You've done the hard yards....
✔️ You've been following a nutrition plan specific to getting your cycle back
✔️ You've been religiously popping your supplements every day
✔️ You haven't missed a day on your exercise regimen
✔️ And you haven't had a drop of alcohol in months.
So why is it that your cycle has now returned and seems to be regular, yet you STILL aren't pregnant?!
When it comes to PCOS and fertility, often we think straight to ovulation and cycle health. If we can tick this off then that's job done - right??
But PCOS and fertility are more complicated than this and there are many more crucial layers involved that you need to know about if you really want to optimize your fertility 100%.
Firstly I recommend making sure that you haven't made these common mistakes...
Following a diet that's tailored to weight loss rather than PCOS and fertility.
One of my biggest learnings in all of my years as a fertility dietitian is that a diet that supports weight loss is SO different to one that supports fertility and PCOS. YES it is possible to have both of these goals achieved through the same nutrition plan- but unless you've worked directly with a PCOS and fertility dietitian to create your plan then there is a big chance that this needs to be addressed. Ovulation is one piece of the fertility puzzle but gut health, progesterone levels, implantation and uterine health, inflammation, and egg quality are a huge part of your fertility too.
Your plan has cut out gluten and/or dairy.
Unless you have coeliac disease or a true gluten sensitivity, gluten is not inherently bad for PCOS. Often gluten avoidance can leave large nutritional gaps in the diet including folate, B12, B6, and niacin which are closely linked with better ovulation and pregnancy rates. It can be detrimental to your reproductive health, fertility, and potentially progress PCOS symptoms as it can have a knock-on effect of insufficient carbohydrate and vitamin/ mineral intakes necessary for hormone production, low energy levels, increase in brain fog, cortisol reduction, and to help you feel full and satisfied from meals.
Likewise, avoidance of dairy can reduce your nutrient intakes and stores of calcium, B vitamins and vitamin D. Given that the risk of nutrient deficiencies is already high with PCOS (particularly with Vit D) then this is definitely something to avoid restricting. Research has also shown that full-fat dairy is one of the 5 key factors associated with a reduction in anovulatory infertility by 69%. It has also been associated with a 30% reduction in the risk of miscarriage for women who ate 40g of cheese every day.
You're restricting carbs too much
Cutting carbohydrates too low can lead to a restrict/ binge cycle where you don’t eat enough carbohydrates to sustain you → your blood glucose levels drop and your body responds with hunger → you crave sugar or carbohydrates as your body’s way to increase blood sugar levels quickly → you are now more prone to binge eating a large amount of carbohydrates (usually high sugar / refined options) → you experience a big crash in blood sugars→ (and repeat)
Insufficient carbs can also contribute to hormonal imbalances (carbohydrates are necessary in the production of sex hormones), vitamin deficiencies especially B vitamins (important for ovulation and reproductive health), fatigue (hello skipped workouts), and poor sleep. Not to mention the negative impacts you might also experience on libido, brain fog, and mood.
There are 3 more common mistakes that I often see made and I share more about these in my FREE PCOS to Pregnant Nutrition guide- so I recommend checking this out to read them all!
Now, once you've made sure you are clear of any common mistakes that might be harming fertility, let's get into what you need to focus on next to help really boost your chances of pregnancy:
✅ Make sure that you are nailing the fertile window and pinpointing ovulation accurately. No sperm or not enough sperm= no fertilized eggs.
✅ Your egg health still needs some support. It takes 12 weeks for an egg to fully develop and mature ready for ovulation- so we need to maximise this opportunity and persevere with intensive, specific interventions to boost egg quality. Poor egg quality= less chance of fertilisation, less chance of implantation, and less chance of a viable pregnancy.
✅ Progesterone levels may be too low to support implantation and pregnancy progression. Progesterone can be sensitive and your diet and lifestyle will impact this directly. Your body relies on progesterone to get the memo that there is in fact an embryo on board and to support its development.
✅ Inflammation may be affecting endometrial receptivity. Inflammation isn’t solved within a day. Some level of inflammation is healthy for healing but too much makes it difficult for an embryo to implant successfully and can damage egg quality.
✅ Your endometrium may not be thick enough after long term anovulation and therefore long term low progesterone levels. Thankfully there are many nutrition factors that you can put into place to improve this drastically and increase your chances of successful implantation.
If you are tired of figuring it all out on your own and just want to know what to do with your diet and supplements that is proven by research to increase your chances of successful pregnancy then you are in the right place!
I have worked with hundreds of women who are TTC with PCOS to create successful, healthy pregnancies and babies. And I can help you too! Learn more about how you can work with me or go ahead and book your free 20min clarity call for us to talk more about your unique situation and needs and map out a plan for you to get from A to Z in as little time as possible. Book this here!
I look forward to supporting you more soon!
Alex Cameron
NZRD
Fertility, Pregnancy, & PCOS Dietitian
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