Transcription
In this video, we're going to talk about five tips for getting pregnant with PCOS. Because if you have PCOS, you have likely been told that you are infertile. And if you are getting ready to try to conceive, or you are ready to start your family, or you've been trying, these tips are going to help you.
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I'm Dr. Laura Shaheen. I'm a reproductive endocrinologist, author, content creator, educator. I love teaching. And if you have found me here on YouTube, welcome. Subscribe to this channel if you want to learn about all things fertility. I have weekly videos and I would love to see you here. Comment with questions that you have, topics that you want me to cover, because I love teaching.
Now, if you have PCOS and you are planning to get pregnant, here are five tips that can help you.
Number one: Don't wait to see a doctor. What do I mean? Well, people are often told, you have to try for a year in order to see a fertility doctor, like me, like a board-certified reproductive endocrinologist or fertility doctor. People are told you have to try for a year. Now, listen, I hear that, but that is for people that are having regular, predictable menstrual cycles associated with regular, predictable ovulation. If you truly have PCOS and it presents itself with irregular periods, like you do not know when you're going to get a period, you can skip cycles for two or three months, and sometimes up to six months, or you can have just multiple episodes of bleeding in a cycle, you should not wait to see a doctor about this. You should get questions answered. You should figure out why you're not ovulating, and you should see a doctor.
If you want to listen to an excellent interview with someone who felt like she waited way too long, listen to my very first episode of my Baby Robust podcast with Karen Jeffries. She is from the incredible Instagram account, Hilariously Infertile, and she is super open about how for a whole year, she just thought she was pregnant every month because she was not getting her period. And she's like, "I wasted so many home pregnancy tests because I just thought I was pregnant." She's like, "I should have seen a doctor sooner."
Tip number two: Make sure you have the right diagnosis. There are lots of reasons that people can have irregular and unpredictable menstrual cycles. There's lots of times where people are diagnosed with PCOS, especially in their teenage years, and then later in life, they just carry this diagnosis, but really, they actually don't have that diagnosis. There are many causes for irregular ovulation, and they're often unrelated to an imbalance of hormones. So, I'll kind of go from top to bottom. Your hypothalamus is a gland in your brain in charge of so many bodily functions, and if you do not have a regularly functioning hypothalamus, you could have irregular cycles. And so, there's something called hypothalamic dysfunction that can cause irregular cycles.
Number two, the pituitary gland, which is a little tiny gland kind of at the base of the brain. If that is out of whack, especially like, one of the most common ones is elevated prolactin levels or hyperprolactinemia, that can throw off your cycles.
Next is your thyroid gland. If your thyroid is too high, hyperthyroidism. If it's too low, hypothyroidism, that can throw off cycles, and you can get misdiagnosed with PCOS. And think about your adrenal glands. Adrenal glands are those little cute glands that sit on top of the kidneys. One specific disease that's actually a genetic disease that affects the function of adrenal glands is called congenital adrenal hyperplasia. If you have that, it can throw off your cycles, and that might be the only presentation. And so, you should really figure out if that's your diagnosis rather than just assuming it's PCOS.
And finally, another diagnosis which is really nerve-wracking to patients until we get the information that's actually okay, but premature ovarian insufficiency, or premature ovarian failure is what it used to be called, really poor diminished ovarian reserve, like if you are really running out of eggs, and that can also cause irregular ovulation. So, that is unlikely, it's rare, but that can be a reason that people get misdiagnosed with PCOS. PCOS is the most common reason that people have irregular ovulation and unpredictable cycles, but you do not want to miss these other things. So, hopefully, you wrote those down, and when you're going to the doctor, because you're not waiting a whole year to try to conceive, you can say, "Hey, can we make sure I don't have any of these other issues?" You can ask and take a list. Do I have any issues with my hypothalamus? How about my pituitary gland? How about my thyroid gland? How about my adrenals? Do I have congenital adrenal hyperplasia? And then, are my ovaries okay? Do I still have eggs left? So, PCOS can be diagnosed pretty easily. You just don't want to miss these other things.
Number three: Tip for conceiving and getting pregnant with PCOS, think about lifestyle changes. This is sensitive. I'm talking about weight, I'm talking about exercise, and I'm talking about nutrition. Now, I am not going to be the doctor that you walk into a clinic and just says, "Oh, lose weight and you'll get pregnant with PCOS." That is not the case for everyone. A lot of people are healthy at heavier weights, and sometimes people try to lose weight with PCOS, and they still, you know, are not ovulating or it's not affecting their fertility at all. So, focusing on health, not a number on a scale, is very important.
But the reason that doctors say this a lot is that there are studies that show that if someone loses five to ten percent of their body weight, they really can start having regular menstrual cycles, ovulating, and have a higher chance of getting pregnant sooner. A lot of this is related to insulin resistance, and that if you are overweight, and that's putting a lot of pressure on your pancreas to make enough insulin, or your insulin isn't working as well, if you can lose weight in a healthy, safe way, you might actually benefit by having more hormone balance and more regular ovulation and hopefully conceive sooner.
Now, if you want to see the study that a lot of doctors are getting this information from, it's by Mahoney et al. from 2014, and it's basically looking at lifestyle modifications and how it can impact PCOS, and that's the study that talks a lot about losing five to ten percent of body weight in order to help with hormone regulation and ovulation function.
Now, interestingly, there are studies that show that regular exercise and moving your body, without weight loss, actually also helps with hormonal function and hormone regulation in PCOS. So, I love those studies, and I talk to my patients about it. An excellent review article in The Lancet journal in 2022 is summarizing a lot of these exercise studies and says that walking 30 minutes three times a week can really be helpful.
Now, what about nutrition? I'm not going to be the doctor that says carbs are bad, and if you've got PCOS, you should stop eating carbs. It comes from carbs increase our glucose levels in our bloodstream, and if we're already having insulin resistance and difficulty using insulin, the theory is that if you decrease your carbs, you're going to allow your insulin to work better, and that should help with the hormone balance and help you start ovulating regularly and having regular cycles. So, I get that theory, but just for someone to blanketly say, "Oh, if you've got PCOS, you should never eat carbs," that's just not right. It's not good advice. There's a little bit of shame when you make these like blanket statements. So, I recommend working with a registered dietitian, someone that has an area of focus and learning and study in PCOS, somebody that can really look at your personal situation and help find the right nutrition for you.
Tip number four: What about medications or supplements for PCOS to help you get pregnant? I'm thinking number one, Metformin. I'm thinking number two, Inositol. First of all, Metformin is a prescription medication that helps your body use insulin better. It's traditionally given to people with high blood sugar or diabetics, specifically type two diabetics, to help decrease their blood sugar levels. And in PCOS, some people do have a tendency towards high blood sugars and can develop diabetes over time. Not everybody, but there is a level of insulin resistance in a lot of people with PCOS. And so, the theory is, if Metformin can help your body use insulin better, insulin is intimately involved in ovarian function, like maturation of the egg and ovulation. If insulin is working better, maybe it'll help you ovulate. And I remember 15, 20 years ago when I was first starting, people used to give Metformin to anybody that was diagnosed with PCOS and just say, "Hey, this will help you ovulate. See you in a year." And for some people, they did find that, you know, they did find that their cycles started getting regular, and they might be able to conceive on their own. But not everybody. It's not a catch-all fix for everybody. But talk to your doctor about your personal situation and just ask about Metformin.
Number two, Inositol. Inositol is a supplement. It's sometimes called vitamin B8. It's not really a vitamin, it's actually a sugar. It's made in the body, and it can be found in some foods. There's nine different types of inositol, but the most common ones that you can find in supplements are the myo-inositol and the D-chiro-inositol. Now, the theory is is that inositol helps people with PCOS use insulin better, kind of like a non-prescription Metformin. Other people just say, "Hey, when I take inositol, I don't have as many PCOS symptoms. My acne gets better. My hair growth decreases." Anositol is one of those things where people might see improvement, but we're still trying to figure out exactly how and why. So, it is not a quick fix, just like Metformin. And make sure you talk to your doctor about whether you should be taking inositol, what type, and whether it's the right thing for you.
And tip number five: Finally, there are medications that will help you ovulate. All the other things like nutrition, health, weight, maybe exercise, maybe supplements, maybe Metformin, those are all kind of ways to hopefully help the hormone balance, help insulin resistance, help your own body kind of click into gear and start ovulating on a regular basis. But there are actually medications out there that can help you do that too. And the medications we use to help with ovulation come in the form of pills or injections. And the pills that you can often hear about are clomiphene or Clomid, or letrozole and Femara. And both of these things are usually given cycle day three through seven, or at the beginning of a menstrual cycle to help with egg recruitment. And for some people with irregular ovulation, whether it's from PCOS or another reason, that can help them ovulate.
The other type of medication that can help with ovulation are injectable medications. These are actually gonadotropins that you can inject, just subcutaneous injections, to help with that egg recruitment. So, the tips I've been talking about here are just making sure you find the right doctor, you have the right diagnosis, you are trying to be healthy, and maybe supplemented Metformin can help. All of these things in the lifestyle optimization can help with hormonal regulation. But these medications are actually helping you ovulate, and that they can be considered fertility treatment.
A really common question people have is, "Oh, I know I have PCOS. I know I'm going to be infertile. I know I'm going to have to do in vitro fertilization." Got lots of videos here on that, all sorts of information about IVF, but that's just not the case. People with PCOS might need to do IVF for other reasons, but just having a diagnosis of PCOS is not a sole reason to do IVF.
I know that is a lot of information. Let's do a little bit of a recap. If you have PCOS and you have been told you are absolutely going to be infertile, that's not necessarily the case. But if you are trying, here are some five tips that can help you get pregnant fast. I hope:
Number one: Do not wait to see a doctor.
Number two: Make sure you have the right diagnosis.
Number three: Think about lifestyle optimization. Focus on health, not restriction, in a positive way, and always be kind to yourself.
Number four: Ask your doctor about Metformin and some supplements like Inositol. It's not for everyone.
And number five: Know that there are medications out there that can help you ovulate. These can be pills, and these can be injectables. But talk to your doctor about what's right for you.
I hope you learned something today because I loved educating you. Make sure you like this video if you learned something. Comment with questions that you have. Subscribe to my channel so you get my weekly videos. If you want to learn more, you can find me at my website, DrLauraShaheen.com. Tons of resources. My weekly podcast, Baby Robust, anywhere you listen to podcasts. Instagram, TikTok, I am here to educate you. And as always, wishing you love, luck, and pineapples. Thank you.