PCOS and Infertility Guest Post with Dr. Pamela Frank
PCOS and Infertility:
Misconceptions about Conception
Guest Post
By Dr. Pamela Frank, BSc(Hons), Naturopathic Doctor
As a naturopathic doctor, I frequently get emails from women diagnosed with PCOS from all over the world, desperately seeking my help to conceive. While my naturopathic license prevents me from giving advice to people that I haven’t seen in person and done a full first assessment with, I wanted to dispel some myths and provide some words of encouragement for women with PCOS who want to have children.
1. It can be done! Many newly diagnosed women with PCOS are fearful that they may never be able to bear children. PCOS clearly presents some difficulties for women who are trying to conceive. There are different “types” of PCOS, some will make conception more difficult than others. What each of the different PCOS types has in common, is absent, irregular or inconsistent ovulation. Obviously to conceive, one has to ovulate. To ovulate, one has to know WHY ovulation isn’t occurring consistently. Nine times out of ten, the women I see who have been diagnosed with PCOS have not had thoroughly sufficient blood testing done to determine why they are not ovulating.
2. Be your own advocate. PCOS is still fairly poorly understood by many doctors and often goes undiagnosed. If you are having trouble to conceive, a full battery of hormone blood tests and a pelvic and transvaginal ultrasound need to be done. Hormone tests need to be taken at specific points in your menstrual cycle in order to be interpreted in context. If you aren’t having regular cycles, try to be aware of symptoms that may indicate that your body is trying to have a period and track periods that you do have in a period tracker app. Context is crucial to accurately assess hormones for fertility.
3. I will have to have expensive fertility treatments like IVF to conceive. Not necessarily. Many women that I treat conceive on their own without expensive treatments or aggressively manipulating their hormones with drugs. The key is to really understand the specific hormone imbalance that is messing with ovulation and then there are diet adjustments, lifestyle changes, vitamins, minerals, acupuncture and herbs that can help restore balance. It may take a lot more work than your friends who don’t have PCOS, but at the end of the day you’ll be healthier for it, your baby will be healthier for it and you will cut your risk of heart disease, endometrial cancer and diabetes significantly. None of this can be said for fertility treatments.
4. “Your AMH is too low or too high”. AMH stands for Anti-Mullerian Hormone. It’s a hormone that is released as egg follicles are in the process of maturing between their resting state (primordial follicles) and when they get released as an egg. Often women with PCOS will have a high AMH because there are many egg follicles trapped in the middle of maturing that don’t make it all the way to a mature egg follicle that is ready to release the egg. The solution is to remove the obstacle to the egg follicle maturing all the way, often in PCOS, that’s high testosterone. But, be aware that high testosterone only accounts for about 60% of cases of PCOS, the rest are due to some other hormone imbalance. Assumptions are often made that every woman with PCOS has high testosterone. This is an incorrect assumption, even in women who “look” like they have high testosterone. Low AMH is often presented to patients as evidence that they don’t have many egg follicles left. This is also incorrect information. Low AMH means not many egg follicles are in the process of maturing into an egg. The solution to a low AMH is to determine why that is and correct it. It could be that testosterone is blocking follicles from maturing, it could be that there isn’t enough estrogen, it could be that prolactin is too high, it could be that DHEAs is too high, it could be that your thyroid is too low and so on. Good detective work is paramount in fixing fertility problems for anyone and is often lacking even in those at fertility clinics.
5. Diet and lifestyle are super important for PCOS women with high testosterone. The best thing you can do to improve your fertility is to cut back on your carbohydrate intake, reduce your stress, get enough sleep and exercise daily. These all help lower insulin and therefore lower testosterone, which then allows eggs to mature and get released normally.
Want a bucket list of PCOS related testing that may help?
1. It can be done! Many newly diagnosed women with PCOS are fearful that they may never be able to bear children. PCOS clearly presents some difficulties for women who are trying to conceive. There are different “types” of PCOS, some will make conception more difficult than others. What each of the different PCOS types has in common, is absent, irregular or inconsistent ovulation. Obviously to conceive, one has to ovulate. To ovulate, one has to know WHY ovulation isn’t occurring consistently. Nine times out of ten, the women I see who have been diagnosed with PCOS have not had thoroughly sufficient blood testing done to determine why they are not ovulating.
2. Be your own advocate. PCOS is still fairly poorly understood by many doctors and often goes undiagnosed. If you are having trouble to conceive, a full battery of hormone blood tests and a pelvic and transvaginal ultrasound need to be done. Hormone tests need to be taken at specific points in your menstrual cycle in order to be interpreted in context. If you aren’t having regular cycles, try to be aware of symptoms that may indicate that your body is trying to have a period and track periods that you do have in a period tracker app. Context is crucial to accurately assess hormones for fertility.
3. I will have to have expensive fertility treatments like IVF to conceive. Not necessarily. Many women that I treat conceive on their own without expensive treatments or aggressively manipulating their hormones with drugs. The key is to really understand the specific hormone imbalance that is messing with ovulation and then there are diet adjustments, lifestyle changes, vitamins, minerals, acupuncture and herbs that can help restore balance. It may take a lot more work than your friends who don’t have PCOS, but at the end of the day you’ll be healthier for it, your baby will be healthier for it and you will cut your risk of heart disease, endometrial cancer and diabetes significantly. None of this can be said for fertility treatments.
4. “Your AMH is too low or too high”. AMH stands for Anti-Mullerian Hormone. It’s a hormone that is released as egg follicles are in the process of maturing between their resting state (primordial follicles) and when they get released as an egg. Often women with PCOS will have a high AMH because there are many egg follicles trapped in the middle of maturing that don’t make it all the way to a mature egg follicle that is ready to release the egg. The solution is to remove the obstacle to the egg follicle maturing all the way, often in PCOS, that’s high testosterone. But, be aware that high testosterone only accounts for about 60% of cases of PCOS, the rest are due to some other hormone imbalance. Assumptions are often made that every woman with PCOS has high testosterone. This is an incorrect assumption, even in women who “look” like they have high testosterone. Low AMH is often presented to patients as evidence that they don’t have many egg follicles left. This is also incorrect information. Low AMH means not many egg follicles are in the process of maturing into an egg. The solution to a low AMH is to determine why that is and correct it. It could be that testosterone is blocking follicles from maturing, it could be that there isn’t enough estrogen, it could be that prolactin is too high, it could be that DHEAs is too high, it could be that your thyroid is too low and so on. Good detective work is paramount in fixing fertility problems for anyone and is often lacking even in those at fertility clinics.
5. Diet and lifestyle are super important for PCOS women with high testosterone. The best thing you can do to improve your fertility is to cut back on your carbohydrate intake, reduce your stress, get enough sleep and exercise daily. These all help lower insulin and therefore lower testosterone, which then allows eggs to mature and get released normally.
Want a bucket list of PCOS related testing that may help?
Visit http://www.naturopathtoronto.ca/pcos-polycystic-ovarian-syndrome/
and scroll to Tests for PCOS to download a list.
Want some help conceiving?
Contact a licensed naturopathic doctor who specializes in PCOS and infertility.
Want some help conceiving?
Contact a licensed naturopathic doctor who specializes in PCOS and infertility.
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