How to Fix the Root Cause of PCOS-driven Infertility
by Carmen Mair | certified Nutrition & Health Coach
The association of PCOS with infertility has been well studied and thought to be responsible for up to 40% of female infertility.
One of the root causes of PCOS-driven infertility is insulin resistance. If you understand the root causes of PCOS- driven infertility, you will be well equipped to counteract and restore your reproductive system naturally.
We generally recommend beginning your journey to a healthy pregnancy with a fertility cleanse to remove excess toxins from a poor diet faster. Nutrition plays a vital role when it comes to putting PCOS symptoms into remission and having a healthy reproductive system. Not many realize that our diets have a huge impact on our hormonal health. The building blocks for hormones are found in the foods we eat.
Infertility, 'period problems' like PMS, heavy, painful periods, and migraines all can be signs that your hormones are out of balance. The most effective PCOS management approach addresses the underlying cause of hormonal imbalance, which is something called Insulin Resistance. Polycystic Ovarian Syndrome (PCOS) is not a disorder of the ovaries primarily, but rather, in essence, a disorder of the hormones.
What causes Insulin Resistance in PCOS
Insulin resistance occurs when your cells stop responding to the hormone insulin.
INSULIN IS A HORMONE THAT CAUSES YOUR BODY TO…
- Store energy (sugar, AKA glucose) as fat and glycogen and
- Block the breakdown of fat
This resistance occurs because the cells have changed the shape of the insulin receptor, to prevent glucose from entering into the cell. This causes higher blood sugar levels so the pancreas still responds by producing more and more insulin in an attempt to lower your blood sugar.
This is a vicious cycle!
Now you have…
- elevated blood sugar which keeps the cycle in forwarding motion
- elevated insulin which leads directly to more androgens, inflammation, and anovulation
- fat stores that are being blocked from breaking down which is the reason why it's so hard to lose weight
- hunger because your brain is signaling to feed the body
Interestingly, the pituitary gland and ovaries remain insulin sensitive. As insulin increases the pituitary gland releases more LH and the ovaries produce more testosterone. This contributes to causing anovulation and leads to many of the symptoms of Polycystic Ovarian Syndrome, such as elevated androgens. Due to excess androgen, you may experience irregular menstrual cycles, anovulation, and therefore infertility.
Signs of Insulin Resistance
It is very challenging for physicians to test for insulin resistance directly. Here are indicators that you may have insulin resistance.
Elevated Blood Pressure
Evidence-based research shows that Your blood pressure is a measurement of the effort it takes for your heart to circulate blood throughout your cardiovascular system. The higher your blood pressure, the harder your heart must work to push blood throughout your body. hypertension is an independent risk factor for insulin resistance.
Waist to Height Ratio >/=.49+
I am not a fan of taking a woman's weight as a predicament for insulin resistance. The weight to height ratio is preferred over BMI and a great way to track improvements in body composition and likely insulin resistance.
- Online Waist to Height Ratio Calculator
- The Waist to Height Ratio predicts insulin resistance in 71% of women with Polycystic Ovarian Syndrome.
- Normal ratio is .42-.48
HOMA-IR >2 (Homeostatic Model Assessment for Insulin Resistance)
- This is the ratio between Fasting Insulin and Fasting Glucose (blood) to determine the likelihood of insulin resistance
- Online HOMA-IR Calculator
- Optimal HOMA-IR is <1.5
Oral Glucose Tolerance Test With Insulin (2-4 hour test)
The oral glucose tolerance test (OGTT) is currently the gold standard for the diagnosis of diabetes. It provides a dynamic view of response and is the best way to assess insulin resistance.
- 75g of glucose is consumed as a liquid after an overnight fast. Glucose and insulin levels are then assessed before and at interval over a 2 to 4 hour period of time.
Break the cycle of insulin resistance and restore fertility
Of course, you can break this vicious cycle. Balance is restored when blood sugar is consistently lowered over time.
It’s important to consider a holistic perspective when working to reduce blood sugar and improving insulin sensitivity. Here is what you can do.
Nutrition for restoring fertility with PCOS
Lowering the overall carbohydrate load of your diet will be the most important step. Eat a high protein and moderate to high-fat diet to lower the rate of glucose absorption.
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- Focus on eating non-starchy vegetables, protein, nuts & seeds, fats. Eat fruit in moderation (1-2 servings a day).
- If you aren’t sure how many carbohydrates or calories you currently consume in a day you could track it for 7-14 days in a free app like Cronometer.
- Consider eating in a smaller window of time, such as 8 AM – 6 PM. You are more insulin sensitive during the daytime and less so at night.
Movement
Adding movement to your daily routine will improve insulin resistance. The goal is 30 minutes for at least 4-5 days a week. You don't have to kill yourself in the gym BUT move your body. The human body is designed to move so go for a walk if you can't be bothered about sweaty HIIT ( high-intensity interval training) workouts. But despite popular belief, you can participate in HIIT workouts despite having PCOS.
Yes, HIIT workouts may lead to elevated levels of cortisol in the bloodstream and heightened symptoms of physical stress. But if you make sure to get good rest between workouts there is no reason to not hit it hard every once in a while. Recovery between intervals and recovery days between workouts are key to seeing positive physical results from your HIIT workouts.
I'd like to encourage you to increase your muscle mass through strength training of any kind. A study concluded that six weeks of single-set resistance exercise to failure results in improvements in insulin sensitivity and increases in muscle size and strength.
Mind-Body
Nourishing your soul and calming your mind will also help to keep your blood sugar balanced.
- Therapy
- Meditation
- Deep breathing
- Journaling
- Creativity
- Literally anything that brings you joy
Herbs & Supplements
Herbs and supplements that have been shown to help with blood sugar and insulin resistance:
- Inositol may increase insulin sensitivity and decrease androgens. (Fromuso, et al. 2015)
- Vitamin D has demonstrated to improve glucose metabolism in women with insulin resistance. (Jamilian M, et al. 2017)
- Chromium Picolinate may help to reduce insulin resistance and stimulate ovulation. (Ashoush S, et al. 2016)
- Berberine has shown improvements in insulin sensitivity. (Rondanelli M, et al. 2020)
- Alpha Lipoic Acid lowers fasting insulin and glucose. (Genazzani AD, et al. 2018)
Medication
While I recognize that Metformin can be a useful medication, I prefer to treat insulin resistance in PCOS at the root cause with diet, lifestyle, and targeted supplementation.
Our 3 months PCOS Fertility Program can help you reduce insulin resistance through tailored meal plans, supporting mindset change and stress management, and support from a Certified Nutrition and Health Coach with extensive experience. Contact us today to learn more!
References:
Ismail AD, Aba Alkhayl FF, Wilson J, Johnston L, Gill JMR, Gray SR. The effect of short duration resistance training on insulin sensitivity and muscle adaptations in overweight men. Exp Physiol. 2019 Jan 29.
Shaibi GQ, Cruz ML, Ball GD, Weigensberg MJ, Salem GJ, Crespo NC, Goran MI. Effects of resistance training on insulin sensitivity in overweight Latino adolescent males. Med Sci Sports Exerc. 2006 Jul;38(7):1208-15.
Ferrannini E, Haffner SM, Stern MP. Essential hypertension: an insulin-resistant state. J Cardiovasc Pharmacol. 1990;15 Suppl 5:S18-25.
Disclaimer: This website and post include general information about nutrition, health, and fertility. This content is not medical advice. It is not a replacement for medical advice, diagnosis, or treatment of any health condition or illness. With that said, if the reader or any other person has a medical condition, concern, or illness, they should consult with their personal doctor or another appropriately licensed healthcare provider. The reader should also never disregard professional medical advice or delay in seeking advice because of something discussed in this information. It is imperative to consult your doctor or another appropriately licensed healthcare provider before implementing any changes to your diet, fitness routine, lifestyle, medications, or nutritional supplements.
Information provided in this document and the use of any products or services related to this document by you does not create a doctor-patient relationship between you and Carmen Mair, Nutrition & Health Coach.
Statements regarding dietary supplements have not been evaluated by the Therapeutic Goods Administration, Australia (TGA) nor Food and Drug Administration, US (FDA) and are not intended to diagnose, treat, cure, or prevent any disease.