February 12th, 2025 | 7 min. read
Did you know that insulin resistance and fertility are connected? Understanding this relationship is especially important for those with polycystic ovary syndrome (PCOS) who are trying to conceive. This guide offers specific tips to help increase your chances of success.
In this article:
What is PCOS?
Polycystic ovary syndrome (PCOS) is the most common endocrine condition in women, representing around 10-15% of the population - likely even more!
The condition can be characterized by ovulatory dysfunction (irregular cycles), elevated androgen levels (the so-called “male” hormones), cardio-metabolic dysfunction (elevated cholesterol panel), insulin resistance, and sometimes, weight gain.
PCOS patients usually have at least two of the above symptoms, but may not exhibit all of them. Individuals who don't struggle with weight gain may even hear the term 'lean PCOS.'
What is insulin resistance?
Many PCOS patients are also challenged by something called insulin resistance.
Insulin is a hormone manufactured in the pancreas, then secreted in response to sugar in the blood stream after eating a meal. Insulin helps to move the blood sugar from the bloodstream into the cells so they can be put to use - providing energy.
When those cells do not respond properly to the insulin hormone, they are considered 'resistant.' The body keeps trying to get a response by telling the pancreas to send out more and more insulin.
Think about it this way: You show up to a friend’s house and knock on the door. No answer. You knock again. Still no answer. So you knock louder and harder. Nothing.
It turns out that your friend is actually inside, but because she's listening to music through her headphones, she can’t hear you at all! In this case, you are the insulin, trying to send messages, and your friend is the cell who is simply not responding.
Why is insulin resistance bad?
At some point, the body gets tired of trying and becomes desensitized to insulin, losing its ability to regulate blood sugar normally. Elevated sugars in the blood stream can cause damage to the nerves, blood vessels, and organs. It can eventually lead to diabetes and other serious conditions.
Insulin can also increase androgen (testosterone, the 'male' hormone) production by the ovaries. This can cause irregular cycles, which means irregular ovulation or possibly no ovulation at all - making achieving pregnancy difficult.
Can insulin resistance cause miscarriage?
Sadly, the answer to that question is yes. Research has shown that elevated insulin levels may be toxic to early placental cells, which means that insulin resistance is associated with a higher rate of miscarriage.
Insulin resistance can also lead to gestational diabetes, which is the most common pregnancy complication in all women. A not-so-fun fact? Individuals with PCOS are three times more likely to develop gestational diabetes than the general public.
Having gestational diabetes can be harmful to your unborn child and increase their own chances of being overweight and developing insulin resistance in the future.
3 Ways to Optimize Your Preconception Health
Whether you have PCOS or not, there are three main ways to improve your overall wellness and increase your chances of a healthy pregnancy and baby. Let's break them down together.
#1 Regular Exercise
If you struggle with excess weight, some research has shown that even a 5-10% reduction in weight may lead to regular ovulation.
A combination of weight-bearing exercise and aerobic exercise is optimal - and an integral part of managing PCOS. Consistent exercise will help with improved insulin levels and better glucose control. In addition, it supports weight loss, lowers androgen levels, improves mood, and may even help to regulate ovulation.
Check out our PCOS Fitness Guide to learn how to get started (psssst...you don't even need a gym membership).
Tip: Exercise routines don't have to be complicated! Walking at a brisk pace is an excellent form of exercise that can be done before, during, and after pregnancy.
#2 Balanced Nutrition
Eating a healthy, well-balanced diet is also key. Many PCOS patients find it helpful to meet with a nutritionist to review your current food intake and tweak it for optimal preconception nutrition.
Ideally, your plate should include lots of vegetables, whole grains (complex carbs), fruits, beans, lean meats, fish (though not too much swordfish or tuna), and some healthy fats (such as olive oil and nuts). Try to avoid processed foods and buy organic, if you're able to.
It's also critical to stay hydrated – always carry a water bottle around with you!
Tip: Strive for healthy meals and snacks, but avoid restriction. You might feel tempted to adopt an extreme diet or count every calorie, but these practices are harmful to your body (and fertility) in the long run. Always consult a nutritionist before making changes.
#3 Medication
While they aren't necessary for every PCOS patient, your provider may discuss adding medications that can be used during the preconception phase to lower insulin levels, specifically if you have demonstrated insulin resistance and/or other PCOS symptoms.
There are insulin-sensitizing supplements, GLP-1 drugs (like Wegovy or Mounjaro), and other medications (like metformin) your provider may prescribe for you. If you have diabetes, your endocrinologist may also prescribe insulin.
Note: You may be asked to undergo a two-hour oral glucose and insulin tolerance test at to determine your level of insulin resistance and if these medications might help you.
Ready to get started?
Get instant access to our free Guide to Life with PCOS for more expert insights on PCOS and nutrition, fertility, treatment options, and more.
Other Lifestyle Changes
In addition to the above, remember that getting enough sleep and reducing stress can have a big impact on your PCOS symptoms during the preconception period (and beyond). Struggle with insomnia? Try practicing meditation or using a sleep app on your phone to help you fall (and stay) asleep.
Where to Find Support
At Illume Fertility, each patient has access to a vetted network of licensed counselors, traditional or laser acupuncture, support groups and free events, a PCOS-informed nutrition team, and other specialized resources to help you optimize your preconception health.
Managing PCOS Symptoms During Pregnancy
Once you are pregnant, remember to keep up the good work! Here are a few simple tips to keep top of mind throughout your pregnancy:
- Continue to exercise during pregnancy. Daily exercise will not only help to optimize insulin levels, but will keep weight under control and make you feel great. It’s fine to go back to exercising as you did before pregnancy with approval from your doctor.
- Continue to eat well balanced meals and drink a lot of water. People used to say, "Eat up! You're eating for two now." That’s not actually the case. You do not need to double your intake of food. Work with a nutritionist to create a delicious, sustainable meal plan.
- Take any medication prescribed to you as directed. If you are on metformin, don’t take it sporadically, take it on schedule. If you are having trouble or experiencing side effects from a medication, speak with your nurse or doctor.
What to Expect During Pregnancy
At some point in your pregnancy, your OB/GYN will order a two-hour oral glucose tolerance test to see how your sugar levels are doing. This is the test that will confirm if you have developed gestational diabetes.
Remember: Your best chance at fighting gestational diabetes is to practice the healthy lifestyle habits we discussed above. While having insulin resistance does increase your chances of developing gestational diabetes, it's not a guaranteed outcome!
At the end of the day, simply try to do the best you can, and you'll be just fine. Never hesitate to reach out for support from your Care Team when you're feeling confused or overwhelmed. We wish you all the best on your fertility journey!
Do I have PCOS?
Take our PCOS symptoms quiz for a quick assessment and learn what to do next.
