Polycystic Ovarian Syndrome, or PCOS, is a health issue marked by hormonal imbalances that do not allow a woman’s eggs to develop properly. Women with PCOS may not ovulate very regularly and this can make it challenging to conceive a baby.

Fortunately, PCOS is more commonly diagnosed and understood these days. The root cause of PCOS is connected to genetic and environmental factors that may be out of our control. However, there is much that can be done to improve ovulation and egg quality with properly recommended nutritional supplements, herbal medicine, dietary therapy, exercise, and a proper lifestyle.

Criteria that can include PCOS diagnosis can include delayed ovulation or menstrual cycles, high androgenic hormones like testosterone, and/ or polycystic ovaries on ultrasound. Only two out of three of these criteria are necessary for a PCOS diagnosis. It is widely thought that both insulin regulation and high circulating androgen hormones such as testosterone are key players that contribute to PCOS. It is also now acknowledged that there are different types of PCOS. This means that clinically the treatment that works for one person may not be what someone else needs.

Women with PCOS are prone to blood sugar regulation issues. Blood sugar regulation is a complicated hormonal process in itself. When most people eat carbohydrates and sugary snacks the body releases a hormone called insulin. Insulin brings the sugar circulating in our bloodstream after a meal back into our cells so it can be used for energy or stored as fat. Some people develop insulin resistance where cells stop responding to insulin’s signal to let in sugar or glucose. This makes the body secrete even more insulin leaving circulating insulin levels high in the bloodstream

When insulin levels are high it can cause the theca cells on the outside of the ovarian follicles to produce more androgens such as testosterone. In addition, high circulating luteinizing hormone (LH) also causes the theca cells in the ovaries to produce more testosterone. While LH is high FSH remains low and this means that the eggs will not mature properly. The reason for high LH is thought to be complex and includes feedback loops that impact the pulses of the gonadotropin-releasing hormone (GnRH) in the brain.

Correcting blood sugar regulation will begin to improve egg quality so that ovulation may be possible or may occur more frequently. Dietary changes are essential to make this possible. Working with a health care practitioner who can give you the support to make empowering changes in your diet that are practical can be very helpful. A diet that works for one person may not be the right diet for another person. For most people adjusting macronutrient ratios is more effective and more sustainable than calorie-restricted types of diets. There are also supplements that have been shown to help support blood sugar regulation and decrease any inflammation that may have occurred as a result of the blood sugar regulation issues.

Exercise is proven in research studies to help with PCOS. Even small amounts of exercise have been shown to be helpful for PCOS. The type of exercise that is helpful can differ from person to person. For example, if you are starting a new type of diet doing too much cardiovascular exercise could trigger cravings for sugar and carbohydrates in some people. If you find this to be true, shifting to lower-intensity exercises such as lifting weights may be more helpful. Lifting weights boosts muscle. Muscle likes to use the glucose circulating in your blood as fuel. This can help to lower blood sugar and insulin levels.

For women who are already ovulating fairly regularly, working on blood sugar regulation may be enough to improve egg quality and conceive a baby. However, some women may need stronger hormone support to bring their cycles back regularly. The reason for this is that many women with PCOS have high and constant luteinizing hormone (LH) levels. LH is the hormone that you are checking for with ovulation predictor kits. It is the hormone the brain releases that gives the signal for the egg to be released every month. However, if you only have immature eggs that are not ready for ovulation, this will not happen. LH signals can be interrupted with appropriately timed progesterone supplements. Some women will only need herbal medicine that helps to support progesterone while others will need stronger forms of progesterone to interrupt this cycle.

Other factors that functional medicine practitioners will screen for in PCOS patients include thyroid issues, adrenal issues that could cause androgen excess, digestive issues, and environmental issues.

Acupuncture has also been shown to be helpful for PCOS in many research studies. Acupuncture has multiple physiologic effects. One way that acupuncture helps PCOS is through the release of beta-endorphins. Beta-endorphins modulate the release of hormones such as GnRH and CRH (corticotropin-releasing hormone) which can alter reproductive, adrenal, and pancreatic function. On a local level, acupuncture has been shown to increase glucose uptake and microcirculation.

In summary, there are many effective functional medicine treatment options for PCOS. By using functional medicine tools to make diet and lifestyle changes, you can increase your chances of natural conception or increase your egg quality to make assisted reproductive technologies (ART) more effective. This will not only improve your quality of life, but epigenetic research has shown that it can improve the quality of life of your children and grandchildren.

Sources:

Johansson, Julia, and Elisabet Stener-Victorin. “Polycystic ovary syndrome: effect and mechanisms of acupuncture for ovulation induction.” Evidence-Based Complementary and Alternative Medicine 2013 (2013).

Jedel, Elizabeth, et al. “Impact of electro-acupuncture and physical exercise on hyperandrogenism and oligo/amenorrhea in women with polycystic ovary syndrome: a randomized controlled trial.” American Journal of Physiology-Endocrinology and Metabolism 300.1 (2011): E37-E45.

Franks, Stephen, Jaroslav Stark, and Kate Hardy. “Follicle dynamics and anovulation in polycystic ovary syndrome.” Human reproduction update 14.4 (2008): 367-378.

We generally don’t like to hear the word “inflammation”. This word has a negative association with being injured or some sort of disease process happening inside the body. However, if you are working on getting pregnant, inflammation is a more complex issue.

Inflammation in the wrong time and wrong place can harm the quality of your developing eggs. We know that the development of eggs is heavily dependent on glutathione, your body’s master antioxidant. Glutathione is used to offset the free radicals produced during DNA and cell replication. If there is inflammation elsewhere in your body, it can use up your body’s precious glutathione, leaving less for egg development.

However, one part of reproduction where inflammation is essential is embryo implantation. When the embryo implants, the uterine wall releases important inflammatory prostaglandins and inflammatory cytokines. Taking anti-inflammatories either in the form of supplements or over-the-counter medications could reduce the chances that implantation takes place. We NEED these inflammatory processes in order to support a developing pregnancy.

Prostaglandins also increase during ovulation and are important for the release of the egg.

For some people, this may not be an issue, but if you have been having difficulty trying to conceive, you may want to be mindful of avoiding pharmaceutical, herbal and food-based anti-inflammatories during these short windows of time.

Ovulation generally occurs approximately 10-36 hours after a positive over-the-counter ovulation predictor kit test.

For someone ovulating at Day 14 of their cycle, the average timing of implantation generally occurs between Days 19 and 21, when the embryo is about 5 to 7 days old. However, this implantation window may extend as far as Days 18 and 24, so caution is warranted during this time.

Pharmaceutical drugs that have anti-inflammatory effects include aspirin, ibuprofen, naproxen and any other non-steroidal anti-inflammatory drugs (NSAIDs) and COX-2 inhibitors. Please discuss with your doctor for a full list if you are unsure.

Many supplements also have an anti-inflammatory effect, and it can be nuanced to understand which are still OK to take during your cycle as anti-inflammatory supplements can be very important for improving egg quality. This means that your fertility specialist may have recommended some of these supplements for you despite this research. Please discuss with your functional medicine fertility specialist for more information on the timing of your supplements to avoid hurting your chances.

There are many strategies for helping people to improve their chances of conceiving and many factors that affect fertility. Some people may need to work more on reducing inflammation and improving egg quality during an initial preconception program whereas, for others, avoiding anti-inflammatories during ovulation and implantation may not be an issue at all. A functional medicine fertility specialist can help you with an individual, tailored plan based on data help you to determine which approach is best!

References:

Griffith, Oliver W., et al. “Embryo implantation evolved from an ancestral inflammatory attachment reaction.” Proceedings of the National Academy of Sciences 114.32 (2017): E6566-E6575.

Niringiyumukiza, Jean Damascene, Hongcai Cai, and Wenpei Xiang. “Prostaglandin E2 involvement in mammalian female fertility: ovulation, fertilization, embryo development and early implantation.” Reproductive Biology and Endocrinology 16.1 (2018): 1-10.