Written by Nathalie Daudet
PCOS, or Polycystic Ovary Syndrome, is a condition that affects 1 in 10 women. We wanted to shed some light on the condition and why some women with PCOS may want to chart their cycle. One big reason: it removes a lot of the confusion about getting pregnant with PCOS and it helps women identify their fertile window, even when they experience longer and more unpredictable cycles.
Contrary to its name, PCOS is more strongly linked to androgen excess than the presence of polycystic ovaries. It's diagnosed with a combination of excess androgens (hormones) and irregular or abnormal cycles. The root causes of PCOS vary from individual to individual, as do the symptoms. Since it's a big topic, I don't have time to cover the basics of PCOS today, but you can find more in this article.
In previous posts I focused on ways in which PCOS can be managed by charting your cycles and using FAM. In this post, let's focus on one large, common struggle of PCOS: fertility. One of the main fears that women with a PCOS diagnosis might have are issues surrounding getting pregnant. Before we dive into what to focus on if you're trying to conceive with PCOS, it’s important to understand why fertility can be an issue when it comes to PCOS.
Ovulation and Pregnancy
In my work as a fertility awareness educator, empowerment through education is key. When it comes to PCOS, when you understand how your hormones work you can become better advocates for your health. In this case, the root cause of fertility problems is not just “infertility.” Meaning, there's a reason you (with PCOS) may have trouble getting pregnant, and understanding why can help you overcome any struggles conceiving.
In order for conception to happen, a few things have to happen. Many of us grow up hearing that we can get pregnant anytime, but it's just not true. Let's look at what has to line up for conception to occur.
The first is ovulation. Ovulation is when your ovary releases an egg. No matter how long your cycle is, ovulation happens 10-16 days prior to your period. If you're on hormonal birth control, breastfeeding, or have certain hormonal imbalances, ovulation may not occur for a long time. Once it does, the egg is viable for 12-24 hours. You can't ovulate twice per cycle, but you may be able to release two eggs in a single ovulation event. When this happens, multiple eggs are released within a 24-hour period.
Once an egg is released, it needs to be fertilized by sperm. The vagina is naturally a hostile environment to sperm, so it needs favorable conditions to remain viable to even try to fertilize an egg. That means it needs cervical mucus to help nourish the sperm and push it on its way to meet up with the egg. With cervical mucus, sperm can remain viable for about 5-7 days.
Ultimately, becoming pregnant means you ovulated and the egg was fertilized within the 12-24 hour period it was viable. The period of time when sperm can stay alive for long enough to fertilize the egg, and therefore you can become pregnant, is called the fertile window.
Most women can't pinpoint this window of fertility if they are not tracking their cycle - it's incredibly difficult unless you understand and watch your body's signs and symptoms. If you have PCOS, it can add another challenge to conceive: not knowing if or when you will ovulate. The reason there may be fertility issues associated with PCOS is because ovulation may not be happening regularly or it may be delayed, giving you a long and drawn out cycle.
Charting Your Cycle
There is a way that to pinpoint ovulation and take some of the mystery out of when the fertile window opens and closes: fertility awareness charting. When you chart your cervical mucus and basal body temperature - and know how to interpret what you chart - you can have some sense of when ovulation is about to happen, and be sure it has happened.
Tracking your cycle with either an app (the Tempdrop app on Android/iOS allows manual charting!) or on paper and making notes about your cervical mucus and basal body temperature. Some methods also use hormone tests like Luteinizing hormone strips or fertility monitors.
In order to conceive, you will want to time intercourse on peak day, the day of the most fertile, egg-white, clear, stretchy cervical mucus. This may happen before you actually ovulate, but it is the type of cervical mucus that will keep sperm alive and nourished. While charting, you can't identify peak day until after it's happened, so often the suggestion is to have intercourse every other day at least until you've confirmed ovulation.
With PCOS you may experience delayed ovulation, or cycles where ovulation does not happen (also known as anovulatory cycles). By tracking your fertility signs with FAM, you can have some sense of when ovulation will happen, even with irregular cycles. One extra benefit of charting is your chart can tell you you're pregnant before you even test! Just because you have PCOS doesn’t mean that you can’t conceive, if you have some sense of where you are in your cycle, you can time intercourse at ovulation.
Address the Root Cause
Most mainstream approaches to PCOS do not address the root cause of PCOS. Educating yourself so you can advocate for your own health and ask for what you need from your practitioner is key. It's possible to manage PCOS symptoms and restore normal cycles with lifestyle and diet changes.
Reducing stress, eating foods that lower insulin resistance and maintain blood sugar balance are key in managing PCOS. The root cause of PCOS has to be addressed first, and it might mean adopting some new habits. Finding yourself some support either virtually or in person, in the form of a mentor or a women’s health-minded practitioner is key. Ask your practitioner about their approach to treating the root cause of PCOS, and remember that you have options. You’re not alone in this journey!