If you’re wondering how to get pregnant with PCOS, then you’ve come to the right place.
In 2016, I overcame what I’d come to believe was incurable PCOS infertility. Since then, I’ve had the pleasure of seeing hundreds of other women take control of their reproductive health and fall pregnant too. This includes women with lean type PCOS as well as those with more classical symptoms where weight loss plays an important role in restoring fertility.
As someone that’s been through the full list of fertility treatments before finally falling pregnant naturally, I’ve written this article to provide a comprehensive overview of both the lifestyle changes and the medical interventions that can help you achieve a healthy happy pregnancy.
With the information you’ll find here in these 13 “must know” things about PCOS and pregnancy, you’ll be able to make the best fertility choices for your particular circumstances.
1. Can You Get Pregnant With PCOS?
Despite the fear that may’ve been instilled in you when you were first diagnosed, there are a hundred good reasons to be optimistic about your chances of getting pregnant with PCOS. While PCOS can be a barrier to this goal, with the right information and support the vast majority of women are able to achieve their dreams of motherhood.
The biggest question in my mind is not can you get pregnant with PCOS. Instead, the question should be how long is it going to take, how healthy is your pregnancy going to be, and will your baby get the best start it needs for a healthy life of his or her own?
If you’re anything like me, once you decide you want to get pregnant, then it needs to happen right when you planned it. Unfortunately, life, sometimes has other plans, as I learned the hard way.
It took me nearly five years to overcome my PCOS infertility and throughout this experience, the ability to stay positive and happy was a never-ending battle. I’d see my friends and family go on to have their first, second, and even third children while I was still busy spending thousands of dollars in fertility treatments that only left me in tears. There’s no denying that trying to figure out how to get pregnant with PCOS can be a very unfair, and overwhelming process.
While I’m probably more confident than you are that you’ll be able to do it successfully, for the sake of your sanity, I think it’s worth budgeting for some extra time to get your PCOS under control before or while you’re trying to conceive. Even for women without PCOS, trying to get pregnant can be an emotional rollercoaster. Bracing for the possibility that it may take longer than you would otherwise like is something I wished I’d been more conscious of before I got started.
2. Why Getting Pregnant With PCOS Is So Hard
When I first started having trouble falling pregnant, I had no idea what I was dealing with and this made the problem a hundred times scarier. It now seems obvious that the first place I should’ve started is understanding the cause of my problem better.
Conception and gestation are the essential steps that’ll take you from happy couple to a family of three. Unfortunately, women with PCOS face an uphill battle with both of these.
Before I address this further, I think it’s worth taking a minute to clarify that while PCOS’s impact on fertility can be a function of what type of PCOS you have, from a solutions-based perspective, the distinction is without a difference.
The medical community describes four types of PCOS: Frank PCOS, Ovulatory PCOS, Normoandrogenic PCOS, and Non-polycystic ovary PCOS (Clark et al. 201447). Other common groupings separate thin-type or lean PCOS, from the more classical body shape that results from this disorder. While I can appreciate the need for the medical community to better define PCOS with these more precise groupings, in my experience they’re not overly helpful.
What is useful to know though is that all but the ovulatory type of PCOS are characterized by irregular or absent periods (in the absence of birth control). Estimates put this at around 87% of the PCOS population, which means re-starting ovulation is key to most women with PCOS that want to have children.
So, if challenge number one, is getting a regular period, the next cab of the rank is producing a quality egg.
Women with PCOS are known to have trouble producing high-quality eggs and this is one of the main causes of infertility within our community (Palomba et al. 20172). Poor egg quality is likely due to an intrinsic defect in the egg along with an excess of androgens like testosterone within the ovary (Patel et al. 200849). Poor egg quality means it is harder for an egg to implant and even if it does you’re also more likely to miscarry. As anyone who’s experienced miscarriage before can tell you, the results can be devastating.
Often ovulation induction is used to address the fact that we don’t get our period, but if we’re not producing quality eggs in the first place then our chances of success are always going to be limited. Rightly or wrongly, this is why so many fertility specialists recommend moving straight to IVF, but even then, there can be issues with eggs not being sufficiently developed (this is what’s meant by having immature oocytes).
Assuming we can get past these essential stages of conception and manage to successfully fertilize a viable egg, the next step of course is implantation in the uterus. Successful implantation of a healthy embryo requires a “receptive” endometrium and a synchronized dialog between the mother and soon-to-be baby. This is a demanding process for all involved and glucose metabolism has been proven to be important for ensuring the endometrium is ready (Schulte et al. 201550).
This is why addressing issues like insulin resistance and excess bodyweight are such powerful ways to improve your chances of success. It’s well known that obesity is a major factor in infertility even in women without PCOS (Broughton et al. 201751). Obesity is known to induce inflammation in the ovaries. This is particularly salient to women with PCOS as not only does this reduce egg quality making it harder to get pregnant (Snider et al. 201952), but since chronic inflammation is possibly the biggest factor driving our diagnosis, it makes all our other symptoms worse too.
I’m sure you’ve heard a lot of this before, but I want to highlight that the relationship between bodyweight and fertility are something to feel positive about. Studies have shown that just by lowering bodyweight by 5-10% we can have a significant impact on our fertility (Clark et al. 199553; Xue et al. 202054). This is a linear relationship for overweight women so every pound you can drop is a pound in your favor (van der Steeg et al. 200855). Even if you’ve been trying all your life to manage your bodyweight, until you’ve experienced how much easier this is with a PCOS diet, having your first or next baby may be easier than you thought.
Helping women adapt to a PCOS diet is the key objective of my free 30-Day PCOS Diet Challenge. During this live event, we take a stage approach to modifying our meals to use more ingredients that support our health and less of the ones that make getting pregnant harder. While I talk about this more below, and explain my 13 PCOS diet principles here, the gist of it is really about eliminating foods that promote inflammation, and swapping them instead, with ingredients that really nourish you.
Kayla Jones is a perfect example of this. After implementing a few of the most effective dietary changes for women with PCOS, she lost 20 pounds and was able to successfully get pregnant with her second child.
3. PCOS Increases Pregnancy Risks
Once you get that big fat positive, go through that anxious two-week wait, and see the rapidly pulsing heart rate of your baby-in-the-making, it’s hard not to spend the next nine months overcome with anxiety. If you’ve previously experienced the pain of miscarriage, it can be an exercise in mental determination to actually enjoy your pregnancy.
Being pregnant is truly one of the most meaningful and memorable times in any woman’s life, even if it’s spent feeling nauseous, in pain, and bitterly uncomfortable. Despite the physical discomfort and anxiety about the future, I know that after battling with their health for most of their lives, women with PCOS have a special appreciation for their pregnancy.
It’s a wonderful achievement to get pregnant with PCOS, but it’s really only a milestone along the way. Staying healthy during your pregnancy needs to be your top priority not just for you, but for your baby too.
The increased risk of pregnancy complications for women with PCOS has been well documented in the scientific literature. This has been shown to be independent of all the usual major variables like age, body weight, and embryo genetics (Luo et al. 20173).
On average, women with PCOS have a 3-4 fold increased risk of pregnancy-induced high blood pressure and pre-eclampsia, a 3-fold increased risk of gestational diabetes, and a 2-fold higher chance for premature delivery (Yao et al. 20174; Lonnebotn et al. 201841; Palomba et al. 201557).
The flip-side of this equation though is that by making positive changes to your diet and lifestyle all of these risks can be mitigated. The majority of these pregnancy risks center around metabolic health. While genetics play a role, at an individual level, what you eat makes the biggest difference to your metabolism. Throw in a little regular exercise and stress management on top to further reduce inflammation, and you’ll be setting yourself up nicely for a healthy, happy pregnancy.
4. The Link Between PCOS And Infertility
Like the majority of women with this disorder, I was put on birth control as a teen because I only had a period about once or twice a year. While this got rid of the presenting problem, little did I know how bad this was for my PCOS. Despite remaining one of the first drugs offered to women in my situation, birth control for PCOS is a band-aid solution that merely masks the symptoms.
When it comes to understanding the root causes of PCOS and infertility the key factors are chronic low-grade inflammation, insulin resistance, and our unusually high levels of androgenic hormones like testosterone.
These mechanisms are the primary cause of ovarian dysfunction and infertility in women with PCOS. They also hint at multiple ways we can improve fertility using diet and lifestyle interventions. For example, by eating pro-inflammatory foods like gluten, dairy, vegetable oils and sugar, we’re essentially adding further fuel to a pre-existing fire. Out of control inflammation drives all PCOS symptoms so, it makes perfect sense that eliminating these foods can boost your chances of getting pregnant with PCOS.
Our chronic inflammation is also closely linked to the way our cells respond to glucose. Regardless of whether you’re thin, or overweight, the majority of PCOS sufferers will have a dysregulated ovarian insulin response.
Insulin resistance is a common issue that affects around three quarters of women with PCOS. While people often focus on the metabolic health concerns associated with this pre-diabetic state, the downstream consequences are responsible for a lot of the hormone dysregulation that leads to infertility.
Excess insulin causes our ovaries to overproduce androgens which ultimately cause our eggs to stop maturing before they get a chance to ovulate. It’s a bit of a circular loop: PCOS means high androgens and chronic inflammation which in turn leads to insulin issues. When our insulin functioning gets bad enough, it then returns the favor by promoting more androgens and further inflammation (Rosenfield et al. 201646).
The good news about insulin resistance is that given the right dietary changes, this condition can be reversed. It’s actually one of the key reasons why women following a PCOS diet, like the one I share during my free 30-Day PCOS Diet Challenge, have been so successful in getting pregnant.
5. Don’t Underestimate Diet And Lifestyle Changes
Many fertility doctors and OBGYN’s will tell you that a PCOS diagnosis means you’ll only ever be able to get pregnant with the help of fertility treatments. This couldn’t be further from the truth.
There’s a huge amount of compelling evidence that shows for many women, the right lifestyle modifications may be all that’s needed to achieve a healthy PCOS pregnancy (Karimzadeh et al. 201042). Even within the mainstream medical establishment, lifestyle modification is understood to be the best initial treatment tool for overweight PCOS women that are trying to conceive (Artini et al. 201848)
I’m a classic example of this after having fallen pregnant naturally despite years of previous unsuccessful fertility treatments. I was able to restore my period by changing my diet and lifestyle which then eventually helped me fulfill my dreams of motherhood without another trip to the fertility clinic. As the case studies I’ve included throughout this article show, this isn’t a rare event, and anyone can do it with the right information and support.
Modifying the way you eat, exercise, and manage stress has been shown to have a profound effect on PCOS and fertility. This is true regardless of whether you’re trying naturally or you need a little extra help with fertility treatments.
Let’s take a better look at the evidence:
If you’ve consulted a doctor about getting pregnant with PCOS and you also happen to be overweight, it’s likely that you would’ve been advised that losing weight before conceiving is a good idea right? While this advice can often be poorly delivered by an insensitive health care professional (often with little support on how to achieve this), there’s good consensus with this view amongst experts (Tarlatzis et al. 20085).
As I mentioned above, excess weight has been shown to adversely affect the reproductive outcomes of a PCOS diagnosis (Baghdadi et al. 20126; Joham et al. 20147) so getting to a healthy preconception body weight can really boost your fertility. In my PCOS weight loss article, I share the 15 things you need to know in order to do this successfully.
A PCOS fertility diet and other lifestyle interventions like exercise and stress management, don’t just improve the fertility of those that are trying to lose weight though. Women with lean type PCOS have just as much to gain from making these changes if ovulation or recurrent miscarriage is holding you back from starting your family.
The benefits of using lifestyle interventions in addition to seeking fertility treatments can best be seen in a study which showed that taking a four month break to improve your diet and lifestyle before starting fertility treatments greatly improves your chances of success (Legro et al. 20168).
To give you a feel for the results that can be achieved, in the lifestyle intervention study referenced above, ovulation rates improved by around 50%, while live births more than doubled as a result of lifestyle modifications prior to fertility treatment.
This is why I say it doesn’t matter if you’re planning on undertaking medical fertility treatments or not. By being intentional about what you eat, the exercise you do, and how you cope with stress, you’re setting yourself up for success irrespective of whatever else you are doing.
Within this list of lifestyle interventions, diet is by far the most powerful. So, let me give you an idea of what’s possible with a couple of real-life case studies – the first from a woman with lean type PCOS and another from a woman with more classical symptoms where weight loss played an important part in improving her fertility.
After not having any luck for more than a year of taking the ovulation induction drug clomid, Karima decided to explore dietary interventions as a way to improve her PCOS and fertility. She signed up for my free 30-Day PCOS Diet Challenge and dedicated herself to the nutritional principles I explain during this program. To her delight, after 6 months of following my dietary guidelines Karima was able to fall pregnant naturally with her gorgeous son.
Jamie Bietzell is another great example of the dramatic turn of events that are possible when putting the right dietary changes into practice.
Jamie and her husband had been trying to conceive for four long years and hung their hopes and dreams on conventional medical treatments like metformin during this time. While she had managed to conceive twice, both pregnancies had ended in miscarriage leaving Jamie wondering if she’d ever be a mom. She knew that a big part of her problem was that she was overweight, but nothing seemed to work no matter how hard she tried.
After completing my free 30-Day PCOS Diet Challenge in November, Jamie found new hope. By January she was getting a regular cycle and by April she’d lost 50 pounds dropping from a size 22 jean to a size 18. Her A1C levels showed she was no longer diabetic, her blood pressure dropped out of the hypertensive range, and a few months later she had fallen pregnant. No drugs, no supplements, just the right PCOS diet plan to get pregnant.
In Jamie’s case, it was the impressive changes to her metabolic health that enabled her to achieve a healthy, happy, natural pregnancy after battling with PCOS infertility for so long. Despite her disarming modesty, Jamie is a perfect example of how beatable PCOS can be when you put your mind to it.
Following the auspicious birth of her son on Christmas day, Jamie kindly gave me permission to share this touching announcement.
Adopting a PCOS diet goes well beyond just helping your fertility though. Eating in a way that supports your PCOS can help you be at your best during and following your successful pregnancy. When you consider the ongoing upside, it’s easy to see why a PCOS diet plan to get pregnant often evolves into a permanent lifestyle change. As long as you’re sustaining this healthy way of living, not only have you effectively solved the underlying cause of your infertility, but you’re also addressing your other PCOS symptoms too.
The downside of using lifestyle interventions to treat PCOS infertility however, is that it can take longer. It takes time for your body to heal and for the effort to convert into real results so plenty of patience is clearly a key factor for success here (definitely not my strong suit).
I can clearly remember that gut-wrenching desperation I felt once I’d decided I was ready to be a mom, so I completely understand the desire to “just get on with it” and the justifications for heading straight to the fertility clinic.
This is largely why I sought fertility treatments for my PCOS in the first place as the dietary changes I had begun to make only a few months earlier still didn’t seem to be working. My lack of understanding meant I completely underestimated just how powerful lifestyle changes could be.
While it took me two years before I started having a regular period, once I got there, I was able to fall pregnant naturally very quickly.
As I found out, sometimes it pays to take a longer-term view as this would’ve saved me and my husband tens of thousands of dollars and untold stress over what ended up becoming many unnecessary fertility treatments.
Not to mention a lot of bruised and collapsed veins!
6. Know When Fertility Treatments Are Needed
To be fair and balanced here, there’s no doubt that fertility treatments certainly have their place and we’re lucky to have this option. The key is knowing when they’re necessary and when they’re not.
If there’s a male factor fertility issue or another complication beyond PCOS, medical intervention may be well warranted.
Fertility treatments may also be a good option if you’re in your late 30’s and are concerned about the time that may be needed to heal your PCOS through diet and lifestyle changes alone. As a 1981 baby that still feels like a spring chicken, I absolutely hate saying that your late 30’s are “old” but unfortunately our biology takes no prisoners.
The effect of age on egg quality can be seen in studies that look at the percentage of embryos produced via IVF that have the correct number of chromosomes. Embryos with the wrong number of chromosomes almost always either fail to implant in your uterus or they result in early miscarriage so chromosome count is an excellent indicator of egg quality.
As the figure below shows, egg quality peaks in your late twenties, and then begins a speedier decline after your mid-thirties. Unfortunately, the reality is that this has a direct effect on your chance of getting pregnant with PCOS.
Figure 1. Percentage of embryos produced by women that have the correct number of chromosomes i.e. “good quality” eggs. (Franasiak et al. 20149).
What this means for our “natural” fertility is that for the average woman, things start to get pretty difficult once you hit 40 as can be seen in the next figure. These results used the genealogical data from women and their husbands born between 1840 and 1859 which is useful for seeing how fertile we’d be if it weren’t for all the advances in the medical technology that we benefit from today.
Figure 2. Changes in relative “natural” fertility rates with age from historical population data (Menken et al. 198610)
The ability to extend the age at which we can start or grow our families is one of the greatest gifts of advanced reproductive technology, but even with the best clinics, age can be a major barrier to a successful PCOS pregnancy. While the media loves to cover celebrities having children in their 50’s, the reality for women wanting to use their own eggs is that even with IVF, once you pass 45 years of age, your cumulative success rates are likely to be less than 20% after three attempted cycles.
While I hate being so blunt, the take home message here is that if you’ve hit your forties, it’d be prudent to pursue fertility treatment regardless of how PCOS friendly you’re living.
7. Understand What Fertility Treatments Can’t Do For PCOS
The downside of fertility treatments is that they do nothing to address your underlying PCOS diagnosis – they’re more of a clever way to get around the problem for the purposes of having children. Just like how taking the pill “solves” irregular periods, fertility treatments are another band-aid solution that may help you get pregnant in the short-term but do not benefit your pregnancy or your health beyond that.
This comes back to what I said before. Working on your diet and lifestyle in addition to fertility treatments not only improves your chances of success, but it also means that when you do get pregnant, you’ll be more likely to have a healthy PCOS pregnancy. It’ll also improve breastfeeding (Boudet-Berquier et al. 201843; Garcia et al. 201644) which will support the long-term health of your baby.
The risk of your PCOS getting worse after pregnancy is also a major concern that I see regularly through my PCOS support group.
This is why I get so many mom’s taking part in my free 30-Day PCOS Diet Challenge. Because it’s also not uncommon for unwanted hair, and PCOS acne to get worse, and many women will struggle with their weight even more following childbirth.
Women that don’t get the help and support they need to adopt a PCOS friendly lifestyle will also often find themselves back to square one when they’re ready to have another baby.
One of the participants from my very first free Challenge found herself in this exact situation. Katrina was suffering from secondary infertility, was struggling with hirsutism, and had gained 50 pounds since her daughter was born four years earlier. The emotional and physical trauma of an earlier miscarriage was taking its toll, leading her to cycle between binge eating and starving herself through depression. It wasn’t like she hadn’t tried to diet before but nothing seemed to work over the long term, and her self-confidence, not to mention her sense of hope was at an all-time low.
Fortunately, after completing the Challenge, Katrina was able to implement and continue a truly PCOS friendly diet. Fast forward a few months and not only had she fallen pregnant, but she was also experiencing a wonderful pregnancy that was so much healthier than the first time around. She even managed to avoid getting gestational diabetes like she had in her first pregnancy.
This short summary hardly does justice to the transformation Katrina undertook so for anyone interested, you can read her entire story here.
8. Be An Informed Fertility Patient If You Need Treatment
Thankfully for the families in need, reproductive technology has advanced a long way beyond telling people to “just relax and it will happen”. This was always a pet peeve of mine during my four and a half years of trying to conceive.
When I first went to get fertility treatments, I really didn’t understand what my options were. I was at the mercy of the doctors I would see, and looking back now, I don’t necessarily think they were as well-informed as I would’ve preferred. This is not intended as a slight towards the profession at all, but many general practitioners, and even some OB/Gyns don’t get the chance to be as versed in the intricacies of PCOS as they’d like either. The value of good nutrition specifically for the treatment of PCOS is often not part of your standard medical education, which is why it always pays to know as much as you can about this topic yourself. The best weapon that an informed patient can wield is good information obtained through high quality self-education.
Here are the basics of the standard PCOS fertility treatment options:
The first options for most fertility specialists that treat women with PCOS are metformin and clomid.
Metformin improves insulin sensitivity/decreases insulin resistance, which hopefully in turn will enable ovulation to be restored. That’s the theory anyway, but the scientific evidence does not support the use of metformin in this way with even leading experts now discouraging it’s use as a first-line therapy “for any indication in women with PCOS” (Barbieri et al. 201835).
In a review of 44 trials involving 3992 women, researchers found that there was no evidence that metformin improved live birth rates, whether it was used alone or in combination with clomid (Tang et al. 201236). Pregnancy rates? Yes. But live birth rates? Not so much, which is the result that really matters. Even the Endocrine Society Clinical Practice Guidelines, which are published regularly to inform doctors state that “…metformin is beneficial for improving menstrual irregularities, but it has limited or no benefit in treating …infertility.” (Legro et al. 201337).
In addition to not being an effective fertility treatment, metformin is well known to deplete vitamin B12 (Aroda et al. 201638), which can negatively affect the health of both you and your baby. B12 deficiency during pregnancy increases the chances of preterm birth/reduced birth weight (Rogne et al. 201739); and raises the risk of your baby developing neural tube defects like spina bifida (O’Leary et al. 201040). After having looked at the latest research about this drug, metformin is something I never would have taken when I first sought fertility treatment, if I knew back then what I know now to be true.
To learn more on this topic, please see my five reasons not to take metformin for PCOS.
Clomid on the other hand takes a more direct approach by forcing your ovaries to ovulate. The downside of Clomid is that it can have some nasty side effects and it doesn’t restore successful ovulation in more than one in four women. Only 29% of women that take this drug actually have a baby (Homburg 200511).
If like me, you fail to fall pregnant after 4-6 months with these drugs, it’s likely you’ll advance to one of the more modern ovulation inducing drugs which will be either an aromatase inhibitor known as letrozole (sold under the brand name Femara) or an injectable hormone product.
It’s worth noting here that many experts now believe that doctors should skip the first step and head straight for letrozole as this drug has been shown to result in better outcomes for women with PCOS (Legro et al. 201412; Klement et al. 201513).
By the time you’re getting to injectable ovulation induction hormones your costs for treatment are going to be getting up there. While you can use these drugs to help you fall pregnant naturally, often times when taking this approach, women will also opt for artificial insemination, or IUI as it’s commonly known (intrauterine insemination). This helps increase your chances of success for a relatively small additional cost on top of the drugs and consults.
One of the most important things to keep in mind when undergoing ANY kind of ovulation induction is that you need to receive regular ultrasound monitoring leading up to the day you ovulate. I appreciate that depending on your health plan, this can add costs to the process but these drugs all greatly increase your chances of having twins and triplets as they can make you ovulate more than one egg at a time.
While this might sound good in theory if you’re in a rush to have lots of kids like I was, falling pregnant with twins or triplets can result in serious health risks to both you and your babies and is generally not an ideal outcome given our already compromised reproductive health.
In my case, I tried six times with clomid before moving on to injectable hormones. I miscarried twice during this process due to chromosomal issues which is what led me down the road to IVF with ICSI and embryonic genetic testing – the most advanced weapon in the fertility specialist’s arsenal.
When you undergo IVF, every step of the reproductive process is controlled and monitored which means any additional fertility issues you have can be identified and by-passed. If you’re afraid you’ll never be able to have kids because of PCOS, then IVF really is the ultimate last resort.
IVF starts with ovulation induction, but unlike when you’re trying naturally or doing an IUI cycle, IVF involves taking a lot more hormones. The goal is to intentionally mature 12 – 20 eggs so the specialist can “harvest” these for fertilizing in the lab.
Once your eggs have been collected, they are then fertilized either by introducing your partner’s sperm and letting the little swimmers do their thing, or by injecting a single lucky sperm directly into the egg – a process known as intracytoplasmic sperm injection (ICSI). This last step is an optional technology which greatly increases fertilization rates and helps overcome shortcomings in your partner’s fertility. This is something my husband and I opted for the second time around after so few of my eggs fertilized during my first cycle.
Once the eggs are fertilized, they are then grown for a few days under carefully controlled lab conditions before either being placed back into your uterus as a “fresh embryo transfer”, or being cryogenically preserved for a later date in what’s known as a “frozen embryo transfer”.
The last IVF technology worth a quick mention here for anyone concerned about getting pregnant with PCOS is PGS testing or pre-implantation genetic screening. As the name suggests, this involves checking to see if an embryo has a normal set of genes before going ahead and putting it back in your uterus. This can make one of the biggest possible differences to your chances of success.
But just to be clear on this technology, women with PCOS have been shown to have a normal risk for chromosomal abnormalities (Luo et al. 20173) so a decision to undergo PGS should be made for other reasons.
In my case, PGS took my IVF success rate probability from 35% per transfer to 70% which essentially halved the chances of an early miscarriage. PGS is super expensive though, so it’s not for the faint hearted and as my successive failed cycle’s show it’s still no guarantee of success.
9. Don’t Make This Preconception Treatment Mistake With Clomid
Putting the principles of Step #8 into practice, here’s some essential knowledge for anyone that’s advised to go on birth control before starting a clomid cycle:
A recent survey revealed many obstetricians and even reproductive endocrinologists have major knowledge gaps when it comes to PCOS (Dokras et al. 201714).
As a result of this gap many doctors will incorrectly prescribe the birth control pill as a short-term preconception treatment. The idea behind this thinking is that the pill will suppress the over-production of androgens, which in theory should then also kick-start ovulation when you then stop taking them.
The problem with this approach is that it’s based on outdated science.
Recent research has shown that taking birth control for four months in preparation for fertility treatment may in fact do more harm than good. Preconception birth control not only has no benefit to your chances of ovulation, but it also worsens metabolic health and may potentially be detrimental to your fertility (Legro et al. 201515; Legro et al. 20168).
As I mentioned earlier, rather than mess around with birth control ahead of taking clomid, it’s been clearly shown that taking a four month break to improve your diet and lifestyle makes it far more likely that you’ll successfully fall pregnant if and when you eventually proceed with your fertility treatments (Legro et al. 20168).
Randiann Tokeshi would be the first to agree with these scientific findings. After three unsuccessful rounds of clomid, two IVF cycles, and a first trimester miscarriage, Randiann felt defeated and fell into depression. Her faith was restored however, after taking part in my free 30-Day PCOS Diet Challenge where she began applying the principles of a PCOS fertility diet. Over a six-month period, she lost 45 pounds and finally decided to give clomid another try. Two cycles later, her six-year journey through heart-breaking infertility had finally ended with the blessing she had longed for.
Randiann gave me permission to use this touching message she posted in my PCOS Support Facebook Group.
During every free 30-Day PCOS Diet Challenge, I see many women struggling with the idea that an answer as simple as dietary change can lead to such powerful results. My hope is that this disbelief will diminish as the latest research is more widely disseminated and we hear more from inspiring women like Randiann.
10. Consider Taking Myo-Inositol
After having been through IVF twice, one of the things I wish I had known before starting IVF, was how useful the supplement myo-inositol is. This is another nugget of information, the most well informed PCOS fertility patients should know about.
Myo-inositol is a safe and affordable supplement that has been shown to increase egg quality and reduce the risk of ovarian hyperstimulation syndrome when doing IVF (Papaleo et al. 200916; Ciotta et al. 201117).
Myo-inositol has also been shown to be more effective than birth control at regulating our ovarian function (Ozay et al. 201618), and appears to be better than metformin for boosting pregnancy rates in women with PCOS (Raffone et al. 201019).
One of the most popular inositol supplements for women with PCOS is the product Ovasitol by Theralogix. This supplement contains a combination of two types of inositol, with myo-inositol being the main ingredient. Ovasitol is widely promoted for helping you to get pregnant with PCOS, and this certainly seems to be well supported by science.
Here’s where I differ from other people about this product though. While Ovasitol is clearly a good supplement, even after allowing for the smaller recommended dosage, it’s three times more expensive than a regular myo-inositol supplement.
For women with PCOS that are only interested in boosting their fertility, this well-marketed product does not appear to be significantly better over the long term than it’s cheaper, myo-inositol only alternative. This is actually spelled out in the results of the most commonly cited study, it’s just that this fact is conveniently omitted by promoters of the product (Nordio and Proietti 201220).
While I’m not a fan of self-prescribing anything besides food and exercise, if you were to take myo-inositol, doses of 4000 mg per day are commonly prescribed for the treatment of PCOS infertility. This dose also appears to improve insulin resistance in pregnant women with gestational diabetes (Regidor et al. 201621; Corrado et al. 201122; D’Anna et al. 201223).
11. Implement A PCOS Diet No Matter Which Path You Choose
While diet changes are listed as #11 on this list, they are actually the MOST important step you can take towards a successful PCOS pregnancy.
At the top of this article I explained the mechanisms by which our hormone imbalances mess-up our ovulatory cycle and that it all begins with high androgens, inflammation, and how our cells respond to glucose. With this in mind, it makes perfects sense that we can reverse these negative effects by being more selective about the foods we eat.
Two women, Alisha P and Bianca K, are perfect examples of what’s possible when implementing the right kind of PCOS diet plan to get pregnant.
Despite having spent nearly two years struggling with infertility, Alisha P was not happy about the idea of taking clomid and metformin to help her ovulate. Instead she chose to join my 10-Week Program and after starting what would become a dramatic change to her diet and lifestyle, Alisha went from having no energy to feeling fantastic. She lost 30 pounds, her skin cleared up, her hormone blood tests started coming back normal, and she regained a normal period after not having one for 8 months. The best part though, was that within months of starting this transformational change, Alisha fell pregnant naturally just the way she’d always hoped for.
Bianca K on the other hand discovered the power of a PCOS diet after she was told that since she needed to lose weight but couldn’t, bariatric surgery was her best option for starting a family. After taking part in my free 30-Day PCOS Diet Challenge, Bianca cancelled her appointment with the surgeon, and went on to do things her own way. After losing 30 pounds by learning how to make PCOS friendly meals, Bianca was able to fall pregnant naturally and is now a mother to a beautiful son.
So, what does a diet geared towards fertility for women with PCOS actually look like in practice?
First, as I’ve already mentioned, a PCOS fertility diet has us eliminating pro-inflammatory foods like vegetable oils and sugar. Other foods that trigger our immune system can also make a big difference to our fertility as I describe in my article about food to avoid with PCOS.
We can also choose foods that promote a slow rise and fall of our blood glucose levels, which help us avoid the cascading events that mess with our ovaries. This is by far one of the most powerful levers to pull. Many women report getting their first period in years when they get started on the meal plans I provide during my free 30-Day PCOS Diet Challenge or by using my free 3-Day PCOS Meal Plan.
Rather than eat foods that spike your blood sugar levels, it’s better to nourish yourself with the best foods for PCOS that sustain you across the day.
By directly addressing your insulin response in this way you’re treating your infertility at a basic level rather than applying another band-aid solution. Instead of taking a drug to alter your hormones, you’re eating in a way that lets your body do so naturally providing a long-term solution with benefits that go well beyond just getting you pregnant.
By treating your PCOS with food you lower your chances of miscarriage, and the likelihood of developing gestational diabetes, or preeclampsia. You’ll breastfeed better, your baby will be healthier long-term, and if you’re blessed with a girl, you’ll lower the chances of passing on your PCOS diagnosis to her (Tata et al. 201824).
If you’re just getting started on your family now, treating your PCOS with food also means you’ll be far better prepared when it’s time for baby number two, three, or four.
From a general health perspective, the right PCOS diet helps you achieve and maintain a healthy body weight, improves both your cardiovascular and metabolic health, and lowers the risk of liver disease, and endometrial cancer which are generally elevated in women with PCOS (Glintborg et al. 201745).
PCOS friendly food really has a lot going for it…
If I’ve managed to convince you that dietary change really is a kick-ass solution and you’re ready for action, make sure to read my comprehensive PCOS diet blog. In this ultimate beginner’s guide, I provide a thorough description of how to do a PCOS diet correctly, in 13 simple steps.
While these 13 steps are definitely simple to understand, when it comes to applying them, they can be a little overwhelming at first. This is exactly why I created my free 30-Day PCOS Diet Challenge. This free program makes it fun and easy to put all these good ideas into practice. As well as weekly meal plans, recipes, and shopping lists, the Challenge also includes video lessons and a vibrant online community to cheer you on.
I run the Challenge four times a year, which means there’s a good chance we’re starting one soon. If the timing isn’t right though and you want to get started today you can still take action by downloading my free 3-Day PCOS Diet Meal Plan. This 15-page ebook includes some of my most popular PCOS recipes as well as an accompanying shopping list and further information on beating PCOS through dietary intervention.
I also have a PCOS Diet Cheat Sheet you can stick on your refrigerator door as a prompt. This handy list summarizes a PCOS fertility diet on a single page using over 180 example foods. It also includes accompanying notes with a bunch of other information I’m sure you’ll find useful.
One of the important things to keep in mind when applying a PCOS friendly diet is that you don’t need to count calories or restrict your energy intake in anyway, even if losing some weight is included in your fertility plan. With the right changes to what you eat, excess body fat can be naturally eliminated without the need to worry about how much you’re eating.
If you’ve spent the last decade dieting, then I know this can sound like crazy-talk. But for people that begin losing weight sustainably for the first time in their lives, while still eating large and filling meals, the fact that this is possible at all is the best kind of crazy. If there’s one thing I’ve learned from being a part of a well-informed and determined PCOS community, it’s that for women that are nutrient deficient, sometimes eating more is actually the secret to losing body fat.
12. Make Exercise Part Of Your Weekly Routine
Like the right PCOS diet, exercise is another powerful way we can directly improve our reproductive potential (and neuro chemistry too) without taking drugs (Hakimi et al. 201725).
For example, it’s been shown that for women with PCOS, progressive resistance training can reduce insulin resistance (Cheema et al. 201426) as well as lower testosterone and free androgen levels (Thomson et al. 200827; Miranda-Furtado et al. 201628).
From what I understand, the way this works is that when we work out, we’re actually increasing the density of mitochondria in our cells. These are cellular components that power our muscles. More mitochondria in our muscle cells make them more sensitive to insulin, and the more sensitive they are to insulin, the better our hormone balance.
Aerobic exercise is also known to have a powerful effect at improving insulin sensitivity, but what’s even more interesting is its effect on inflammation – another root cause of many PCOS symptoms and health risks. This too has been well documented by science (Covington et al. 201629).
All of this should be of great interest to women with lean type PCOS as much as it is to women with more classical symptoms that want to know how to lose weight with PCOS. By reducing androgen levels, ovarian function is directly improved and this means better baby-making potential, whether or not you are wanting to lose weight.
This is saying nothing for the fact that exercise is one of the cheapest, safest and most effective way to help with stress management – the third key pillar to a PCOS friendly lifestyle. Put simply, exercise is awesome for both PCOS and fertility.
13. Implement Stress Management Techniques
Many people mistakenly ignore the psychological impact of infertility on reproductive function. This is fairly understandable given the research is fairly anecdotal still, and most people have become accustomed to stressful lifestyles where we’re pushed to our limits all the time.
But if you’ve ever felt anxious after a strong cup of coffee, or depressed after a boozey night, then you’ll have an appreciation for the link between our emotional state and our hormones. Our physiology affects our mental state, and our mental state affects our physiology with the link of course being our hormones.
While coping with stress is important for anyone’s good health, it’s particularly important that women with PCOS take care of their emotional wellbeing. Especially if you are trying to get pregnant.
Studies have shown that women with PCOS have elevated levels of the hormone cortisol when subjected to stressful situations (Benson and Arck 200930). Not only does this reduce our capacity to cope with stress well, but it also causes fat to accumulate on our stomachs and thighs, promotes insulin resistance, and markedly increases our probability of suffering from heart disease (Black 200331; Pasquali 200632; Koertge 200233).
For anyone trying to conceive, cortisol is the enemy which is why despite the obnoxiousness, there’s actually something to that “just relax” advice. In a world first, US researchers managed to demonstrate the link between stress and fertility status. After controlling for confounding factors such as female age, race, income, and the use of alcohol, caffeine and cigarettes, a two-fold increased risk of infertility was observed in women that had the highest bio-markers of stress (alpha-amylase) compared to those who were the most chilled-out (Lynch et al. 201434).
The interventions that I have always found most useful when trying to conceive (which I generally like to group as “self-care” therapies) include cognitive behavioral therapy, mindfulness meditation, and the practice of self-compassion. Relaxation exercises are also fantastic for acute stress and insomnia, and certain essential oils can be a great help too.
By practicing self-care in a methodical, disciplined way, we can actually attenuate our hyper-sensitive cortisol levels and have a small but real effect on our chances of falling pregnant.
Self-care really is one of the best things you can do for yourself if you’re trying to get pregnant with PCOS.
Don’t Lose Hope – PCOS Pregnancy Success Stories
Motivation is the secret sauce that makes all of these powerful lifestyle changes work. So let me give you a taste of what’s possible with another couple of inspiring examples of women that have taken this approach seriously and fallen pregnant as a result:
From the time she was 17, the only way Hanna would ever get her period was to be on birth control. But by the time she was ready to start her family, the problem came to a head for her and she became serious about taking better care of her PCOS.
She started doing short workouts that included a progressive resistance training program designed specifically with PCOS in mind. As I mentioned above, this type of exercise has been shown to be highly effective at restoring hormone balance in women with PCOS. But perhaps more importantly, Hanna also made the dietary changes she learned during my free 30-Day PCOS Diet Challenge. While this sounds almost too good to be true, her periods returned astonishingly quickly and within a few months she was happily pregnant.
Nellsy was another woman, who was able to overcome four years of infertility simply by changing her diet. Over the course of a full year following her participation in my 30-Day Challenge, Nellsy worked hard to quit sugar and to follow all of my dietary principles as best she could. With time, a PCOS friendly diet became second nature to her, she lost weight, and she was rewarded with the birth of her gorgeous rainbow baby after a healthy natural pregnancy.
Nellsy is now an enthusiastic advocate for the power of dietary change to overcome PCOS and infertility and was happy to let me share this inspiring post she wrote shortly after giving birth.
While Hanna, Nellsy, and the other women I’ve mentioned above may sound like extreme cases, the fact of the matter is that I’ve now lost count of the number of women with PCOS that I’ve seen fall pregnant after taking part in my free 30-Day PCOS Diet Challenge.
Even for me personally, despite all the medical treatment I went through, in the end, it was a low carb, nutrient dense, anti-inflammatory diet that restored my period for the first time since puberty and finally led to me falling pregnant naturally.
While the scientific evidence is extremely compelling, it’s my personal experience and the success of all these other women around me that makes me so optimistic whenever I meet someone facing PCOS and infertility.
Whether you pursue assisted reproduction, or you want to keep doing it the old fashioned way, by sticking to a PCOS friendly diet, by doing the right kind of exercise, and by proactively managing your stress, you are going to greatly increase your chances of getting pregnant with PCOS.
So, if you’re ready for action, then come and join me for my next free 30-Day PCOS Diet Challenge.
And if you are pumped after reading this and don’t want to wait for the next live Challenge to start, then make sure to download this free 3-Day PCOS Meal Plan and this fridge-friendly PCOS Diet Cheat Sheet.
Having kids really is all it’s cracked up to be and you totally deserve every ounce of joy that they bring.
Wishing you the best of luck in your journey to that BFP!
Kym Campbell is a Health Coach and PCOS expert with a strong passion for using evidence-based lifestyle interventions to manage this disorder. Kym combines rigorous scientific analysis with the advice from leading clinicians to disseminate the most helpful PCOS patient-centric information you can find online. You can read more about Kym and her team here.
This blog post has been critically reviewed to ensure accurate interpretation and presentation of the scientific literature by Dr. Jessica A McCoy, Ph.D. Dr McCoy has a master’s degree in cellular and molecular biology, and a doctorate in reproductive biology and environmental health. She currently serves as a University professor at the College of Charleston, South Carolina.
This blog post has also been medically reviewed and approved by Dr. Sarah Lee, M.D. Dr. Lee is a board-certified Physician practicing with Intermountain Healthcare in Utah. She obtained a Bachelor of Science in Biology from the University of Texas at Austin before earning her Doctor of Medicine from UT Health San Antonio.
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