[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 were 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. 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. Let's dive in.

[00:00:47] You have a period every 60 days or how about once a year? If that's you, then this episode is going to be really important for you today. I want to really help you [00:01:00] understand what your body is doing during your period. I'm going to share with you what a normal cycle looks like. I'm going to refer to a normal cycle as a fertile cycle today, because when you have a cycle that, you know, is a Normal set of 28 days, what's happening.

[00:01:20] It doesn't matter that it's exactly 28 days. What matters is that that's what is happening hormonally to get you to this juicy, fertile place. And so if you're having irregular cycles right now, really long cycles, this is your goal to get to a place where you have a really fertile cycle. And that is when your hormones are balanced throughout the month.

[00:01:45] When you have adequate egg quality, really happy, healthy egg quality to have an egg that ovulates and all of those things come together to help you have a fertile cycle. So you're going to understand [00:02:00] the foundations of what that means for your body and your hormones today. Before we get into it, could you take just a few seconds and head on over to Apple Podcasts to give this podcast a positive review because reviews are what makes this podcast go around and your support just means the world to me.

[00:02:22] So thank you in advance for doing that. Okay. So if you have long cycles right now, or if you have irregular cycles, you need to get crystal clear on your goal. Uh, not just your goal of making a baby, your goal of what your menstrual cycle should look like that makes you into the most fertile place that you can be to help you make that baby.

[00:02:49] And that's what we're diving into today. So what's happening in a fertile cycle? Well, a fertile cycle is typically 28 days. We love [00:03:00] talking about 28 days, but it doesn't have to be exactly 28 days. It could be 27 days. It could be 30 days. You know, there's about a four day window there where it's pretty normal.

[00:03:13] If one month you have a 27 day cycle, the next month you have 30 day and the next month you have 28. That's still considered pretty regular, okay? Irregular cycles are going to be, if one cycle is 24 days, then the next cycle is 45, the next cycle is 60, the next cycle is 85. Those are irregular cycles. Also, if you have consistently long cycles, like you get a period once every 60 days, or you get two cycles a year, that still, even though they're, they come regularly, like you can plan, okay, five months from now, I'm going to have my next.

[00:03:53] cycle. That still is not a hormonal picture that is setting you up for fertility. [00:04:00] And so you want to be moving forward to bring your cycle into that 28 day ish cycle because that's when the hormones are doing what they need to be doing in order to help you make a baby. So day one of the cycle is the first day of bleeding.

[00:04:18] Okay? That's an easy way to know what day of your cycle you start on. If you spot, the day of spotting should be considered day one of the cycle. And so day one moves you into the follicular phase, and this is the first half of your cycle. It is day one, the first day of bleeding all the way up to mid cycle when ovulation happens.

[00:04:44] So, during this phase, estrogen is the dominant hormone that's elevated in this first half of the cycle. And estrogen is there so that it increases the uterine lining so that it's nice and [00:05:00] plump and thick and just juicy, ready for implantation when that happens after ovulation. Estrogen, you want it to be at a really nice, healthy level for fertility in this first half of the cycle.

[00:05:15] We're going to talk about progesterone in a minute, but with progesterone, you really want it to be high. Here in the first half of the cycle with estrogen, you don't want it too high and you don't want it too low. You want it in this really nice place for fertility. With PCOS, it's very common to be estrogen dominant to have too much estrogen, which you don't want.

[00:05:40] I see a lot of times actually women who have low estrogen, but interestingly, and I was talking about this with another doc the other day. Um, we are talking about how so many women with PCOS are put into this estrogen dominant place, um, into this, you know, diagnosis because they [00:06:00] have more estrogen than progesterone, but their estrogen levels are still super low and not what's needed to help create that nice thick lining of the uterus.

[00:06:11] So again, you want to be sure that your estrogen levels are just in this really nice, healthy range for fertility purposes. So estrogen is that dominant hormone in the first half of the cycle. And then ovulation is what happens in the middle of the cycle, typically. Okay. Now for just explanation sakes, we are going on this 28 day cycle with ovulation happening mid cycle.

[00:06:39] So that would happen on day 14. Some women, it's really common, even if they have a 28 day cycle, that they ovulate a few days later or maybe a day or two earlier. But ovulation typically is happening that mid cycle day. Okay. This is when, uh, LH [00:07:00] surges, the LH levels in your body, which those are a hormone, those surge right before ovulation happens.

[00:07:08] So if you're doing at home ovulation predictor kits. Like the urine test, those are testing for that rise in LH. And so you'll see that peak, that rise of LH on an ovulation predictor kit. And then that tells you you're going to ovulate very shortly. So understanding when you ovulate is really important.

[00:07:31] key to making a baby. One, it lets you know, okay, is an egg actually being able to ovulate? If you don't get ovulation tests, there's a variety of issues that could be contributing to that. With PCOS, elevated insulin, elevated testosterone, those are the big things that are shutting down ovulation. Uh, not enough progesterone can impact that and a [00:08:00] variety of other hormonal issues.

[00:08:02] Egg quality is another key part of ovulation because if your eggs have not developed as they need to, then they can't ovulate. So you want to be sure that ovulation is happening in the body. The other reason why it's important to know when you ovulate is because then you know your fertile window. And your fertile window is the five days leading up to ovulation.

[00:08:28] And the reason that it's five days is because sperm can live up to five days. So if you have sex, like four days before you ovulate, those sperm are just hanging out, having a party, just waiting around. And so you can still get pregnant from that sperm, even though it was a few days ago. Okay. And your egg lives for about 24 hours.

[00:08:52] So it's that five days leading up to ovulation. Pretty much a day after ovulation [00:09:00] happens. And so you want to be sure that you know your fertile window so that you know when to be getting busy in the bedroom for when that will help you make a baby because we are not fertile every single day of the month of the year of our lives.

[00:09:17] Okay, you know that you are fertile every day of your life, right? Because we go through menopause, but it's really important to understand those few days because there are five, maybe six days in your entire month that your body is going to be fertile to help you make a baby. So after ovulation, estrogen levels fall and progesterone becomes the dominant hormone of the second half of the cycle.

[00:09:44] The second half of the cycle is the luteal phase, and that's from like around day 15 through day 28, or the first day of bleeding for the next cycle. Okay. So what happens is if, [00:10:00] as long as you ovulated. Then that corpus luteum that was left by the egg produces progesterone, which then is elevated throughout that second half of your cycle.

[00:10:13] If you got pregnant during that cycle, then that progesterone level stays elevated. And if your body doesn't produce enough progesterone, So that if you do get pregnant that cycle and it just doesn't have enough progesterone to keep that pregnancy going, then you have a really high risk of miscarriage.

[00:10:34] And so you want to be sure that you can get your progesterone levels tested to see that you're having adequate levels to help carry the pregnancy forward. Once you are pregnant, it's your body's own progesterone that keeps the pregnancy going in the first trimester. In the second and third trimesters, it's the [00:11:00] placenta that takes over that progesterone production.

[00:11:03] So, you know, I have a lot of women who are working with me and I have them on bioidentical progesterone, um, even if they're getting vaginal suppositories of progesterone from their doctor. Regardless of what form of progesterone you're taking, if you're taking it for preconception and fertility health, you have to keep taking it once you get pregnant to, because you have to take it during that whole first trimester.

[00:11:32] And then at the end of the first trimester, you can taper off because then the placenta takes over the progesterone and you don't need to Provide your body with extra progesterone. And if you didn't get pregnant that cycle, then it's that drop in progesterone, estrogen as well, but the drop in hormones that then says to the body, oh, hey, we didn't get pregnant this month, so we need to [00:12:00] shed our uterine lining.

[00:12:01] That's what your monthly bleed is. It's that uterine lining that was built up throughout the month. We need to just get that out of here and start over next month. And so progesterone drops, and then you're back at day one, beginning of the follicular phase for your next cycle. When you're getting hormones tested for looking at your estrogen and progesterone levels, because there's different hormones going on at different parts of the cycle, then you're gonna get recommended that you go in to get lab tests done on different days of the cycle.

[00:12:38] So estrogen, or it's referred to as estradiol when you're getting it run through a lab test, you're going to have that done on day three of your cycle. Progesterone levels are recommended to get drawn on day 19, 20, or 21 of a cycle if you ovulate it on day 14, but [00:13:00] really you want it to be run about seven days post ovulation.

[00:13:04] So that's another reason to be hyper aware of when ovulation is happening for you, because then you know you can get your progesterone levels tested around seven days. After that's happening. So if you ovulate on day 16, then you know that you're going to want to get your progesterone tested just a little bit later than if you had ovulated on day 14.

[00:13:31] Now to look at ovulation tests, Now to know when you ovulated, there's a few different options. One, your body might just tell you, right? There's ovulation changes in the body. An increase in cervical mucus is going to be the biggest change that many women see. Now, I will say that you could have a fertile change in cervical mucus and just not see it.

[00:13:59] It's just [00:14:00] not apparent. Right? For many people, they have just increased discharge and You know, for some people, they, it's so confusing why they have all this discharge, they go get it checked out at the doctor, but it's all just normal. Okay. But even if you don't have that level of discharge, then it could still be making the fertile changes that you need in the body.

[00:14:22] Okay. Temperature changes. So if you're somebody who tracks your temperature, you're already going to notice that your temperature rises with ovulation. And so that's another sign. Some people get some mild pelvic cramping. Then you can get some tests done. You can use the at home ovulation predictor kits.

[00:14:46] Those typically are the urine tests, like the dip tests, and they are looking for the LH levels, right? That, the, that Peak of LH to then say, oh, ovulation should be happening [00:15:00] in a day. You could do that or you can go in and talk to your doctor about getting your progesterone levels tested because a certain level of progesterone will show that you did or did not ovulate that month.

[00:15:15] Or you could get a, an ultrasound done, which would show, okay, was there an egg that was released this month? An ultrasound and progesterone testing is going to be the most specific. I find with the at home OPK kits that those can have a pretty wide range of how well they're working. Um, it's really common for me to hear from women that they were using one particular brand and then they switched to a different brand.

[00:15:47] That second brand said they ovulated on a different day, which was actually more specific. And then they were able to get pregnant. because they ovulated. They were able to really hone [00:16:00] in on their ovulation, so that's important. If you've been using the same ovulation predictor kit at home for a long time, then go ahead and switch to another one and see if that works better.

[00:16:12] There's testing, um, the one that I like to use is menstrual cycle mapping, and that's a urine test. that you do a sample almost every day of your cycle. And then you get this really wonderful map that shows what your estrogen, what your progesterone, and what your LH were doing all month long. And so you can see, okay, well, do you have enough progesterone?

[00:16:34] But did it stay high that whole second half of the cycle? Did your LH rise? really closely to ovulation or do you actually have a wider peak of LH because that's really common in PCOS to have, you know, a few days of an LH peak rather than just one day. And so if that's you then, you know, you need to be testing for [00:17:00] LH a few days earlier.

[00:17:02] And so there's a variety of tests to understand if you're ovulating and that's going to be key to help you understand your fertility. Okay, but let's take a step back and let's just talk about what you're going to do moving forward based on what you know about this fertile cycle from today. So number one, if you haven't been tracking your cycles, you've got to get specific about that.

[00:17:30] Okay? If you remember when your last cycle started, then go ahead, jot it down on your calendar and then wait for your next cycle to start. And write down day one, and you're going to count from day one of your previous cycle all the way to day one of your next cycle. And however many days that is, that's how long your cycle was.

[00:17:53] And every month or every cycle, I should say, uh, you're going to write down on your calendar day [00:18:00] one when it happened. And the most powerful way is to see over time how that is. looking every cycle. Is your cycle the same number of days? Is it different? Is it really long? And so that gives you really good information about what's going on in your body.

[00:18:21] Foundational information. This is something that every woman that's working with me to help improve their fertility. I am tracking her cycles. It's one of the first things that I ask at every session, right? What is your cycle doing? What was your last cycle? What day are you on today? And how long was your last cycle?

[00:18:41] And because that's really important to track. And so if I'm tracking it, you need to be tracking it as well. So the first thing you do is you track your cycle. The second thing you do is figure out if you're ovulating or not. We just talked about a few ways to check for ovulation and so, you know, you can evaluate is [00:19:00] your way that you're tracking ovulation right now, is that effective for you or do you need to get some other testing done or switch methods?

[00:19:08] So, once you know if you're ovulating and when you're ovulating, then what you're going to do is write down your fertile window. So those five days leading up to ovulation and that day of ovulation, that's your fertile window. So that's when you're going to get busy in the bedroom and you want to know what those days are because again, you are not fertile your entire cycle.

[00:19:34] And this type of tracking your fertile window is actually the basis of natural family planning. So either using tracking your cycles to understand your fertile window in order to get pregnant or tracking your cycles so that you know your fertile days. So that you don't get pregnant and it's really powerful to know this about your body because Then you [00:20:00] know what is happening and what your body is doing at different parts of the cycle And so if you're somebody who has irregular or very long cycles and you're not having this Fertile hormone picture you're not having ovulation happen Then what do you need to do?

[00:20:17] Well, we talked a little bit about this last week with the birth control episode about how birth control is the most commonly recommended dedication to help regulate cycles. And we talked about how that's not really effective because it just shuts everything down rather than helping to balance your body.

[00:20:35] So if you're someone who has irregular cycles, you don't have any positive ovulation, predictor kits, you know, you know you're not ovulating, then what's your next step? That's to figure out what's causing your cycles to be long and irregular and what's causing your ovulation not to happen. Is your insulin too high?

[00:20:56] Is your insulin too high, which is pushing testosterone [00:21:00] too high, which is then shutting down ovulation. Is your estrogen levels too low, which makes your uterine lining too thin, so implantation can't happen. Is your progesterone too low, so maybe you can get pregnant, but you don't have enough progesterone, so you can't actually keep that pregnancy going in those first few weeks.

[00:21:23] See, those are the kinds of conversations you need to be happening next. If you have an irregular cycle, you need someone to ask you about your egg quality. Do you have the right foundation to support good egg quality so that your eggs are happy and healthy and they're ready to opulate and help you make a baby?

[00:21:45] So we've talked about some really cool foundational things about your menstrual cycle this week and understanding what that fertile cycle looks like, what hormones are shifting throughout the month, what [00:22:00] ovulation, when it's happening, and then when your fertile window is. So, based on what you learned today, what is your one degree shift moving forward?

[00:22:11] A one degree shift, think about a boat and it's sailing and it is set forward on a path. If it changes its course by one degree over two weeks, over a month, that course of that boat is going to be in a completely different part of the world than it would have been on its original course. So what's your one degree shift that you can take from what you learned today that weeks from now, a month or two from now, we'll take you in this completely different positive direction for your fertility, write it down so that you can take action on it today.

[00:22:54] I believe in your ability to positively change your fertility, [00:23:00] and I am so honored to be on this journey with you. I'll see you next week.

[00:23:03] 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.

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