How to Increase Ovulation with PCOS

Polycystic Ovary Syndrome, or PCOS, is the main cause of ovulatory infertility in the United States, affecting up to 80% of women who have it.

A normal menstrual cycle, on average, is every 28 days although flow may be anywhere from every 21 to 35 days. During this time, a follicle, which contains the occyte or egg grows and matures and gets released during peak ovulation (usually around day 14 although women with PCOS tend to ovulate later) to be fertilized with that one sperm.

Because of the hormonal imbalance seen in PCOS (high testosterone and leutenizing hormone levels), ovulation often doesn’t occur and the egg doesn’t get full released to be fertilized. Instead, the egg hangs out on the ovaries as a fluid like sac sometimes referred to as a “cyst” which can be seen on a trans vaginal ultrasound as a string of pearls.

After ovulation, your egg is only viable for 12-24 hours. Not only are these eggs immature but they also tend to be poor quality which can increase the chance of miscarriage.

There have been many advancements over the past decade aimed at increasing ovulation among women with PCOS. This article reviews the best ways to increase ovulation and egg quality with PCOS along with suggestions for ways to monitor your own signs of ovulation at home.

Note: This post contains affiliate links, which means I will make a commission at no extra cost to you should you click through and make a purchase.

Nutrition for Ovulation

You have heard how what you eat can impact your baby, but did you know that what you eat can affect the quality of your eggs and your ovulation too?

In a study of over 18,000 nurses, women who ate high fiber foods (fruits, vegetables, beans and legumes and whole grains) had the best fertility. They also ate omega-3 rich foods like fish, avocados, and olive oil, and consumed mostly a plant-based way of eating, with the exception of eggs and a serving or two of full fat dairy which were associated with better fertility.

Women who had the lowest fertility were the ones who consumed more trans and saturated fat and animal protein.

Antioxidants have been shown to improve egg quality and ovulation. We get antioxidants from the foods mentioned above such as fruits and vegetables, whole grains, and omega-3 fats.

Approximately 70% of women with PCOS have insulin resistance. High insulin levels cause higher testosterone levels which further affect hormone balance and ovulation in PCOS. Eating foods that don’t spike insulin: moderate amounts of high fiber foods, paired with protein and fat foods, can help with ovulation.

Exercise for Ovulation

Exercise is another effective way to help to increase ovulation and get your period back if you have PCOS. When compared with a low calorie diet, previously sedentary women with PCOS who exercised for 30 minutes on a stationary bike three times a week, experienced more regular periods and ovulation than the diet group.

Moderate exercise, both cardio and weight training is a great way to help lower elevated insulin levels and can improve mood and well being.

Don’t have 30 minutes? Even 10 minutes of moderate walking can help ovulation. Keep in mind, two separate increments of 15 minutes of exercise adds up to 30 minutes. On the other hand, too much intense exercise may negatively affect ovulation.

PCOS Supplements for Ovulation

An international survey found that 99% of women with PCOS wanted an alternative treatment to medication. There is good research on the following supplements on improving ovulation in women with PCOS, either alone, or along with prescribed medications. These supplements include:

Vitamin D

Vitamin D is not only a vitamin but a hormone. Vitmain D receptors have been found on every cell in the body, including oocytes. Research shows a strong correlation with low levels of vitamin D and infertility. Vitamin D has been shown to improve ovulation and egg quality and reduce testosterone levels. If you are trying to improve your ovulation, definitely make sure you are supplementing with vitamin D. I usually recommend my patients who are trying to conceive take 4,000 IU daily of vitamin D. You may need more depending on your vitamin D levels. Because vitamin D is fat soluble, it is best taken at the same time as a food that contains fat.

Inositols

Inositols, particularly myo inositol, has been shown to improve ovulation and help regulate periods in women with PCOS. The recommended dosage is 2,000 mg myo and 50 mg d-chiro inositol taken twice daily in two separate doses. Inositols are best taken with food and have also shown to lower insulin and glucose levels in PCOS. We sell Ovasitol, an NSF-certified supplement which has this ideal 40:1 ratio of Myo to DCI in our supplement store.

NAC

N-acetylcystine (NAC) is both an antioxidant and amino acid which  may help to improve ovulation and regulate periods in women with PCOS. NAC when added to clomid helps to improve pregnancy and ovulation rates in women with PCOS. NAC has also been compared with metformin in PCOS women and was shown to work better than metformin for lowering insulin and cholesterol levels.

All of these supplements and more are available in the PCOS Nutrition Center Supplement Store:PCOS Nutrition Center supplements for ovulation

Medications

Metformin

While metformin gets a bad (ok, really bad) rap for its side effects, this medication has been shown to help regulate periods in women with PCOS.

Letrozole

Newer research now shows that letrozole works better than clomid in women with PCOS for ovulation and pregnancy. Letrozole has fewer side effects and less risk of having multiple babies than clomid.

Monitoring for Signs of Ovulation at Home

Of course, if you are trying to conceive, it is helpful to monitor your body for signs of ovulation so you can time intercourse properly.

Checking Cervical Mucus

One key way to monitor your body for ovulation if you have PCOS is by looking at the changes to your cervical mucus throughout the month. What to look for if you are ovulating: your cervical mucus will be stretchy, with an egg white consistency. If your cervical mucus is dry, you are not ovulating.

Taking Daily Temperature Checks

Using a thermometer to check your basal body temperature (BBT) is another way to monitor ovulation if you have PCOS.

Your BBT is your temperature when you are at rest. This is best taken as soon as you wake up, before you get out of bed. During ovulation, increased progesterone levels will cause your temperature to rise or spike up higher than other days. Charting your temperature at the same time each morning can be helpful to track ovulation patterns.

Tempdrop is a temperature tracker that can be worn around your arm and can synch to an app to chart your temps for you. Tempdrop contains multiple sensors that measure your core temperature continuously throughout the night. TempDrop’s patented algorithm learns your unique nightly and monthly temperature patterns, filtering out disturbances for accurate results. TempDrop is great for accurate readings, especially if you tend to forget to take your temperature right away, get up several times during the night or sleep in on the weekends. You can get a discount on Tempdrop with code PCOSNUTRITION

tempdrop ovulation monitor

Ovulation Monitors

There are dozens of kits to track your ovulation at home. Usually these require you to pee on strips to check hormone levels. They may or not be accurate in PCOS due to the hormonal imbalance. One ovulation kit I love is Pearl Fertility which measures your progesterone levels along with the standard LH and FSH levels in one test to get a more accurate reading for your unique ovulation window. Save 10% on a Pearl Fertility Kit with code PCOSNUTRITION10

Share with US! What has helped you to improve your ovulation or monitor it at home?

 

pcos dietitian angela grassiAngela Grassi, MS, RDN, LDN is the founder of The PCOS Nutrition Center where she provides evidence-based nutrition information and coaching to women with PCOS. Angela is the author of several books on PCOS including PCOS: The Dietitian’s Guide, The PCOS Workbook: Your Guide to Complete Physical and Emotional Health, and The PCOS Nutrition Center Cookbook Recognized by Today’s Dietitian as one of the Top 10 Incredible Dietitian’s making a difference in 2014, Angela is the past recipient for The Outstanding Nutrition Entrepreneur Award, The Award in Excellence in Practice in Women’s Health and The Award for Excellence in Graduate Research, from the Academy of Nutrition and Dietetics. Having PCOS herself, Angela has been dedicated to advocacy, education, and research of the syndrome. To learn more about one-on-one nutrition coaching or to schedule a call with Angela, click here

References:

The association between fertility diet score and polycystic ovary syndrome: A Case-Control study. Health Care Women Int. 2021 Apr 2:1-15.

Contributions of the Nurses’ Health Studies to Reproductive Health Research. Am J Public Health. 2016 Sep;106(9):1669-76.

Structured exercise training programme versus hypocaloric hyperproteic diet in obese polycystic ovary syndrome patients with anovulatory infertility: a 24-week pilot study. Hum Reprod. 2008

Role of exercise training in polycystic ovary syndrome: a systematic review and meta-analysis. Clin Obes. 2018 Aug;8(4):275-284.

Vitamin D Status Relates to Reproductive Outcome in Women With Polycystic Ovary Syndrome: Secondary Analysis of a Multicenter Randomized Controlled Trial. J Clin Endocrinol Metab. 2016 Aug;101(8):3027-35.

N-acetyl-cysteine is a novel adjuvant to clomiphene citrate in clomiphene citrate-resistant patients with polycystic ovary syndrome. Fertil Steril. 2005 Feb;83(2):367-70.

A comparison between the effects of metformin and N-acetyl cysteine (NAC) on some metabolic and endocrine characteristics of women with polycystic ovary syndrome. Gynecol Endocrinol. 2016;32(4):285-9.

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Comments (2)
  • Anne Kinchen, LAc

    August 26, 2021 at 12:34 pm

    No mention of berberine!?

  • Angela Grassi

    August 26, 2021 at 1:45 pm

    Berberine may help with ovulation too but research isn’t as strong as the others mentioned in the article.

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