PCOS + Pregnancy Loss

Polycystic ovary syndrome (PCOS) is one of the most common causes of female infertility, affecting 6% to 12% of US women of reproductive age. That’s about 5 million American women. Unfortunately many women have no idea that they even have PCOS until they get off of birth control and are ready to start their family. Although the root cause of PCOS is still unknown, researchers believe that PCOS has a significant genetic as environmental cause that often go hand in hand.

Excess insulin, although known as insulin resistance, is commonly associated with PCOS. Insulin resistance prevents the body from properly lowering your sugar levels leaving your blood with elevated levels of sugar with nowhere to go. Not only can this excess of sugar lead to diabetes but it can stimulate additional production of insulin which in turn can increase the production of testosterone. Elevated testosterone levels can lead to anovulatory and irregular cycles, making it harder to get pregnant.

Not only are women with PCOS more likely to suffer from infertility, but they are also at an increased risk of pregnancy loss. In fact, researchers have found that women with PCOS are more likely to experience recurrent pregnancy loss when they experience androgen like symptoms (facial hair, acne, elevated serum androgens - testosterone and DHEA-S), or have insulin resistance, are overweight or obese or have elevated homocysteine levels.

This is why addressing diet and lifestyle factors should be a top priority for all patients with PCOS, especially those who have unfortunately experience a miscarriage or pregnancy loss. So, today, I thought it would be important for us to talk about a few important ways to reduce the risk of miscarriages and improve your pregnancy outcomes if you are suffering from PCOS.

Comprehensive Testing

Just because you might be part of the 5 million American women diagnosed with PCOS, doesn’t mean your care should be a “one-size-fits-all”. Making sure to advocate for comprehensive testing is an essential part in reducing your risk of pregnancy loss. Some of the most important tests to ask for include:

HbA1C, prolactin, thyroid panel (TSH, freeT4, freeT3, TPO-Ab, TG-Ab)
Labs Drawn on Cycle Day 3-5 (remember, Cycle Day 1 is the first NOT THE LAST day of your period)

Estradiol, FSH, LH: AMH, Total and Free Testosterone, DHEA-S

Labs Drawn in Luteal Phase (generally cycle day 18-21 in a 28 day cycle) progesterone
HOMA-IR (insulin resistance panel)
Homocysteine, lipid panel
Complete blood count, vitamin D, vitamin B12, iron and ferritin

Metformin

As a naturopathic doctor, patients are often surprised that I discuss medication as an option in their care, but the reality is an integrative approach is often one of the most beneficial ways to help support patients during their fertility journey. One medication that has specifically grown in popularity over the years for patients with PCOS is Metformin. Metformin can not only improve insulin resistance, but it has been shown to reduce the risk of early pregnancy loss in women with PCOS. (Al-Biate 2015). Metformin has even helped increase pregnancy outcomes in women undergoing IVF even without being diagnosed with PCOS. Although Metformin specifically works to lower your blood sugar levels by improving the way your body handles insulin, it also appears to have an anti-inflammatory prosperity and improves your immune system, specifically improving aberrant lymphocyte count. Metformin can be a great option for many women with PCOS who have experienced an early pregnancy loss, however it is important to note that a potential side effect of Metformin is a reduction in vitamin B12. Since Vitamin B12 is an essential vitamin involved in the development in your baby’s nervous system, additional Vitamin B12 supplementation is often recommended in patients taking metformin even prior to conception.

Don’t Discredit Exercise

Chances are if you have PCOS, your doctor has told you to “eat less, exercise more” and although these recommendations are often provided with limited guidance and support, it’s important we talk about the importance exercise has specifically on insulin resistance. Exercise, especially shortly after meals, can be a great way to improve your sugar and insulin levels. Getting outside for a short 5-10 minute walk after each meal can be a great way to get in a 30 minute daily exercise goal without feeling overwhelmed. One of the most powerful ways to support your exercise goals is to make them a part of your daily routine. Most patients are most successful with keeping up with an exercise routine when they incorporate some form of movement each and every day. Aiming to move your body for 15-20 minutes 7 days a week is an important and critical way to improve, and even reverse, your insulin resistance while also reducing your risk of pregnancy loss associated with PCOS. Once you have made daily movement a priority and a habit you can hold on to, we often recommend incorporating weight resistance training at least 3 times a day. In fact, researchers have found that adding in 30 minutes of weight resistance training, three times a week isn’t only a great option for you but it is just as impactful for your partner! Weight resistance training, 30 minute sessions, 3 times a week can significantly improve semen parameters and has much better success rates in improving live birth rate than any other “male fertility supplement”. So instead of adding yet another supplement to your cart, make it a priority to put exercise first! We suggest taking a few moments to pull out your calendar and schedule time to exercise. Working out in the morning is often best to normalize blood sugar and to maximize the chances of consistent exercise. Consider taking a moment right now to book a repeating meeting with yourself, each and every day!

Why When Your Doctor Says “Eat Less” This Rarely Improves Your Results

If you have been struggling with PCOS and pregnancy loss, chances are your doctor has mentioned the importance of a healthy weight. He or she may have had good intentions when discussing this with you but rarely does it provide benefit to patients as there is often limited guidance and support provided. It also rarely answers the question about what you SHOULD be eating and puts the blame on the patient as though it’s their fault they are struggling with their weight. But the reality is, we are learning more and more about the way in which patients with PCOS metabolize and digest their food and how even the composition of the microorganism in their gut can influence factors like inflammation and insulin resistance making it harder to just “eat less and lose weight”. Instead, we should be focusing on high quality diet choices and more sustainable and realistic diet practices.

For patients suffering from PCOS, balancing your blood sugar is a number one priority when it comes to dietary changes. This most often incorporates healthy fats and proteins with EVERY meal, including snacks and limits your exposure to processed foods, carbohydrates, artificial sweeteners, and added sugars. When evaluating your diet, it is often best to ask yourself at each meal where you are getting your healthy fat and proteins from as this will help stabilize your blood sugar.

How much protein should I be consuming?

Although the amount and type of protein may vary, we generally follow the guidelines of 1.2-1.5grams of protein per kilogram of weight per day. In other words, let’s say you weight, 165 lbs that’s 74.84kg. 74.84kg X 1.5 grams is 112.26 grams of protein per day. That’s about 18 grams of protein per meal (3 meals + 2 snacks).

Don’t Overlook Your Sleep

When optimizing your fertility, especially in patients with PCOS who have experienced pregnancy loss, it is critical to make sleep a priority. In fact, researchers have found that poor sleep can increase your blood sugar levels. Even partial sleep deprivation over ONE night can increase insulin resistance. Making sleep a priority should be a non-negotiable if you are trying to conceive. Making sure to incorporate healthy sleep hygiene habits, adequate sleep hours and proper nutrition before and after sleep is essential for your success! Aiming to incorporate a healthy fat and protein within 2 hours of sleeping can be an important way to improve your sleep quality and balance your sugar throughout the night.

About the Author: Meet Dr. ZenAlissia Zenhausern- Pfeiffer, NMD, FABNE, (commonly known by her patients as Dr. Zen), is a licensed naturopathic doctor board certified in naturopathic endocrinology and the founder of NMD Wellness of Scottsdale, a premier naturopathic medical practice that focuses on helping women to take a proactive approach to their hormone and fertility health. Dr. Zen has been featured as a lead expert in Forbes, Shape Magazine, and Instyle and is deeply passionate about bridging the gap between traditional and natural medicine in the world of fertility. She works with a variety of hormone related issues including PCOS, endometriosis and unexplained infertility. Her goal is to help more women get back into the driver’s seat of their own health to make lasting transformational changes to their health to bring more cute and adorable babies into this world. Read More About Dr. Zen...