Taking Charge of Your Fertility

by Toni Weschler

  These are considered among the most common causes, but to be clear, they’re not present in all cases, and indeed, there may be other factors such as obesity and low-grade inflammation which intensify the underlying syndrome. Of course, much of the confusion is that at the same time, PCOS itself can exacerbate these conditions.

  Diagnosing PCOS

  Women often develop the condition as early as their teens, but are typically not diagnosed until their 20s and 30s. In any case, in order to be diagnosed with PCOS, women will usually have at least two of the following three symptoms:

  •Irregular cycles greater than 35 days

  •Elevated male hormones with associated conditions such as acne, excess facial and body hair, and male pattern hair loss

  •The “string of pearls” on the ovary

  In addition, you should be aware of a relatively new test that looks at your level of antimullerian hormone (AMH), which is associated with excessive antral follicles. A high AMH reading is therefore often considered an accurate marker for PCOS diagnosis.

  Finally, other related disorders must be ruled out before the diagnosis of PCOS can be made. These include, for example, elevated prolactin levels, thyroid dysfunction, and androgen-secreting tumors.

  Petra’s chart. PCOS. Petra experiences one of the classic hallmarks of a PCOS cycle—numerous days of fertile-quality cervical fluid culminating in a very delayed ovulation and long cycle, in this case, 39 days. In reality, PCOS cycles are often exceedingly long and irregular, up to 100 days or so. In this cycle, she eventually ovulates about Day 26 and has a thermal shift the next day.

  MYTHS ABOUT PCOS

  Symptoms of PCOS are the same for all women

  Not every woman with PCOS is short and obese with excessive androgenic characteristics such as oily skin, acne, and excessive hair. Many are model tall and slender with no signs of high androgen levels. In fact, some women with the condition do not even have polycystic ovaries!

  Women with PCOS cannot have children

  It may be difficult, but women can still become pregnant with their own eggs.

  Having your ovaries or uterus removed will cure PCOS

  Because it’s about so much more than just the ovaries, removing your reproductive organs will not cure the condition.

  The birth control pill cures PCOS

  The pill only regulates your bleeding, but it does nothing to address the underlying causes of the disorder.

  Women who don’t want children needn’t worry about managing PCOS

  Unfortunately, because the condition affects so many aspects of your general health, its impact on fertility is not your only significant concern.

  PCOS remains the same over time

  The characteristics and severity of PCOS actually decrease as women get older (finally, some good news about this condition!).

  The Varied Approaches to Treatment

  It’s crucial that this disorder be treated entirely individually, depending on your phenotype and genotype, as well as whether or not you are trying to get pregnant. I address PCOS and pregnancy achievement in Chapter 15.

  There are several possible approaches, and unfortunately, physicians are fairly resolute about their preferred treatment, often vehemently disagreeing with each other. There are many pros and cons to each approach, so once you have been diagnosed, you will want to find a specialist who has as much experience in PCOS treatment as possible, such as a reproductive endocrinologist. Family doctors and even OB/GYNs may not be familiar enough with the complexities of this condition.

  Treating PCOS with an Emphasis on Nutrition

  Before trying any invasive medical options, you may want to do all you can to take control of your PCOS through the natural methods discussed in the next chapter, because in addition to being healthier for you all around, they don’t have any side effects.

  Until recently, one of the only things that was clear is that it was important for women to get exercise and try to attain a normal weight. But they still tended to focus on the individual symptoms of, for example, irregular cycles, acne, or hirsutism. Now with the discovery of the role that insulin resistance plays in most women with PCOS, they also realize that recommending a typical low-fat-high-carbohydrate diet is neither effective nor healthy for women with this condition.

  Rather, in order to keep PCOS symptoms in check, it’s important to eat mainly foods that are low-carbohydrate and low-glycemic (minimally altering glucose levels). In addition, healthy diets should primarily include foods or combinations of foods that don’t cause blood sugar to spike, as seen in the box below.

  THE PCOS WAY OF LIFE DIET

  •Always try to combine carbs with a protein or fat

  •Select lower glycemic index foods (those that tend to have more fiber in them so that they don’t turn to sugar in the blood so quickly)

  •Space your carbs throughout the day to prevent blood sugar spikes

  •Keep to a minimum your intake of carbs that trigger hunger or cravings, such as foods that of course you probably love, like pasta and bagels

  •Take two to three 500 mg calcium pills a day, spaced out during the day

  •Take a daily multivitamin with minerals and 400 mcg of folic acid if you are trying to get pregnant

  •Drink at least 8 cups of noncaffeinated fluid daily

  •Limit foods high in saturated and trans fats

  •Select mainly monounsaturated and omega 3 fats

  Treating PCOS Through Various Medical Options

  Aside from agreeing on exercise, weight, and diet, physicians vary in the treatments that they tend to choose. Among the possible options they may prescribe are the following:

  •Birth control pill

  Women are often prescribed the pill to try to regulate their cycles, but as you know, it does nothing to treat PCOS, itself, which has numerous other issues besides irregular cycles. In addition, the disorder will undoubtedly recur as soon as the woman goes off the pill.

  •d-Chiro-inositol

  This is a naturally occurring substance that increases the action of insulin in patients with PCOS. It has been shown to be effective in improving ovulatory function and decreasing serum androgen concentrations as well as blood pressure.

  •Cyclic progesterone therapy

  One theory is that the lack of progesterone in women who don’t ovulate ultimately leads to an imbalance in the ovary, causing excess male hormones and irregular periods. In addition, the constant estrogen without progesterone after ovulation increases the risk of endometrial cancer. So treating women cyclically with progesterone acts to counter the unopposed estrogen that women with PCOS have.

  •Metformin (Glucophage)

  This is a drug that is normally given to diabetics to treat high blood sugar, but it’s often prescribed to women with PCOS because they have a similar issue related to insulin resistance.

  •Ovarian drilling

  This procedure uses a laser fiber or electrosurgical needle to puncture the ovary up to about 10 times, usually resulting in a dramatic lowering of male hormones within days. It’s especially useful for women who fail to ovulate with Clomid or Metformin therapy. Side effects are rare, but may include adhesion formation or ovarian failure if there are complications during the procedure.

  •Ovarian wedge resection

  Decades ago, women with PCOS desiring pregnancy were often treated with this seemingly strange surgery. As the name implies, it involves slicing a wedge out of the enlarged, cystic ovary in order to reduce excess androgen production. It had a high success rate for pregnancy achievement, but it often resulted in adhesions and thus was abandoned as a common treatment once modern fertility drugs and IVF became widely used.

  Today, however, there is a small group of highly trained physicians who have improved upon the original surgery to such an extent that it rarely causes scarring anymore. It’s therefore a potential option you might want to investigate, since when performed well, the procedure doesn’t just help with
getting pregnant but may also significantly lessen the numerous bodily symptoms and risks of PCOS itself. (Click here, regarding which surgeons are trained in this procedure, as well as more general information on how to handle PCOS when trying to conceive.)

  •A special protocol for getting pregnant

  If you are trying to get pregnant, find a doctor who is experienced in working with women with PCOS, since your condition will probably be handled differently. See the gray box here.

  For more on PCOS, click here.

  CHAPTER 9

  Natural Ways to Balance Your Hormones

  WOMEN WHO MAY BENEFIT FROM READING THIS CHAPTER INCLUDE THOSE WHO:

  •don’t ovulate

  •have irregular cycles

  •have short luteal phases

  •have limited or no cervical fluid

  •have hormonal conditions such as PMS, PCOS, or endometriosis

  •have been trying to get pregnant for at least six months

  •have had at least one miscarriage

  •are significantly underweight or overweight

  •are coming off the pill or other hormones

  •are chocolate cake fans (just testing to see if you’re paying attention)

  •are in their mid-30s or older and may be using assisted reproductive technologies to try to get pregnant but who still want to be able to get in the best shape possible to sustain a pregnancy

  If we all lived in a mystical Shangri-La with beautiful fruits and vegetables magically sprouting from our pristine gardens, where life was carefree with no financial worries or family drama, where we got a full eight hours of rejuvenating sleep a night and had unlimited time and energy to take Zumba classes and bicycle around gorgeous lakes under crystal clear skies, and our skin and lips never touched a single man-made chemical as we maintained an ideal body weight, then maybe this chapter would be irrelevant. But, alas, in the real world, your fertility cycle is an intricate feedback system affected by numerous external factors that can throw you off balance. This is why your cycles often reflect not only your fertility, but your general health, as well.

  So if you experience any of the issues in the box on the opposite page, or other symptoms such as mood swings, insomnia, or those often associated with menopause (hot flashes, night sweats, and vaginal dryness), your hormones may be out of balance.

  There are basically two ways in which you can balance your hormones naturally. The first is strictly through your own efforts, and the second is through the guidance of any number of natural health-care providers. Regardless, the best way to think of the process is that you are actively nurturing your body, rather than depriving it.

  It may seem like playing semantic games, but the brain is a powerful tool. So try to think about how much you are nourishing your body with, for example, fresh fruits and vegetables, rather than how much you are depriving yourself by not eating chocolate cake. Oh heck, who am I kidding? It may prove tough, but the rewards, especially for those trying to get pregnant, will more than compensate for any sense of deprivation.

  Making Healthy Changes on Your Own

  Many of the suggestions below are an overview of the types of things that you can often do, without so much as stepping into a clinic.

  Herbal supplements

  Of all of the herbs that are now widely used for women’s hormonal issues, perhaps none is as enthusiastically regarded as vitex.* It’s a complex herb that is often considered the most important natural aid in treating conditions associated with hormonal imbalance, from PMS to perimenopause and everything in between. The reason it is believed to be so effective is that it specifically acts on the trifecta of women’s bodies: the hormonal loop between the hypothalamus, pituitary, and ovaries. In fact, recommending vitex is now relatively standard practice among most natural medicine practitioners.

  There are several scientific studies that support its use and safety in treating many hormonal conditions, though unfortunately, there haven’t been as many studies done for vitex or herbs in general as there are for traditional drugs. This is in part because it’s so expensive to complete clinical studies, and also because there’s little incentive for manufacturers of herbal supplements to invest in research, since their products can rarely be patented. You should also be aware that the FDA doesn’t regulate herbs, and thus consumers should use such remedies with caution.

  I encourage you to initially use them with the guidance of an experienced practitioner in the field. This is in part because there are so many varieties of herbs (and often aggressively marketed!), but they can only be safe and effective if the correct herb and dosage are appropriately selected for the specific condition that you’re trying to remedy. Regardless, there are also various websites devoted to this topic, so there is plenty of detailed information out there. I would stick to websites that employ doctors, nurses, nutritionists, or other reputable women’s health practitioners (I recommend a couple relevant ones here).

  Diet

  One of the most important studies in this field is the landmark 1990s Harvard Nurses’ Health Study, which followed 18,000 women’s diets over eight years to determine which foods improved their fertility. And even if you are not currently trying to get pregnant, if your cycles are in any way irregular, the recommendations below may apply to you, as well. The one exception is women with PCOS, who typically benefit the most from very specific guidelines discussed in the prior chapter. Based on their findings, Harvard researchers developed a list of evidence-based suggestions, all discussed in detail in their 2009 book, The Fertility Diet. Below is a synopsis of some of their discoveries:

  Avoid trans fats. Read your labels! Another name for trans fats is “partially hydrogenated oils.” This type of fat can compromise fertility in general, to say nothing of damaging your heart and blood vessels.

  Use more unsaturated vegetable oils. Monounsaturated and polyunsaturated fats help improve the body’s sensitivity to insulin and decrease inflammation, two things that are good for fertility. Enjoy nuts, seeds, and cold-water fish such as salmon and sardines. And, of course, decrease saturated fats.

  Increase vegetable protein. Try to replace a serving of meat each day with a variety of vegetable proteins such as beans, peas, soybeans, tofu, and nuts.

  Choose slowly digested carbs. Foods such as fresh fruits and vegetables, whole grains, and beans are all rich in fiber and can improve your fertility by controlling blood sugar and insulin levels.

  Get plenty of iron from plants. This includes whole-grain cereals as well as spinach, tomatoes, beets, beans, and pumpkin.

  Drink a lot of water to stay hydrated. You don’t need to avoid everything else, and even coffee and tea are fine in moderation. But skip sugary sodas when you are trying to conceive.

  Take a multivitamin. If you are trying to get pregnant, be sure to take at least 400 micrograms a day of folic acid to help prevent spinal cord defects in the baby.

  Achieving an Ideal Body Fat Ratio

  The best range for healthy ovulation is a body mass index (BMI) of 20 to 24. Being overweight can cause you to produce extra estrogen, wreaking havoc on your complex hormonal feedback system. But being underweight can cause you to stop ovulating altogether.

  Exercise

  Do whatever makes you want to exercise, whether it’s swimming, bicycling, or anything else that doesn’t feel like a chore. The key is to find something that you will look forward to rather than resenting. So, a daily 15-lap jog around an indoor track? Not so much.

  Stress Reduction

  In keeping with the theme of nurturing rather than depriving, one of the best things you can do when trying to balance your hormones is the novel idea of pampering yourself. That means, among other things, reducing stress through activities that you love rather than just doing what society deems relaxing. So if yoga or meditation is your idea of an excruciatingly slow death by boredom, try hiking, reading a wonderful novel, or soaking in a hot bubble bath.

  Sleep

  Ge
t at least 8 hours of sleep! If that means TIVOing Jimmy Fallon and watching him the next morning on your stationary bike, so much the better.

  Night Lighting

  What’s the difference between women who wake up to use the bathroom and then run into furniture in the darkness versus those who can practically read the minuscule warning labels on prescription bottles due to all the extraneous light in their bedrooms? The quality of their cycles, of course! As it turns out, small amounts of light from such seemingly innocuous sources as the moon, a night-light, or even a digital clock passes through our eyelids while we sleep, and this is picked up by the pineal gland.

  The problem is that this gland produces melatonin, which directly affects the hypothalamus, which as you know, is the center of a woman’s universe. So if you are having problems with your cycles, ranging from irregularity to short luteal phases, you may want to try completely removing any source of light. (This might involve having to use blackout shades to block outside light.)*

  Avoiding Hormone Disruptors

  Unless you live in a cave, it’s pretty unlikely that you will be able to completely avoid hormone disruptors called xenohormones, which are man-made chemicals that have the ability to, well, disrupt your hormones! Among the most ubiquitous and potentially harmful are a type of preservative called parabens, which are found in everyday products such as makeup and shampoos as well as foods and beverages. Another type of chemical compound implicated in endocrine disruption is phthalates, which are frequently found in flexible plastic.

  If possible, try to find replacement products that do not contain these chemicals so that you can keep them out of your medicine cabinet and kitchen. And for a more comprehensive (and perhaps intimidating) list of xenohormones, just google them. You obviously can’t avoid them all, but you may want to try to focus on those that you can keep out of your own home with a little effort.