PCOS Fertility Special Report

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					Suffering from Polycystic Ovary Syndrome (PCOS) & Struggling with
Infertility?

In this special report you’ll find tips, tools and information to boost your
chances of finally becoming a Mum!



What is Polycystic Ovary Syndrome?

Polycystic ovary syndrome is also commonly known as PCOS.

PCOS is a women’s health challenge with a host of different, but interdependent,
hormonal imbalances. PCOS can affect many areas of a woman’s heath: menstruation,
fertility, appearance and weight, to name a few.

PCOS is a significant cause of female infertility. It increases the risk of miscarriage, and
can also cause pregnancy complications.


Why is it called Polycystic Ovary Syndrome?

Poly Cystic Ovary Syndrome (PCOS) derived its name from the multiple (i.e. “poly”)
cysts (i.e. “cystic”) in the ovaries (i.e. “ovary”). These cysts are actually immature
follicles. Follicles typically contain a single immature egg, which grows and develops,
and when healthy, culminates in ovulation. Researchers demonstrate that there are an
increased number of growing follicles in the poly cystic ovary. The egg follicles begin to
develop, but stop growing. This is known as “follicular arrest”. If the dominant follicle
does not enlarge, and the egg does not mature, this egg is not released. This is known
as “anovulation”.

Diagnosing PCOS

There are two main criteria used to diagnose PCOS:


1.) The Rotterdam Criteria define PCOS as being present when at least two of the
following are present:

      infrequent menstruation
      excessive levels of “male” hormone (“hyperandrogenism”)
      poly cystic ovaries are found with ultrasound

2.) The National Institute of Health criteria define PCOS as being present when there is:
    the presence of hyperandrogenism and infrequent ovulation (“oligo-ovulation”).


Other disorders that may be responsible for the signs and symptoms being experienced
must be excluded first.

The Incidence of PCOS

If you are suffering from PCOS, you are not alone.

It is estimated that more than ten percent of women worldwide suffer from PCOS, with
higher incidence rates occurring in African-American, Hispanic, Asian and Indigenous
Australian women. Currently, this means approximately 15.6 million American; 1.13
million Australian; 3.13 million UK and almost 37 million European women suffer from
this syndrome. The rates are also similar in other countries such as New Zealand,
Canada, India and China. Girls as young as age eleven can suffer from PCOS.

What Causes PCOS?

Many women with PCOS have less than nine periods per year. Some women have
completely absent periods (“amenorrhea”). Without a regular period, conception is less
likely. Women with PCOS may also have anovulatory cycles, which means they have a
period, but they do not ovulate, or release and egg, mid cycle. Without the release of an
egg, there is no chance of conception. PCOS is in fact the leading cause of anovulatory
infertility.

Let’s take a look at the hormonal fluctuations in a healthy menstrual cycle:
Picture Credit: http://nursingcrib.com/news-blog/physiology-of-menstruation/



Now let’s take a look at some of the hormones important in PCOS:

          High Levels of Luteinizing Hormone (LH)

          Luteinizing Hormone helps in the final maturation of the egg, and the LH surge
          triggers ovulation. Women with PCOS typically have high levels of LH, but often
          don’t experience the all-important surge. “Inappropriately raised LH levels may
          have adverse effects on the developing oocyte (egg) or endometrium either
          directly, or indirectly by causing an elevation in testosterone and oestrogen
                   1
          levels.”

          High LH levels contribute to the lack of an egg being released from the ovary
          (anovulation). This sustained high level of LH is different from the “LH surge” that
          occurs just before ovulation, which serves to ‘push’ the egg through the ovarian
          wall. When eggs aren’t released for fertilization, infertility is unavoidable.

          Abnormal LH to Follicle Stimulating Hormone (FSH) Ratio

          An abnormal LH to Follicle Stimulating Hormone (FSH) ratio has been postulated
          as a factor in PCOS. Although some research suggests that examining this ratio
          is of limited use, and may be less of a factor than originally thought. FSH triggers


1
    http://humrep.oxfordjournals.org/content/8/6/829.abstract
    a follicle to develop into a mature egg. A typical LH to FSH ratio is 1:1. Some
    health professionals consider ratios of 2:1 or 3:1 to indicate possible PCOS.

    High Insulin Levels

    Most women with PCOS have high insulin levels, and/or insulin resistance. Their
    body has trouble using the hormone insulin correctly, and so they produce more
    insulin to compensate. With increasing insulin levels, the cells effectiveness in
    responding to insulin is reduced. This can result in insulin resistance. Signs and
    symptoms of insulin resistance include:


   Weight gain, and difficulty losing weight
   Fatigue
   Foggy brain
   Skin tags
   Darkening of the skin (acanthosis nigricans)
   Diabetes
   Fatty liver
   Irregular periods

    These high insulin levels increase the production of androgens (male hormones),
    which can also contribute to infertility. Signs and symptoms of androgen
    overproduction include:

   Acne
   Excessive hair growth
   Weight gain
   Problems with ovulation

    Inflammation

    Inflammation may be a factor in the development of PCOS. There is evidence
    that inflammation causes reduced insulin sensitivity, which can increase insulin
    levels, and subsequently androgen levels. This can cause anovulation and
    infertility. One 2004 study concluded that PCOS and inflammation were not
    necessarily correlated. This study compared “inflammatory markers”, substances
    found in the blood indicating inflammation to a control group. Research published
    in 2005 examining insulin resistance and inflammatory markers in obese and
    non-obese women with PCOS showed that all women with PCOS had elevated
    levels of inflammatory markers. Some suggest that weight and obesity may be
    the cause of the high levels of inflammatory markers and problems often
    associated with women that have PCOS, like heart dis-ease and diabetes. A
    2012 study confirmed that the studies on inflammation and PCOS “do not
    consistently demonstrate a clinically relevant increase in the above mentioned
    [inflammatory] biomarkers.” More research is necessary.


    Low Progesterone Levels

    Low progesterone levels are common in women with PCOS. A 2004 study of 19
    women with PCOS concluded that insulin resistance maybe responsible for low
    progesterone levels during the luteal phase (the second half of the menstrual
    cycle, from ovulation to the first day of the bleed).

    Heredity

    Genetics may play a role in the development of PCOS. Those with mothers and
    sisters with PCOS are more likely to develop it. There have been no specific
    genes, though, which have been isolated as a cause. However…

    Epigenetics

    Epigenetics is the study of how the environment affects the way a gene is
    expressed, i.e. whether it is switched on, or switched off. Think about the gene,
    for example, that causes the production of protein responsible for stopping the
    flow of blood from a cut. The gene that produces this protein is only ‘turned on’
    when you have a cut.

    The expression of a gene can be altered by things such as your diet, stress,
    activity, sleep, medications, toxins, and more. Epigenetics are a critical factor in
    PCOS. These changes, which are not part of the DNA itself, can be then passed
    down for generations. A 2011 pilot study of primates suggests that excess
    exposure to male (“androgen”) hormones while in utero may predispose subjects
    to PCOS by changing the epigenome, Other research has shown that obesity in
    the mother can trigger insulin resistance in the baby growing in the womb.


    Signs and Symptoms of PCOS

    Symptoms of PCOS vary. They may include:

   Difficulty or inability to become pregnant due to a lack of ovulation
   Infrequent, absent, and/or irregular menstrual periods
   Increased hair growth on the face, chest, stomach, back, fingers or toes
   Cysts on the ovaries
      Acne
      Oily skin
      Difficulty losing weight
      Weight gain around the waist, or obesity
      Baldness or thinning of the hair
      Thick, dark brown or black skin patches on the neck, arms, breasts or thighs
      Skin tags
      Pelvic pain
      Mood problems like anxiety or depression
      Sleep apnea
      Fatigue
      Pain
      Depression, anxiety, low self-esteem
      Hot flushes
      Mood swings

PCOS and Fertility

PCOS:

- is the most common endocrine disorder affecting female fertility
- makes up 90-95% of women presenting to infertility clinics with anovulatory infertility
(infertility due to the lack of ovulation)
- increases the miscarriage risk for women, with rates of between 30 - 50 percent in the
first trimester.
- increases the risk of Ovarian Hyperstimulation Syndrome.
- and overweight/obesity often go hand-in-hand. This can increase the risk of
spontaneous abortion
- increases the risk of gestational diabetes, the birth of small-for-gestational-age babies
- increases the risk of babies being born needing transfer to the neonatal intensive care
unit.
- may increase the risk of pre-eclampsia in women with PCOS, particularly in those who
are insulin resistant
- may reduce the success rates of assisted fertility techniques such as IVF


In women with PCOS, the hormones necessary for an egg to mature may not be
sufficient. The follicles usually grow, but their growth may be arrested. In this case,
ovulation does not occur. Instead the follicles retain fluid and may become cysts. The
production of the hormone progesterone is then inhibited; as progesterone is made
once the ‘hole’ left by the released egg becomes a temporary gland known as the
corpus luteum. This then interferes with normal menstruation. While ovulation remains
foundational in becoming pregnant, achieving a pregnancy is possible when you suffer
from PCOS.

Other factors leading to infertility must first be ruled out before identifying PCOS as the
causative factor. Other possible reasons for infertility are:

      Scarred ovaries or fallopian tubes
      Malfunction of the pituitary gland or the hypothalamus
      Premature menopause
      Unruptured follicular syndrome
      Abdominal dis-eases like colitis, and celiac
      Congenital defects (defects that are present at birth)
      Infections
      Endometriosis
      Abnormalities of the uterus, such as fibroids or polyps
      Abnormal cervical mucous
      Being overweight or underweight
      Tobacco and alcohol use
      Lead and radiation exposure
      Exposure to some pesticides
      Male factors

While 90-95 percent of women who attend infertility clinics do so due to anovulation,
women with PCOS are not sterile. Many women with PCOS-related infertility can be
assisted and do become pregnant. Some, however, do not. Women with PCOS remain
at risk for pregnancy complications once they do become pregnant.

Possible Complications During Pregnancy

Women with PCOS appear to be at a higher risk of developing:

      Miscarriage
      Gestational diabetes
      Pregnancy-induced high blood pressure (preeclampsia)
      Premature delivery

Because pregnant women with PCOS are often at higher risk, and because many been
prescribed medications for PCOS-related signs and symptoms (like high blood pressure
and diabetes), they may require careful monitoring.
Reason for Increased Miscarriage Rate

The rate of miscarriages in women with PCOS are between 30 - 50 percent in the first
trimester, and these same women also have a greater chance of suffering from
gestational diabetes, high blood pressure and other pregnancy complications.

Miscarriages in women with PCOS can be attributed to several factors, including low
progesterone and high LH levels.

Progesterone is a hormone that supports the menstrual cycle and pregnancy.
Progesterone preserves the uterine lining, allowing the embryo to attach and receive
nourishment as the placenta is formed. When healthy progesterone levels are not
maintained in pregnancy, the uterine lining may shed, dispelling the embryo in the
process. This results in a miscarriage.

Higher insulin levels, poor egg quality and the manner in which the egg attaches to the
uterus may also play a role in miscarriages.

A significant increase in serum levels of LH was found in unexplained first
trimester miscarriage groups.2 As discussed above, women with PCOS often
have higher LH levels.

Reason for Recurrent Miscarriage Rates

According to Wikipedia, “Habitual abortion, recurrent miscarriage or recurrent
pregnancy loss (RPL) is the occurrence of three or more pregnancies that end in
miscarriage of the fetus, usually before 20 weeks of gestation.” It is not
uncommon for women with PCOS to experience recurrent miscarriages, and
often there is no explanation, or advice for future pregnancies, given. Let’s have
a look at some studies that may help shed some light on this heart-breaking
problem.
 “A total of 31 women suffering from habitual abortion have been examined when
not pregnant. Both increased and normal prolactin levels were recorded. In
hyperprolactinemia (high levels of the hormone, prolactin) the level of the
luteinizing hormone (LH) secretion was high and no ovulatory peaks were
detected (LH peaks just prior to, and brings about, ovulation), whereas in normal
prolactin secretion the level of LH was moderately increased during all phases of


2
    http://www.ncbi.nlm.nih.gov/pubmed/19886396
the menstrual cycle. Sex steroid secretion was disturbed.”3 What this means is
that recurrent miscarriage may be related to the hormonal imbalances in a
women with PCOS, particularly LH, prolactin, and the sex hormones like
progesterone and/or testosterone.

“Although women with recurrent miscarriage and delayed endometrium had
significantly lower progesterone levels than those with normal endometrial
development, only 8/24 had mid-luteal progesterone levels below 30 nmol/L.
Endocrinological and endometrial abnormalities are present in about a quarter of
women with unexplained recurrent miscarriage.”4 This indicates that one cause of
miscarriage in women with PCOS may be low progesterone levels, but these
lower levels may not be significantly outside of ‘normal limits.’

In a study on recurrent miscarriage, 81% of recurrent miscarriage and 10% control
subjects had polycystic ovaries. “The 81% of women with recurrent miscarriage had
either raised urinary LH excretion or a premature LH surge (which was considerably
different to the control subjects). Total LH excretion during the cycle and mean follicular
phase serum testosterone was significantly greater with early pregnancy loss than in the
control group, the difference in LH being greatest in the early luteal phase. Urinary
oestrogen was raised in the early luteal phase of the cycle in the group with early
miscarriage. Inappropriately raised LH levels may have adverse effects on the
developing oocyte or endometrium either directly, or indirectly by causing an elevation
in testosterone and estrogen levels.”5

“FSH, estradiol (one form of oestrogen), LH, prolactin and DHEAS concentrations were
significantly higher in the unexplained recurrent miscarriage group than in the explained
recurrent miscarriage group, although serum concentrations of all hormones were within
the normal range.”6 This means that the levels of the hormones adversely affecting the
health of your pregnancy may be raised, but not enough that they will be detected as
being causative.

What if You Need Some Assistance to Become a Mother?

Your doctor will introduce you to the assisted reproductive technique/s most suitable for



3
  http://www.ncbi.nlm.nih.gov/pubmed/6440139
4
  http://www.ncbi.nlm.nih.gov/pubmed/11192102
5
  http://humrep.oxfordjournals.org/content/8/6/829.abstract
6
  http://www.ncbi.nlm.nih.gov/pubmed/14503976
your current circumstances. Common medical fertility treatments for women with PCOS
include:

       Clomiphene: Clomiphene is a medication that is a regularly recommended
        treatment for infertility in women with PCOS. Some studies show that using
        clomiphene increases the chance of women getting pregnant by at least 40
        percent. A study of more than 500 infertile women, however, published in 2008,
        showed that treatment with clomiphene was no more effective than natural
        treatments for infertility, and in fact it remained slightly less effective than natural
        treatments. More research is needed. A suitable trial of clomiphene is three to
        four cycles, and most health experts don’t suggest using clomiphene for more
        than six cycles. Using clomiphene increases the likelihood of women having
        multiple simultaneous pregnancies, such as twins or triplets. It may also lead to
        birth defects if continued after conception.7

        Metformin: Although not currently approved by the FDA for treatment of PCOS-
        related infertility, some health care providers recommend metformin to treat
        infertility associated with PCOS. Metformin is an insulin-sensitizing drug currently
        used to treat diabetes. Treatment with metformin successfully initiated ovulation
        in recent studies. Some experts will use a combination of clomiphene and
        metformin. This combination appears to slightly improve the chance of
        pregnancy over treatment with either medication alone, and using a combination
        reduces the number of multiple pregnancies when compared to using
        clomiphene alone. When taking Metformin, a vitamin B complex should be
        included, as this insulin sensitising agent has been shown to “deplete the
        essential B vitamins, folic acid and B12, which can increase inflammation.”8

       Gonadotropins: Gonadotropins are hormones often used in low doses to
        successfully treat PCOS-related infertility when clomiphene and metformin have
        not been effective in procuring a pregnancy.

       In Vitro Maturation (IVM) and In Vitro Fertilization (IVF): With in vitro
        maturation, a health expert removes immature eggs from a woman early in her
        cycle. These eggs are left to mature in a lab setting using hormones

7
 http://www.cdc.gov/ncbddd/features/Clomiphene-Citrate.html
8
 Wulffele MG, Kooy A, Lehert P, Bets D, Ogterop JC, Borger Van Der Burg B, Donker AJ, Stehouwer
CD, ‘Effects of Short-term Treatment with Metformin on Serum Concentrations of Homocysteine, Folate
and Vitamin B12 in Type 2 Diabetes Mellitus: a Randomised, Placebo- controlled Trial’, Journal of Internal
Medicine, 254(5), November 2003, p455-p463
          (gonadotropins). With in vitro fertilization, medication is used to stimulate follicle
          growth prior to harvesting the eggs. Once matured, the eggs are fertilized and
          then returned to the uterus. Rates of pregnancies resulting from IVM remain low,
          and the risk of miscarriage is high. For this reason, this procedure is usually
          reserved for those who have unsuccessfully been treated with medications.
          Rates of pregnancy with IVF are higher. A recent study of 46 asymptomatic
          women who had polycystic ovaries on ultrasound who had up to three cycles of
          IVF treatments had an 82 percent higher rate of achieving a live birth than
          women with normal ovaries.

Whether you are at the start of your fertility path, or requiring assisted fertility treatment,
the good news is that you can take significant steps to boost the success of your fertility
naturally, or with treatment, and you can encourage a healthy, full-term pregnancy with
a safe birth.

Fertility Boosting Tips Include:

             Stress Management: High levels of stress increase the levels of the
              hormone cortisol, and may affect your weight, your ability to conceive and
              your ability to maintain a pregnancy.

              Recently, an article in Forbes discussed the role significant stress and
              emotional trauma can cause in PCOS, infertility and in miscarriage. You can
              read this article by clicking here9

              One study noted “optimum benefit to the patients might involve not only
              provision of a good clinic ambiance and pharmacological preparations,
              but also relaxation therapies such as Autogenic Training, which
              significantly lowered psychological and biochemical stress marker
              scores.”10

              Sanders and Bruce found that “psychosocial stress influences fertility in
              females”11

              And a study by Cwikel, Gidron & Sheiner stated “Psychological factors such


9
 http://www.forbes.com/sites/womensenews/2012/08/29/conflict-trauma-in-kashmir-leads-to-infertility-
miscarriages/

10
     http://www.ncbi.nlm.nih.gov/pubmed/2875038
11
     http://humrep.oxfordjournals.org/content/12/10/2324.short
            as depression, state-anxiety, and stress-induced changes in heart rate and
            cortisol are predictive of a decreased probability of achieving a viable
            pregnancy.”12

            Infertility, itself, can be very stressful. It has been shown that stress in
            response to infertility can lead to depression and can reduce the success of
            fertility treatment/s.

            A study in the Journal of Fertility & Sterility indicated, that “infertility-related
            stress has direct and indirect effects on treatment outcome.”13 Another found
            that “psychological stress may affect the outcome of IVF treatment”14, that
            there may be a “complex relationship between psychosocial stress and
            outcome after IVF/ICSI”15 and that “treatment and therapy to reduce stress,
            and in so doing enhance fertility”16 is a worthwhile exercise.

            Chronic stress can cause depression, changes your sleep habits, cause
            mood swings, affect your relationship, reduce your immune and gut function,
            cause insulin resistance, adversely affect your libido, cloud your brain
            function…

            All making becoming – and remaining - pregnant more difficult.

            Effectively managing stress is crucial for your—and your baby’s—health.
            Exercise, yoga, tai chi, meditation, deep breathing, surrounding yourself with
            beauty and safety, massage and Chiropractic care can help to reduce your
            stress levels. Whenever you feel your heart racing and your stress levels
            rising, learn to pause, take a few deep breaths and slow down. Other stress
            management strategies include:

                1. Talk to your partner or spouse

                2. See a counselor

                3. Realize you are not alone by joining a support group or online forum

                4. Inform yourself about infertility, the challenges you face, and the steps
                   you can take to help yourself.

12
   http://www.ejog.org/article/S0301-2115(04)00257-X/abstract
13
   http://www.sciencedirect.com/science/article/pii/S0015028205004085
14
   http://onlinelibrary.wiley.com/doi/10.1034/j.1600-0412.2000.079002113.x/abstract
15
   http://humrep.oxfordjournals.org/content/20/4/991.short
16
   http://humrep.oxfordjournals.org/content/21/7/1651.short
       5. Understand that your feelings are normal

       6. Learn stress reduction techniques such as meditation, yoga and
          affirmations

       7. Avoiding consuming too much caffeine

       8. Exercise regularly (great physically, mentally and emotionally)

       9. Arm yourself about your cause/s of infertility, and your treatment
          options

       10. Ensure you receive enough sleep

       11. Supplement with, or include foods rich in, Vitamin B6, Zinc and omega
           3 fatty acids

       12. Enjoy sex for fun – not reproduction

   Fertility Friendly Foods and Nutrients: Food can do amazing things to help
    boost your fertility, regulate your monthly cycle, balance your hormones, and
    help you maintain a healthy weight or lose weight, if needed. By regularly
    including certain foods in your food plan, you can bolster the success of any
    fertility plan or treatment and reduce the risk of miscarriage. It’s best to
    acquire your vitamins and nutrients through a wide variety of health, natural
    foods. Supplementing is also a great idea as this can improve your fertility,
    and ensure you receive the nutrients critical to a healthy pregnancy and a
    healthy baby. If you do wish to supplement with a vitamin or mineral, always
    check with a health care professional qualified in this area first.


              1. Omega-3 fatty acid rich fish: Many women with PCOS have
                 been shown to have higher levels of inflammatory markers, and
                 insulin resistance. Supplementation with quality omega 3 fatty
                 acids has been proven to reduce inflammation, improve insulin
                 sensitivity, and they may help to lower the risk of premature
                 birth. Omega 3s also help to increase the length of
                 pregnancy, and improve the birth weight by promoting fetal
                 growth with increased blood flow. Results from research
                 studies also show that Omega 3s help to reduce
                 preeclampsia (high blood pressure during pregnancy) and
                 depression after the birth of your child.
                 Omega 3 fatty acids can be found in cold water, oily fish like
                 salmon, tuna, mahi-mahi, mackerel and sardines. To reduce
                 risks associated with potential higher mercury levels found in
                 some of these fish, limit your intake to about 12 ounces or 340
                 grams per week. Other good sources of omega 3 fatty acids
                 include nuts, free-range eggs and healthy plant oils such as
                 flaxseed oil.

              2. Nuts: Include a handful of nuts each day. Almonds, walnuts,
                 Brazil nuts, as well as others. Nuts offer a great source of
                 omega-3 fatty acids, protein, B vitamins and fertility-boosting
                 minerals such as copper, manganese, magnesium and
                 potassium.

              3. Gluten-free whole grains: Small amounts of gluten-free oats,
                 brown rice and other gluten-free whole grains can improve
                 fertility in both women and men. They are rich in the vitamins
                 and minerals that support ovulation, and they help carry the
                 sperm safely to the uterus. In addition, they provide folic acid,
                 which is critical for your baby’s growth and development.

              4. Lean proteins: Free-range eggs, nuts, seeds and meats such
                 as fish are beneficial for both eggs and sperm quality. These
                 fantastic foods can be enjoyed in palm-sized amounts two or
                 three times per day. They’re also good for building muscle,
                 reducing hunger cravings and helping you to feel fuller, for
                 longer. This has been shown to reduce the amount of foods
                 eaten, and aid in any weight loss efforts.

              5. Variety: Remember to eat a “rainbow” of foods. The more
                 colourful the food on your plate, the better. Green spinach, red
                 peppers, yellow tomatoes, pink salmon, black beans. Colour
                 rich foods contain higher amounts of antioxidants, which are
                 critical for fertility. And with colour, you can create meals that
                 look as good as they taste!

   Sound Sleep and Good Sleep Hygiene: Everyone feels better after a good
    night’s sleep, but if worry about conceiving or miscarriage is keeping you up
    at night, you may be suffering from sleep deprivation. One study showed
    women who suffered from a lack of sleep weighed more when compared to
    women who slept eight hours per night. Reduced sleep has been also shown
    to reduce insulin sensitivity. As insulin resistance is a main driver of PCOS,
    and because it has profound effects on fertility, ensuring enough sleep
    remains critical to both conception and a healthy pregnancy.

    To maintain a good sleep pattern, make sure your bedroom is only used for
    sleeping and sex. Keep the bedroom electronic -TV, computer and mobile
    phone--free. Ensure that it is completely dark at night. Try to find a sleep
    schedule that works for you consistently, so that your sleep and wake times
    remain the same. You can get my secret sleep report for free at
    www.DrRebeccaHarwin.com.

   Exercise: Being active enhances fertility, stress reduction and weight loss. It
    also helps to keep you in good shape so you can better support a pregnancy
    and a safe birth. You can begin while trying to conceive, and continue to
    exercise, with your health care professionals approval, during your
    pregnancy. Walking is one of the best low-impact, do-anywhere exercises.
    Walk briskly for 30 to 60 minutes a day to increase your heart rate and
    metabolism. Other great options are yoga, strength-training, gardening, dance
    classes, biking and swimming. Find something you enjoy and that you can
    stick with for the long term. But beware: too much exercise can literally
    reduce you fertility, particularly if you are of normal weight or are underweight.
    A review of multiple studies on exercise and PCOS noted also that exercise
    improved insulin sensitivity, a primary factor in fertility. Experts recommend a
    minimum of ninety minutes per week of moderate exercise in order to
    enhance reproductive health in women with PCOS.

   Optimal Thyroid Health: Your thyroid is a small gland at the base of your
    neck that can have a huge impact on how you feel. It is responsible for
    releasing hormones that govern your metabolism and energy level and it’s
    involved in your reproductive functions, affecting menstruation, ovulation and
    fertility. When you’re feeling sluggish, so are your eggs, which is one reason
    why optimal thyroid health is so important. Poor thyroid function can reduce
    Follicle Stimulating Hormone (FSH) levels, causing incomplete egg
    maturation and possible anovulation. An underactive thyroid can lead to
    infrequent or erratic periods while an overactive thyroid can increase the risk
    of miscarriage, birth defects and premature delivery. Get tested to ensure
    your thyroid is operating at a healthy level. The most common Thyroid test is
    Thyroid Stimulating Hormone (TSH). Although many pathology laboratories
    suggest between 0.5 – 4 or 5 mIU/L is ‘within normal limits’, the latest
    research suggests a more accurate reference range for health should be
    between 1 - 2/2.5 mIU/L. Be certain to consume an optimal amount of iodine
    from foods such as seaweed, oysters, scallops, radishes, onions and if you’re
    feeling adventurous sea vegetables (150 micrograms if you’re not pregnant;
    250 if you are). Also enjoy lean protein, fruits and veggies, nuts and seeds,
    and filtered water to support thyroid health.

   Temperature Tracking: Since ovulation is a silent process for most women,
    tracking your basal body temperature (your body temperature when you are
    completely at rest) can give you a strong indication of ovulation, which is the
    most fertile part of your cycle. Using a fertility thermometer, you’ll be able to
    detect probable ovulation by noting an increase in body temperature--as
    much as one degree Fahrenheit. Start taking your temperature on the first
    day of your cycle (the first day of your menstrual bleed) in the morning before
    you even get out of bed. Repeat throughout your cycle and note any changes
    that indicate ovulation. For best results, track basal body temperature over
    three or four months. You can download temperature tracking charts and
    instructions at www.ConquerYouPCOSNaturally.com/Ovulation.

    * Note: it is important to use both temperature tracking and cervical
    mucous in determining probable ovulation.

   Environment Detoxification: A growing number of environmental pollutants
    can adversely affect your fertility, conception and pregnancy, so it’s important
    to pay attention to and eliminate as many of these as possible. Remove
    chemical cleaners, harmful cosmetics and other household items that contain
    mercury, lead, PCBs, parabens and pthlates from your environment. Focus
    on eating organic where you can, non-processed foods, drinking filtered water
    not stored in plastic containers, and using natural cosmetic products, which
    are free from harmful ingredients.

   Inflammation Reduction: Many women with PCOS have constant low-grade
    inflammation, and this may reduce fertility. These various inflammatory
    markers can suppress the reproduction system, and this may lead to lower
    quality eggs. To reduce inflammation, eat from the wide variety of fertility
    foods, eliminate gluten containing foods, engage in regular stress
    management activities, include a quality fish oil, reduce/eliminate alcohol,
    cigarettes, unnecessary medications and all illicit drugs, and keep your body
    moving.

   Ideal Weight Management: Whether you are trying to boost ovulation and
    fertility prior to conception, or trying to maintain a healthy weight to reduce
    pregnancy complications and promote a smooth delivery and healthy child,
    simply put, a healthy weight can lead to a healthier you and a healthier child.
    Weight loss, when appropriate, has consistently been shown to boost fertility,
          and the good news is that eating many of the fertility foods can help you both
          lose weight and maintain that weight. During your pregnancy, however, a
          weight loss regimen is not recommended. But do focus on health. Enjoy a
          variety of nutritious, plant-based, colourful foods to support you and your baby
          during this time.

          Many women with PCOS are overweight or obese. A small percentage of
          women with PCOS have below-average weights. Either extreme can
          negatively impact on fertility. Research data confirms that both obesity and
          underweight combined, accounts for twelve percent of primary infertility.
          Even more surprising? The twelve percent is split down the middle, with six
          percent of primary infertility due to obesity, and six percent to being
          underweight. The good news? More than seventy percent of women who are
          infertile as a result of inappropriate body weight conceive spontaneously with
          appropriate weight loss or gain.

         Other Professionals

                    1. Acupuncture: A 2011 review of the literature on infertility and
                       acupuncture suggests that acupuncture may help boost fertility,
                       for males and females. It may help initiate ovulation via the
                       nervous and endocrine systems, and by improving ovarian
                       blood flow and metabolism. By possibly increasing uterine
                       blood flow, reducing mobility of the uterus and by quelling
                       anxiety, stress and depression, acupuncture may also improve
                       the outcome of IVF treatments. It may also help improve male
                       fertility, although the exact mechanism behind this is unknown.
                       Some studies have successfully added traditional Chinese
                       medicine to their acupuncture therapy to boost fertility.

                    2. Chiropractic Care: A very small 2006 study indicated success
                       in initiating ovulation with an applied kinesthetic approach called
                       Neuro Emotional Technique. This techniques works to reduce
                       toxins from the body that may be inhibiting ovulation.


Pre-Conception Plan

Preparing for pregnancy will increase the chances of ovulation, conception, and a
successful and healthy pregnancy and birth. To help yourself and your future baby, try
the following:

          a. Start taking preconception multi-vitamins
         b. Engage in exercise at least 3 times per week
         c. Eat the recommended 5-9 servings of fruits and vegetables each day
         d. Include calcium rich foods such as figs (dried), egg yolk, cinnamon
            (ground), tahini, duck meat, almonds, salmon, and spinach
         e. Reduce/eliminate your consumption of processed foods
         f. Re-evaluate your finances to reduce financial stress while on maternity
            leave
         g. Think positively, and manage your stress levels
         h. Consider eating organic foods, especially those foods known to be
            sprayed with pesticides: apples, celery, sweet bell peppers, peaches,
            strawberries, imported nectarines, grapes, spinach, cucumbers, lettuce,
            domestic blueberries and potatoes
         i. Lose any additional weight, prior to trying to conceive
         j. Detoxify your system by abstaining from caffeine, nicotine, refined sugar
            and alcohol. The detoxification rate and fertility appear to be directly
            proportional to each other.
         k. Improve insulin sensitivity. Exercise (particularly interval training), fish oil,
            magnesium, chromium, stress reduction and adequate sleep help
            enormously.




Congratulations! What to Do Now That You are Pregnant

Congratulations on your pregnancy and surpassing the conception challenges of PCOS!
The next several months will provide a wonderful bonding opportunity with you and your
baby. It will also bring a share of ongoing changes and possible challenges.
Your pregnancy food plan (other than having an increased calorie and nutrient
requirement), stress management, movement and sleep plan can remain much the
same – eat well, drink adequate filtered water, move regularly (talk to your health care
professional before doing any high-impact exercise such as running), manage your
stress through yoga, meditation and breathing, and try to ensure at least eight hours of
sleep each night. You are not only taking care of yourself, you’re taking care of your
baby as well, so it’s extra important to maintain a very healthy and balanced lifestyle.

Ask your doctor if there are any tests that need to be done in relation to your PCOS and
pregnancy, and try to enjoy your pregnancy as much as possible.

What Can You Do to Reduce Your Risk of Miscarriage and Pregnancy
Complications?

Women with PCOS remain 45 percent more likely to miscarry, although the exact cause
may remain unknown. Obesity, a condition experienced by many women with PCOS,
remains an independent risk factor for miscarriage. Regular exercise - 30 minutes on
most days, reduces obesity and improves insulin sensitivity to improve your chances of
carrying your baby healthily to term and through the birthing process.

It has been postulated that women with PCOS often miscarry because of higher
luteinizing hormone levels, and/or higher insulin and glucose levels. These hormonal
changes are common in women with PCOS. Elevated levels of insulin or glucose may
impair egg implantation or impede embryonic development. Insulin resistance may also
reduce          egg           quality,        leading         to         miscarriage.

Hyperinsulinemia is an independent risk factor for early pregnancy loss (EPL) and
decreases the levels of two major endometrial proteins (glycodelin and IGF binding
protein-1 (IGFBP-1)) – these are proteins that are important for the health of the lining of
the womb. During the first trimester, the concentrations of these two proteins are
markedly reduced in PCOS. This suggests the lining of the uterus around the time of
implantation and in early pregnancy is adversely altered, and may be responsible for
EPL in PCOS.17 Improving insulin sensitivity, as we talk about in this report, may
therefore reduce miscarriage.

A low-glycaemic index, low glycaemic load food plan including mono-unsaturated fatty
acids has been shown to reduce inflammation and plasminogen activator inhibitor-1
(PAI-1 levels), improving your chance of carrying your baby to full term. High levels of
PAI-1 have independently been associated with recurrent miscarriages in women with
PCOS. Elevated PAI-1 levels remain a core feature of insulin resistance syndrome
(IRS). Several reports also indicate that inflammation can initiate insulin insensitivity.

Taking the medication metformin may reduce your chances of miscarriage. In one
study, women with PCOS who took metformin throughout their pregnancies had a nine

17
     http://jcem.endojournals.org/content/89/2/833.short
percent miscarriage rate versus a 45 percent rate of those who did not take metformin.
Taking metformin during pregnancy, however, remains an area of controversy. As with
any treatment during pregnancy, you should weigh the benefits and risks with your
physician in order to make the best decision for you and your baby. If you choose to
take metformin, ensure you include a B-vitamin complex to reduce the higher levels of
homocysteine (an inflammatory marker) that may result.

If you have low progesterone levels in the luteal phase, taking medications like
clomiphene or receiving FSH or LH/FSH injections may help.

Progesterone is often low in women with PCOS, and if the progesterone levels drops
and the lining of the uterus is shed, so is the fertilized egg. Progesterone is known as
the ‘pregnancy hormone’. It is critical in maintaining a pregnancy until the placenta takes
over progesterone production in the second trimester. Progesterone is a ‘heating
hormone’. In the luteal phase (the second half) of the menstrual cycle, when
progesterone levels are higher, you will see a higher reading as taken by a fertility
thermometer (these thermometers are ideal as they are more accurate than an every
day thermometer). One way to track your hormonal changes is to track your basal
temperature before, and throughout, a pregnancy. If your temperature drops during
pregnancy, this may indicate that your progesterone level has dropped. This may
indicate an impending miscarriage. By boosting progesterone levels when this drop
occurs, you may be able to save the pregnancy. Some women with PCOS have been
treated through out

Lowering high blood sugar levels will also reduce the production of excessive
androgens, which may help.

Pre-eclampsia, a syndrome experienced by some pregnant women, characterized by
high blood pressure after the 20th week of pregnancy, is more likely to occur in women
with PCOS. Pre-eclampsia can lead to kidney, brain and liver problems for the mother,
and it may lead to a more serious condition—eclampsia. Eclampsia also carries the risk
of seizures and coma. Regular blood pressure monitoring will identify potentially
dangerous fluctuations that may lead to pre-eclampsia. Many pre-term births from
women with PCOS are attributable to the mother having pre-eclampsia. Pre-term births
put the infant at risk for complications associated with having a low birth weight and
underdeveloped lungs.

The risk of pre-eclampsia and eclampsia can be reduced by giving Magnesium
Sulphate; which also probably reduces the risk of maternal death.18,19

Fish-oil supplementation (containing 2·7 g n-3 fatty acids) in the third trimester seems to
prolong pregnancy by preventing early delivery.20

18
   http://ukpmc.ac.uk/abstract/MED/1530019
19
   http://ukpmc.ac.uk/abstract/MED/12057549
20
   http://www.sciencedirect.com/science/article/pii/0140673692905339
To prevent complications associated with high glucose levels and high blood pressure,
women with PCOS should have their blood pressure and glucose levels monitored
frequently in order to identify and address any potential problems early on.

How to Improve Your Chances of Breast Feeding

PCOS may reduce a woman’s ability to breastfeed. Some research points to inadequate
glandular tissue development in the breast in women with PCOS, due to chronic low
progesterone levels. Higher androgen (‘male’ hormone) levels may also interfere with
prolactin receptors. Prolactin is a hormone that is essential for breast tissue
development and milk production.

Many women with PCOS have no breastfeeding challenges, and breastfeeding may
actually improve glucose tolerance a short time after giving birth. Increasing the
frequency of feedings and/or pumping breast milk at regular intervals may help improve
the breast milk supply. Some new moms have found metformin and herbal remedies
that improve milk supply. Always check with your qualified health care professional
before taking herbal supplements, or medications, while breastfeeding. There are some
that can be passed through your mil supply to your feeding baby.

Breastfeeding is by far the best option for your baby, where you can. Perhaps the best
advice is just to relax and enjoy the bonding time with your new baby. Ask for support
from your partner, and consider reaching out to a supportive professional group, like La
Lache League. A lactation consultant can be incredibly beneficial here.

How to Protect My Future Child

When the womb is bathed in an insulin resistance environment, the growing baby is
more likely to develop insulin resistance later in life, through epigenetic change. This
increases their risk of developing the health challenges that come with this like PCOS,
heart disease, and diabetes. If the baby is a girl, her eggs are developing in her ovaries,
as she develops in you, and so this epigenetic change can potentially affect a second
generation as well – your grandchildren. By losing weight – where necessary, improving
your insulin sensitivity prior to conception, and making the right lifestyle changes during
pregnancy, you can reduce this risk significantly.

Environmental chemicals that a woman is exposed to during pregnancy can also be
passed on for generations. Researchers studied rodents that were exposed to various
chemical found in fungicides, pesticides and plastics. Study results revealed that
exposure of one generation to the toxins affected up to the two generations following.
The offspring had fewer egg follicles in their ovaries compared to controls, indicating a
reduced pool of available eggs. Both generations also had an increased number of
ovarian cysts compared to controls. These epigenetic changes occurred because the
chemicals affect how the DNA is expressed in the developing fetus. By completing a
healthy, professionally supervised detoxification program prior to your preconception
plan, you can also reduce this risk.
So there you have it.

The tips and tools for making your baby dream a reality.

PCOS is a syndrome, but not a sentence. While PCOS may make becoming pregnant,
and carrying and giving birth to a healthy baby challenging, by no means should it
defeat you. Women with PCOS lead happy and healthy lives, with infants and toddlers
to boot.

The great news? Many factors associated with PCOS can be significantly changed for
the better by a modified, improved lifestyle. These changes are not only effective for
reducing symptoms of illnesses related to PCOS, like obesity, diabetes, high blood
pressure and heart disease, they’re great for your general health.

That means that you are more in control than you think.

I want to also let you know about a great resource that can help you address all the
areas that may be contributing to your fertility, and PCOS, woes. Chock full of ideas,
tips and information to help you Conquer Your PCOS. ‘Conquer Your PCOS Naturally’
is a “life changing” cutting edge book that lays out the steps, the strategies and the stuff
you really need to know to succeed. To discover more, click here
http://www.conqueryourpcosnaturally.com/Grab_The_Book now.


Yours In Wellness!




Dr. Rebecca Harwin is a PCOS Expert and international author of ‘Conquer Your PCOS
Naturally’.


P.S. Don’t forget to click ‘like’ at http://www.facebook.com/ConquerYourPCOS for daily
tips, articles, advice, recipes and more!
Resources and Endnotes:

Abnormal body weight: A preventable cause for infertility. (n.d.). Retrieved from
     http://www.asrm.org/Abnormal_Body_Weight/

Balbis, P., Pollard, H., & Monti, D. (2006). Resolution of anovulation infertility using
       neuro emotional technique: a report of 3 cases. Journal of chiropractic
       medicine, 5(1), 13-21. doi: 10.1016/S0899-3467(07)60128-1


Bjercke, S., Dale, P.O., Tanbo, T., Storeng, R., Ertzeid, G., Abyhol, T. (2002) Impact of
Insulin Resistance on Pregnancy Complications and Outcome in Women with Polycystic
Ovary Syndrome. Gynecol Obstet Invest;54:94–98


Boomsma, C. M., Eijkemans, M. J., Hughes, E. G., Visser, G. H., Fauser, B. C., &
     Maklon, N. S. (2006). A meta-analysis of pregnancy outcomes in women with
     polycystic ovary syndrome. Human reproduction update, 12(6), 673-83.
     Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/16891296
Brinsden, P.R., Wada, I., Tan, S.L., Balen, A., Jacobs, H.S. (1995). Diagnosis,
prevention and management of ovarian hyperstimulation syndrome. BJOG 102(10),
767-772.

Campbell, H. (2012, June 19). 2012 dirty dozen: The 12 most contaminated foods.
     Retrieved from
     http://www.science20.com/science_20/blog/2012_dirty_dozen_12_most_contami
     nated_foods-91251

Cho, L. W., Javaqopal, V., Kilpatrick, E. S., Holding, S., & Atkin, S. L. (2006). The lh/fsh has little
       use in diagnosing polycystic ovarian syndrome. Ann clin biochem, 43(Pt 3), 217-9.
       Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/16704758

Common treatment for infertility ineffective: Study. (2008). Retrieved from
    http://afp.google.com/article/ALeqM5jz6xeD_ie6LMECtzT3mJGCgqi2Aw

Defining PCOS. (n.d.). Retrieved from
       http://www.uchospitals.edu/specialties/pcos/pcos.html

Dhindsa, G., & Bhatia, R. (2004). Insulin resistance, insulin sensitization and
      inflammation in polycystic ovarian syndrome. Journal of postgraduate medicine,
      50(2), 140-144.

Duleba, A. J., & Dokras, A. (2012). Is PCOS an inflammatory process? Fertility and
      Sterility, 97(1), 7-12. Retrieved from
      http://www.ncbi.nlm.nih.gov/pubmed/22192135

Engmann, L., Maconochie, N., Sladkevecius, P., Bekir, J., Campbell, S., & Lin Tan, S.
     (1999). The outcome of in-vitro fertilization treatment in women with sonographic
     evidence of polycystic ovarian morphology. Human reproduction, 14(1), 167-71.
     doi: 10.1093/humrep/14.1.167

Epigenomics. (n.d.). Retrieved from http://www.genome.gov/27532724

Gallenberg, M. M. (n.d.). For women, is there any connection between hypothyroidism
      and infertility? Retrieved from http://www.mayoclinic.com/health/hypothyroidism-
      and-infertility/AN01436

Harrison, C., Lombard, C., Moran, L., Teede, H., &, (2010). Exercise therapy in
       polycystic ovary syndrome: A systematic review. Human reproduction
       update, 17(2), 171-83. doi: 10.1093/humupd/dmq045

Homburg, R., Pregnancy complications in PCOS. Best Practice & Research Clinical
Endocrinology & Metabolism. Volume 20, Issue 2, June 2006, Pages 281–292
Huang, D. M., Huang, G. Y., Lu, F. E., Stefan, D., Andreas, N., & Robert, G. (2011).
     Acupuncture for infertility: is it an effective therapy? Chinese journal of
     integrative medicine, 17(5), 386-95. Retrieved from
     http://www.ncbi.nlm.nih.gov/pubmed/21611904

Inflammation, insulin resistance and PCOS. (2007, December). Retrieved from
      http://www.pcosupport.org/newsletter/articles/article122707-2.php

Jensen, L., Sloth, B., Krogg-Mikkelsen, I., Krogg-Mikkelsen, I., Krogg-Mikkelsen, I.,
      Krogg-Mikkelsen, I., Flint, A. & Raben, A. (2008). A low glycemic index diet
      reduces plasma plasminogen activator inhibitor-1 activity, but not tissue inhibitor
      of proteinases-1 or plasminogen activator inhibitor-1 protein, in overweight
      women. American journal of clinical nutrition, 87(1), 97-105.

Juhan-Vague, I., Alessi, M. C., Mavri, A., & Morange, P. E. (2003). Inflammation,
      obesity, insulin resistance .Journal of thrombosis and haemostasis, 1(7), 1575-
      79.

Lopez-Segura, F., Velasco, F., Lopez-Miranda, J., Castro, P., Lopez-Pedrera, R.,
      Blanco, A., Jiminez-Pereperez, J., & Torres, A., Ordovas JM, Pérez-Jiménez F.
      (1996). Monounsaturated fatty acid-enriched diet decreases plasma plasminogen
      activator inhibitor type 1.Atherosclerosis, thrombosis and vascular biology, 16(1),
      82-8. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/8548431

Marasco, L. (2005, April-May). Polycystic ovary syndrome. Retrieved from
     http://www.llli.org/llleaderweb/lv/lvaprmay05p27.html

Meenakumari, K. J., Aqaarwal, S., Krishna, A., & Pandey, L. K. (2004). Effects of
     metformin treatment on luteal phase progesterone concentration in polycystic
     ovarian syndrome. Brazilian journal of medical and biological research, 37(11),
     1637-44. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/15517078

Moderate exercise boosts fertility, study says. (2012, March 21). Huffpost Daily Living.
     Retrieved from http://www.huffingtonpost.com/2012/03/21/moderate-exercise-
     boosts-fertility_n_1354796.html

Omega 3 fatty acids. (n.d.). Retrieved from http://www.umm.edu/altmed/articles/omega-
     3-000316.htm

Patel, S. R., Malhotra, A., White, D., Gottlieb, D., & Hu, F. (2006). Association between
       reduced sleep and weight gain in women. American journal of
       epidemiology, 164(10), 947-54. doi: 10.1093/aje/kwj280
Patient fact sheet: Stress and infertility. (n.d.). Retrieved from
       http://www.asrm.org/uploadedFiles/ASRM_Content/Res

Polycystic ovarian syndrome faq. (n.d.). Retrieved from
      http://www.inciid.org/faq.php?cat=infertility101&id=2

Reversing infertility with sleep apnea treatment. (2011). Retrieved from
      http://www.aadsm.org/articles.aspx?id=2629

Saldeen, P., & Saldeen, T. (2004). Women and omega 3 fatty acids. Obstetrical and
      gynecological survey, 59(10), 722-30.

Understanding ovulation. (n.d.). Retrieved from
      http://www.americanpregnancy.org/gettingpregnant/understandingovulation.html

U.S. Department of Health and Human Services, National Institute of Child Health and
      Human Development. (2008). Beyond infertility: PCOS (08-5863). Retrieved from
      National Institute of Health website:
      http://www.nichd.nih.gov/publications/pubs/upload/PCOS_booklet.pdf

U.S. Department of Health and Human Services, Office on Women's Health. (n.d.). Poly
      cystic ovary syndrome (PCOS) fact sheet. Retrieved from website:
      http://www.womenshealth.gov/publications/our-publications/fact-sheet/polycystic-
      ovary-syndrome.pdf

Wang, J.X., Davies, M.J., Norman, R.J. Polycystic ovarian syndrome and the risk of
spontaneous abortion following assisted reproductive technology treatment. Hum.
Reprod. (2001) 16 (12): 2606-2609.

What causes female infertility? (n.d.). Retrieved from
      http://www.stanford.edu/class/siw198q/websites/reprotech/New Ways of Making
      Babies/Causefem.htm

Xu N, Kwon S, Abbott DH, Geller DH, Dumesic DA, et al. (2011) Epigenetic Mechanism
      Underlying the Development of Polycystic Ovary Syndrome (PCOS)-Like
      Phenotypes in Prenatally Androgenized Rhesus Monkeys. PLoS
      ONE 6(11): e27286. doi:10.1371/journal.pone.0027286

				
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