PCOS and Infertility

By Mona Fahoum, ND
Reviewed by Tori Hudson, ND
September 1, 2023

Polycystic Ovarian/Ovary Syndrome (PCOS) is the most common endocrine disorder, affecting an estimated 1 in every 15 women. However, PCOS is a lifestyle disease, meaning it is caused by poor diet, environmental toxicity, drugs and/or many other lifestyle factors. This means that you don’t “catch” PCOS rather it develops over time. The good news about this is that changing your diet, exercise, environment and lifestyle can completely reverse PCOS. The bad news is that because it is a lifestyle disease, there is no one magic pill that will fix it!

PCOS can manifest in many different ways with each woman experiencing different symptoms such as hair loss, hormonal acne, excess facial or body hair, weight gain. But one of the most common symptoms of PCOS is infrequent or cessation of menstrual cycles and thus infertility.

One of the most common side effects of PCOS is infertility. However, the best news is that the very preconception health steps you would ideally take to have a perfectly healthy baby are for the most part the exact same steps you would want to take to reverse PCOS. This is the very reason why so many women conceive shortly after addressing their own PCOS and hormone imbalance.

A recent study from the Perelman School of Medicine at the University of Pennsylvania revealed that there is a major gap in education and support for women with PCOS. Finding the sad truth that one-third of women diagnosed with PCOS saw at least three health professionals over the course of two years before receiving a diagnosis.

We know it can be frustrating and discouraging to be shuffled around from doctor to doctor, which is why our medical.team@symphonynaturalhealth.com are available to support you, and connect you to a Functional Doctor in our community, close to you, with experience in PCOS who could not only diagnose you but work with you to provide the answers and exact solutions for you and your individual experience with PCOS.

This article is also here to start to answer some of those questions and explore the choices available and some of the most important first steps – hormone balance.

Your endocrine system includes all the glands in your body that make hormones. The hypothalamus, pituitary gland, and pineal gland are in your brain. The thyroid and parathyroid glands are in your neck. The thymus is between your lungs, your adrenals are on top of your kidneys, and your pancreas is behind your stomach. Your ovaries are in your pelvic region.

Your HPTAO-axis (hypothalamus + pituitary + thyroid + adrenal + ovaries) is command central for hormone production. Ideally, your hormones work together like a finely tuned orchestra to produce hormones at levels that support harmony, health, and fertility.

In women with PCOS, two of the hormones naturally produced by your HPAO axis – luteinizing hormone (LH) and follicle stimulating hormone (FSH) – are produced in abnormal proportions. For many, but not all, women with PCOS, the imbalance of these two hormones prevents the follicles in your ovary from developing properly: the follicles tend to remain small and don’t mature enough to release an egg, but do form on your ovary. They are often described as resembling a string of pearls. Because no egg matures or is released, ovulation does not occur and the hormone progesterone is not made. Without progesterone, your menstrual cycle becomes irregular or can even stop altogether. Those small follicles produce male hormones (androgens), adding to the imbalanced level of androgens in your bloodstream.

The prevalence of infertility in women with PCOS varies between 70 - 80%. According to the American Society for Reproductive Medicine, the evaluation of infertility in women with PCOS should start after six months of attempting pregnancy without success, assuming you and your partner had intercourse 2 to 3 times a week without using contraception.

Treatment initially includes preconception guidelines such as weight loss, folic acid therapy, no smoking or drinking, etc. That certainly makes sense, although, if your weight is as a result of PCOS, telling you to lose weight is not very helpful.

You have several choices if you have PCOS and are having difficulty becoming pregnant. There are pharmacological options, non-pharmacological options, and natural, Holistic options. Here’s a quick overview. Please remember, no matter what option you choose, you will want to understand all the risks and benefits associated with each option and work with your Health Professional to find which is right for you. As we said PCOS manifests differently in each woman as does the severity of each case, so there is no one size fits all. Make sure whomever you work with does not gloss over side effects because “only a small percentage” are usually affected. You could easily be one in that group of “small percentages” and a specific solution that isn’t ideal for everyone could be perfect or necessary for you!

The first-line pharmacological treatment is Clomiphene Citrate (Clomid, Serophene). Clomiphene is a synthetic chemical, taken orally, that binds to estrogen receptors in your brain to trigger your pituitary gland to secrete an increased amount of follicle stimulating hormone (FSH) and luteinizing hormone (LH). This stimulates the growth of the ovarian follicle and initiates ovulation. There are often common side effects (stomach upset, bloating, hot flashes, breast tenderness, headache or dizziness) as well as the possibility of your developing a serious condition known as ovarian hyperstimulation syndrome (OHSS) in which fluid builds up in the stomach, chest and heart area. A percentage of women are allergic to this synthetic chemical.

Because Clomiphene Citrate is not recommended for treatment beyond six months, the second-line pharmacological treatment includes the administration of synthetic peptide drugs known as Gonadotropin-Releasing Hormone (GnRH) Agonists (Lupron, Synarel, or Zoladex) or Antagonists (Cetrotide or Antagon). A daily Agonist injection overstimulates your pituitary gland, triggering production of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) at greater levels than normal. This makes your pituitary gland shut down. Called “pituitary down-regulation,” at the same time or afterwards, an ovulation-stimulating medicine is used to trigger ovulation, with the goal of harvesting good-quality eggs on a predictive schedule to be used for intrauterine insemination.

A GnRH Antagonist injection is a recent addition to infertility treatment. Agonists act over several days to stop ovulation, while Antagonists act almost immediately.

The GnRH agonist used most commonly is leuprolide acetate (Lupron®). Lupron is an “antineoplastic agent,” meaning that it is a cancer chemotherapy drug and is classified as a “hazardous drug” that healthcare workers should only handle when wearing protective gowns and gloves.

There have been no prospective or clinical studies on Lupron’s safety for PCOS patients with infertility issues and the FDA has not approved Lupron for use in infertility treatment or assisted reproduction procedures such as IVF. Its use occurs “off-label,” an option that allows an FDA-approved drug to be used for medical purposes neither originally specified in the drug’s approval nor described on the drug’s labelling. Lupron is a hazardous drug with side-effects that can last for weeks or months after the drug is discontinued. No data are being gathered on Lupron’s long-term effects on women using the drug for endometriosis, fibroids, or assisted reproductive technology.

Laparoscopic ovarian drilling is an invasive method that requires general anesthesia and has a higher cost and potential complications. The goal is between four and ten punctures because a larger number may favor the development of premature ovarian failure. The long-term impact of ovarian drilling on the ovarian reserve/ovarian function remains unknown. Moreover, the lack of standardization of the surgical technique and the absence of studies that have evaluated the repercussions of long-term ovarian drilling demonstrate that this procedure should not be routinely performed.

In Vitro Fertilization begins with ovarian stimulation initiated with low doses of gonadotropins, while the pituitary is suppressed with a GnRH antagonist. This combination reduces the risk of OHSS.

Calcium and vitamin D are two of the most reaching nutrients our body needs affecting muscles, bones, thyroid, brain, heart, hormones, colon, breast and more. Calcium and vitamin D regulation may also contribute to the development of faulty ovarian follicle development in women with PCOS, resulting in reproductive and menstrual dysfunction. A deficiency of vitamin D may be more frequent in women with PCOS and in a small study, five of thirteen women had an overt vitamin D deficiency. Seven of the nine women with no menses or infrequent menses had a return to a normal menstrual cycle within two months of being given 50,000 IU once or twice per week of vitamin D and 1,500 mg per day of calcium.

Maca is a herb cultivated in the central Peruvian Andes at 12,000-14,000 feet. Maca has been classified by some as a potential adaptogen - a rare class of herb that generally impacts the adrenal glands to help the body deal with stress and fatigue. However, research over the last fourteen years has demonstrated that there are in fact 13 different types, or phenotypes, of maca that can be different colors, have different DNA, different analytical profiles, and most importantly, different physiological effects on the body.

Traditionally the Peruvian’s simply mixed all the different types of maca together, in the natural ratios that they grow, and made it into a powder and said that is maca, however, what we have found over the last 14 years, is that, that combination or ratio focuses primarily on energy and the adrenals. Whereby having the potential to make the hormone imbalance of testosterone and estrogen experienced by women with PCOS worse! As many Doctors and patients who have tried standard maca powders can attest.

However, excitingly, over the last 14 years over 60 medical journal publications on individual maca phenotypes or novel combinations have proven that each phenotype of maca can impact different parts of the body and have different physiological effects. In fact, there are specific types or combinations which don’t just impact the adrenals but rather the entire HPTAO Axis – which is critical for PCOS where you are wanting to rebalance testosterone and estrogen as well as blood sugar (insulin and glucagon) and metabolism – all controlled by the Hypothalamus. This has given rise to novel maca products specifically for prostate inflammation or sperm production in men and other maca phenotype formulas for menopause, fertility, bone health and hormone balance in women.

Using the right phenotype has proven to be so critical, it can mean the difference between a positive and a negative outcome when addressing PCOS.

Our team of doctors at Symphony Natural Health specialize in women’s hormone health and PCOS and are able to answer questions and have created a PCOS Guide you can find here.

It’s important to remember that there are so many variables that exist with PCOS that it may take some time to discover your best solution, but with the right information and support you can decide on the right solution for you.