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Infertility is a very common condition for which women very seldom receive needed emotional and medical support. Just in the USA alone, surveys tell us, 3.3 million couples are trying to conceive a child and can't.

Up to 50 Per Cent of Women with PCOS Can Become Pregnant After Dietary Intervention

And when the problem is infertility in the female partner, PCOS, also known as polycystic ovarian syndrome, is the most likely cause.

PCOS is the accepted term for a condition it describes poorly. Some women who have PCOS do not have ovarian cysts. And other women who do not have PCOS do have ovarian cysts. The "syndrome" in polycystic ovarian syndrome is fundamentally a hormonal imbalance. There is a great deal that can be written about the hormonal imbalances associated with PCOS, but the hormone that is most important to understand is testosterone.

Women's bodies make testosterone. More specifically, women's ovaries make testosterone. The ovaries have to hold all the eggs a woman will ever have, so the body makes sure they get priority nourishment. Many tissues in the body can "turn off" receptors for insulin when there is too much sugar in the bloodstream. The ovaries, however, never reject nourishment. When women have high blood sugar levels, the sugary fuel flows into the ovaries and revs up their production of both estrogen and testosterone.

Fortunately, in about 50 per cent of women who have PCOS, simply keeping blood sugar levels in check is enough to reduce the production of testosterone. This reduces acne and hair growth and restores fertility, usually, assuming there are no other fertility issues with either partner, in about 12 months. The one essential key to success on any PCOS diet is very simple: Never eat too much.

Serving Size, Mixing Foods, and the PCOS Diet

If you want to treat PCOS with diet, the thing you need to be sure to do is to smaller meals that your body can process. Eating a bag of chips, or a carton of ice cream, or a big helping of rice or potatoes requires more insulin than your body can easily produce. Even worse, the higher your blood sugar levels go, the more insulin your body has to make to keep up.

Blood sugar levels are usually measured in mg/dl or mmol/L. It takes four times as much insulin to lower your blood sugar levels from 300 mg/dl (16.5 mmol/L) to 200 mg/dl (11 mmol/L) as it does to lower your blood sugar levels from 200 mg/dl (11 mmol/L) to a nearly normal 100 mg/dl (5.5 mmol/L). If you really just have to have a sugary dessert, have just a little bit now and save the rest for later. If you limit your consumption of sugar foods, your ovaries won't be constantly flooded with the sugar that fuels the production of testosterone.

It also helps to avoid mixing carbohydrate and fat at the same meal. Blood sugar levels soar when you eat sugary foods and fatty foods together, because insulin doesn't just transport sugar out of the bloodstream. It also transports fat out of the bloodstream, but it stores fat first. Eating carbohydrate foods and fatty foods at the same time leaves sugar in your bloodstream to fuel the production of testosterone.

The effects of your diet on PCOS are not instantaneous. In fact, your testosterone levels go down whenever you eat anything at all, for an hour or two, and they go down more immediately after a high-fat meal than immediately after healthier high-fiber meal! This does not mean, however, that it is OK to give in to your cravings for fast food or fatty foods, especially fast foods or fatty foods followed by dessert. Your baseline levels of testosterone go up and up the more you eat sugary foods and the more you eat carbs and fats together.

Specific Foods for Your PCOS Diet

Once you get into the habit of eating smaller meals and avoiding meals that combine carbohydrates and fat, you can slowly add specific foods that fight polycystic ovarian syndrome. Some foods that have been documented as helpful in PCOS include:

Almonds and walnuts. Up to about 30 to 50 grams (1 to about 2 ounces) of almonds or walnuts every day can have the surprising effect of helping you lose weight while they lower your testosterone levels. Filled with healthy omega-3 fats, these healthy nuts help your body reduce inflammation. They also increase levels of sex hormone binding globulin, which takes testosterone out of circulation, and they lower levels of testosterone by about 30 per cent in a month. Clinical trials have found that despite adding 300 to 450 calories a day to the diet, women who eat almonds or walnuts lose weight, have greater sensitivity to insulin, and lower cholesterol levels.

Prunes do not have any measurable effects on testosterone levels, but they contain compounds that help balance the active and inactive forms of estrogen in a woman's body, and they are a good snack when you are fighting the urge to overeat. Just don't eat the entire package of prunes. A serving of 4 to 6 prunes is enough to blunt your appetite until your next meal.

Healthy foods that are low on the glycemic index, such as salad greens, almost all steamed vegetables (except Irish or sweet potatoes), lentils, kidney beans, pinto beans, and fresh fruit are probably useful for any woman who has PCOS, but they are definitely helpful for women who take metformin. The combination of a low glycemic index diet and metformin has been shown in clinical studies to help women with PCOS lose weight while their menstrual periods become more regular.
How much and how long do you have to diet to make a difference in PCOS? Usually, dieting long enough to lose 5 to 7 per cent of body weight is enough to restore normal menstrual periods and ovulation and possibly to conceive. If you don't want to count calories or exchanges, try rating your plate. Eat one plate of food three times a day, filling one quarter of the plate with a low-fat protein food, one-quarter of the plate with a low glycemic index carbohydrate food, and half your plate with a vegetable (even at breakfast). If you aren't losing weight, switch to a smaller plate.

It's better to take a few months to a year to do this; of course if you biological clock is ticking, you may want to see your doctor for additional treatments if you do not conceive in the first six months. Since the underlying improvement in your hormonal health requires keeping blood sugar levels low to reduce testosterone production, you will need to lose weight by diet, rather than by exercise.

  • Kalgaonkar S, Almario RU, Gurusinghe D, Garamendi EM, Buchan W, Kim K, Karakas SE.Differential effects of walnuts vs almonds on improving metabolic and endocrine parameters in PCOS. Eur J Clin Nutr. 2010 Dec 15. [Epub ahead of print]
  • Katcher HI, Kunselman AR, Dmitrovic R, Demers LM, Gnatuk CL, Kris-Etherton PM, Legro RS. Comparison of hormonal and metabolic markers after a high-fat, Western meal versus a low-fat, high-fiber meal in women with polycystic ovary syndrome. Fertil Steril. 2009 Apr, 91(4):1175-82. Epub 2008 Mar 10
  • Marsh KA, Steinbeck KS, Atkinson FS, Petocz P, Brand-Miller JC. Effect of a low glycemic index compared with a conventional healthy diet on polycystic ovary syndrome. Am J Clin Nutr. 2010 Jul, 92(1):83-92. Epub 2010 May 19
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