[00:00:00] Welcome to the PCOS Fertility Health Podcast, where you will learn how to boost your chances of getting pregnant. You are in the right place if you have PCOS and you are struggling to get pregnant. You are tired of getting dismissive information like, just eat better and stay on birth control. And you want fertility answers.

[00:00:23] Join me, your host, Dr. Angela Potter to learn key steps to optimize fertility with PCOS. I am the creator of the PCOS Fertility Protocol and have also shared the stage with leaders from companies like Microsoft and Google. So get ready for another powerful episode about boosting fertility with PCOS.

[00:00:44] Let's dive in.

[00:00:49] Are you here and you're feeling like your body isn't doing what it is literally made to do? Are you not feeling good enough of a woman? Feeling as if your [00:01:00] body failed you or if you failed your body? Has your gynecologist been also been dragging you through the hoops? Do you have to advocate for yourself to get blood work done?

[00:01:12] Does your doctor not listen to you? If that sounds like something you've been through, I am really glad that you're here because I want to listen to you and I want to be a resource for you to help you understand what's going on in your body with PCOS and steps you can take to improve your health. And I'm here with you and I'm here for you because women like you with PCOS are just getting pushed under the bus when it comes to fertility care.

[00:01:46] Many doctors are just giving you 15 minutes and sending you out the door with a pamphlet and a prescription, or they give advice like, Oh, just eat better and get back on birth control. [00:02:00] Now, it's not their fault, right? They are doctors because they want to be helping and they want to support you in helping your fertility, but there's resource issues and time issues that they, you know, have to get people in and through, um, there's not a lot of nutrition education, not really much at all in medical schools.

[00:02:26] And so there's just a few factors.

[00:02:33] That's why I'm here for you. Okay. That's why my expertise is PCOS fertility, because I want you to understand what's going on in your body. What's keeping you from getting pregnant? Why is your body? Doing these things that feel unnatural and what can you be doing in order to support your fertility health moving forward.

[00:02:58] So, today [00:03:00] we are focusing on ovulation and fertility. So, you know, are you asking yourself this question? You know, why can I not ovulate naturally? Can't I just have my period every month, ovulate and have my baby, right? Are those kinds of thoughts going through your mind? Uh, you're not alone. Ovulation is a big deal with PCOS.

[00:03:26] Not ovulating is really at the heart of fertility struggles when it comes to PCOS. Okay. But let's start with the basics. What is ovulation? Ovulation is when that egg is mature inside the ovary and then it pushes out of the ovary. It says, I'm ready. I'm ready to go. And you know, typically this happens once a month, but with PCOS not.

[00:03:56] It's uncommon to have regular cycles, [00:04:00] and so it could be happening less frequently than once a month. But that egg pushes through the ovary. It swims over to the fallopian tube, which is an amazing miracle of the body because there's nothing connecting the fallopian tube and the ovary. The egg just literally moves into open space and finds it.

[00:04:24] Self to the fallopian tube. It's really incredible. Anyway, it goes down the fallopian tube then into the uterus to hopefully Connect with the sperm. Okay and make a baby. So that's what ovulation is It's literally the egg breaking through the ovary to go on its way to make a baby. Okay, um, you know this happens Even if you're not trying to make a baby, okay, this is just what happens in the body What's supposed to be happening in the body?

[00:04:54] but Why is it not happening with P. C. O. S. That's what [00:05:00] we're talking about today. But before we jump into that, I wanted to mention, um, the ovulation is the main goal when it comes to fertility medications for P. C. O. S. So 1st line fertility medications right now are those ovulation induction medications, clomid and letrozole.

[00:05:21] Okay, so those are medications that are shifting brain chemistry in order to then support to talk to the ovary is to then push the egg out of the ovary. Okay. Those are 1st line medications happening for PCOS right now. We know that they are not magic pills, right? And we know that because if. Everyone who wanted to get pregnant could by taking these medications, and that's not happening.

[00:05:53] Um, I see a lot of women who are in a variety of places in the fertility journey. You know, some are [00:06:00] thinking, well, I would like to get pregnant at some point, but I want to optimize my fertility right now. Others are. Saying, well, I've tried for two years. I've been on 10 rounds of letrozole and my doctor says IVF is the only next option for me.

[00:06:15] What can I do? Other people talk to me and they say, oh, it's been six months and I still haven't gotten pregnant, but I'm 39. What can I do?

[00:06:28] A lot of people who are coming to talk to me have tried a fertility medication before. It hasn't worked. Their doctor says, well, I don't have another answer for you outside of IVF. And that's when they come find me because they know that there's got to be something else that they can try before jumping to IVF.

[00:06:46] Now, these fertility medications are not bad, but the issue that I see with them is that they're being used at the wrong time in the process. Because they are the, um, [00:07:00] first line medications recommended for PCOS, but... they don't take into consideration your whole body, your whole unique, beautiful body, and what's happening that's keeping you from ovulating.

[00:07:15] What's causing your hormones not to be doing what they're supposed to be doing? Those are important questions that we should be asking before jumping to those fertility medications, because there's ways that we can optimize nutrients, balance hormones to then help those medications have a higher chance of them working.

[00:07:36] If indeed you need to still use medications in order to help get pregnant. So what is causing these ovulation issues with PCOS? There's a few things and. You, all of these could be happening in your body or just one or two. And that's why it's really important to get that individualized plan to know, okay, what is [00:08:00] happening in my body?

[00:08:01] That's keeping me from ovulating and what can I do to address that specific thing in order to then help me opulate so insulin issues are. One of the hallmarks of of of causing ovulation to not happen naturally and those insulin issues. A lot of people think that in order to have, you also have insulin issues.

[00:08:31] That is not true. It is not part of the diagnosis for it is 1 of the PCOS types. But it is the most common of the PCOS types. Okay, so insulin resistance is really common. Upwards of 80 percent of people with PCOS also have insulin resistance. And what that insulin is doing is when your blood sugar levels just rise too high and fall too [00:09:00] low, and that pushes insulin levels to be higher.

[00:09:03] Insulin is a hormone. that creates then for testosterone to elevate, which then shuts down ovulation. Um, I have a whole podcast episode about blood sugar. I will link that in the show notes. So if you're curious about this, if insulin resistance is one of your types, PCOS types are part of your picture, you're going to want to go over and listen to that episode next.

[00:09:30] So insulin issues are shutting down ovulation, badabing, bada boom, right in the opposite direction of, yeah, we don't want it. Badabing bada booming. Uh, poor egg quality is leading to ovulation not happening, and egg quality has to do with how your eggs develop in the ovaries and does one egg that. Time when [00:10:00] you're getting ready to ovulate has it reached that mature stage where it's happy.

[00:10:05] It's healthy It has divided 23 chromosomes. And so it's saying yeah I've got all the building blocks needed to go meet with a sperm connect with its 23 chromosomes to go make a baby and If you are someone with poor egg quality, that means that an egg in that particular cycle is not getting those amount of chromosomes, is not able to divide and ovulate to go make a baby.

[00:10:36] So that's really important, and egg quality is often a missing piece when it comes to fertility. Right, those fertility medications, they aren't focused on a quality. They are just focused on pushing that egg out of the ovary, right? A quality is actually affected over time as that egg is dividing those chromosomes [00:11:00] in really that whole year leading up to ovulation, but you can still positively improve on a quality within a couple of weeks to a few months.

[00:11:10] So, you know, is your doctor talking to you about your egg quality and are they supporting you with a quality? I just last week was the egg quality podcast episode So if you think a quality is an issue for you Or if you are not sure and need to know what tests are done What symptoms or signs is my body saying in order to improve my egg quality?

[00:11:38] I will link that egg quality podcast in the notes here as well. Too many androgen hormones is also affecting ovulation, natural ovulation with PCOS. Androgen hormones are really those, for lack of a better term, male pattern hormones. Because for people with male [00:12:00] organs, testosterone is their dominant hormone, right?

[00:12:04] The androgen hormones are the most dominant reproductive hormones in their bodies. For people with female organs, testosterone and DHEA are still important in our bodies, but they need to be at a really healthy level, like healthy for what our bodies need, okay? We don't want them too elevated. And what's happening with PCOS is these hormones are too elevated.

[00:12:32] So the androgen hormones are testosterone and DHEA, and when those are elevated with PCOS, Well, then that's just shutting down ovulation. I was mentioning with insulin issues that insulin then causes testosterone to elevate, which then shuts down ovulation. Okay, you can have elevated testosterone without having.

[00:12:58] Insulin issues, [00:13:00] so they aren't always connected. Okay, you could have elevated testosterone first, but normal insulin levels and that testosterone that's in the body is still shutting down ovulation. You can get them tested, but you could have signs in your body like acne and the unwanted hair growth, like chin, upper lip, back, belly, upper thigh, places like that.

[00:13:27] If you have hair growth. Those are classic signs for elevated androgen, androgen hormones, um, and then elevated estrogen also shuts down ovulation. And so estrogen is the hormone that's dominant in the 1st, half of the cycle. So, from day 1, which day 1 is bleeding through mid cycle, which is when ovulation should be happening.

[00:13:51] But that 1st, half of the cycle, estrogen is elevated estrogen. Should be where in this [00:14:00] happy, healthy fertility spot in that 1st half of the cycle to help build the uterine lining and to get everything ready for ovulation and potentially implantation. If there's too much estrogen in the body, then that shuts down ovulation and the body doesn't have the hormone patterns that it wants in order for ovulation to happen.

[00:14:25] So elevated estrogen can lead to that uterine lining getting too big. It can also lead to things like uterine fibroids, uterine polyps. So having estrogen in a really nice, healthy fertility range is ideal for improving natural ovulation. Those were 4 different going on in the body that shut down ovulation with PCOS.

[00:14:51] So let's now talk about three ways to support bringing natural ovulation back into the body. [00:15:00] And I'll also mention that ovulation is one of the main focuses for people who come and talk with me about fertility support. I've heard pretty commonly women say to me, well, you know, I really want to get pregnant, but right now, my main goal is to ovulate naturally and to get my periods back normally, because then I will know that my body is working as it's supposed to and of course, bringing on ovulation is going to.

[00:15:33] help increase fertility and but seeing that and feeling that natural rhythm in the body is really important for a lot of people. And so I wanted to say that just to see if you know, that's something that you resonate with. And if you're feeling really alone right now, then perhaps that gives you just a sign of feeling like you're in this greater community.

[00:15:57] So the first thing to do is to figure out your [00:16:00] PCOS type. There are four types of PCOS, four, and they help you to understand what's going on in your body that's leading to the ovulation issues, the hormone issues, there's insulin resistance PCOS. post pill, adrenal, inflammatory. So those four types, you could be one of them, or you could be a mix of all four of them.

[00:16:25] It really doesn't matter how many of the types that you have. It just matters that you figure it out. And then you get a plan that addresses what's going on in your body for those types, because those types are helping you understand Why ovulation is not happening in the body. And that's the first step that I am working on with people who are coming to me for fertility support.

[00:16:52] It's, okay, so we've, you know that you have PCOS, now we need to figure out your PCOS type. And we go [00:17:00] in through a questionnaire. Sometimes there's extra lab work that needs to be done so that we can get a really clear picture of, okay, is inflammatory PCOS. And again, this is helpful because it gets you that next level of individualized care of what's going on in your body.

[00:17:24] The second thing that you can do is take a look at your fertility lab work from the eye of an optimal fertility perspective. What do I mean by that? So labs come back and there's usually reference ranges and it'll tell you, right? Are you in in that reference range? Are you below it, or are you above it?

[00:17:49] And it will tell you that reference ranges are typical for a lot of labs, not every single 1 of them, but they're usually made just because it's an [00:18:00] average of the results that they see. So it's not specific to fertility. It's not specific to age or whether you're, you have male organs or female organs or any of that.

[00:18:14] Now, like I mentioned, some tests are specific, um, but because there's so many that are general, it's really important to look at your lab work to understand what the optimal fertility ranges are. I will tell you that TSH, the main thyroid hormone, is one of the most important labs to read from a fertility perspective.

[00:18:38] The standard reference range for TSH goes from, I believe it usually starts at 1 and goes up to 8 or maybe 10. That's a huge range, and for fertility it needs to be much tighter. So, If your doctor is just reading your labs and not bringing anything up for you because, oh, you [00:19:00] just fell into the normal reference range of that lab, then you need to be taking that next step to advocate for yourself to.

[00:19:09] Say, no, I need someone to be looking at these labs from a fertility perspective, because this would be a big help for you to know TSH, the thyroid hormone talks directly to the ovaries. The thyroid hormone cascade impacts ovaries for ovulation. And so it's really important that it's in a tighter fertility range for optimal fertility.

[00:19:36] And then the third thing that you can do in order to help bring on natural ovulation with PCOS is to get crystal clear on your cyclical hormones, uh, also known as your reproductive hormones, okay? These are the hormones that are Cycling throughout the month or throughout your cycle. If you have longer cycles in a month, [00:20:00] they are estrogen and progesterone.

[00:20:03] I would include LH and FSH in those as well, but you want to get clear on what these hormones are doing throughout the month. And I'm going to have a whole episode on this soon, what the menstrual cycle looks like. So you can just have those foundations. As I mentioned earlier, estrogen is the dominant hormone in the first half of the cycle that switches.

[00:20:26] Progesterone is dominant in the second half of the cycle. You also need LH and FSH rising and falling throughout that all, you know, to create this big, beautiful symphony to help you ovulate. And then If you do get pregnant that cycle, those hormones then keep that pregnancy going. And so, is your doctor testing those hormones for you?

[00:20:53] Do you have a really clear picture of what your estrogen levels are doing all throughout the month? Yes, [00:21:00] it's the dominant hormone in that first half of the cycle, but the levels all throughout the month matter. Same with progesterone. Do you know what your progesterone levels are doing? Do you have enough progesterone to show?

[00:21:15] Yes, you ovulated and if you get pregnant you have enough progesterone to then keep the pregnancy going. Oh, you want to get crystal clear on what those hormones are doing because they are supporting ovulation to happen. And so if nobody is actually testing these hormones for you or helping you to get them back into balance, then you're missing out on a big missing link for Helping your body to ovulate naturally with PCOS.

[00:21:45] If you're in that place of feeling disappointed every single month because your body can't do the one thing that it's supposed to do, you are not alone. And if you've been left feeling alone and you [00:22:00] haven't been given the information about what's going on in your body or why it's happening or what you can do to improve that, then you're in the right place.

[00:22:12] And I am overjoyed that you're here with me today so that you could learn this powerful piece about your body, about why ovulation isn't happening for you, and some steps that you can be taking in order to help improve your ovulation. And if nobody has told you this today. You are absolutely incredible.

[00:22:34] You are a light in this world and you have so many gifts to share. If you need help with your PCOS fertility, I'm here for you. You can reach out and book a PCOS fertility breakthrough session. I will jump on the phone with you to help you get the clarity that you need so that you don't have to feel like your body is failing you.

[00:22:55] Blessings to you. I will see you next week.

[00:22:57] [00:23:00] Thank you so much for being here. It is such an honor to be on this platform with you and to have you in this community. So thank you. As we wrap things up today, I want to share the legal language with you. This podcast is for informational purposes only. It should not replace the medical advice, diagnosis, or treatment given to you by your doctor.