Infertility and PCOS
Infertility is at an all-time high with no signs of getting better. The #1 cause of infertility in the US is PCOS and even with it being a popular diagnosis, I think that PCOS is still underdiagnosed. Infertility affects close to 11% of females between the ages of 15 and 44 and PCOS syndrome is a major player. In women with PCOS, miscarriage rates are between 30% and 60%. It is important to determine if you have PCOS if you are trying to conceive.
What is PCOS?
PCOS is actually a syndrome or collection of symptoms rather than an actual disease. Symptoms of PCOS include, but are not limited to:
- Difficulty losing weight (“apple” shaped)
- Fluid retention
- Adult acne in 20s and 30s
- Facial hair growth (70% of women with PCOS have hair growth)
- Irregular menstrual cycles (short or long)
Because PCOS isn’t a specific disease, to diagnose PCOS you must meet 2 of 3 criteria.
- Irregular cycles. They can be infrequent, non-existent or too frequent.
- Physical or biochemical signs of androgen excess. The physical manifestations of androgen excess could be loss of hair on the top of the head or development of facial, back or chest hair similar to a male. The biochemical signs are also often seen on lab tests if you get a hormone panel.
- Cysts on the ovaries. Cysts on the ovaries are usually discovered via diagnostic ultrasound after your feel lower abdominal pain or you are looking for causes of infertility.
As you can see from the list above, it doesn’t require cysts on your ovaries to have a diagnosis of PCOS. In fact, less than 50% of women with PCOS present with cysts. Probably the most common diagnostic criteria are an irregular monthly cycle and facial hair growth.
What happens in PCOS?
In PCOS, a hormonal dysfunction results in the ovaries not being able to fully mature an egg. Follicles in PCOS begin to develop and build up fluid like they should, but with PCOS the follicles don’t go far enough to release an egg. Instead little cysts filled with fluid form and a vicious cycle begins. Normally, a follicle would fill with fluid, develop and eventually release a single egg. The release of the egg should stimulate progesterone production and create a normalized cycle, but in PCOS, without the release of an egg and subsequent progesterone production, menstruation becomes irregular or stops altogether.
Cysts are also known to create more androgens (male hormones) and thus disrupt your cycle even more. Some women with PCOS and cysts have such a high androgen level that it actually stimulates even more estrogen, causing a rise in LH, but due to the excess estrogen, no egg is released.
In others, the hormonal imbalances cause the egg release to be slightly delayed and thus a lower quality egg is released. As a result, there is an elevated risk of miscarriage or conception. Of course, this is compounded by the concurrent low progesterone that is required to maintain the pregnancy.
What Is The Root Cause of PCOS?
By now you know we have to look at more root level causes…right? And like so many other conditions, this root has many branches.
The culprit at the root of PCOS is insulin. Anything that spikes or creates surges of insulin is going to promote PCOS. The first thing that is obvious that will spike insulin is any sugar. Next are other sweeteners (natural or synthetic) or any type of carbohydrate. This is not one of those times you want to ask if agave or stevia is better. If you want to regain fertility, you want to avoid anything like that at all costs! This is the first thing that you can do at home to regulate your insulin. You should immediately change your diet to be primarily comprised of vegetables, lean meats and healthy fats. As the saying goes, you can cheat all you want, but you are only cheating yourself in infertility and PCOS.
Do You Already Have a Healthy Diet?
Someone right now is reading this and saying that they eat a Paleo/sugar-free diet, they aren’t overweight one bit and they exercise regularly, so they are sure they don’t have an insulin problem…right? Wrong! If it was that easy, I wouldn’t be writing this :-D
What Else Can Cause Insulin Surges? The Real Root!
Anything that causes an increase in cortisol can cause an insulin surge. Common things I find that increase cortisol are allergies, inflammation, infection, toxins, previous injuries or emotionally stressful events. Once diet is in control, these are the real issues that often prolong infertility.
Let’s see how this works with an allergy for example.
Histamine from allergies is the most potent internal biochemical stimulator of the adrenal glands. The adrenal glands also play a large role in fertility. The adrenals are highly involved in your “fight-or-flight” response and thus if your adrenals feel like you are running from the proverbial tiger, you won’t get pregnant. This is a simple law of preservation. Your body will always prioritize what is most important to keeping you alive for today, not necessarily for 10-50 years.
Is Histamine Really A Big Deal?
When I was in college my brain was smarter than it was holistic. I was just barely learning what a holistic diet and lifestyle was all about at that time. I was still in the stage of “biohacking” rather than trying to be truly healthy. I think most go through this stage at some point in their search for health. Biohacking is all about symptom management or exploiting one system at the detriment to another.
So in college, I knew that I was really sensitive to yellow dye #5. It causes me to get rashes and even can cause some shortness of breath, both symptoms of histamine production. Because I knew that, I stayed away from it and didn’t consume food or beverages with the dye.
But, I also knew that histamine was a huge adrenal stimulator, the most potent in fact. So, when I was in the middle of finals week and I had completely exhausted all of my energy studying, I would drink an unnamed sports drink without any caffeine that I knew had yellow dye #5 and I knew I was sensitive to. In response, it would create a huge histamine surge which would stimulate my adrenals and it would keep me up most of the night and allow me to study. This is a great example of how I used a biohack to exploit one system at the detriment of another.
So, to the skinny, healthy eating and fit PCOS patients out there, you should be focusing on discovering hidden allergies, infections, and structural and emotional stressors that are causing you to have adrenal issues or blood sugar imbalances that are impeding pregnancy.
One other note on diet is that many people still don’t know that a low-fat diet is not beneficial to health. There are even websites online that promote a vegetarian diet for fertility. (Don’t even get me started!) Saturated fat is very beneficial for fertility. Whether you choose to up your butter, olive oil, coconut oil, dairy fats or all of the above, a high-fat diet will promote fertility and help fight off PCOS. In some traditional societies it is actually a requirement to drink milk for a period of time before trying to conceive to ensure a healthy fetus.
Continue reading in Part 2