PCOS (Polycystic Ovary Syndrome) as it relates to fertility

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)
Magnesium
Zinc

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.