
Regular exercise is essential for everyone, but people with PCOS need to be more cautious about their training. While many workouts can be a stress reliever, doing too much or too intense exercise can have the opposite effect, warns Okell.
'High-intensity workouts a few times a week are great if you enjoy them but if all your movement is high intensity then the amount of stress on your body will increase. This means that there may be higher circulating levels of cortisol (a stress hormone) which negatively impacts PCOS and fertility by boosting insulin levels and disrupting the balance of female hormones in the body,' she says.
Instead, balance your workouts between intense movement and gentle activity like walking and yoga that reduce blood sugar and stress levels. Strength training is also brilliant for metabolic health which can support hormone levels.
Think about supplements
'Everyone who is trying to conceive should be taking folic acid,' reminds Okell. While this nutrient is mainly taken to reduce the risk of problems in the baby’s development in the early weeks of pregnancy, 'folic acid supplementation has also been seen in some studies to help conception rates in people with PCOS.'
She also recommends pairing that with inositol, a B-like vitamin that is naturally produced in the body and can improve symptoms of PCOS by helping lower insulin and testosterone levels.
In a study from 2018, 3602 people with PCOS who couldn’t get pregnant were given 4000mg of myoinositol and 400mcg of folic acid every day. 70% of the participants restored their ovulation and 545 people (over 15% of the study) fell pregnant.
Finally, in the winter months, everyone in the UK should be supplementing with vitamin D, too. 'Vitamin D levels play a role in fertility and affect the outcomes of IVF, in people with and without PCOS,' adds Okell.
Manage your stress
Reducing stress is easier said than done when struggling with something like fertility issues. But the catch-22 is that the more stressed you are, the harder it might be to conceive. 'Stress massively impacts fertility. Continued cortisol production increases insulin levels, affecting female hormone balance. Focus on prioritising your sleep and rest and reducing external stress levels where possible,' says Okell.
That might mean being stricter with your work/life balance, cancelling plans that mean you’re booked back-to-back without any rest or spending extra time around loved ones who make you feel good. Most importantly, if you are worried about your chances of conceiving always talk to your doctor or healthcare provider who can support you.