PCOS (Polycystic Ovary Syndrome) as it relates to fertility

by | Sep 26, 2023

If you have been diagnosed with Polycystic Ovarian Syndrome (PCOS) and are struggling to conceive, you’re not alone. PCOS is a common hormonal disorder affecting women of childbearing age, with an estimated 6 to 12 percent of women facing this condition. The journey towards motherhood can feel like an uphill battle, but it’s important to remember that infertility associated with PCOS is not a dead end; it’s a challenge that can be overcome with the right approach and treatment.

Understanding PCOS
Polycystic Ovarian Syndrome is a complex hormonal disorder that can manifest in various ways. Its hallmark features include missed or irregular menstrual periods, the presence of cysts or fluid-filled follicles on the ovaries, anovulatory cycles (cycles where ovulation doesn’t occur), and elevated androgen levels. Androgens are “male” hormones, and their excess can lead to symptoms such as high testosterone, high DHEA, elevated AMH, and other reproductive hormone imbalances.

To diagnose PCOS accurately and develop a tailored treatment plan, a comprehensive approach to laboratory testing is crucial:

1. Fasting Labwork
Fasting labwork, conducted after an overnight fast, provides essential baseline information about your hormonal and metabolic profile. These tests are typically performed early in the morning to ensure accurate results, and typically include the following and more: 

Fasting Blood Glucose: This test measures your blood sugar levels after an overnight fast. Elevated fasting blood glucose can indicate insulin resistance, which is common in PCOS.

Insulin Levels: Checking fasting insulin levels can help identify insulin resistance, a key factor in many PCOS cases.

Lipid Profile: Assessing cholesterol levels and triglycerides is important, as women with PCOS may be at an increased risk of cardiovascular issues.

2. Hormonal Assessment

Hormonal imbalances are at the core of PCOS. Specialized functional lab testing can provide a deeper understanding of these imbalances:

Luteinizing Hormone (LH) and Follicle-Stimulating Hormone (FSH) Ratio: An elevated LH/FSH ratio is a common finding in PCOS and indicates disrupted ovulation.

Sex Hormone-Binding Globulin (SHBG): Low levels of SHBG are often seen in PCOS and can contribute to higher levels of free testosterone.  High levels are also seen. 

DHEA-Sulfate: Elevated DHEA-S levels may indicate adrenal involvement in androgen production and involvement in the adrenal system. 

3. Ovarian Reserve Testing

If fertility is a concern, assessing ovarian reserve can provide insights into your reproductive potential:

Anti-Mullerian Hormone (AMH): AMH levels can help estimate the number of eggs remaining in your ovaries.  This can be very high in PCOS. 

Antral Follicle Count (AFC): This ultrasound-based test evaluates the number of small, resting follicles in the ovaries.

4. Inflammatory Markers**

Chronic inflammation is associated with some types of PCOS. Measuring inflammatory markers can guide treatment:

High-Sensitivity C-Reactive Protein (hs-CRP): Elevated CRP levels may indicate systemic inflammation.

5. Thyroid Function Testing

Thyroid dysfunction can mimic PCOS symptoms. Comprehensive thyroid testing includes:

Thyroid Stimulating Hormone (TSH)
Free T3 and Free T4
Thyroid Antibodies (TPOAb and TgAb)

6. Comprehensive Nutritional and Micronutrient Assessment**

Nutritional deficiencies can exacerbate PCOS symptoms. Assessing vitamin and mineral status, along with functional nutrient testing, can guide supplementation:

Vitamin D
B Vitamins (B12, Folate, B6)


7. Comprehensive Hormone Panel

Specialized functional hormone testing may include measuring additional hormones like cortisol, progesterone, and estradiol to assess the overall hormonal picture.

8. Food Sensitivity and Gut Health Testing

Digestive issues and food sensitivities can impact inflammation and hormonal balance. Assessing gut health and identifying potential food sensitivities through specialized testing can inform dietary interventions.

The Four Types of PCOS

Recent research has identified that PCOS is not a one-size-fits-all condition. In fact, there are four distinct types of PCOS, each with its own unique characteristics and underlying hormonal imbalances. Understanding which type you have is crucial for tailoring your treatment plan effectively:

1. Insulin-Resistant PCOS (Type A)

This type of PCOS is often associated with insulin resistance, where the body’s cells don’t respond well to insulin. This can lead to elevated insulin levels in the bloodstream, which in turn triggers increased androgen production by the ovaries. Symptoms typically include weight gain, difficulty losing weight, and skin issues such as acne and hirsutism. Managing insulin levels through diet, exercise, and sometimes medication is key to addressing this type of PCOS.

2. Inflammatory PCOS (Type B)

Inflammatory PCOS is characterized by chronic inflammation in the body, which can further exacerbate hormonal imbalances. Symptoms may include severe menstrual cramps, painful periods, and inflammation-related conditions such as irritable bowel syndrome. Addressing inflammation through an anti-inflammatory diet and lifestyle changes is essential for this type of PCOS.

3. Adrenal PCOS (Type C)

In this type of PCOS, the adrenal glands play a more prominent role in androgen production, leading to symptoms such as fatigue, low blood sugar, and difficulty managing stress. Treatment often involves adrenal support, stress management techniques, and dietary modifications to stabilize blood sugar levels.

4. Post-Pill PCOS (Type D)

Some individuals develop PCOS-like symptoms after discontinuing hormonal birth control (the pill). This is known as Post-Pill PCOS and can involve irregular periods, acne, and other hormonal imbalances. Restoring hormonal balance and addressing underlying causes is essential in this scenario.

The Emotional Toll of PCOS

PCOS is not just a physical condition; it can also have a significant emotional impact, especially for those trying to conceive. The frustration and disappointment that often accompany infertility can take a toll on mental health. It’s essential to acknowledge and address these emotional challenges alongside the physical ones.

Hope Through Natural Treatments

While PCOS can present formidable obstacles, there is hope. Natural treatments can be highly effective in managing the condition and improving fertility. Here are some key strategies:

1. Diet and Lifestyle Changes

Our bodies are sensitive to fluctuations in blood sugar and hormones, which can be influenced by our diet and lifestyle. Therefore, adopting a PCOS-friendly diet and lifestyle is crucial for success.

* Eliminate Inflammatory Foods: Reducing or eliminating inflammatory foods such as processed sugars and unhealthy fats can help regulate insulin and hormone levels.

* Balance Blood Sugar: Focus on foods that stabilize blood sugar levels, including whole grains, colorful fruits and vegetables, quality fats, and healthy sources of protein.

* Consider Food Sensitivity Testing: Some individuals with PCOS may benefit from food sensitivity testing to identify adverse reactions to specific foods.

* Explore Intermittent Fasting: Research suggests that intermittent fasting can help regulate insulin levels and balance hormones in some cases.

2. Physical Activity

Regular physical activity is a powerful tool for balancing hormones and improving overall health. Whether it’s going for a brisk walk, practicing yoga, or hitting the gym, find a form of exercise that you enjoy and can incorporate into your lifestyle.

3. Herbal and Nutrient Supplements

Certain herbal, vitamin, and nutrient supplements can play a crucial role in balancing hormones in individuals with PCOS. Treatment plans should be customized to meet individual needs, but some supplements that have shown promise include:

* DIM (Diindolylmethane)
* Inositol
* Saw Palmetto
* Licorice
* Vitex
* Chromium
* Berberine
* Alpha-Lipoic Acid
* N-Acetyl Cysteine (NAC)
* Green Tea Extract
* Curcumin

It’s essential to work with a healthcare provider or naturopathic doctor to determine the right supplements and dosages for your specific situation.

4. Addressing the HPO Axis

The Hypothalamic-Pituitary-Ovary (HPO) axis plays a crucial role in regulating reproductive hormones. Modalities such as acupuncture, adrenal support, homeopathy, and ensuring quality sleep can help retrain the ovaries to communicate effectively with the brain, ultimately aiding in hormone regulation.

5. Stimulating Ovulation Naturally

One of the primary goals in treating PCOS-related infertility is to encourage more frequent ovulation cycles. Natural medicine offers various therapeutics to stimulate this process, allowing the body to regulate hormone signaling naturally.

In some challenging cases, fertility medications may be considered to assist with ovulation. However, natural therapeutics should always be explored first, as they can encourage the body to regain its hormonal balance independently.

Never Lose Hope

If you have PCOS and are struggling to conceive, please remember that there is light at the end of the tunnel. While the journey may be challenging, it’s important to remain hopeful. Our bodies are incredibly resilient and capable, and pregnancy is a natural, innate process.  

Seek the guidance of healthcare professionals who specialize in PCOS and fertility, and develop a comprehensive treatment plan tailored to your unique needs. By making dietary and lifestyle changes, incorporating physical activity, exploring natural supplements, and addressing the HPO axis, you can take significant steps toward overcoming infertility and realizing your dream of starting a family.

PCOS may present obstacles, but with determination, support, and the right approach, you can navigate this journey with hope and confidence. Remember that you are not alone, and there are resources and experts available to help you every step of the way.

The combination of accurate laboratory testing and targeted natural treatments can empower you to take control of your PCOS and improve your chances of achieving a healthy pregnancy. Embrace this journey with resilience and optimism, for there is indeed hope for a brighter and fertile future.

Rosia Parish headshot

By: Dr. Rosia Parrish  |  Naturopathic Wellness Center Boulder

Dr. Rosia Parrish (She/Her/Hers) is a Naturopathic Doctor and Fertility Specialist with a passion for helping individuals and couples achieve their dream of starting or growing their family. With advanced practitioner training through the Institute of Functional Medicine (IFM) and a Doctor of Naturopathic Medicine from the esteemed Bastyr University, Dr. Parrish has over a decade of clinical and research experience.

Dr. Rosia’s approach is centered around identifying the root cause of complex health concerns, providing gentle and efficient care, and supporting her patients in achieving optimal and lifelong health. She is committed to working with you to develop a personalized treatment plan that will help you achieve your fertility goals and overall wellness.


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