Not that long ago, few people had even heard of polycystic ovarian syndrome (PCOS). Now it has been recognized as a likely cause of female infertility, leading to widespread interest in what it is and how it can affect a woman’s ability to have a baby.

What Is PCOS?

PCOS, short for polycystic ovarian syndrome, is a common cause of a lack of ovulation (the releasing of an egg each month), and therefore a major cause of female infertility. Not all women with PCOS have cysts on their ovaries, so the name can be confusing, but they might have irregularities in their ovaries that can interfere with normal ovulation.

What Happens with Normal Ovulation?

With normal ovulation, an egg is released about 14 days into the menstrual cycle. With PCOS, because it is a hormonal imbalance, the egg is not always released. The imbalance can be related to androgens, the more “manly” hormones women also have (such as testosterone), or related to progesterone.

Progesterone is an essential female hormone related to pregnancy and the maintenance of a healthy pregnancy. In PCOS, a lack of progesterone contributes to irregular periods and to a lack of fertility.

Who Gets PCOS?

PCOS affects about 8 to 10% of all women of reproductive age, and the infertility rate in these women tends to be very high. It can be devastating for some women who try for a baby but do not get pregnant. In this case, their doctor may recommend fertility treatment. The type of treatment will depend on the type of hormonal imbalance, and how severe it is.

For example, some women with polycystic ovary syndrome will ovulate (that is, release a mature egg) and it will get fertilized, but the pregnancy does not take. In other cases, the woman never ovulates, in which case they would attempt to stimulate a mature egg so sperm could fertilize it.

Fertility treatments

Fertility treatments can be quite promising for some women. However, there are others that it may not work for…either due to cost or just overall inefficacy. Fertility treatments can also cause a range of unpleasant side effects. It is important to be aware of all the risks involved in using them.

What can functional medicine do for infertility?

With a functional medicine approach, I tend to take a “deep-dive” look into the possible reasons causing infertility with PCOS in order to address the root cause. Just because two women have PCOS, it doesn’t mean their approach to treatment should be exactly alike. Of course, implementing healthier lifestyle choices (such as getting good sleep, lowering stress levels, and eating a healthy diet) are important for everyone. In order to personalize the approach, many functional medicine practitioners will take a closer look at what that should look like for YOU.

Hormone testing

When evaluating infertility as a functional medicine physician, I tend to check all of important hormones because they’re very much interconnected. So we’ll look at thyroid levels, adrenal levels, and sex hormone levels. Many of these can’t be accurately detected in blood, so we’ll often do DUTCH testing to get the best results.

I will also test for signs of insulin resistance when investigating hormonal health. Talk with your provider about testing a fasting blood sugar and a fasting insulin level. If there are signs of insulin resistance (usually fasting level above 7), it is time to consider a low-carb diet and/or intermittent fasting. This will depend on whether or not your stress hormone (cortisol) levels are high. If cortisol levels are high, sometimes “over-exercise” or fasting can worsen the situation.

Nutrient deficiencies

Testing for nutrient deficiencies such as magnesium, vitamin d, and zinc also play a role in evaluating infertility; as many of these are necessary to properly metabolize or even build good hormone levels. If low, we discuss supplementation or the right kinds of foods to help improve these numbers.

Addressing toxicity

I’ll also often address toxicity, as it’s tough to metabolize or use hormones effectively if the body is not detoxing well. Toxins such as BPS, pats end, phthalates and pesticides can wreak havoc on your hormones. So trying to stay away from plastic and paying attention to what you put on your skin is incredibly important. I often say “your skin is like a giant mouth”. If you wouldn’t risk eating it, you probably shouldn’t lather it on your skin either.

An important component of detox is good bowel health, so ensuring my clients have regular bowel movements, are eating enough fiber, drinking enough water, etc is very helpful. Evaluating for the right combination of gut bacteria is also a vital piece to the puzzle. If something is off with gut imbalance, fermented foods such as kimchi, sauerkraut, or taking probiotics can often be useful in balancing the microbiome.

What about exercise?

Exercise is a key component to addressing infertility snd improving hormone health, but often needs to be more individualized. For some women with high cortisol levels, we’ve found that high-intensity exercises can work against you! A sign I’ll often see is if a women’s period stops, then it could be due to over-exercise or too little calorie intake. For some women, lower impact exercises like walking, yoga/Pilates may actually be more effective at weight loss and balancing hormones than something like CrossFit.

These are just some of the “root cause” issues that a functional medicine practitioner will evaluate for to ultimately reverse symptoms and regain fertility. The journey to fertility can be confusing and frustrating, but partnering with a Functional Medicine practitioner to help you understand the root cause of your problem can be the key to better health. If you’ve yet to consider that approach, I’d encourage you to give it a try.