Getting Pregnant with PCOS

Getting Pregnant with PCOS: Key Steps for a Root Cause, You-First Fertility Plan

If you’ve been diagnosed with PCOS and are trying to get pregnant, it can feel like you’re swimming upstream. Maybe you’ve been offered medications like Metformin, birth control until you’re “ready,” or jumped straight to Clomid or IVF. But deep down, you know something’s missing from that approach.

Here’s the truth: pregnancy is possible with PCOS. But instead of jumping into override mode, what if you took a step back and gave your body what it needs to function naturally? In this blog, we’re walking through a root cause, you-first fertility plan that brings clarity, calm, and confidence back to your fertility journey.

PCOS Isn’t One Size Fits All

As a functional medicine dietitian, I believe in uncovering and addressing the root causes behind women’s health challenges—PCOS included.

PCOS is a syndrome, not a disease. It’s a collection of symptoms that can look very different from woman to woman. Much like IBS, I often see it used as a blanket diagnosis for women experiencing hormone imbalances or struggling to conceive. But in many cases, these women don’t actually meet the criteria for PCOS—or the root cause of their symptoms has yet to be explored.

A major barrier in the PCOS space is that once a woman receives the diagnosis, that label alone often dictates the next steps—typically medications or fertility treatments. But that diagnosis should be a starting point, not a conclusion. It’s an invitation to slow down and explore which diet, lifestyle, or environmental factors may be interfering with hormone balance.

At its core, PCOS is a condition of androgen excess, most often driven by three key imbalances: blood sugar dysregulation, chronic inflammation, and stress or HPA-axis dysfunction. These underlying drivers are rarely addressed in conventional care—and that’s where the system often falls short.

The good news? With the right root-cause approach, PCOS is not only manageable—it’s often reversible.

A quick note on “lean PCOS”:
I don’t clinically identify with this term. Many of the women I work with are navigating hormone imbalances, post-birth control symptoms, or hypothalamic amenorrhea—but they’ve been labeled with “lean PCOS” simply because they don’t fit the typical high-androgen or insulin-resistant profile.

In these cases, bandaid solutions like Metformin, Spironolactone, or birth control are often prescribed to mask symptoms until reproductive intervention is needed.

The problem? These approaches rarely address the actual imbalance.

We need to ask better questions:
What’s truly driving the hormone dysfunction?
How can we create more internal harmony and resilience?

The Root Cause Drivers That Block Fertility in PCOS

Let’s dig into the top three drivers that I consistently see interfering with fertility in PCOS:

1. Stress – Physical & Emotional

Stress isn’t just in your head. It shows up in your labs, hormones, and symptoms. Emotional stress from work, relationships, or unresolved trauma and physical stress from under-eating, over-exercising, or poor sleep all add up.

These stressors disrupt the HPA axis (your brain-adrenal-ovary connection), which can suppress ovulation and throw your cycle out of rhythm. In adrenal PCOS specifically, stress is often a main driver of symptoms.

2. Blood Sugar Dysregulation

You don’t have to have diabetes to be affected by blood sugar issues. In fact, blood glucose dysregulation and insulin resistance are one of the most common—but often overlooked—drivers of PCOS, and it can show up even in women with “normal” lab work or those who appear lean.

Here’s why it matters:
When insulin levels are elevated (even mildly), it disrupts ovarian function by stimulating the ovaries to produce more androgens like testosterone, which can interfere with ovulation, cycle regularity, and overall hormone balance.
At the same time, frequent blood sugar spikes and crashes trigger inflammation, metabolic stress, and further hormone dysregulation. This creates a vicious cycle that’s often missed in conventional care.

Signs you might be dealing with this include:

• Energy crashes, especially after meals
  
• Intense carb or sugar cravings
  
• Feeling “hangry” between meals
  
• Anxiety or shakiness when you go too long without food
  

Functional testing tools that can help you assess this include:

• Fasting insulin (even more telling than fasting glucose)
• HbA1c (to assess longer-term blood sugar trends)
• Leptin (a hormone tied to appetite regulation and metabolic signaling that can be altered in PCOS)
• Continuous glucose monitors (CGMs) like Theia—a powerful tool I use in my practice to see in real time how your meals and stress affect blood sugar and insulin patterns
  

Reconnecting with your body’s unique blood sugar rhythm is a key step in restoring hormone harmony—and a major piece that’s often skipped in conventional PCOS support.

3. Inflammation & Gut Health

Chronic inflammation disrupts hormone communication and makes it harder for your body to maintain balance. Many women with PCOS experience underlying inflammation driven by factors such as nutrient deficiencies, impaired methylation (like MTHFR mutations affecting vitamin utilization), compromised detoxification pathways, digestive imbalances, environmental exposures (toxins and mold), and poor diet quality—especially low fiber, antioxidants, and protein intake.

Supporting nutrient status, optimizing methylation, enhancing detoxification, improving gut health, and focusing on a nutrient-dense diet rich in fiber, antioxidants, and adequate protein can significantly reduce inflammation. This creates a healthier internal environment where hormones can communicate effectively—improving both fertility and overall well-being.

Foundational Steps to Rebuild Fertility Naturally with PCOS 

Before we even get to ovulation tracking or timed intercourse, we need to lay the groundwork for a body that feels safe to reproduce. Especially with PCOS, these non-negotiables help restore hormone harmony and signal to the body that it’s safe and supported to ovulate:

Balanced Blood Sugar: Build meals with protein, fat, and fiber
• Blood sugar dysregulation is a major driver of PCOS and can prevent ovulation altogether
• Elevated insulin increases androgen production (like testosterone), which disrupts egg development and regular cycles
• Stabilizing blood sugar helps lower inflammation, reduce cravings, improve cervical mucus, and bring back more predictable ovulation

Sleep & Circadian Rhythm Support: Aim for 7–9 hours of quality sleep and morning light exposure
• Poor sleep and disrupted circadian rhythms spike cortisol, which can further dysregulate insulin and suppress ovulation
• Reproductive hormones like LH, FSH, and progesterone are deeply connected to your internal clock
• Quality sleep supports consistent cycles, healthy egg development, and a better luteal phase (the phase needed for implantation)

Nutrient Repletion: Focus on magnesium, zinc, B vitamins, omega-3s, and inositol
• PCOS is often linked with underlying nutrient deficiencies due to inflammation, stress, or long-term birth control use
• Magnesium and B vitamins support blood sugar and stress regulation; zinc is critical for egg quality and ovulation
• Inositol has been shown to support insulin sensitivity, lower androgens, and improve ovulation in women with PCOS

Daily Movement Without Burnout: Walking, strength training, and gentle cycles of movement
• Overexercising (especially with PCOS) can elevate cortisol and suppress reproductive hormone signaling
• Gentle, consistent movement helps lower insulin, improve ovulatory function, and enhance blood flow to the reproductive organs
• Walking and strength training in particular support metabolism and reduce androgen excess without pushing the body into stress mode

Gut & Detox Support: Bitter foods, whole foods, and reduced toxic load (think clean water, clean products)
• Your gut and liver help eliminate excess hormones and regulate inflammation—both crucial for restoring ovulation with PCOS
• Gut imbalances can worsen androgen excess, affect thyroid function, and impair nutrient absorption
• Supporting detox pathways and reducing toxin exposures (like endocrine disruptors from plastics or mold) creates a more fertile internal environment

What If Your Cycle Is Irregular or Missing?

You can still build awareness of your cycle, even without consistent periods. Cycle awareness isn’t just for textbook 28-day cycles—it’s about tuning into your body’s patterns.

Look for:

• Cervical fluid changes
• Waking body temperature
• Shifts in energy, mood, and sleep
• Libido changes

These clues tell us where you are in your healing and if your body is starting to respond to nourishment and rhythm.

What About Fertility Treatments?

There’s absolutely a time and place for assisted reproductive technologies (ART) like Clomid, Letrozole, or IVF. But too often, women with PCOS are rushed into these interventions before their bodies are remotely ready.
When ovulation is forced in a hormonally depleted system, success rates drop—and the emotional and physical toll often rises.

One of the most frustrating myths I hear is that “there’s nothing you can do for PCOS.” That couldn’t be further from the truth.

With a more intentional, root-cause approach, there’s so much you can do—whether you’re trying to conceive naturally or preparing for fertility treatment:

• Give yourself a 3–6 month runway before ART to lay the groundwork for hormone balance
• Focus on ovary-nourishing nutrients, stress reduction, and consistent blood sugar balance
• Prioritize eating enough—especially protein, healthy fats, and micronutrients that support ovulation and egg quality
  Ask your provider: What would increase my chance of success with this intervention?
  
  • If the answer is vague or unclear, it might be a sign your body needs more foundational support first

Supportive Tools That Help (Without Overwhelm)

There are tools that can accelerate your progress when used wisely:

• Theia CGM for real-time blood sugar feedback
• Foundational supplements: magnesium glycinate, inositol (with better research that Metformin for PCOS), omega-3s, Methylated B-vitamins (if low), nourishing and tailored adrenal support
• Gut support: stool testing for targeted gut support 
• Lab testing to identify what’s really going on with your hormones, gut, and minerals

Reminder: tools are only helpful if you’re grounded in your foundations first.

You Deserve More Than a Band-Aid

Getting pregnant with PCOS is possible—but you shouldn’t have to hustle your way there or rely on short-term fixes. When you understand your root drivers and give your body the nourishment, rhythm, and care it’s been missing, fertility doesn’t have to feel like a fight.

You are not broken. Your body may just need a different approach.

Ready to take the next step with support that sees the whole picture? Learn more about my Nourish Core program or explore my free 7-day meal inspiration guide to begin rebuilding from the inside out.