PCOS & Fertility

Polycystic Ovarian Syndrome (PCOS) is the most common metabolic and endocrine disorder among women of reproductive age, and is thought to affect between 6-20% of women. 

What is happening in PCOS?
PCOS can feel like a very manageable abbreviation for a condition that is very confusing. This is likely because PCOS leads to a range of symptoms that occur all through the body, and is not just to do with the reproductive system.
It is especially confusing as the word ‘cysts’ can be a bit misleading - there are no actual ‘cysts’ as we typically understand them, instead the fluid filled sacs that stay in the ovaries are actually follicles. Follicles usually keep the egg safe while it develops before being released during ovulation, however in PCOS this doesn’t happen, which disrupts ovulation and leaves the follicles looking like cysts. 

Because of the disruption of ovulation, PCOS affects the hormones that are released throughout the menstrual cycle - this is what we call an endocrine disorder (hormones and glands make up the endocrine system). The change in hormones with PCOS is what leads to irregular periods and often higher levels of testosterone. 

How could it affect fertility?

PCOS is different in every woman, in fact there is so much variation that it has been considered that changing the name would better suit more people with the diagnosis. The variation means that not everyone’s fertility is impacted the same way. 

Aside from the disruption in ovulation, one way that PCOS affects fertility is its link to increased insulin resistance. That means that the body is less receptive to insulin (which normally helps lower blood glucose), so our blood glucose level runs higher than normal, which is linked to increased cravings, hunger and weight gain. In turn, a higher body weight can negatively impact our fertility (blog post about this coming soon). 

Another way in which PCOS impacts fertility is because of hormone deregulation. For example, women  with PCOS often have higher testosterone levels than women who do not have PCOS. Higher levels of testosterone have been linked with longer follicular phase, and a  higher incidence of amenorrhea (missed periods) and anovulation (where no egg is released). 

Finally, PCOS is associated with  chronic inflammation, or being in a ‘proinflammatory’ state. Being a pro-inflammatory state can mean that there are increased numbers of free radicals in the body, known as oxidative stress, which can damage cell membranes. This has been linked to follicles not maturing properly, which means that eggs cannot be released. Furthermore, being in a state of chronic inflammation also contributes to insulin resistance and weight gain, as mentioned above. 

What can we do?

Although there is not one ‘cure all’ diet for PCOS, there have been many studies which show positive outcomes from dietary change. The evidence base suggests that aiming for a Mediterranean style diet is helpful. There are several factors involved, one of which is because the focus on whole grain sources of carbohydrate lead to slower blood glucose rise after eating, which helps to reduce the impact of insulin resistance. Whole grains and seeds are also a good source of Magnesium, which is commonly found as a deficiency in women with PCOS. The Mediterranean diet is also helpful as the relatively high protein content has been shown to help with insulin resistance. Furthermore, the Mediterranean diet promotes foods like oily fish, which are known to be high in Omega 3s, which are the precursors of hormone formation. 

Future blog posts will cover dietary change for PCOS in more depth, however if you would like more support in your PCOS or fertility journey, you can contact us via the website for 1-2-1 guidance. 

References:
DOI: 10.1210/jc.2013-3996
DOI: 10.1016/0002-9378(79)90463-0
DOI: 10.2174/187221309787158371
DOI:10.1097/01.ogx.0000140038.70473.96
DOI: 10.1093/cdn/nzz108