Polycystic ovarian syndrome (PCOS) can make it difficult to conceive due to its impact on a woman’s menstrual cycle and ovulation. But it’s important to remember that there is a lot you can do to improve ovulation and your chances of conceiving. 

What is ovulation?

Ovulation is when an egg is released from your ovary into the fallopian tube ready to be fertilized by a healthy sperm. There are multiple follicles present in each ovary. During each cycle one of these follicles matures to the point where it is ready to be released and then fertilised for pregnancy. This usually occurs 13-15 days before the start of your period, however this is different for everyone and can differ each month, in fact some months ovulation may not occur at all. There are multiple hormones which are responsible for triggering different stages of ovulation, specifically oestrogen, a follicle stimulating hormone and luteinizing hormone. PCOS can cause an imbalance of these hormones which is what may delay or stop ovulation from happening.  

How do you know if you’ve ovulated? 

There are many ways to track ovulation, however, it’s important to know that there is no method that is 100% accurate. 

Using apps like Clue or Flo to track your cycles can help you identify when ovulation is likely to occur based on the pattern of your cycles. 

More accurate methods are measuring your basal body temperature or monitoring your cervical mucus. Measuring basal body temperature involves taking a body temperature reading every morning at the same time, your body temperature usually drops before ovulation and then increases rapidly. 

Your cervical mucus changes throughout your cycle. 1-2 days before ovulation occurs, oestrogen levels peak and you may notice that your cervical mucus resembles raw egg white and that you are able to stretch it for a few inches between your finger and thumb.

If you’ve already purchased or investigated using ovulation test strips then you may have noticed that they often advise women with PCOS not to use them. These strips test for the presence of luteinizing hormone, this hormone peaks triggering ovulation. The problem with PCOS is that levels of luteinizing hormone are often elevated which would constantly give a false positive ovulation test.  

If you are already or are contemplating using any of the above methods to monitor ovulation, please be aware of the impact it may have on your mental health. Cortisol (our stress hormone) is not good for ovulation. If at any point you find that tracking ovulation becomes stressful, I’d highly recommend taking a break, trying to have sex every 2-3 days instead and enjoying the process rather than worrying about when you’re ovulating.

What can I do to regulate ovulation? 

Many of the hormonal imbalances which impact ovulation in PCOS are driven by insulin resistance and elevated testosterone levels. Therefore, the key is to choose foods that don’t spike insulin levels. 

Choosing foods that are high in fibre and pairing these with proteins and a healthy fat source helps keep insulin levels stable. 

Regular exercise helps increase insulin sensitivity. This doesn’t mean you need to spend hours at the gym, even doing 20-30 minutes most days of the week can have a positive impact. 

Antioxidants are also great for improving egg quality and ovulation, we can get these through eating a diet that contains a wide variety of colorful fruits and vegetables. 

Are there supplements or medications that can help me ovulate? 

For many women, making some of the lifestyle changes mentioned above is enough for them to ovulate regularly and successfully conceive without having to use medication. 

You may benefit from taking supplements alongside these lifestyle changes to regulate ovulation. 

Vitamin D has been shown to lower testosterone levels, improve ovulation and egg quality. As women with PCOS are more likely to have a vitamin D deficiency it’s important to ensure you are taking a Vitamin D supplement, especially in the winter months as the sun’s UV rays are not strong enough to produce vitamin D. The recommendation is 10micrograms or 400IU. Remember that vitamin D is a fat-soluble vitamin and is best taken with a food/meal that contains fat. 

Inositol not only acts as an insulin sensitiser improving insulin resistance, it also improves ovulation and egg quality. The recommended dose is 4000mg per day, split in to two doses of 2000mg each. 

If you are actively trying to conceive, then it’s important that you’re taking a folic acid supplement to reduce the risk of major birth defects.  The recommendation is 400micrograms until your 12th week of pregnancy. 

If you feel like you’ve explored all the lifestyle changes and supplements and are not having much luck then you can discuss medication options with your gynae/endocrinologist. Before you do this, I’d really encourage you to try acupuncture - science has proven that regular acupuncture can help regulate ovulation, and it has none of the side effects experienced when taking medication. 

Before starting medication it’s important that your gynae checks for other medical reasons, such as blocked tubes. And please make sure your partner has had a semen analysis done – it’s important to rule out all other reasons before starting medication. 

Don’t underestimate the impact of stress

Stress is often overlooked when we look at making lifestyle changes even though most of us experience some level of stress daily. 

Studies have shown that being stressed for an extended period can result in elevated insulin levels and increased inflammation. If we’re being exposed to stress daily, then it makes sense that we need to find ways to unwind and destress daily too. Activities such as yoga, going for a walk outside, meditating, exercise or journaling can call help reduce stress levels.