PCOS and Infertility: Causes, Treatment, and Hope

Polycystic Ovary Syndrome (PCOS) is one of the most common hormonal disorders among women of reproductive age, affecting up to 1 in 10 globally. Yet despite its prevalence, many women find themselves feeling isolated, confused, and frustrated—especially when PCOS and infertility go hand in hand. If you’re between the ages of 15 and 45 and struggling with irregular cycles, unwanted weight gain, acne, or difficulty getting pregnant, you’re not alone—and there is hope.

From a functional medicine perspective, PCOS isn’t just a reproductive condition— a complex metabolic and hormonal imbalance that affects the whole body. Understanding the root causes of PCOS is key to unlocking real healing and restoring fertility.

What is PCOS?

PCOS is diagnosed when at least two of the following are present:

• Irregular or absent menstrual cycles

• Excess androgen levels (e.g., testosterone), often causing acne, hair thinning, or excessive hair growth

• Polycystic ovaries on ultrasound (multiple immature follicles)

But symptoms of pcos are just the surface. Beneath them lies a network of hormonal imbalances that often include insulin resistance, inflammation, and dysregulated stress hormones. These imbalances affect your metabolism, mood, energy, and can contribute to PCOS and infertility.

Why PCOS and Infertility Impact One Another

To get pregnant, your ovaries need to release a mature egg each month (ovulation). In PCOS, releasing an egg is often delayed, irregular, or absent. Why? Here are the primary root causes:

Insulin Resistance

This is one of the most common underlying drivers of PCOS. When cells don’t respond well to insulin, your body compensates by producing more. Elevated insulin levels can disrupt ovulation by signaling the ovaries to produce more testosterone and fewer female hormones like estrogen and progesterone.

Elevated Androgens

High levels of androgens ("male" hormones) can interfere with the normal development of eggs in the ovaries. This often leads to multiple immature follicles—what we see as "polycystic" ovaries on ultrasound.

Chronic Inflammation

Low-grade inflammation—often from poor diet, gut dysbiosis, toxin exposure, or stress—can interfere with ovulation, worsen insulin resistance, and contribute to hormonal chaos.

Stress and HPA Axis Dysfunction

Chronic stress alters your brain's communication with your ovaries via the hypothalamic-pituitary-adrenal (HPA) axis. Cortisol, the body’s main stress hormone, competes with sex hormones and can suppress ovulation over time.

Functional Medicine Approach to PCOS and Fertility

Functional medicine focuses on the root causes of disease and views the body as one interconnected system. Instead of treating symptoms in isolation, we ask: What’s driving the imbalance, and how can we restore optimal function?

Personalized Nutrition

Nutrition is foundational to managing PCOS. A whole-food, anti-inflammatory diet that balances blood sugar is key.

• Focus on: lean proteins, healthy fats (avocados, olive oil, fatty fish), leafy greens, cruciferous vegetables (like broccoli and Brussels sprouts), berries, and low-glycemic fruits.

• Limit or avoid: processed carbs and foods, sugary drinks, excess dairy, and inflammatory oils (like soybean or canola oil).

In some women, moderate carbohydrate restriction (around 30–40g per meal) paired with adequate protein can improve insulin sensitivity and ovulatory cycles. Please work with a Healthcare Provider to individualize your nutritional needs.

Stabilizing Blood Sugar and Insulin

Even women with a healthy weight can have insulin resistance. Tools to address this include:

• Regular meals with protein and fiber

• Adequate daily water intake with limited caffeine

• Movement after meals (like a 10-minute walk) and during other times of the day. Consistent physical activity is essential for blood sugar regulation

Hormone Balancing and Detoxification

Supporting your body’s natural ability to metabolize hormones is essential:

• Liver support with cruciferous veggies and possibly other supplements based on your individual needs. Avoid alcohol and excessive use of products containing Acetaminophen (Tylenol)

• Fiber to help excrete excess estrogen

• Avoiding endocrine disruptors (like BPA, parabens, and phthalates)

• Having adequate levels of Vitamin D either from sunlight exposure, diet or and/or supplementation

Herbs such as vitex (chasteberry), spearmint tea, and licorice root may also help regulate cycles, but should be used under guidance.

Stress Reduction and Sleep Optimization

High cortisol can shut down ovulation. Prioritizing rest, setting boundaries, and daily stress management can make a real difference.

• Practice: yoga, meditation, deep breathing, journaling

• Sleep: Aim for 7–9 hours per night. Poor sleep worsens insulin resistance and inflammation.

Gut Health

Your gut microbiome plays a role in hormone metabolism, immune regulation, and even mood. Healing the gut may help reduce systemic inflammation and support hormonal balance.

• Supportive steps: probiotics, fermented foods (like sauerkraut, kefir), prebiotic-rich vegetables, and addressing any gut infections or food sensitivities.

Conventional Fertility Treatments: Helpful or Harmful?

Common medical treatments for PCOS include birth control pills (to regulate cycles) and metformin (to improve insulin sensitivity). While these may help manage symptoms, they don’t address root causes—and may not support long-term fertility goals.

In some cases, ovulation-inducing medications like letrozole or Clomid are used when trying to conceive. Functional medicine can be complementary, often improving outcomes with fewer side effects.

There is Hope

If you've been told "losing weight" or that birth control is your only option, know this: your body wants to heal. With the right support, many women with PCOS can restore regular ovulation, improve their symptoms, and even conceive naturally.

Healing PCOS is not about quick fixes—it’s about rebalancing your whole system so that your hormones, metabolism, and reproductive health can thrive.

You are not broken. You are not alone. And you do not have to settle for one-size-fits-all answers.

Final Thoughts

If you're navigating PCOS and fertility challenges, consider partnering with a practitioner who understands the interconnected nature of hormones, metabolism, and lifestyle. Whether you’re just beginning your reproductive journey or have been trying for years, there is always a path forward.