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The No. 1 Reason Women Can’t Get Pregnant

PCOS as a cause of infertility by Hormone Cure author Sara GottfriedYour androgens—a group of sex hormones that affect your energy, libido, mood, and self-confidence—might be sabotaging your fertility. Sara Gottfried, M.D. explains in her book, The Hormone Cure: Reclaim Balance, Sleep, Sex Drive, and Vitality Naturally with the Gottfried Protocol.

Most women with excess androgens have PCOS. It sounds like a scary syndrome, and it is. The most common hormone condition in women of reproductive age, PCOS affects 20 percent of women and can interfere with fertility by blocking regular monthly ovulation. If you are trying to conceive, I recommend asking—no, demanding—that your doctor do a blood test to check your fasting insulin, glucose, progesterone on Day 21, and leptin. This will clarify whether or not you have insulin resistance. Before you go the ubermedical route, you may be able to improve your fertility with a few small lifestyle and food changes specifically targeted to women who want to get pregnant.

Women with PCOS typically develop many small cysts on their ovaries—often between ten and one hundred small cysts. We believe the cysts are a result of disturbed hormones and ovulation, so that eggs don’t go through the normal maturation sequence of (1) a cyst forming around a ripening egg (the corpus luteum); (2) the release of luteinizing hormone (LH) from the brain to trigger the ripe egg to pop out of the cyst and head toward the fallopian tube for possible fertilization; and (3) the now-empty cyst getting reabsorbed into the ovary. Short version: the maturation sequence of the eggs is disturbed so that there is a breakdown and ovulation doesn’t happen. And if you’re not ovulating, you won’t be getting pregnant.

The cysts in PCOS are not dangerous. It’s more that the multiple cysts, along the periphery of the ovaries like a string of pearls, are along for the ride—they are a sign that ovulation is not happening. Over time, the cysts do not grow. They are not the type of cysts that require surgical removal and, unlike some other cysts, are not associated with an increased risk of ovarian cancer. Women are often treated for PCOS with a birth control pill, which suppresses LH and thereby lowers production of ovarian androgens. Not the sort of treatment you want if you’re trying to get pregnant.

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