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PCOS Diet For Fertility

Dec 18, 2022
Woman's hands chopping vegetables

If you’re one of the estimated 12% of women to struggle with polycystic ovarian syndrome (PCOS), then you know how confusing and frustrating this diagnosis can be.

You’ve likely heard that PCOS is the leading cause of female infertility, and if you’ve done any Google searching, no doubt, you’ve been overwhelmed with conflicting information about how to manage this condition for hormone health and fertility.

The good news is that you CAN manage your PCOS and get pregnant, naturally!

The focus of this blog is the best PCOS diet for fertility – what foods help with PCOS fertility, what foods to avoid if you have PCOS, and how to find the best PCOS fertility diet and exercise plan for you.

The focus is on PCOS diet for fertility is because nutrition and lifestyle are shown to be more effective than pharmaceuticals like metformin and hormonal birth control.

Diet, exercise and lifestyle are your first line of defense to improve your fertility with PCOS.

I will also cover how to know if you have PCOS, what symptoms to look for, and how to cater your PCOS diet to your particular "type" of PCOS and your symptoms.

As a fertility dietitian, I have helped dozens of women with PCOS to get their cycles regular and hormones in balance so they could get pregnant naturally, and go on to have a healthy pregnancy.

It’s your turn!  Let’s dive in.   

How do I know if I really have PCOS?

Before diving into the PCOS diet for fertility, it’s important to understand the cause underlying this condition, which can vary from person to person. Nutrition, diet, and exercise recommendations may vary slightly, based on the root cause of YOUR PCOS.

If I have cysts on my ovaries, does that mean I have PCOS?

You can have cysts on your ovaries without having PCOS. In fact, about 25% of the time, women have polycystic ovaries as a normal part of their cycles. Each menstrual cycle a handful of follicles in your ovaries mature, but do not ovulate. These remaining follicles can then show up on ultrasounds as cysts before they’re reabsorbed back into your ovary.

In cases of PCOS, you have to have at least 12 cysts on your ovaries, often larger in size. This indicates that there was no dominant follicle to suppress the maturation of the other follicles, and thus you had anovulatory cycles (i.e., you didn’t ovulate). 

Can I have PCOS even if I don’t have cysts?

Yes, you can also have PCOS without any cysts on your ovaries. Despite the name, PCOS is not about the cysts. It’s really about the hormonal imbalance and metabolic consequences, namely insulin resistance and elevated androgens (male sex hormones like testosterone and DHEA).  

(If you were told you have cysts on your ovaries and therefore you have PCOS, it’s time to question that diagnosis. PCOS cannot be diagnosed by ultrasound alone.)

How is PCOS diagnosed?

Part of the confusion behind the name is that we don’t have universally agreed upon diagnostic criteria for PCOS.

Rotterdam Criteria are the most widely accepted criteria for diagnosing PCOS, which requires you have at least two of the following three symptoms:

  • Oligo-ovulation or anovulation (i.e., irregular cycles or anovulatory cycles, defined by cycles longer than 35 days or fewer than 10 menstrual cycles per year);
  • Hyperandrogenism (elevated male sex hormones, as noted either by the symptoms listed below or through testing); or
  • Polycystic ovaries (with more than 12 cysts) as seen on an ultrasound.

What are the symptoms of PCOS?

It’s the hyperandrogenism (elevated male sex hormones like testosterone and DHEA) that causes most of the symptoms associated with PCOS, including:

  • Irregular cycles and anovulatory cycles;
  • Acne and oily skin, especially along the jawline;
  • Hirsutism (male pattern hair growth on your face and body – on your chin, cheeks, chest and nipples);
  • Androgenic alopecia (hair loss or hair thinning on the top of your head);
  • Depression and anxiety are also more common among women struggling with PCOS.

Note that PCOS is one cause of high male sex hormones, not the ONLY cause. If you have elevated testosterone or DHEA, before diagnosing PCOS, you first need to rule out other issues like:

  • Hypothyroidism (low thyroid hormone);
  • High prolactin hormone;
  • Certain medications and birth controls that can cause high androgens;
  • Rare pituitary or adrenal diseases; and
  • Congenital adrenal hyperplasia. 

How do I achieve a healthy weight with PCOS?

I put this question in here because too often, the only advice providers offer is to lose weight. This is based on a misunderstanding of the condition, and it's not at all helpful.

If it were that easy to lose weight, like flipping a light switch, we wouldn't have an obesity epidemic. 

Whatsmore, losing 10 lbs or more SHUTS DOWN ovulation! 

Aaaand, note that I did NOT list high BMI (body mass index) or excess body fat as a symptom of PCOS. An estimated 30-70% of women with PCOS are also overweight, which means 30-70% of women with PCOS are not overweight.

Contradictory to conventional treatment, I do NOT recommend focusing on weight loss for PCOS.

The cascade of hormone imbalances that occur as a result of PCOS include disruption to your hunger and satiety signaling hormones (insulin, ghrelin, leptin and neuropeptide-Y).

If you have PCOS and are prone to binge eating, or you're always hungry, it’s not a lack of willpower. Your hormones are making you hungry.

Rather than focusing on eating less when you’re hungry, never a realistic or sustainable goal, let’s get your hormones in balance so you naturally feel satisfied. Doesn't that sound better? 

What causes PCOS? 

We don't have a good answer to this question. It is a complex condition that shows up very differently from woman to woman. The most common drivers of PCOS are:

  1. Insulin resistance;
  2. Overactive adrenal glands – think chronic stress to your system; and/or
  3. Inflammation, typically in the gut.

I recommend requesting advanced testing, working with a dietitian (like myself ;) a functional medicine provide, or a naturopathic doctor, to identify the driver of your PCOS, which can help you determine your first action steps to relieving your symptoms.

The list of testing to request includes (I can order these tests for you- let’s chat):

  • Fasting insulin,
  • HS-CRP (highly sensitive C-reactive protein, a marker of inflammation)
  • DHEA-S
  • Testosterone
  • On day 3 of your cycle: estradiol, LH (luteinizing hormone), FSH (follicle stimulating hormone), and prolactin
  • A full thyroid panel including: TSH, free T3, free T4, TPO and TgAb

These tests will help you identify the source of your hormone imbalances - for instance, do you have too much testosterone coming from your ovaries secondary to insulin resistance, or too much DHEA coming from your adrenals secondary to chronic stress? 

With this information, you get a starting point to make the condition less overwhelming.

You also get to take a personalized approach, rather than weeding through generalized recommendations designed for the masses. 

PCOS Diet for Fertility

Now, what do you do with all this information? What’s the best diet for your PCOS, to help you get pregnant naturally, or if you’re doing IVF, to avoid the heartbreak of failed fertility treatments?

The good news is that it is VERY possible to control your PCOS - to lower inflammation, improve insulin sensitivity, and reduce adrenal output of male sex hormones, to improve your fertility and get your baby - all through nutrition, exercise and lifestyle.

No matter what the underlying cause of your PCOS, the best PCOS diet for fertility has to include enough of all your macro and micronutrients, be blood sugar balanced and reduce inflammation.

How do you achieve these nutrition goals? The quick & dirty answer to is to eat real, whole foods (minimally processed), tons of fresh vegetables, proteins and anti-inflammatory fats, in every meal. 

  • Read all about The Fertility Diet, which is essentially, the Mediterranean diet.
  • To go deeper, I cover fertility nutrition in depth, including six weeks of fertility meal plans, in the Prepare for Pregnancy Bundle that I made for you.

Now, let’s break this down into more specifics for you. 

What foods help with PCOS Fertility?

  • Make 1/2 your plate an abundant variety of vegetables! You probably didn’t need a dietitian to tell that you need more veggies, but it can’t be skipped.
    • Your goal is 8-10 servings of vegetables per day.
    • The greater the variety, the better to give you more phytonutrients (like antioxidants) that combat inflammation.
  • Prepare & season your food with fertility fats:
    • Omega-3 fatty acids to reduce inflammation (from cold water fish like salmon);
    • Extra virgin olive oil
    • 100% grass-fed butter or ghee
    • Avocados, avocado oil
    • Coconuts & coconut oil
    • Nuts, nut butters and seeds
  • Make 1/4 of your plate protein:
    • Plant-based proteins like lentils and organic, unprocessed soy (tofu, tempeh and edamame)
    • Pastured and organic eggs, chicken and turkey
    • Limit red meat to just a few times a week, and choose 100% grass-fed beef, pork or lamb
  • Make 1/4 of your plate fiber-full carbohydrates:
    • Whole grains (quinoa, brown rice, lentil pasta)
    • Sweet potatoes, winter squash, pumpkin
    • Whole fruit
    • Corn, parsnips and peas 

Contrary to popular belief, low-carb and keto diets are typically not beneficial for PCOS.

While these diets may promote weight loss, insulin sensitivity and make you feel better in the short term, in the long term, they put your body in a state of stress.

Chronic stress means your adrenal glands have to work overtime, producing more inflammatory cortisol and more of the androgens that we’re trying to tame down.

Leading women's health experts report that even if your total calorie and protein intake is sufficient, if carbs get too low, you lose your period (especially in younger women under 35 years old). 

Takeaway: carbs are not bad - in fact, they're good for you (your ovaries need carbs to ovulate!), as long as you choose the ones that are full of fiber, and less of the highly refined varieties, then they will not cause the same spikes to your blood sugar. 

Proteins and fats for better insulin sensitivity

Proteins and fats are essential because they slow down digestion, which prevents the spike in blood sugar that lead to insulin resistance.

Proteins further support lean muscle mass, and we know that the more muscle you have, the better your insulin sensitivity. 

Fertility fats can help bring down inflammation. They also help you absorb fat soluble nutrients that are essential to your fertility -  vitamins A, D, E and K.

This simple plate method will reduce inflammation, provide the macro and micronutrients you need for hormone balance, and promote better blood sugar control for better insulin sensitivity.

To help you remember, I call this FFPP (Fiber, Fat, Protein & Phytonutrients).

Remember FFPP for each meal, and you’re well on your way to hormone balance, reduced inflammation and a healthy pregnancy.  

What foods to avoid if you have PCOS? 

Foods to avoid for PCOS, to prevent further inflammation, insulin resistance or hormone imbalance include:

  • Highly refined fats like canola, soy, corn safflower and sunflower oils - these oils are all highly inflammatory; 
  • Protein from conventionally raised dairy, eggs, poultry, beef & pork;
  • Highly refined carbohydrates, you know, white rice, white bread, spaghetti, desserts and sugary beverages, etc. 

Notice that the recommendation here is just to eat less of these foods. You don’t have to go for perfection to reap the benefits. 

There are only a couple of foods I put on the “absolutely never” list. These are:

  • Trans fats (Even if the front of the package says “trans fat free” or “0 trans fats”, you still have to look out for “partially hydrogenated oils”on the ingredients list of crackers, baked goods, peanut butters and other packaged foods that perplexingly never seem to spoil)
  • Artificial sweeteners like Splenda, sweet n low, aspartame, etc. (Note, naturally derived calorie-free sweeteners like stevia and monk fruit can be ok in moderation).

If you’re addicted to diet coke, I get it, I was there. But, for your fertility and hormone health, it’s time to kick the habit. 

PCOS fertility diet and exercise plan

When it comes to the best exercise for PCOS, the most important thing is to pay attention to how you feel.

If you’re dragging in the hours post workout, or not sleeping well at night, then it’s highly likely that you’ve overtaxed your body– this means more androgens and more inflammation. You want your exercise to energize you, not deplete you.

I recommend more strength training and less HIIT or long bouts of cardio, like marathon training. It’s extremely challenging to run, bike, swim or do burpees & mountain climbers for more than an hour without putting your body into a state of stress.

Strength training, on the other hand, increases muscle mass which revs up your metabolism to promote healthy fat loss, and increase lean muscle, which improves insulin resistance.

How do we put this all together for the best PCOS fertility diet and exercise plan for you? 

Given that there is so much individuality in how PCOS shows up, there is not a one-size-fits-all nutrition and exercise plan. 

I recommend working with a provider (like me ;) who can do some of the advanced testing listed above to customize a diet & exercise plan to your unique physiology. Here are some tips for getting started:

  • If your PCOS is inflammation driven, we first need to find that source of inflammation and get you on an inflammatory diet. 
  • If your PCOS is driven by adrenal overload and stress, we need to identify the source of stressors – they could be physical, mental or emotional.
  • Last but not least, if you have or are developing insulin resistance, we need start with eating for blood sugar balance.

Despite the potential variability, there are principles that apply universally to help you get started on your own:

  • Eat your FFPP ever 3-4 waking hours, starting within 1 hour of waking up. (That’s right, no intermittent fasting because it puts your body under too much stress and poses too much risk of nutrient deficiency).
  • Limit strenuous exercise that leaves you exhausted and depleted. Aim for strength training 2-3 times per week, then light cardio, like walking or chill biking 4-5 times per week. Bonus points if you include some yoga in there. 
  • Sleeping at least 8 hours per night cannot be omitted from this conversation. Sleep promotes better insulin sensitivity and appetite control, balanced hormones, and improved mood.

My hope is that you walk away with an understanding that a PCOS diet for fertility does not mean you have to go to any extremes, cutting out carbs, starving yourself all day, or cutting out all of your favorite foods.

Instead, a PCOS diet for fertility is all about eating an abundant variety of vegetables, always planning your meals with FFPP in mind, not going too crazy with sweets, and giving your body the nourishment you need to thrive.

If you want more personalized guidance on the best diet to manage your PCOS so you can get pregnant more quickly and easily, that's what I'm here for.

To get started, apply for a free 30-min fertility strategy session

I can help you conceive easily and enjoy a healthy pregnancy.

Fertility is not one-size-fits-all.

As a registered dietitian, I use strategic testing to understand your unique physiology, and a data-driven approach to balance your hormones, improve egg quality and get you pregnant. Let's make a baby!

Apply for a free Fertility Strategy Session

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