PCOS Fertility: A Functional Nutrition Guide
Fertility is frequently a struggle with polycystic ovary syndrome (PCOS) and with infertility in PCOS on the rise, functional nutrition is more valuable than ever. But what is functional nutrition and what answers does it hold to actually help PCOS fertility? I’ll aim to answer that for you in this article as well as give some concrete strategies to improve fertility in PCOS.
What is PCOS?
PCOS or polycystic ovary syndrome affects approximately 6-12% of women and is characterized by small cysts which form on the ovaries, usually accompanied by lack of ovulation or inconsistent ovulation, irregular periods, excess testosterone, and weight gain or adrenal issues.
There are three main root causes of PCOS symptoms: insulin resistance, inflammation, and adrenal dysfunction. If you’re curious what your makeup of root causes might be, you can take my root cause quiz here.
How does PCOS cause infertility?
PCOS contributes to infertility by reducing the frequency of ovulation. Here’s a little primer on this:
In order to become pregnant, a woman needs to grow an egg into a follicle, select that follicle to fully mature and then release that follicle into the fallopian tube. Sperm and egg meet and fertilization occurs and then the egg implants into the lining of the uterus and begins to grow.
With PCOS, changes in our hormones caused by those root causes above tend to delay ovulation. Insulin resistance and inflammation can both cause excess testosterone production which then leads to poor quality eggs or eggs that don’t release. Altered signaling hormones like luteinizing hormone (LH) are often found as well which can create issues with releasing follicles. Additionally, the impact of these hormone imbalances means we typically don’t have enough progesterone since this is produced from where we ovulate our follicles. Too little progesterone can lead to over-estrogenized environments that make implantation difficult in the endometrial lining.
So, in PCOS we tend to have issues getting pregnant because of:
- irregular or absent ovulation
- poor egg quality
- not releasing follicles that are ready to release
- irregularities with endometrial lining and implantation difficulties
- menstrual irregularity leading to issues finding the right days for conception
Each of these core issues has a connection to the PCOS symptom root causes.
What is functional nutrition?
Functional nutrition is somewhat different than conventional nutrition. In conventional nutrition, a person with PCOS might be put on a standard PCOS diet- something with lots of whole grains and fruits and veggies. This might help their PCOS but it doesn’t take into account their individuality.
Functional nutrition for PCOS is different. Functional nutrition relies on the latest evidence-based nutrition approaches tailored to you as an individual. It looks at your PCOS and how it’s connected to your overall health, genetics, and history, not just your diet. In functional nutrition, we try to help you see yourself as a unique person with unique needs and give you the tools to modify diet and lifestyle approaches so they are best for you.
Basically, functional nutrition sees you as a whole person and is devoted to seeking out the root causes of your PCOS hormone imbalances so you can see real, lasting changes to your symptoms.
How does functional nutrition help PCOS fertility?
When looking at infertility with PCOS, the key is to ask the big “why” questions. Why is our body struggling with infertility? Why is our body not ovulating regularly? Why is my body not getting pregnant?
Through functional nutrition approaches, we seek to find the deepest root cause issues- things like gut health disturbances, stress hormone imbalances, and chronic inflammation. By addressing those, the body’s fertility begins to respond.
In a lot of ways, fertility in PCOS is about your overall health. Your body may delay pregnancy in an effort to protect you.
Fertility is an excellent marker of health in women, so when there are issues with fertility, the body may perceive itself as being unhealthy or too overwhelmed to reproduce.
Insulin Resistance and PCOS infertility
The first root cause issue that disrupts PCOS fertility is insulin resistance.
What is Insulin Resistance?
Insulin resistance is a condition in which cells in the body become less responsive to the hormone insulin. Insulin plays a crucial role in regulating blood sugar levels by facilitating the uptake of glucose from the bloodstream into cells for energy. When cells become resistant to insulin, they require higher levels of insulin to respond, leading to elevated blood sugar levels.
If you’d like to learn more about Insulin Resistance and PCOS, here’s a podcast on it.
How Insulin Impacts PCOS Hormones
Insulin itself is a hormone and therefore, it can impact other hormones like testosterone. In the case of PCOS, excesses of insulin lead to the ovaries creating more testosterone. Testosterone then confuses the delicate signaling in the ovary and lead to us creating more and more follicles instead of choosing one follicle to put all our energy into.
Testosterone is not just responsible for many of the annoying PCOS symptoms like facial hair, it is also the reason we make so many cysts (follicles). Each of those cysts then creates hormones like estrogen that further disrupt fertility hormones and signals.
Because insulin resistance can vary based on your diet, you may have found that when you’re eating healthy you have a period more frequently.
When we are able to improve our insulin signals, our body can do the work of creating mature follicles faster. However, when our insulin resistance is not well controlled, ovulation can be all over the place. For some with PCOS, ovulation will simply be delayed (they may ovulate on day 20 or 30 instead of day 14) but for others, ovulation disappears entirely.
Why we have periods
Periods occur when we have ovulated midway through our menstrual cycle. When we ovulate, we produce progesterone from the place the egg left the ovary. This is called the corpus luteum.
Eventually, if pregnancy does not occur, our body will stop producing progesterone and the sudden drop in hormones is what leads to the shedding of our endometrial lining (our period).
In PCOS, because ovulation can vary wildly from month to month or even completely disappear, it’s often hard to tell when might be the best time to have sex to get pregnant. This makes fertility more difficult in PCOS as well because we have fewer chances to conceive.
Inflammation and PCOS Infertility
Chronic inflammation is another reasons for hormone disturbances in PCOS.
What is Chronic inflammation?
Chronic inflammation is a persistent, low grade immune response that can damage tissues and organs over time. In PCOS, chronic inflammation can come from many different places but in my practice I typically see it connected to gut health issues, autoimmune conditions, food allergies and sensitivities, insulin resistance, and nutrient deficiencies.
Here’s more on the connection between PCOS and inflammation.
How Inflammation Impacts PCOS Fertility
Similar to insulin resistance, inflammation has the ability to force the ovaries to create extra testosterone leading to infrequent or absent ovulation.
But in addition to that, inflammation can impact PCOS fertility by harming egg quality. Our eggs are some of the most sensitive tissue in our bodies and any inflammation can impact their health, leading to lower overall egg quality.
Egg quality is harmed by excess oxidative stress which is common in PCOS and means that even if we ovulate, the egg may not be high enough quality to be viable.
Chronic inflammation also places our body under stress which can throw off our adrenal and stress hormones, impacting our thyroid as well.
Adrenal Dysfunction and PCOS Infertility
The adrenals are the sight of our “fight, flight, or freeze” hormones. Two small glands that sit on top of your kidneys, the adrenals are an important source of energy for the body.
Adrenal dysfunction is a another common way that fertility can be harmed in PCOS.
What is adrenal dysfunction?
The adrenal glands help keep us energized for our days, as well as ready for any threat we might encounter. This is an important and primal function.
The issue begins with our modern lives. So many of the things that we are involved in on a daily basis are triggers for the adrenals. Our brains do not have a great ability to recognize when something is truly a danger or when it isn’t. For example, an email from the boss might be no big deal, but your adrenals may not know that and may send up stress signals anyway.
These important hormones help give us energy but can also be a tax on our fertility hormones when we need larger amounts of them. Over time, too high production of adrenal hormones like cortisol can lead to issues with energy, sleep, and hormone production.
How adrenal dysfunction impacts PCOS fertility
The old wives tales about stress and pregnancy may be obnoxious and hurtful, but they do have a grain of truth in them. When we are very anxious or naturally live under a higher level of pressure and stress, our adrenals end up needing more resources. This can then “steal” energy from the resources we have to create our sex hormones like progesterone, estrogen and testosterone.
Quality sleep is a key component of fertility, but adrenal dysfunction can make it tough to truly rest, making us feel “wired but tired”
Here’s a bit more on the adrenals.
Strategies for Improving PCOS Fertility
Improving fertility in PCOS starts by looking at the deepest root causes of metabolic and hormonal issues and working our way up. It begins with nourishing your body, resting and recovering, and improving your underlying health first.
To do that, we will need to change parts of your diet and lifestyle and avoid certain things. Let’s talk about some of those.
Changing Your Diet to Support PCOS Fertility
Diet for PCOS fertility begins by addressing all three root cause issues. We need to manage and improve three main areas:
- Blood sugar and insulin balance
- Reduce inflammation
- Keep steady energy and prevent stress spikes
To do this, the following is key:
Increase protein for PCOS fertility
Aim for about 30g of protein with each meal, or about 4 oz minimum. Protein is key for blood sugar regulation and is an important part of eating for your baby’s health during pregnancy as well! Protein will help keep your blood sugar steady without having to limit carbohydrates too much and will keep you full.
Limit sugar and starch
Added sugars and starches are the most common reasons for blood sugar spikes that can damage fertility. These foods shouldn’t be cut completely out of your diet, but enjoyed in moderation.
Check labels of packages for added sugar and try to limit yourself to 20g added sugar per day.
Generally, I recommend no more than a half cup of starchy foods like potatoes, sweet potatoes, breads, pastas, etc at each meal and ideally most would come from whole foods sources.
Increase fiber and plant foods
Fiber is another important tool for managing blood sugar and many high fiber foods are also great fertility foods! Aim to include at least one serving of leafy green vegetables per day. This includes foods like spinach, kale, etc.
Aim for at least one serving of cruciferous vegetables as well- things like broccoli, cauliflower, and cabbage as these support hormone metabolism in the liver and can help your cycles stay more regular.
High fiber foods like whole grains (quinoa, whole wheat bread, brown rice, etc) and legumes (black beans, pinto beans, chickpeas, lentils, etc) have a lot of fiber. Fiber plays many of the roles we discussed for protein like keeping you full and balancing blood sugar. Fiber also feeds your beneficial gut bacteria which helps can help you manage your hormones and insulin much better with time.
Increase anti-inflammatory fat
Omega 3 fatty acids that we get from fish (salmon, cod, sardines, etc) are also key in a fertility diet. Try to eat 3 servings a week and consider also taking a high quality fish oil supplement like this one.
Fish oils help reduce inflammation and balance blood sugar and can improve egg quality as well.
Additionally, incorporating extra virgin olive oil as your main cooking fat can have numerous beneficial health benefits for PCOS and is the main fat I recommend consuming.
Add PCOS Superfoods for PCOS fertility
There are several foods like matcha that can be powerful tools to support PCOS fertility. I’d highly recommend including some of them. Below I’ll link to that post and some other resources that might help you with this process.
Matcha For PCOS- The Surprising Benefits (and recipe!)
The Mediterranean Diet: How to do it, how to modify it, things to be careful of and more- Episode 59
How to Plan Your PCOS Diet like a Nutritionist
Eat on time & Relax
Key for managing your adrenals and absorbing nutrients from your food- make sure you are eating at regular intervals and relaxing while doing so.
Our bodies need to be in a restful (parasympathetic) state to properly produce the enzymes we need to digest our food well and absorb the nutrients from it. As often as possible, try to take a few deep breaths and relax before eating. Chew your food fully and eat slowly and calmly.
Working on fertility is also usually not the best time to incorporate strategies like intermittent fasting. While fasting can be helpful in PCOS in some cases, I find that fasting is too stressful on the body for fertility.
Instead, I recommend 3 meals and 1 or 2 protein rich snacks per day.
How many meals per day should we eat with PCOS?
Lifestyle Changes to Support PCOS Fertility
A few key lifestyle changes will also improve your fertility with PCOS.
Exercise
Movement and exercise are important for reducing stress hormones, balancing blood sugar, and improving mood and energy. Aim for 30 minutes of activity daily, at minimum. Try to set a timer on your phone to get up and stretch every hour as well (and drink some water while you’re doing it!)
A balance between cardio and strength training is generally best for PCOS.
What Exercise is Best for PCOS?
Rest and Recovery
If you enjoy strength training or endurance exercise, be careful not to overdo it. We can increase inflammation by over exercising so listen to your body! If you begin to get injured, feel too exhausted to complete your workouts, or need excessive caffeine to push through, it may be time for a rest day.
I recommend one full day a week totally for rest. It’s very restorative and if you’re regular with your rest, you can keep a more consistent routine.
Sleep
Avoid sacrificing your sleep for workouts. For fertility purposes, sleep is one of the most important things we can focus on. 8 hours minimum of quality, restful sleep in a dark room is absolutely key. Although I know it can be hard, try to put your phone away a couple hours before bed and avoid lights from screens. These are my favorite Sleep Hygiene Tips.
If you find that you still struggle to sleep, that can often be a sign of adrenal dysfunction. You may want to research further on that topic. There are lots of articles and podcasts on my website to learn more!
Episode29: Better Sleep and Signs of Deeper Sleep Issues
Self Care & Mindfulness
One thing I avoided doing while trying to get pregnant was implement self care and mindfulness. In my mind, they couldn’t possibly matter as much as how I was eating.
However, I learned through my own process and through watching many of my clients that a daily mindfulness and self care routine is actually one of the most important things for PCOS and fertility in particular.
Mindfulness has many benefits for PCOS including reducing insulin resistance, inflammation, and even improving egg quality.
I’d recommend at least 15 minutes of some kind of meditation. Guided meditations can help a lot at first and there are some great PCOS fertility focused meditations on Youtube.
The meditations I used while trying to get pregnant were from circle and bloom. You can find those here.
Additionally, outsourcing your self care practices to a practitioner can be really effective. Think things like acupuncture, pelvic floor therapy, and even Reiki!
Things to Avoid While Trying to Get Pregnant with PCOS
While trying to get pregnant with PCOS, focusing on a whole foods diet and quality sleep and movement are the most helpful things. But there’s also a few things we should avoid.
Added sugar
Very sugary or starchy foods like candy, juice, pastries, and chips will all spike blood sugar and reduce egg quality.
Advanced Glycation End Products (AGEs)
Cooking foods to the point of caramelization (that yummy browned topping foods get when grilled, fried, or broiled) is harmful for egg quality and has been directly linked to many PCOS symptoms. Try to vary your cooking methods to include more baking and steaming and add fresh herbs and lemon juice when cooking to cut down on AGE production!
Alcohol & Smoking
Alcohol in moderation is likely fine but I’d recommend avoiding drinking more than once a week and stick to 1 drink. Hard on your liver, alchohol makes it more difficult for your body to metabolize hormones. In general, I’ve found my clients who don’t drink or drink rarely to be more successful with conception that clients who drink regularly.
Smoking, of course, is inflammatory and damaging to egg quality, so avoid.
Inflammatory foods
Fried foods and fast foods are the main culprits here besides the ones we listed above. Try to eat at home as often as possible and cook your own meals to avoid inflammatory foods.
Fasting and extreme calorie restriction
As mentioned above, fasting can be hard on stress hormones and may harm fertility. Additionally, mild to moderate calorie restriction may be helpful, but avoid going to extremes.
Further Resources for PCOS Fertility
Functional Courses for PCOS
One of the best things you can do when starting a PCOS journey is follow a plan laid out by a professional. Working one on one can also be helpful, but I find that many women can tackle the basics of PCOS eating on their own if they have a guide.
I created PCOS Foundations as a course to help you manage the three root causes of PCOS and support all of them at once. It’s designed in a fertility friendly way with meal plans and grocery lists and it would be an excellent place to start as you work on improving your health for pregnancy!
Here’s a link to the course if you’d like to check it out: https://amberfischer.thinkific.com/courses/pcos-foundations
Supplements for PCOS fertility
Some supplements are extra supportive for PCOS fertility and I love to recommend them. I’ll link to my favorite, high quality brands. Remember that potency and safety are key components for supplements, especially when trying to conceive. Always purchase the best quality you can afford. It’s better to include one good high quality supplement than 5 low quality, low potency ones.
N-acetyl-cysteine
This powerful pre-cursor to the body’s master antioxidant, glutathione, is my favorite supplement for PCOS in general and especially for egg quality. NAC has protective effects for egg quality while also helping to lower inflammation, decrease insulin resistance, help with skin, and help to regulate periods. If you take just one supplement for your conception journey, I’d recommend NAC.
Ideally, you’d take a dose around 500-600 mg per day. This is my favorite NAC that comes in that potency and from a high quality brand that participates in third party safety testing. Find it here.
CoQ10
Coenzyme Q10 (CoQ10) is an antioxidant that supports mitochondrial function and energy production in cells, improving egg quality and fertility in women with PCOS. It’s also very helpful for mitochondrial function, which is a key issue in the root causes of PCOS.
You can find my favorite Co-Q-10 here.
Inositol
Inositol, particularly myo-inositol in a 40:1 ratio with D-chiro inositol, helps regulate insulin sensitivity, ovarian function, and hormone levels in women with PCOS, promoting better reproductive health and fertility.
The inositols are likely the most popular PCOS supplements and for good reason- they tend to be very effective for those who struggle with insulin resistance as part of their PCOS. You do want to insure you get a version with the 40:1 blend, studies have not shown as much benefit for myo or d-chiro inositol on their own.
This is the inositol blend I recommend. It also includes some extra antioxidants that make it really special!
Methylated Prenatal
Methylated prenatal vitamins provide essential nutrients like folate in a bioavailable form, supporting overall health and reducing the risk of birth defects in women with PCOS who are trying to conceive.
More severe versions of the MTHFR gene mutation are likely more common in PCOS and can contribute to lower levels of the important B-vitamins like B-12 and Folate which are important for egg quality and fertility.
My favorite basic prenatal for PCOS is this one. You should always take a prenatal of some kind when trying to conceive and especially once pregnant.
Vitamin D3 with K2
Vitamin D deficiency is remarkably common, especially among those with PCOS and can be a contributor to irregular cycles and egg quality issues. I’d highly recommend getting tested for your vitamin D levels to ensure you aren’t deficient and also to take extra Vitamin D3 with K2 if you are. The prenatal above does contain some Vitamin D but it often isn’t quite enough, especially if deficient.
Get tested regularly to ensure your levels stay optimal. Find the Vitamin D3 I recommend here.
Putting it all together
Addressing fertility concerns in the context of polycystic ovary syndrome (PCOS) requires a multifaceted approach that considers the underlying metabolic and hormonal imbalances unique to you. By understanding the root causes of PCOS-related infertility—such as insulin resistance, inflammation, and adrenal dysfunction—you can implement targeted strategies to optimize reproductive health.
From managing blood sugar levels to reducing chronic inflammation and supporting adrenal health, using these functional nutrition strategies we aim to create an optimal environment for conception and pregnancy. By nourishing the body with nutrient-dense foods, prioritizing rest and recovery, and adopting mindful lifestyle practices, you can enhance your PCOS fertility potential and pave the way for a healthier future (and future child!).
Remember, fertility is not just a destination but a journey—one that requires patience, persistence, and self-care. By prioritizing your health and well-being, you’re not only investing in your ability to conceive but also nurturing your overall vitality and resilience.
As you embark on this transformative path, know that you’re not alone. Seek guidance from healthcare professionals, nutrition experts, and supportive communities to navigate the complexities of PCOS-related fertility with confidence and empowerment.
I hope this article helps you embrace the power of functional nutrition to unlock the door to fertility and embrace a future filled with hope, abundance, and possibility.
PCOS thoughts & Tips, every friday.
Sign up for Amber's free newsletter to get exclusive PCOS articles, discounts and alerts.
MEdical Disclaimer
The information contained on amberfischernutrition.com is for informational and education purposes only and should not be construed as medical advice. As a nutrition professional, I draw upon evidence based practices and personal experience with myself and clients to form recommendations like the ones made in this guide. You are an individual with your own unique set of health goals and concerns. Ensure you discuss any changes to your diet with a qualified healthcare professional, like your doctor, to ensure these changes are right for you. This is especially important if you have any other underlying medical conditions. Do not consume foods you are allergic to. Results will be individual and will vary.
Affiliate Disclosure
This site contains affiliate links. When you make a purchase through a link provided on this website, I may make a small commission. This does not add to the purchase price of the item. I only link to items I truly use and recommend.
