How do women with PCOS get pregnant?
Welcome back. In this video, I’m going to be talking about PCOS and trying to conceive with PCOS, because it can be pretty tricky, but if you do get the right support, with the right plan, and give yourself enough time, you can get pregnant. It’s actually one of my favorite conditions to support because I think there’s so much that can be done, so much progress that can be made, and I do believe that the majority of you can get pregnant naturally with PCOS if you do get the right support. And on top of that, the first woman I ever helped conceive did have PCOS, and I helped her with two children. And so PCOS is something that is true to my heart, it’s something that I love to support, and brings me back to the original reason why I started supporting patients on their fertility journeys.
Questions about PCOS are ones that I get on a regular basis, which is why I’m going to be doing a series completely devoted PCOS, PCOS & Fertility, PCOS & Secondary Infertility, PCOS & Thyroid, PCOS & Egg Quality. You name it, we’re going to talk about it in this series, devoted to supporting all of you who have polycystic ovarian syndrome. So let’s get started with the first video, which I’m going to dive deeper into this one question that get asked all the time. Can I get pregnant with PCOS naturally, even if I don’t have a regular cycle? So let’s get into it.
For those of you who don’t know, I’m Dr. Mark. Sklar, also known as The Fertility Expert, and I’ve been working with couples for over 19 years, right here in sunny San Diego, and through my online coaching programs. And supporting women and couples, for that matter, with PCOS is something that we regularly see, and something that I love, love to inform all of you about. And this YouTube channel is exactly about that. It’s about informing all of you, giving you the proper information and knowledge to support you on your fertility journeys. That’s my mission. And a little thing that you can do to help me on my mission to spread the word and inform couples from all over the world is like and subscribe to this video, and my channel, FertilityTV, so that we can support and reach more couples throughout the world.
Before I dive into this week’s video, and give you so much useful and hopefully practical information that you can get started with, I do want to mention and give thanks to this week’s sponsor for this video. Fairhaven Health is sponsoring this video, and I think it’s an appropriate video for them to sponsor because we’re talking about PCOS and their FH Pro for Women, which is an amazing supplement, does exactly that. It’s got all the foundational nutrients, specifically to help those women with PCOS. Now, it does support all women, regardless of if you have PCOS or not, but this is one of my favorite ones for those of you who do so. Check it out using the link in the description below.
So PCOS is a relatively big topic, and one that does require a lot of time and attention, and there’s so much information to cover. That’s why I’ve created this series for you. And today, I want to start at some of the more foundational, basic things. I do want to ask all of you though, if you have PCOS or have questions about PCOS, and want more information about it, I want you to comment below and let me know, what are those questions? What information are you looking for about PCOS that I can work into these coming videos to help you on your fertility journey, and getting better control over your PCOS? So comment below in the comment section and let me know what your questions are about PCOS.
So the two main questions that I want to actually dive into today is, “How do I, or how can I get pregnant if I have PCOS? And I got pregnant the first time no problem. Now, after my delivery and pregnancy, I’m not ovulating, I’m not having a regular cycle. What’s going on?” This can be what we call secondary infertility with PCOS. That’s not always the case, but we’re going to dive into those main questions right now. So I want to dive into what is PCOS and how can I conceive with PCOS by actually asking some different questions. And these are not questions that I created, these are questions that all of you have asked me routinely. So this is where I’m going to start. The first one, which I’m going to read for my computer says, “What does PCOS mean?” Well, PCOS stands for polycystic ovarian syndrome.
And what it really means is that your ovaries are producing a lot of follicles. In this case, with the syndrome, we’re calling them cysts, and we’re calling them cysts because the follicles do not mature at a proper rate to become at the eyes to ovulate, and release the egg. We don’t expect all of those follicles to release eggs, but you are prone, with PCOS, to have more follicles that might mature and be ready to ovulate at ovulation time than if you didn’t have PCOS. These follicles are not really cysts. And I often like to joke that this condition really should be called, instead of polycystic, polyfollicular ovarian syndrome, because these are follicles that are not maturing. And most of the time, they don’t turn into major cysts, although that can happen.
And so typically, with women with PCOS, they’re going to have irregular cycles, maybe no menstrual cycle at all, or very rarely, maybe 2, 3, 4 times a year, because those follicles are not maturing, and they take a long time to mature, meaning months before one or two of them are big enough to mature. And so this could happen for multiple reasons. I have actually tons of videos on PCOS that I’ve recorded previously, that you can check out where I dive much deeper into it. But for the sake of this video, I just want you all to understand that is a very common issue with PCOS, is this irregularity with your cycle, you’re not ovulating appropriately, it could take a long time to ovulate. And when we run lab work, blood work, hormones, we will see often that we’ll have either elevated A1C, which is a diabetes marker, or high glucose levels, or insulin, because that is a big component of PCOS.
We’ll also see that your androgen levels can also be elevated because that’s a typical sign, or in this case, lab work result of PCOS. Now, that doesn’t mean that everyone who has PCOS will have the same presentation. Actually, there are 4 to 10 different variations of PCOS. I’m just talking about the classical textbook presentation of that, where someone might be overweight, difficulty losing weight, unwanted facial hair, body hair, cystic acne. These are all signs and symptoms of a classic presentation of PCOS. But everyone doesn’t fit into that category. And about 50% of the women that we were work with who have PCOS don’t have that classical presentation, and are a more atypical presentation when it comes to PCOS. Again, I have a couple of videos completely devoted into that if you’re trying to figure out if you have PCOS or not. You can check those out after you watch this video.
So the next question that I want to address as we’re setting the stage and talking about some of the foundational information around PCOS is why do women with PCOS have trouble conceiving? Well, the reason they have trouble conceiving is for all the reasons I just mentioned. When you’re not ovulating regularly, or frequently at all, it’s very difficult to time intercourse with ovulation, in conjunction with ovulation, so that the sperm can meet the egg at the right time, fertilize and implant. So that is one of the biggest variables causing a disruption or making it more difficult for someone to conceive with PCOS. So in those situations, we do want to focus on having a more regular or consistent cycle, where you can predict ovulation, or at least track your cycles, monitor ovulation, and have intercourse around that fertile window.
Now, that doesn’t happen for everybody, but that is our goal. And in these situations, I’m less concerned with having somebody get into the 28-day typical, regular cycle, and I’m more concerned with just making sure that they ovulate consistently and have a consistent cycle. Even if that cycle is, let’s just say, 35 days or 40 days, because then at least they can time intercourse appropriately based on that situation. With women who are atypical PCOS, so in those situations, we typically find that you’re ovulating regularly and have a relatively regular or predictable menstrual cycle, that situation will be different. That’s where we have to fall back more on supporting the other symptomology that we’re seeing and regulating the hormones that I mentioned earlier. That’s a big key to this piece of the puzzle as well, and making sure that we have a good, strong ovulation, we have a good, healthy follicle.
So moving on to another question which we get all the time is, does this mean that women with PCOS need to do IVF to be successful or get pregnant? No, the answer is no. I have seen typically and believe that 90% of women with PCOS can get pregnant naturally, and should get pregnant naturally with the right plan and support. It doesn’t mean that IVF won’t be useful for you. It will be, if that’s the choice you go and the path you go down. But typically, I also see that’s not necessary, and many couples go down the IVF road unnecessarily or prematurely, just because they think that’s really the answer, and no one has really worked to support them. One of my pet peeves when it comes to PCOS, which I’m not a big fan of, is that often these women put on birth control pills to help them get pregnant.
They’re put on birth control, or you’re put on birth control, to regulate your cycle. Birth control, hence its name, will not allow you to get pregnant. It’s going to make things more challenging. My preference would be that we work and you work to find a way to regulate your hormones and get a better consistent cycle and ovulation on your own versus relying on the birth control pill to do that. Because at some point, we’re going to have to do that if you want to get pregnant. We got to come off the birth control and we’ve got to regulate your hormones and support your body properly. And so I do encourage all of you who have PCOS, or have been diagnosed with PCOS, to start on that path as soon as possible.
So how can you get pregnant with PCOS if you don’t have a regular cycle, or you’re not ovulating consistently, and you don’t know when you ovulate? Well, therein lies the first piece of the puzzle. We need to support ovulation first. And this comes back to what I said before. We have to test your hormones, we have to understand what’s going on, and then address what we see. All too often, women are diagnosed with PCOS just by visually looking at the ovaries and seeing that there’s a lot of follicles or cysts, and not doing all the necessary blood work to understand what’s going on hormonally, so they bypass that. The other piece of that is if you’ve been diagnosed with that when you were younger, then you’re put on birth control when you’re younger, and then everybody just thinks, “Well, everything’s going to be fine and everything’s controlled,” and it’s not. And then hormones aren’t retested later.
So we do need to come back to some of the foundational things. And as you often hear me say, let’s test and not guess. Let’s run some labs, let’s understand what your body’s doing. What is going on with your blood sugar levels? What is going on with your androgen levels? What’s going on with all your other hormones? Which I’ll get into in some of these other videos, because there are other that are impacted and affected by PCOS that also need to be addressed because that’s going to make it easier to regulate your symptoms and control the syndrome. Some of those, just to hint of that, is your thyroid, digestive system, stress. These are all big variables that need to be considered when you’re working on regulating and controlling your PCOS symptoms and cycles. And it’s going to be very difficult to do that if we don’t also address some of these other systems that are impacting it.
But as we’re talking about regulating your cycles and ovulation, foundational things here are going to be essential. Diet is a huge, huge piece of regulating PCOS. Sleep, getting proper, healthy, consistent, good quality sleep is essential for regulating PCOS. Exercise, not too much, not too little, really not focusing on the weights, but more cardio, that is also going to be an essential piece of PCOS. Now, in those atypical cases where you might be thinner, we do have to also be very careful about exercise in that situation. And typically, what I find in those situations, is that we’re exercising too much and that’s causing a problem. I see a lot of athletes who have PCOS, relatively thin, that’s impacting your androgen levels, that causes all sorts of issues as well with PCOS. So exercise is a big piece, and then managing your stress. We can’t really achieve success long term if we’re not managing your stress levels when we are focusing on supporting you with PCOS.
And I see this, and I’m going to harp on this for just a moment, I see this all the time. Stress comes in many forms, okay, whether it’s dietary stress, emotional stress, lack of sleep stress, whatever it is. And for all those women who I help regulate their cycles, often what I see is they’ll reach back out to me, send me an email, “Mark, all of a sudden, my cycles are not doing well. Why is that happening?” My first question back is, “Have you’ve been stressed? Why? What’s going on?” And invariably, almost 99% to 100% of the time they say, “Yes, I have.” And they give me their reason. Stress dramatically will throw off your hormones when you have PCOS, you’re more sensitive to it, and it will cause irregularities quickly. So you do have to manage that long term to keep your hormones stable, and to keep your cycles consistent.
I do want to expand on this piece just a little bit, when we’re talking about ovulation and irregular cycles. I’ve had women who ovulate every 3, 4, 5 months get pregnant with PCOS. I’ve had women who ovulate every month get pregnant with PCOS. I recently recall the story of a woman, she would not get her cycles maybe once a year at best, and she had a ton of digestive issues. Stress was a big factor, her thyroid was a big factor. We took a long time to regulate her hormones and to get her on track. She never thought she was going to get pregnant. She actually gave up trying after, I think, it was about seven of months of working with me. And in the eighth month, she emails me to tell me she’s pregnant. She was actually pregnant when she gave up. I mean, she didn’t realize it.
It can happen, but you need the right plan. You need the right approach, the right guidance and coaching, and you need patience. You need to give your body time to respond to what you’re doing so that you can see the long-term results, and get the pregnancy that you deserve and want. So, in terms of what you can do to support your PCOS, like how do you start to put all of this together? We talked about a lot of those foundational things, just a moment ago, diet, sleep, managing stress levels, exercise, lifestyle management. These are all things that are essential, but I didn’t talk about supplements. Supplements, I do think are a big part of what you are going to need to help you regulate your hormones and get a consistent ovulation and menstrual cycle.
And in the beginning of this video, I did mention our sponsor, Fairhaven Health, with their FH Pro. I do think this is a great product to start with, you can check it out in the link below. But many of you might need a customized plan. This is just a one size fits all. It’s not for everybody, and I do believe that most of you are going to need a little bit of fine-tuning and adjustment for what you need. What happens if you do have raised androgens? What happens if your blood sugar’s not regulating on its own, or with that product? Maybe you need a little bit more support. These are all things that really take a refined look at your situation. And this is why most of you need additional support and guidance, and why I find that many women with PCOS, although you try to do it on your own, because there’s so much information out there, really need a little bit of fine-tuning and guidance and coaching to get the fundamental results that you’re looking for.
So yes, there are good supplements when it comes to that. But I do believe that most of you need refining when it comes to that, so that you can get a customized plan, a specific plan, to what you need versus just taking whatever’s off the shelf. Now, I know most of you are still going to just go and grab something off the shelf, and so be it. But I don’t see the best results that way. And I do think if you’re going to do that, you also need to give it a little bit of time to make sure you’re getting the results that you desire. But I would start by using that link below to check out the FH Pro product first. I do also get questions about medication. What drugs or medication can I take to support my cycles and my fertility and help me ovulate? Well, there is certainly Clomid and letrozole, that can be helpful.
Now, I want to be clear about these medications. They will help you ovulate, they will help you to recruit more follicles to mature to ovulate, but they will not, in and of themselves, regulate your cycle. I actually often see the opposite. And I often see when you go on these that your cycles will become shorter or longer, they won’t be as predictable if you did have a predictable cycle. So I just want you all to be mindful of that. These are not meant to fix anything, they’re meant to bypass the problem, allow you to ovulate, and hopefully recruit an egg. And in that situation, hopefully try naturally with IUI or IVF. There is a place for that. And if that’s what you desire, fine, but I want you all to know that it’s not fixing anything, okay? It’s bypassing things. The other question I get asked a lot about when we start talking about PCOS in terms of medication is metformin.
Metformin is a standard treatment for PCOS, and yes, it can be really beneficial for all of you. But I would also say that you might not need it depending on your circumstances and what your blood sugar levels are. And that is primarily the main form of treatment that your OB-GYN or REI are going to have for you, it doesn’t mean it’s the only form. I like to try myo-inositol. The inositol family is actually very good for regulating blood sugar. And in research studies, has shown to be just as good, if not better than metformin, and with less side effects. So why not try that? I do think that’s about getting the right dosage for all of you. Now, again, I do think that many of you need a trained eye to refine things with your plan. And some of you might say, “Well, I’ve been on it and it hasn’t done anything.” Well, that’s why you need a trained eye to understand what’s going on and to support you in the right way.
But those are questions I get often, so I did want to address them for all of you. This question that I’m going to wrap up on is really a unique question. And one that I’ve been getting more recently. What happens if I’ve already been pregnant, had a child, and now I have PCOS but I didn’t have it before? How is that the case? Well, I will say is there’s a couple variables we need to look at. First and foremost, it may have been missed before, and it might not have been so extreme that it was easily missed, or maybe at that time you had more of an atypical form of PCOS. And so you were ovulating menstruating regularly, so it wasn’t really picked up on. But after your pregnancy and delivery, something changed hormonally for you, and now things are off. So that can be the case.
And whether you had the tendency before or not, again, you’re no longer the same person you were after you got pregnant, 10 months of carrying a child, delivered, and now you’re caring for a baby and postpartum, your body’s not the same, your hormones aren’t the same. So things have shifted. Often, I find that’s a result of all these other systems that are impacting your hormones, like your adrenal system, your stress response, that can be impacting because life is no longer the same. You’re caring for a little child as you should, you don’t take care of yourself in the same way, maybe diet’s off, you’re not sleeping well, whatever it might be, those are impacting your hormones, and causing you to have irregular cycles and possibly PCOS. The other one is thyroid disease.
Thyroid conditions are very common today, and even more so postpartum, if you didn’t have it before. And that can also throw off your hormones and cause you to have PCOS-like symptoms or develop PCOS. So those are common things that I do see clinically. And I do think that they could impact your ability to conceive the second time, which is what we would call secondary infertility. And so if you are struggling there, we do want to rule those things out, but there could be other reasons as well. It doesn’t have to be PCOS, it could just be amenorrhea, for other reasons, your hypothalamus could be impacted. So we do need to look at the entire picture and not make assumptions. But regardless of what that looks like, I want you to know that happened as a result of certain things occurring, whether it was in the pregnancy or postpartum or delivery, and I do believe that those things can be supported and hopefully regulated so that you can get back on track and get pregnant again. But you need the right plan and support for you.
So I want to encourage all of you, whether you have secondary fertility issues, PCOS, atypical, classical presentation, we all need coaching and support, and we all need the support that is unique to us because there is no one size fits all situation for any healthcare condition, but especially with PCOS and fertility. So I want to encourage you all to get the right support and attention that you all need and deserve. For those of you who are interested in working with me and my team, then I want to invite you to apply to join my HOPE Fertility Coaching Program. All you have to do is use the link in the description below to apply to see if you qualify. And then you’ll be able to set up a call with my team to discuss your needs and see if we can support you on your fertility journeys. We’d love the opportunity. And if you want that opportunity, all you have to do is use the link in the description below.
By the way, before I wrap up, I do want to remind you all, I have a free fertility guide that I recently created and released for all of you. And if you are tired of wasting time and money and resources, you don’t know where to go with your plan, you don’t know what’s the right products, the right way to approach your fertility, then I do believe this free resource is going to be an amazing resource for all of you, and really valuable. And the feedback we’ve been getting from everybody has been really tremendous, saying how much they appreciate all this information, and how much it’s really helping them. So if you want that free fertility guide, use the link in the description below to download it and check it out.
Now, again, if you are watching this video for the first time and you are new to FertilityTV, then you’ve got to like and subscribe, like this video, subscribe to this channel, so you know when I put out a new video for all of you, which I try to do regularly. I will also want to invite you all and remind you all to comment below. What did you like about this video? What did you learn about this video? More importantly, what questions do you have about PCOS? Comment below, ask them there, and I’ll do my best to answer them in the coming videos. All right, everyone. Thank you so much for watching til the end. Until the next video, stay fertile.