The fertility fix for PCOS: How to conceive naturally

If you’re navigating fertility challenges with PCOS, you’re not alone. Polycystic ovary syndrome affects up to one in 10 women of reproductive age and is one of the leading causes of ovulatory infertility. While traditional treatments often focus on medications like Clomid or IVF, there’s growing evidence that nutrition and lifestyle, especially when guided by a functional medicine approach, can significantly improve your chances of conceiving naturally.

This article breaks down how PCOS impacts fertility, the role of insulin resistance, and how targeted dietary and lifestyle changes can help rebalance hormones and support your reproductive health.

How PCOS and insulin resistance affect fertility

At the root of PCOS for many women is insulin resistance. When your body doesn’t respond well to insulin, it compensates by producing more of it, which can lead to higher blood sugar levels and inflammation. Here’s how that impacts your fertility:

• More androgens (male hormones): High insulin levels signal your ovaries to make more testosterone. This can lead to acne, irregular periods, and a lack of ovulation.
• Disrupted ovulation: The imbalance between luteinizing hormone (LH) and follicle-stimulating hormone (FSH) can prevent eggs from maturing and releasing.
• Higher miscarriage risk: Insulin resistance may also affect egg quality and early embryo development.

The good news? Lowering insulin resistance through diet and lifestyle can often restore ovulation and improve your chances of a healthy pregnancy.

Can a ketogenic diet help?

One of the most researched approaches for improving insulin sensitivity in PCOS is the ketogenic diet, which involves eating fewer than 50g of carbohydrates per day. In a study of women with PCOS who had previously failed IVF cycles, following a ketogenic diet for 14 weeks led to:

• an average weight loss of 7.9 kg
• better insulin sensitivity (HOMA-IR scores dropped significantly)
• improved blood sugar and triglyceride levels
• an 83% implantation rate vs. 8.3% in their previous IVF cycle
• live birth rates of 66.7% (compared to 0% previously)

Interestingly, while the number and quality of eggs didn’t change, the improved endometrial environment may have supported successful implantation and pregnancy.

Other studies have shown similar improvements in hormone levels, with lower testosterone, better LH/FSH ratios, and even spontaneous pregnancies.

Why a low-carb diet can support fertility

You don’t necessarily have to follow a strict keto diet to benefit. A more moderate, low-carb, whole-food diet can still:

• lower insulin and testosterone levels
• support more regular ovulation
• reduce inflammation and support a healthier uterine lining

The key is reducing refined carbs and sugar while emphasising fibre, protein, and healthy fats.

What about inositol?

If you’ve heard about inositol for PCOS, the hype is backed by science. Inositol (specifically myo-inositol and D-chiro-inositol in a 40:1 ratio) is a natural supplement that improves insulin sensitivity and supports ovulation.

Benefits include:

• lower fasting insulin and testosterone levels
• improved ovulation and menstrual regularity
• better pregnancy outcomes - without the side effects often seen with metformin
• one study found that 86% of women taking D-chiro-inositol ovulated within six weeks, compared to 27% in the placebo group.

Inositol is a favourite in functional medicine because it addresses one of the root drivers of PCOS: insulin resistance, without disrupting the gut or causing blood sugar crashes.

Final thoughts: Your next step toward pregnancy

When it comes to optimising fertility with PCOS, addressing insulin resistance is key. Whether through a low-carb or ketogenic diet, adding inositol, or making mindful lifestyle shifts, there’s a lot you can do to support ovulation and conception naturally.

Functional medicine goes beyond symptom management. It aims to uncover and treat the root causes, so you can feel better and improve your fertility from the inside out. If you’re feeling overwhelmed, know that you're not alone, and support is there to guide you step by step.

Ready to take control of your PCOS and fertility?

You deserve more than trial-and-error. Let’s get to the root of your symptoms with hormone testing, a customised nutrition and supplement plan, and the support you need to move forward with confidence.

Book a one-to-one consultation today with a practitioner to explore your personalised fertility plan and get the guidance your hormones - and your future - deserve.

References

• Palomba S, Falbo A, Zullo F. Management strategies for ovulation induction in women with polycystic ovary syndrome and known insulin resistance. Curr Opin Obstet Gynecol. 2009 Dec;21(6):465–73. doi:10.1097/GCO.0b013e3283319a63
• Paoli A, Bosco G, Camporesi EM, Mangar D. Ketogenic diet and phytoextracts: The effective combination for the treatment of polycystic ovary syndrome. J Endocrinol Invest. 2015 Jul;38(7):733–9. doi:10.1007/s40618-015-0253-7
• Mavropoulos JC, Yancy WS, Hepburn J, Westman EC. The effects of a low-carbohydrate, ketogenic diet on the polycystic ovary syndrome: a pilot study. Nutr Metab (Lond). 2005 Dec 16;2:35. doi:10.1186/1743-7075-2-35
• Genazzani AD, Prati A, Santagni S, Ricchieri F, Chierchia E, Rattighieri E. Differential insulin response to myo-inositol and D-chiro-inositol in obese and lean PCOS patients: A randomised controlled trial. Gynecol Endocrinol. 2014 Mar;30(3):223–6. doi:10.3109/09513590.2013.860231
• Costantino D, Minozzi G, Minozzi E, Guaraldi C. Metabolic and hormonal effects of myo-inositol in women with polycystic ovary syndrome: a double-blind trial. Eur Rev Med Pharmacol Sci. 2009 Jul-Aug;13(2):105–10.