PCOS FAQ

Polycystic ovary syndrome (PCOS) is one of the most common hormonal disorders affecting people with a uterus of reproductive age, and it can have a significant impact on fertility. However, with proper management through diet, lifestyle changes, and medical treatments, many individuals with PCOS can successfully conceive. To help answer some of the most frequently asked questions, Hillary Wright, MEd, RDN, LDN, Director of Nutrition at Boston IVF’s Wellness Center, shares her insights on managing PCOS and optimizing fertility.

1. What is PCOS and how does it affect fertility?
PCOS is a hormonal disorder that affects how the ovaries function. Individuals with PCOS may have irregular or absent menstrual cycles, making it harder to predict ovulation and conceive naturally. Other symptoms include excess hair growth (hirsutism), thinning hair on the scalp, and weight gain. PCOS can also increase the risk of insulin resistance, which can further disrupt hormonal balance and fertility.

2. Can individuals with PCOS have children?
Yes, individuals with PCOS can have children. While PCOS may cause fertility challenges, it is a manageable condition. There are several fertility treatment strategies available, including medications to help regulate ovulation, lifestyle changes, and assisted reproductive technologies (ART) like in vitro fertilization (IVF). It's important to seek help from a fertility specialist who can develop a personalized treatment plan based on your specific needs.

3. Why do people with PCOS have irregular menstrual cycles?
Irregular menstrual cycles in individuals with PCOS are typically due to hormonal imbalances. Specifically, people with PCOS may experience higher levels of insulin, which can interfere with the hormones needed for regular ovulation. When ovulation doesn’t occur regularly, menstrual cycles can become unpredictable or absent altogether.

4. What is insulin resistance and how is it connected to PCOS?
Insulin resistance occurs when the body’s cells don’t respond effectively to insulin, a hormone that helps regulate blood sugar. To compensate, the body produces more insulin, which can lead to higher-than-normal levels. This excess insulin can disrupt other hormones, such as those responsible for ovulation, contributing to the symptoms of PCOS. Managing insulin resistance through diet and lifestyle changes can improve fertility outcomes for people with PCOS.

5. What diet and lifestyle changes can help manage PCOS?
Diet and lifestyle play a central role in managing PCOS. Here are a few strategies that can help:

• Focus on a plant-based diet: This doesn’t mean you need to be vegetarian, but increasing your intake of fruits, vegetables, and whole grains can help regulate blood sugar and insulin levels.
• Monitor carbohydrate intake: Carbohydrates trigger an insulin response, so it's important to choose high-quality carbs and pair them with protein to help regulate blood sugar. Spreading your carbohydrate intake throughout the day can also help.
• Increase physical activity: Regular exercise helps lower blood sugar and improves insulin sensitivity. Building muscle is particularly beneficial since muscles help the body use insulin more effectively.
• Sleep and stress management: Adequate sleep and stress reduction are key components of hormonal balance and overall health.

These changes not only improve fertility but also lower the risk of chronic conditions such as diabetes and cardiovascular disease.

6. Do all people with PCOS struggle with weight?
Not all individuals with PCOS are overweight. Some people have what's called "lean PCOS," meaning they do not have excess body weight but still experience symptoms such as irregular periods or facial hair. Both lean and overweight individuals with PCOS can have insulin resistance, though people with "lean PCOS" may experience it to a lesser degree. It's important to focus on overall health and lifestyle changes, regardless of weight.

7. Do people with PCOS need to lose weight before trying to conceive?
While weight loss can improve fertility outcomes for some people with PCOS, it’s not always necessary to delay fertility treatments for weight loss. For individuals who are overweight, even a modest weight loss of 5-10% can have a positive effect on menstrual regularity and ovulation. However, the primary focus should be on adopting healthy eating and exercise habits that improve overall health and fertility, rather than solely focusing on weight loss.

8. What fertility treatments are available for people with PCOS?
There are several fertility treatments available for people with PCOS, including:

• Ovulation induction: Medications like clomiphene citrate or letrozole can help stimulate ovulation.
• Metformin: This medication is often prescribed to improve insulin sensitivity and regulate menstrual cycles.
• Intrauterine insemination (IUI): This procedure involves placing sperm directly into the uterus to increase the chances of fertilization.
• In vitro fertilization (IVF): IVF is an option for people who do not respond to other treatments. It involves retrieving eggs, fertilizing them outside the body, and then transferring an embryo into the uterus.

9. When should someone with PCOS seek help from a fertility specialist?
If you have PCOS and have been trying to conceive for 6-12 months without success, it’s a good idea to seek help from a fertility specialist. Individuals over the age of 35 should seek help sooner, after about six months of trying to conceive. Early evaluation and intervention can improve your chances of achieving pregnancy.

10. Can managing PCOS improve long-term health?
Yes, managing PCOS through diet, exercise, and lifestyle changes not only improves fertility but also lowers the risk of long-term health issues such as type 2 diabetes, high blood pressure, and cardiovascular disease. The same strategies that improve fertility can support your overall health, so it’s important to adopt these habits for the long term.

Conclusion
PCOS is a common and manageable condition, and with the right approach, many people with PCOS can achieve successful pregnancies. At Boston IVF, we take a comprehensive approach to managing PCOS, offering both medical treatments and lifestyle counseling to help optimize your health and fertility. If you have been diagnosed with PCOS and are struggling to conceive, we encourage you to reach out to our team for support and guidance on your journey to parenthood.