Conquer Your PCOS Naturally



[pic]

Suffering from Polycystic Ovary Syndrome (PCOS) & Struggling with Infertility?

In this book you’ll find tips, tools and information to boost your chances of finally becoming a Mum!

[pic]

[pic] [pic] [pic]

Table of Contents:

What is Polycystic Ovary Syndrome 6

Why is it called Polycystic Ovary Syndrome 6

Signs and Symptoms of PCOS 6

Diagnosing PCOS 7

The Incidence of PCOS 7

Pathophysiology of the ovary 7

What does a Poly Cystic Ovary look like? 8

What is the difference between Poly Cystic Ovaries and Poly Cystic Ovary Syndrome? 9

It’s not just your ovaries 10

Two of the main drivers of PCOS: Insulin Resistance and Inflammation

Insulin Resistance 10

Inflammation 10

Is there a cure? “Why not adjust causes instead of treating effects?” 10

What Causes PCOS 11

Why PCOS can adversely affect fertility 11

High Levels of Luteinizing Hormone (LH) 12

Abnormal LH to Follicle Stimulating Hormone (FSH) Ratio 12

High Insulin Levels 13

Inflammation 13

Low Progesterone Levels 14

Heredity 14

Epigenetics 14

More On PCOS and Fertility

PCOS 14

Other factors leading to infertility 15

Possible Complications During Pregnancy 16

Reason for Increased Miscarriage Rate 16

Reason for Recurrent Miscarriage Rates 17

What if You Need Some Assistance to Become a Mother 18

Clomiphene 18

Metformin 18

Gonadotrophins 19

In Vitro Maturation (IVM) and In Vitro Fertilization (IVF) 19

Fertility Boosting Tips

Stress Management 19

Fertility Friendly Foods and Nutrients 21

Omega-3 fatty acid rich fish 22

Nuts 22

Gluten-free whole grains 22

Lean Proteins 22

Variety 23

Sound Sleep and Good Sleep Hygiene 23

Exercise 23

Optimal Thyroid Health 24

Temperature Tracking 24

Environmental Detoxification 24

Inflammation Reduction 25

Ideal Weight Management 25

Other Professionals 25

Pre-Conception Plan 26

Congratulations! What to Do Now That You are Pregnant 27

What Can You Do to Reduce Your Risk of Miscarriage and Pregnancy Complications 27

How to Improve Your Chances of Breast Feeding 29

How To Protect Your Future Child 30

Great PCOS Tools And Resources 31

Your Notes 34

References & endnotes 35

Dedication:

If you have Polycystic Ovary Syndrome (PCOS) and you want to become a mum, this book has been written to empower you to boost your fertility, reduce your risk of miscarriage and pregnancy complications, and improve the health of yourself and your baby.

What is Polycystic Ovary Syndrome?

Polycystic ovary syndrome is also commonly known as PCOS.

PCOS is a women’s health challenge with a host of different, but interdependent, hormonal imbalances. PCOS can affect many areas of a woman’s heath: menstruation, fertility, appearance and weight, to name a few.

PCOS is a significant cause of female infertility. It increases the risk of miscarriage, and can also cause pregnancy complications.

Why is it called Polycystic Ovary Syndrome?

Poly Cystic Ovary Syndrome (PCOS) derived its name from the multiple (i.e. “poly”) cysts (i.e. “cystic”) in the ovaries (i.e. “ovary”). These cysts are actually immature follicles. Follicles typically contain a single immature egg, which grows and develops, and when healthy, culminates in ovulation. Researchers demonstrate that there are an increased number of growing follicles in the poly cystic ovary. The egg follicles begin to develop, but stop growing. This is known as “follicular arrest”. If the dominant follicle does not enlarge, and the egg does not mature, this egg is not released. This is known as “anovulation”.

Signs and Symptoms of PCOS

Symptoms of PCOS vary. They may include:

• Difficulty or inability to become pregnant due to a lack of ovulation

• Infrequent, absent, and/or irregular menstrual periods

• Increased hair growth on the face, chest, stomach, back, fingers or toes

• Cysts on the ovaries

• Acne

• Oily skin

• Difficulty losing weight

• Weight gain around the waist, or obesity

• Baldness or thinning of the hair

• Thick, dark brown or black skin patches on the neck, arms, breasts or thighs

• Skin tags

• Pelvic pain

• Mood problems like anxiety or depression

• Sleep apnea

• Fatigue

• Pain

• Depression, anxiety, low self-esteem

• Hot flushes

• Mood swings

Diagnosing PCOS

There are two main criteria used to diagnose PCOS:

1.) The Rotterdam Criteria define PCOS as being present when at least two of the following are present:

• infrequent menstruation

• excessive levels of “male” hormone (“hyperandrogenism”)

• poly cystic ovaries are found with ultrasound

2.) The National Institute of Health criteria define PCOS as being present when there is:

• the presence of hyperandrogenism and infrequent ovulation (“oligo-ovulation”).

Other disorders that may be responsible for the signs and symptoms being experienced must be excluded first.

The Incidence of PCOS

If you are suffering from PCOS, you are not alone.

It is estimated that more than ten percent of women worldwide suffer from PCOS, with higher incidence rates occurring in African-American, Hispanic, Asian and Indigenous Australian women. 10% of the total female population accounts for 15.6 million Americans; 1.13 million Australians; 3.13 million Brits and almost 37 million European women. Given girls as young as eleven can suffer from PCOS, and many of those who had PCOS and have gone through menopause remain insulin resistant (the main underlying driver for most women with PCOS), there are many, many millions of women struggling with PCOS just like you. The rates in other countries such as New Zealand, Canada, India and China are also similar.

Pathophysiology of the ovary

Poly (meaning multiple) Cystic Ovary Syndrome (PCOS) got its name from the multiple ‘cysts’ in the ovaries. However, these ‘cysts’ are in actual fact immature follicles. Researchers (Hughesdon, Webber, Maciel) showed there is an increased number of growing follicles in a Poly Cystic Ovary (PCO). These egg follicles begin to develop, but may stop growing, known as ‘follicular arrest’. If a dominant follicle does not enlarge and the egg does not mature, an egg is not released. This is known as anovulation, and affects hormonal balance. The numerous follicles also cause enlarged ovarian size.

[pic]

Picture: The appearance of Poly Cystic Ovaries on either side of the uterus.

What does a Poly Cystic Ovary look like?

The definition of a Poly Cystic Ovary is one in which there is “either 12 or more follicles measuring 2-9mm in diameter and/ or increased ovarian volume (>10cm3)” 1. The follicles appear in a typical peripheral pattern, also known as the ‘string of pearls’ appearance. This is most commonly determined by ultrasound − abdominal, and/or trans-vaginal. It’s very important to have your scans performed by an experienced ultrasonographer. It is more accurate to have both abdominal and trans-vaginal scans performed. The trans-vaginal scan may not be performed if you are a virgin, or you refuse.

[pic]

Picture: MRI image of multiple ‘cysts’, in a peripheral pattern, also known as the ‘string of pearls’ appearance.

[pic]

Picture: The appearance of a Poly Cystic Ovary under ultrasound.

What is the difference between Poly Cystic Ovaries and Poly Cystic Ovary Syndrome?

The appearance of Poly Cystic Ovaries, and Poly Cystic Ovary Syndrome, are two separate entities. A woman with the appearance of Poly Cystic Ovaries (PCO) may or may not have PCOS. Approximately 19-33% of the general female population2 may show PCO appearance on an ultrasound.

Approximately 6-8% (although I have read many reports at up to 10%) of the female population has PCOS3. There is some thought that PCO may develop into PCOS given the ‘right’ conditions (i.e. weight gain, or an increase in insulin levels), however, until further research is conducted, these two entities should be considered distinct from one another. However, the lifestyle changes and advice in this book are not only what is best for a women with PCOS to be well, but also for a human being to be well. Regardless of whether you have PCO or PCOS, following the advice in this book will improve your health.

It’s not just your ovaries


The name PCOS is somewhat misleading. It may lead you to believe this is an ovarian condition, but this is simply not the case. Your ovaries play an important role. However, PCOS is a ‘whole body’ endocrine condition, a systemic syndrome that affects the entire body. 


Two of the main drivers of PCOS: Insulin Resistance and Inflammation

Insulin resistance

One of the issues now known to lead to and aggravate PCOS is Insulin Resistance. Your body produces insulin to allow your cells to ‘take in’ glucose. When a person’s body cannot respond properly to the insulin, it produces excessive amounts − known as hyperinsulinemia. As hyperinsulinemia continues, Insulin Resistance results. The excess insulin causes the ovaries to swell and develop cysts, and stimulates secretion of excess amounts of androgen. These ‘male hormones’ affect regular ovulation, the menstrual cycle and cause the masculine characteristics associated with PCOS.

Implementing positive lifestyle changes will help you overcome Insulin Resistance. You can discover more about how to overcome insulin resistance in my book ‘Conquer Your PCOS Naturally.’

Inflammation

Inflammation is an underlying cause of dis-ease that is rarely discussed, let alone appropriately addressed. This is no different in women with PCOS, regardless of age. Women with PCOS have been found to have elevated markers of inflammation. Even before you begin to develop the telltale signs of PCOS, you may be suffering from chronic low grade inflammation affecting every part of your body.

Is there a cure?

“Why not adjust causes instead of treating effects?”

DD Palmer – Founder of modern day Chiropractic

The reality of the situation is this... you can take a variety of drugs to ‘treat’ each symptom, and then more to deal with the side effects. But, your body is not sick because of a lack of a drug. There is no miracle drug to cure PCOS. The best way to overcome PCOS sign and symptoms, and to naturally boost both your fertility and the chances of giving birth to your own healthy baby, is lifestyle change. One truth remains constant for all human beings − what you eat, how you move, what you think and your environment, have dramatic effects on your body, mind and soul. Now saying that, sometimes women with PCOS may need the help of assisted reproductive technique/s. The good news is, if you do need this help (and this should be after you have tried other less invasive avenues first), you are more likely to succeed in having a healthy live birth after following the changes recommended throughout this book.

As a sufferer of PCOS, it is necessary to re-evaluate each aspect of your life. You need to create an environment conducive to a healthy life. The good news is the best lifestyle for a woman with PCOS is simply the same as the best lifestyle for any human being. You need to remove deficiency and toxicity and attain purity and sufficiency. By making healthy changes, you not only significantly boost your fertility, reduce your risk of miscarriage and pregnancy and birth complications, you also reduce future risk to your future child and help to ensure you will be there to watch them grow up and maybe have babies of their own.

Why PCOS can adversely affect fertility

Many women with PCOS have less than nine periods per year. Some women have completely absent periods (“amenorrhea”). Without a regular period, conception is less likely. Women with PCOS may also have anovulatory cycles, which means they have a period, but they do not ovulate, or release and egg, mid cycle. Without the release of an egg, there is no chance of conception. PCOS is in fact the leading cause of anovulatory infertility.

Let’s take a look at the hormonal fluctuations in a healthy menstrual cycle:

[pic]

Picture Credit:

Now let’s take a look at some of the hormones important in PCOS:

High Levels of Luteinizing Hormone (LH)

Luteinizing Hormone helps in the final maturation of the egg, and the LH surge triggers ovulation. Women with PCOS typically have high levels of LH, but often don’t experience the all-important surge. “Inappropriately raised LH levels may have adverse effects on the developing oocyte (egg) or endometrium either directly, or indirectly by causing an elevation in testosterone and oestrogen levels.”[1]

High LH levels contribute to the lack of an egg being released from the ovary (anovulation). This sustained high level of LH is different from the “LH surge” that occurs just before ovulation, which serves to ‘push’ the egg through the ovarian wall. When eggs aren’t released for fertilization, infertility is unavoidable.

Abnormal LH to Follicle Stimulating Hormone (FSH) Ratio

An abnormal LH to Follicle Stimulating Hormone (FSH) ratio has been postulated as a factor in PCOS. Although some research suggests that examining this ratio is of limited use, and may be less of a factor than originally thought. FSH triggers a follicle to develop into a mature egg. A typical LH to FSH ratio is 1:1. Some health professionals consider ratios of 2:1 or 3:1 to indicate possible PCOS.

High Insulin Levels

Most women with PCOS have high insulin levels, and/or insulin resistance. Their body has trouble using the hormone insulin correctly, and so they produce more insulin to compensate. With increasing insulin levels, the cells effectiveness in responding to insulin is reduced. This can result in insulin resistance. Signs and symptoms of insulin resistance include:

• Weight gain, and difficulty losing weight

• Fatigue

• Foggy brain

• Skin tags

• Darkening of the skin (acanthosis nigricans)

• Diabetes

• Fatty liver

• Irregular periods

These high insulin levels increase the production of androgens (male hormones), which can also contribute to infertility. Signs and symptoms of androgen overproduction include:

• Acne

• Excessive hair growth

• Weight gain

• Problems with ovulation

Inflammation

Inflammation may be a factor in the development of PCOS. There is evidence that inflammation causes reduced insulin sensitivity, which can increase insulin levels, and subsequently androgen levels. This can cause anovulation and infertility. One 2004 study concluded that PCOS and inflammation were not necessarily correlated. This study compared “inflammatory markers”, substances found in the blood indicating inflammation to a control group. Research published in 2005 examining insulin resistance and inflammatory markers in obese and non-obese women with PCOS showed that all women with PCOS had elevated levels of inflammatory markers. Some suggest that weight and obesity may be the cause of the high levels of inflammatory markers and problems often associated with women that have PCOS, like heart dis-ease and diabetes. A 2012 study confirmed that the studies on inflammation and PCOS “do not consistently demonstrate a clinically relevant increase in the above mentioned [inflammatory] biomarkers.” More research is necessary.

Low Progesterone Levels

Low progesterone levels are common in women with PCOS. A 2004 study of 19 women with PCOS concluded that insulin resistance maybe responsible for low progesterone levels during the luteal phase (the second half of the menstrual cycle, from ovulation to the first day of the bleed).

Heredity

Genetics may play a role in the development of PCOS. Those with mothers and sisters with PCOS are more likely to develop it. There have been no specific genes, though, which have been isolated as a cause. However…

Epigenetics

Epigenetics is the study of how the environment affects the way a gene is expressed, i.e. whether it is switched on, or switched off. Think about the gene, for example, that causes the production of protein responsible for stopping the flow of blood from a cut. The gene that produces this protein is only ‘turned on’ when you have a cut.

Things such as your diet, stress, activity, sleep, medications, toxins, and more can alter the expression of a gene. Epigenetics are a critical factor in PCOS. These changes, which are not part of the DNA itself, can be then passed down for generations. A 2011 pilot study of primates suggests that excess exposure to male (“androgen”) hormones while in utero may predispose subjects to PCOS by changing the epigenome, Other research has shown that obesity in the mother can trigger insulin resistance in the baby growing in the womb.

More On PCOS and Fertility

PCOS:

- is the most common endocrine disorder affecting female fertility

- makes up 90-95% of women presenting to infertility clinics with anovulatory infertility (infertility due to the lack of ovulation)

- increases the miscarriage risk for women, with rates of between 30 - 50 percent in the first trimester.

- increases the risk of Ovarian Hyperstimulation Syndrome.

- And overweight/obesity often goes hand-in-hand. This can increase the risk of spontaneous abortion

- increases the risk of gestational diabetes, the birth of small-for-gestational-age babies

- Increases the risk of babies being born needing transfer to the neonatal intensive care unit.

- May increase the risk of pre-eclampsia in women with PCOS, particularly in those who are insulin resistant

- may reduce the success rates of assisted fertility techniques such as IVF

In women with PCOS, the hormones necessary for an egg to mature may not be sufficient. The follicles usually grow, but their growth may be arrested. In this case, ovulation does not occur. Instead the follicles retain fluid and may become cysts. The production of the hormone progesterone is then inhibited; as progesterone is made once the ‘hole’ left by the released egg becomes a temporary gland known as the corpus luteum. This then interferes with normal menstruation. While ovulation remains foundational in becoming pregnant, achieving a pregnancy is possible when you suffer from PCOS.

Other factors leading to infertility must first be ruled out before identifying PCOS as the causative factor. Other possible reasons for infertility are:

• Scarred ovaries or fallopian tubes

• Malfunction of the pituitary gland or the hypothalamus

• Premature menopause

• Unruptured follicular syndrome

• Abdominal dis-eases like colitis, and celiac

• Congenital defects (defects that are present at birth)

• Infections

• Endometriosis

• Abnormalities of the uterus, such as fibroids or polyps

• Abnormal cervical mucous

• Being overweight or underweight

• Tobacco and alcohol use

• Lead and radiation exposure

• Exposure to some pesticides

• Male factors

While 90-95 percent of women who attend infertility clinics do so due to anovulation, women with PCOS are not sterile. Many women with PCOS-related infertility can be assisted and do become pregnant. Some, however, do not. Women with PCOS remain at risk for pregnancy complications once they do become pregnant.

Possible Complications During Pregnancy

Women with PCOS appear to be at a higher risk of developing:

• Miscarriage

• Gestational diabetes

• Pregnancy-induced high blood pressure (preeclampsia)

• Premature delivery

Because pregnant women with PCOS are often at higher risk, and because many been prescribed medications for PCOS-related signs and symptoms (like high blood pressure and diabetes), they may require careful monitoring.

Reason for Increased Miscarriage Rate

The rate of miscarriages in women with PCOS are between 30 - 50 percent in the first trimester, and these same women also have a greater chance of suffering from gestational diabetes, high blood pressure and other pregnancy complications.

Miscarriages in women with PCOS can be attributed to several factors, including low progesterone and high LH levels.

Progesterone is a hormone that supports the menstrual cycle and pregnancy. Progesterone preserves the uterine lining, allowing the embryo to attach and receive nourishment as the placenta is formed. When healthy progesterone levels are not maintained in pregnancy, the uterine lining may shed, dispelling the embryo in the process. This results in a miscarriage.

Higher insulin levels, poor egg quality and the manner in which the egg attaches to the uterus may also play a role in miscarriages.

A significant increase in serum levels of LH was found in unexplained first trimester miscarriage groups.[2] As discussed above, women with PCOS often have higher LH levels.

Reason for Recurrent Miscarriage Rates

According to Wikipedia, “Habitual abortion, recurrent miscarriage or recurrent pregnancy loss (RPL) is the occurrence of three or more pregnancies that end in miscarriage of the fetus, usually before 20 weeks of gestation.” It is not uncommon for women with PCOS to experience recurrent miscarriages, and often there is no explanation, or advice for future pregnancies, given. Let’s have a look at some studies that may help shed some light on this heart-breaking problem.

“A total of 31 women suffering from habitual abortion have been examined when not pregnant. Both increased and normal prolactin levels were recorded. In hyperprolactinemia (high levels of the hormone, prolactin) the level of the luteinizing hormone (LH) secretion was high and no ovulatory peaks were detected (LH peaks just prior to, and brings about, ovulation), whereas in normal prolactin secretion the level of LH was moderately increased during all phases of the menstrual cycle. Sex steroid secretion was disturbed.”[3] What this means is that recurrent miscarriage may be related to the hormonal imbalances in a women with PCOS, particularly LH, prolactin, and the sex hormones like progesterone and/or testosterone.

“Although women with recurrent miscarriage and delayed endometrium had significantly lower progesterone levels than those with normal endometrial development, only 8/24 had mid-luteal progesterone levels below 30 nmol/L. Endocrinological and endometrial abnormalities are present in about a quarter of women with unexplained recurrent miscarriage.”[4] This indicates that one cause of miscarriage in women with PCOS may be low progesterone levels, but these lower levels may not be significantly outside of ‘normal limits.’

In a study on recurrent miscarriage, 81% of recurrent miscarriage and 10% control subjects had polycystic ovaries. “The 81% of women with recurrent miscarriage had either raised urinary LH excretion or a premature LH surge (which was considerably different to the control subjects). Total LH excretion during the cycle and mean follicular phase serum testosterone was significantly greater with early pregnancy loss than in the control group, the difference in LH being greatest in the early luteal phase. Urinary oestrogen was raised in the early luteal phase of the cycle in the group with early miscarriage. Inappropriately raised LH levels may have adverse effects on the developing oocyte or endometrium either directly, or indirectly by causing an elevation in testosterone and estrogen levels.”[5]

“FSH, estradiol (one form of oestrogen), LH, prolactin and DHEAS concentrations were significantly higher in the unexplained recurrent miscarriage group than in the explained recurrent miscarriage group, although serum concentrations of all hormones were within the normal range.”[6] This means that the levels of the hormones adversely affecting the health of your pregnancy may be raised, but not enough that they will be detected as being causative.

What if You Need Some Assistance to Become a Mother?

Your doctor will introduce you to the assisted reproductive technique/s most suitable for your current circumstances. Common medical fertility treatments for women with PCOS include:

• Clomiphene: Clomiphene is a medication that is a regularly recommended treatment for infertility in women with PCOS. Some studies show that using clomiphene increases the chance of women getting pregnant by at least 40 percent. A study of more than 500 infertile women, however, published in 2008, showed that treatment with clomiphene was no more effective than natural treatments for infertility, and in fact it remained slightly less effective than natural treatments. More research is needed. A suitable trial of clomiphene is three to four cycles, and most health experts don’t suggest using clomiphene for more than six cycles. Using clomiphene increases the likelihood of women having multiple simultaneous pregnancies, such as twins or triplets. It may also lead to birth defects if continued after conception.[7]

• Metformin: Although not currently approved by the FDA for treatment of PCOS-related infertility, some health care providers recommend metformin to treat infertility associated with PCOS. Metformin is an insulin-sensitizing drug currently used to treat diabetes. Treatment with metformin successfully initiated ovulation in recent studies. Some experts will use a combination of clomiphene and metformin. This combination appears to slightly improve the chance of pregnancy over treatment with either medication alone, and using a combination reduces the number of multiple pregnancies when compared to using clomiphene alone. When taking Metformin, a vitamin B complex should be included, as this insulin sensitising agent has been shown to “deplete the essential B vitamins, folic acid and B12, which can increase inflammation.”[8]

• Gonadotropins: Gonadotropins are hormones often used in low doses to successfully treat PCOS-related infertility when clomiphene and metformin have not been effective in procuring a pregnancy.

• In Vitro Maturation (IVM) and In Vitro Fertilization (IVF): With in vitro maturation, a health expert removes immature eggs from a woman early in her cycle. These eggs are left to mature in a lab setting using hormones (gonadotropins). With in vitro fertilization, medication is used to stimulate follicle growth prior to harvesting the eggs. Once matured, the eggs are fertilized and then returned to the uterus. Rates of pregnancies resulting from IVM remain low, and the risk of miscarriage is high. For this reason, this procedure is usually reserved for those who have unsuccessfully been treated with medications. Rates of pregnancy with IVF are higher. A recent study of 46 asymptomatic women who had polycystic ovaries on ultrasound who had up to three cycles of IVF treatments had an 82 percent higher rate of achieving a live birth than women with normal ovaries.

Whether you are at the start of your fertility path, or requiring assisted fertility treatment, the good news is that you can take significant steps to boost the success of your fertility naturally, or with treatment, and you can encourage a healthy, full-term pregnancy with a safe birth.

Fertility Boosting Tips Include:

• Stress Management: High levels of stress increase the levels of the hormone cortisol, and may affect your weight, your ability to conceive and your ability to maintain a pregnancy.

Recently, an article in Forbes discussed the role significant stress and emotional trauma can cause in PCOS, infertility and in miscarriage. You can read this article by clicking here[9]

One study noted “optimum benefit to the patients might involve not only provision of a good clinic ambiance and pharmacological preparations, but also relaxation therapies such as Autogenic Training, which significantly lowered psychological and biochemical stress marker scores.”[10]

Sanders and Bruce found that “psychosocial stress influences fertility in females”[11]

And a study by Cwikel, Gidron & Sheiner stated “Psychological factors such as depression, state-anxiety, and stress-induced changes in heart rate and cortisol are predictive of a decreased probability of achieving a viable pregnancy.”[12]

Infertility, itself, can be very stressful. It has been shown that stress in response to infertility can lead to depression and can reduce the success of fertility treatment/s.

A study in the Journal of Fertility & Sterility indicated, that “infertility-related stress has direct and indirect effects on treatment outcome.”[13] Another found that “psychological stress may affect the outcome of IVF treatment”[14], that there may be a “complex relationship between psychosocial stress and outcome after IVF/ICSI”[15] and that “treatment and therapy to reduce stress, and in so doing enhance fertility”[16] is a worthwhile exercise.

Chronic stress can cause depression, changes your sleep habits, cause mood swings, affect your relationship, reduce your immune and gut function, cause insulin resistance, adversely affect your libido, cloud your brain function…

All making becoming – and remaining - pregnant more difficult.

Effectively managing stress is crucial for your—and your baby’s—health. Exercise, yoga, tai chi, meditation, deep breathing, surrounding yourself with beauty and safety, massage and Chiropractic care can help to reduce your stress levels. Whenever you feel your heart racing and your stress levels rising, learn to pause, take a few deep breaths and slow down. Other stress management strategies include:

1. Talk to your partner or spouse

2. See a counselor

3. Realize you are not alone by joining a support group or online forum

4. Inform yourself about infertility, the challenges you face, and the steps you can take to help yourself.

5. Understand that your feelings are normal

6. Learn stress reduction techniques such as meditation, yoga and affirmations

7. Avoiding consuming too much caffeine

8. Exercise regularly (great physically, mentally and emotionally)

9. Arm yourself about your cause/s of infertility, and your treatment options

10. Ensure you receive enough sleep

11. Supplement with, or include foods rich in, Vitamin B6, Zinc and omega 3 fatty acids

12. Enjoy sex for fun – not reproduction

• Fertility Friendly Foods and Nutrients: Food can do amazing things to help boost your fertility, regulate your monthly cycle, balance your hormones, and help you maintain a healthy weight or lose weight, if needed. By regularly including certain foods in your food plan, you can bolster the success of any fertility plan or treatment and reduce the risk of miscarriage. It’s best to acquire your vitamins and nutrients through a wide variety of health, natural foods. Supplementing is also a great idea as this can improve your fertility, and ensure you receive the nutrients critical to a healthy pregnancy and a healthy baby. If you do wish to supplement with a vitamin or mineral, always check with a health care professional qualified in this area first.

1. Omega-3 fatty acid rich fish: Many women with PCOS have been shown to have higher levels of inflammatory markers, and insulin resistance. Supplementation with quality omega 3 fatty acids has been proven to reduce inflammation, improve insulin sensitivity, and they may help to lower the risk of premature birth. Omega 3s also help to increase the length of pregnancy, and improve the birth weight by promoting fetal growth with increased blood flow. Results from research studies also show that Omega 3s help to reduce preeclampsia (high blood pressure during pregnancy) and depression after the birth of your child.

Omega 3 fatty acids can be found in cold water, oily fish like salmon, tuna, mahi-mahi, mackerel and sardines. To reduce risks associated with potential higher mercury levels found in some of these fish, limit your intake to about 12 ounces or 340 grams per week. Other good sources of omega 3 fatty acids include nuts, free-range eggs and healthy plant oils such as flaxseed oil.

2. Nuts: Include a handful of nuts each day. Almonds, walnuts, Brazil nuts, as well as others. Nuts offer a great source of omega-3 fatty acids, protein, B vitamins and fertility-boosting minerals such as copper, manganese, magnesium and potassium.

3. Gluten-free whole grains: Small amounts of gluten-free oats, brown rice and other gluten-free whole grains can improve fertility in both women and men. They are rich in the vitamins and minerals that support ovulation, and they help carry the sperm safely to the uterus. In addition, they provide folic acid, which is critical for your baby’s growth and development.

4. Lean proteins: Free-range eggs, nuts, seeds and meats such as fish are beneficial for both eggs and sperm quality. These fantastic foods can be enjoyed in palm-sized amounts two or three times per day. They’re also good for building muscle, reducing hunger cravings and helping you to feel fuller, for longer. This has been shown to reduce the amount of foods eaten, and aid in any weight loss efforts.

5. Variety: Remember to eat a “rainbow” of foods. The more colourful the food on your plate, the better. Green spinach, red peppers, yellow tomatoes, pink salmon, black beans. Colour rich foods contain higher amounts of antioxidants, which are critical for fertility. And with colour, you can create meals that look as good as they taste!

• Sound Sleep and Good Sleep Hygiene: Everyone feels better after a good night’s sleep, but if worry about conceiving or miscarriage is keeping you up at night, you may be suffering from sleep deprivation. One study showed women who slept 6 hours or less per night weighed 6-8kg more after a period of years when compared to women who slept eight hours per night, independent of other factors. Reduced sleep has been also shown to reduce insulin sensitivity. As insulin resistance is a main driver of PCOS, and as both it and obesity have profound adverse effects on fertility, ensuring enough sleep remains critical to both conception and a healthy pregnancy.

To maintain a good sleep pattern, make sure your bedroom is only used for sleeping and sex. Keep the bedroom electronic -TV, computer and mobile phone - free. Ensure that it is completely dark at night. Try to find a sleep schedule that works for you consistently, so that your sleep and wake times remain the same. You can get my secret sleep report for free at

• Exercise: Being active enhances fertility, stress reduction and weight loss. It also helps to keep you in good shape so you can better support a pregnancy and a safe birth. You can begin while trying to conceive, and continue to exercise, with your health care professionals approval, during your pregnancy. Walking is one of the best low-impact, do-anywhere exercises. Walk briskly for 30 to 60 minutes a day to increase your heart rate and metabolism. Other great options are yoga, strength training, gardening, dance classes, biking and swimming. Find something you enjoy and that you can stick with for the long term. But beware: too much exercise can literally reduce you fertility, particularly if you are of normal weight or are underweight. A review of multiple studies on exercise and PCOS noted also that exercise improved insulin sensitivity, a primary factor in fertility. Experts recommend a minimum of ninety minutes per week of moderate exercise in order to enhance reproductive health in women with PCOS.

• Optimal Thyroid Health: Your thyroid is a small gland at the base of your neck that can have a huge impact on how you feel. It is responsible for releasing hormones that govern your metabolism and energy level and it’s involved in your reproductive functions, affecting menstruation, ovulation and fertility. When you’re feeling sluggish, so are your eggs, which is one reason why optimal thyroid health is so important. Poor thyroid function can reduce Follicle Stimulating Hormone (FSH) levels, causing incomplete egg maturation and possible anovulation. An underactive thyroid can lead to infrequent or erratic periods while an overactive thyroid can increase the risk of miscarriage, birth defects and premature delivery. Get tested to ensure your thyroid is operating at a healthy level. The most common Thyroid test is Thyroid Stimulating Hormone (TSH). Although many pathology laboratories suggest between 0.5 – 4 or 5 mIU/L is ‘within normal limits’, the latest research suggests a more accurate reference range for health should be between 1 - 2/2.5 mIU/L. Be certain to consume an optimal amount of iodine from foods such as seaweed, oysters, scallops, radishes, onions and if you’re feeling adventurous sea vegetables (150 micrograms if you’re not pregnant; 250 if you are). Also enjoy lean protein, fruits and veggies, nuts and seeds, and filtered water to support thyroid health.

• Temperature Tracking: Since ovulation is a silent process for most women, tracking your basal body temperature (your body temperature when you are completely at rest) can give you a strong indication of ovulation, which is the most fertile part of your cycle. Using a fertility thermometer, you’ll be able to detect probable ovulation by noting an increase in body temperature--as much as one degree Fahrenheit. Start taking your temperature on the first day of your cycle (the first day of your menstrual bleed) in the morning before you even get out of bed. Repeat throughout your cycle and note any changes that indicate ovulation. For best results, track basal body temperature over three or four months. You can download temperature tracking charts and instructions at Ovulation

* Note: it is important to use both temperature tracking and cervical mucous in determining probable ovulation.

• Environmental Detoxification: A growing number of environmental pollutants can adversely affect your fertility, conception and pregnancy, so it’s important to pay attention to and eliminate as many of these as possible. Remove chemical cleaners, harmful cosmetics and other household items that contain mercury, lead, PCBs, parabens and pthlates from your environment. Focus on eating organic where you can, non-processed foods, drinking filtered water not stored in plastic containers, and using natural cosmetic products, which are free from harmful ingredients.

• Inflammation Reduction: Many women with PCOS have constant low-grade inflammation, and this may reduce fertility. These various inflammatory markers can suppress the reproduction system, and this may lead to lower quality eggs. To reduce inflammation, eat from the wide variety of fertility foods, eliminate gluten containing foods, engage in regular stress management activities, include a quality fish oil, reduce/eliminate alcohol, cigarettes, unnecessary medications and all illicit drugs, and keep your body moving.

• Ideal Weight Management: Whether you are trying to boost ovulation and fertility prior to conception, or trying to maintain a healthy weight to reduce pregnancy complications and promote a smooth delivery and healthy child, simply put, a healthy weight can lead to a healthier you and a healthier child. Weight loss, when appropriate, has consistently been shown to boost fertility, and the good news is that eating many of the fertility foods can help you both lose weight and maintain that weight. During your pregnancy, however, a weight loss regimen is not recommended. But do focus on health. Enjoy a variety of nutritious, plant-based, colourful foods to support you and your baby during this time.

Many women with PCOS are overweight or obese. A small percentage of women with PCOS have below-average weights. Either extreme can negatively impact on fertility. Research data confirms that both obesity and underweight combined, accounts for twelve percent of primary infertility. Even more surprising? The twelve percent is split down the middle, with six percent of primary infertility due to obesity, and six percent to being underweight. The good news? More than seventy percent of women who are infertile as a result of inappropriate body weight conceive spontaneously with appropriate weight loss or gain.

• Other Professionals

1. Acupuncture: A 2011 review of the literature on infertility and acupuncture suggests that acupuncture may help boost fertility, for males and females. It may help initiate ovulation via the nervous and endocrine systems, and by improving ovarian blood flow and metabolism. By possibly increasing uterine blood flow, reducing mobility of the uterus and by quelling anxiety, stress and depression, acupuncture may also improve the outcome of IVF treatments. It may also help improve male fertility, although the exact mechanism behind this is unknown. Some studies have successfully added traditional Chinese medicine to their acupuncture therapy to boost fertility.

2. Chiropractic Care: A small 2006 study indicated success in initiating ovulation with an applied kinesthetic approach called Neuro Emotional Technique. This techniques works to reduce toxins from the body that may be inhibiting ovulation.

Pre-Conception Plan

Preparing for pregnancy will increase the chances of ovulation, conception, and a successful and healthy pregnancy and birth. To help yourself and your future baby, try the following:

a. Start taking preconception multi-vitamins

b. Engage in exercise at least 3 times per week

c. Eat the recommended 5-9 servings of fruits and vegetables each day

d. Include calcium rich foods such as figs (dried), egg yolk, cinnamon (ground), tahini, duck meat, almonds, salmon, and spinach

e. Reduce/eliminate your consumption of processed foods

f. Re-evaluate your finances to reduce financial stress while on maternity leave

g. Think positively, and manage your stress levels

h. Consider eating organic foods, especially those foods known to be sprayed with pesticides: apples, celery, sweet bell peppers, peaches, strawberries, imported nectarines, grapes, spinach, cucumbers, lettuce, domestic blueberries and potatoes

i. Lose any additional weight, prior to trying to conceive

j. Detoxify your system by abstaining from caffeine, nicotine, refined sugar and alcohol. The detoxification rate and fertility appear to be directly proportional to each other.

k. Improve insulin sensitivity. Exercise (particularly interval training), fish oil, magnesium, chromium, stress reduction and adequate sleep help enormously.

[pic]

Congratulations! What to Do Now That You are Pregnant

Congratulations on your pregnancy and surpassing the conception challenges of PCOS! The next several months will provide a wonderful bonding opportunity with you and your baby. It will also bring a share of ongoing changes and possible challenges.

Your pregnancy food plan (other than having an increased calorie and nutrient requirement), stress management, movement and sleep plan can remain much the same – eat well, drink adequate filtered water, move regularly (talk to your health care professional before doing any high-impact exercise such as running), manage your stress through yoga, meditation and breathing, and try to ensure at least eight hours of sleep each night. You are not only taking care of yourself, you’re taking care of your baby as well, so it’s extra important to maintain a very healthy and balanced lifestyle.

Ask your doctor if there are any tests that need to be done in relation to your PCOS and pregnancy, and try to enjoy your pregnancy as much as possible.

What Can You Do to Reduce Your Risk of Miscarriage and Pregnancy Complications?

Women with PCOS remain 45 percent more likely to miscarry, although the exact cause may remain unknown. Obesity, a condition experienced by many women with PCOS, remains an independent risk factor for miscarriage. Regular exercise - 30 minutes on most days, reduces obesity and improves insulin sensitivity to improve your chances of carrying your baby healthily to term and through the birthing process.

It has been postulated that women with PCOS often miscarry because of higher luteinizing hormone levels, and/or higher insulin and glucose levels. These hormonal changes are common in women with PCOS. Elevated levels of insulin or glucose may impair egg implantation or impede embryonic development. Insulin resistance may also reduce egg quality, leading to miscarriage.

Hyperinsulinemia is an independent risk factor for early pregnancy loss (EPL) and decreases the levels of two major endometrial proteins (glycodelin and IGF binding protein-1 (IGFBP-1)) – these are proteins that are important for the health of the lining of the womb. During the first trimester, the concentrations of these two proteins are markedly reduced in PCOS. This suggests the lining of the uterus around the time of implantation and in early pregnancy is adversely altered, and may be responsible for EPL in PCOS.[17] Improving insulin sensitivity, as we talk about in this report, may therefore reduce miscarriage.

A low-glycaemic index, low glycaemic load food plan including mono-unsaturated fatty acids has been shown to reduce inflammation and plasminogen activator inhibitor-1 (PAI-1 levels), improving your chance of carrying your baby to full term. High levels of PAI-1 have independently been associated with recurrent miscarriages in women with PCOS. Elevated PAI-1 levels remain a core feature of insulin resistance syndrome (IRS). Several reports also indicate that inflammation can initiate insulin insensitivity.

Taking the medication metformin may reduce your chances of miscarriage. In one study, women with PCOS who took metformin throughout their pregnancies had a nine percent miscarriage rate versus a 45 percent rate of those who did not take metformin. Taking metformin during pregnancy, however, remains an area of controversy. As with any treatment during pregnancy, you should weigh the benefits and risks with your physician in order to make the best decision for you and your baby. If you choose to take metformin, ensure you include a B-vitamin complex to reduce the higher levels of homocysteine (an inflammatory marker) that may result.

If you have low progesterone levels in the luteal phase, taking medications like clomiphene or receiving FSH or LH/FSH injections may help.

Progesterone is often low in women with PCOS, and if the progesterone levels drops and the lining of the uterus is shed, so is the fertilized egg. Progesterone is known as the ‘pregnancy hormone’. It is critical in maintaining a pregnancy until the placenta takes over progesterone production in the second trimester. Progesterone is a ‘heating hormone’. In the luteal phase (the second half) of the menstrual cycle, when progesterone levels are higher, you will see a higher reading as taken by a fertility thermometer (these thermometers are ideal as they are more accurate than an every day thermometer). One way to track your hormonal changes is to track your basal temperature before, and throughout, a pregnancy. If your temperature drops during pregnancy, this may indicate that your progesterone level has dropped. This may indicate an impending miscarriage. By boosting progesterone levels when this drop occurs, you may be able to save the pregnancy. Some women with PCOS have been treated through out

Lowering high blood sugar levels will also reduce the production of excessive androgens, which may help.

Pre-eclampsia, a syndrome experienced by some pregnant women, characterized by high blood pressure after the 20th week of pregnancy, is more likely to occur in women with PCOS. Pre-eclampsia can lead to kidney, brain and liver problems for the mother, and it may lead to a more serious condition—eclampsia. Eclampsia also carries the risk of seizures and coma. Regular blood pressure monitoring will identify potentially dangerous fluctuations that may lead to pre-eclampsia. Many pre-term births from women with PCOS are attributable to the mother having pre-eclampsia. Pre-term births put the infant at risk for complications associated with having a low birth weight and underdeveloped lungs.

The risk of pre-eclampsia and eclampsia can be reduced by giving Magnesium Sulphate; which also probably reduces the risk of maternal death.[18],[19]

Fish-oil supplementation (containing 2·7 g n-3 fatty acids) in the third trimester seems to prolong pregnancy by preventing early delivery.[20]

To prevent complications associated with high glucose levels and high blood pressure, women with PCOS should have their blood pressure and glucose levels monitored frequently in order to identify and address any potential problems early on.

How to Improve Your Chances of Breast Feeding

PCOS may reduce a woman’s ability to breastfeed. Some research points to inadequate glandular tissue development in the breast in women with PCOS, due to chronic low progesterone levels. Higher androgen (‘male’ hormone) levels may also interfere with prolactin receptors. Prolactin is a hormone that is essential for breast tissue development and milk production.

Many women with PCOS have no breastfeeding challenges, and breastfeeding may actually improve glucose tolerance a short time after giving birth. Increasing the frequency of feedings and/or pumping breast milk at regular intervals may help improve the breast milk supply. Some new moms have found metformin and herbal remedies that improve milk supply. Always check with your qualified health care professional before taking herbal supplements, or medications, while breastfeeding. There are some that can be passed through your mil supply to your feeding baby.

Breastfeeding is by far the best option for your baby, where you can. Perhaps the best advice is just to relax and enjoy the bonding time with your new baby. Ask for support from your partner, and consider reaching out to a supportive professional group, like La Lache League. A lactation consultant can be incredibly beneficial here.

How To Protect Your Future Child

When the womb is bathed in an insulin resistance environment, the growing baby is more likely to develop insulin resistance later in life, through epigenetic change. This increases their risk of developing the health challenges that come with this like PCOS, heart disease, and diabetes. If the baby is a girl, her eggs are developing in her ovaries, as she develops in you, and so this epigenetic change can potentially affect a second generation as well – your grandchildren. By losing weight – where necessary, improving your insulin sensitivity prior to conception, and making the right lifestyle changes during pregnancy, you can reduce this risk significantly.

Environmental chemicals that a woman is exposed to during pregnancy can also be passed on for generations. Researchers studied rodents that were exposed to various chemical found in fungicides, pesticides and plastics. Study results revealed that exposure of one generation to the toxins affected up to the two generations following. The offspring had fewer egg follicles in their ovaries compared to controls, indicating a reduced pool of available eggs. Both generations also had an increased number of ovarian cysts compared to controls. These epigenetic changes occurred because the chemicals affect how the DNA is expressed in the developing fetus. By completing a healthy, professionally supervised detoxification program prior to your preconception plan, you can also reduce this risk.

So there you have it.

The tips and tools for making your baby dream a reality.

PCOS is a syndrome, but not a sentence. While PCOS may make becoming pregnant, and carrying and giving birth to a healthy baby challenging, by no means should it defeat you. Women with PCOS lead happy and healthy lives, with infants and toddlers to boot.

The great news? Many factors associated with PCOS can be significantly changed for the better by a modified, improved lifestyle. These changes are not only effective for reducing symptoms of illnesses related to PCOS, like obesity, diabetes, high blood pressure and heart disease, they’re great for your general health.

That means that you are more in control than you think.

[pic]

Yours In Baby-Making Health!

[pic]

Dr. Rebecca Harwin

‘The PCOS Expert’

P.S. I really value feedback, and I love to share PCOS success stories! I’d love to hear your stories about motherhood, and your journey from PCOS to pregnancy and beyond. Feel free to email me at info@

P.P.S. Here are some great PCOS tools to help you in your impending success x

PCOS Tools And Resources

Great PCOS Resources:

Great resources that help you to correctly address all the areas that may be contributing to your fertility, and PCOS, woes are critical. Most of the advice contained within the pages of this book, and the advice that is helpful for women with PCOS to live healthy, symptom free lives, will not be found in the offices of mainstream health. Here is a list of resources to help you succeed.

Books & Special Reports:

1) ‘Conquer Your PCOS Naturally’ Chock full of ideas, tips and information to help you Conquer Your PCOS. ‘Conquer Your PCOS Naturally’ is a “life changing” cutting edge book that lays out the steps, the strategies and the stuff you really need to know to succeed. To discover more, click here now. You can also grab this book from your local bookstore within Australia, or from or

2) ‘11 Tips For Successful Weight Loss’ Losing weight can be a critical step to overcoming your infertility and creating a health, happy baby. Head to to get this special report for free.

3) ‘The Secret Sleep Report’ When you don’t sleep well, this can cause insulin resistance which has been proven to cause insulin resistance (which can lead to weight gain and infertility), lower your sex drive and more. Click to now to get this special report for free.

Courses:

‘Conquer Your PCOS – The 12 Week Action Plan’ This advanced course is for those of you really looking to grab the PCOS bull by the horns, so to speak. If you are ready to take the steps necessary to help you succeed over your PCOS, to identify and address each aspect of your syndrome, and to significantly boost your fertility, lose weight and more, this course is for you. Go to to find out more.

Consultation:

Personalized one-on-one consultations. If you need tailored help by a leading expert in the field of natural PCOS treatments, head to Appointments can be In Clinic, or via our Skype Clinic to allow women from the far reaches of our globe to get the help they need.

Other resources:

1) Facebook. For daily updates, articles, the latest PCOS advice, research, recipes and support, ‘like’ ConquerYourPCOS

2) Twitter. If Twitter is more your scene, head to for daily updates, articles, research, recipes, tips and more.

3) Blog. Twice weekly articles covering everything PCOS, as written by me, Dr. Rebecca Harwin.

4) Ovulation Charting. Charting your cycle can give you great insight in to what is happening in your body. Head to Ovulation for free copies of the chart and charting instructions. Or head to for a great online version.

5) Grab the first three chapters of ‘Conquer Your PCOS Naturally’ for free at

Your Notes:

Resources and Endnotes:

Abnormal body weight: A preventable cause for infertility. (n.d.). Retrieved from

Balbis, P., Pollard, H., & Monti, D. (2006). Resolution of anovulation infertility using neuro emotional technique: a report of 3 cases. Journal of chiropractic medicine, 5(1), 13-21. doi: 10.1016/S0899-3467(07)60128-1

Bjercke, S., Dale, P.O., Tanbo, T., Storeng, R., Ertzeid, G., Abyhol, T. (2002) Impact of Insulin Resistance on Pregnancy Complications and Outcome in Women with Polycystic Ovary Syndrome. Gynecol Obstet Invest; 54:94–98

Boomsma, C. M., Eijkemans, M. J., Hughes, E. G., Visser, G. H., Fauser, B. C., & Maklon, N. S. (2006). A meta-analysis of pregnancy outcomes in women with polycystic ovary syndrome. Human reproduction update, 12(6), 673-83. Retrieved from

Brinsden, P.R., Wada, I., Tan, S.L., Balen, A., Jacobs, H.S. (1995). Diagnosis, prevention and management of ovarian hyperstimulation syndrome. BJOG 102(10), 767-772.

Campbell, H. (2012, June 19). 2012 dirty dozen: The 12 most contaminated foods. Retrieved from nated_foods-91251

Cho, L. W., Javaqopal, V., Kilpatrick, E. S., Holding, S., & Atkin, S. L. (2006). The lh/fsh has little use in diagnosing polycystic ovarian syndrome. Ann clin biochem, 43(Pt 3), 217-9. Retrieved from

Common treatment for infertility ineffective: Study. (2008). Retrieved from

Defining PCOS. (n.d.). Retrieved from

Dhindsa, G., & Bhatia, R. (2004). Insulin resistance, insulin sensitization and inflammation in polycystic ovarian syndrome. Journal of postgraduate medicine, 50(2), 140-144.

Duleba, A. J., & Dokras, A. (2012). Is PCOS an inflammatory process? Fertility and Sterility, 97(1), 7-12. Retrieved from

Engmann, L., Maconochie, N., Sladkevecius, P., Bekir, J., Campbell, S., & Lin Tan, S. (1999). The outcome of in-vitro fertilization treatment in women with sonographic evidence of polycystic ovarian morphology. Human reproduction, 14(1), 167-71. doi: 10.1093/humrep/14.1.167

Epigenomics. (n.d.). Retrieved from

Gallenberg, M. M. (n.d.). For women, is there any connection between hypothyroidism and infertility? Retrieved from and-infertility/AN01436

Harrison, C., Lombard, C., Moran, L., Teede, H., &, (2010). Exercise therapy in polycystic ovary syndrome: A systematic review. Human reproduction update, 17(2), 171-83. doi: 10.1093/humupd/dmq045

Homburg, R., Pregnancy complications in PCOS. Best Practice & Research Clinical Endocrinology & Metabolism. Volume 20, Issue 2, June 2006, Pages 281–292

Huang, D. M., Huang, G. Y., Lu, F. E., Stefan, D., Andreas, N., & Robert, G. (2011). Acupuncture for infertility: is it an effective therapy? Chinese journal of integrative medicine, 17(5), 386-95. Retrieved from

Inflammation, insulin resistance and PCOS. (2007, December). Retrieved from

Jensen, L., Sloth, B., Krogg-Mikkelsen, I., Krogg-Mikkelsen, I., Krogg-Mikkelsen, I., Krogg-Mikkelsen, I., Flint, A. & Raben, A. (2008). A low glycemic index diet reduces plasma plasminogen activator inhibitor-1 activity, but not tissue inhibitor of proteinases-1 or plasminogen activator inhibitor-1 protein, in overweight women. American journal of clinical nutrition, 87(1), 97-105.

Juhan-Vague, I., Alessi, M. C., Mavri, A., & Morange, P. E. (2003). Inflammation, obesity, insulin resistance .Journal of thrombosis and haemostasis, 1(7), 1575- 79.

Lopez-Segura, F., Velasco, F., Lopez-Miranda, J., Castro, P., Lopez-Pedrera, R., Blanco, A., Jiminez-Pereperez, J., & Torres, A., Ordovas JM, Pérez-Jiménez F. (1996). Monounsaturated fatty acid-enriched diet decreases plasma plasminogen activator inhibitor type 1.Atherosclerosis, thrombosis and vascular biology, 16(1), 82-8. Retrieved from

Marasco, L. (2005, April-May). Polycystic ovary syndrome. Retrieved from

Meenakumari, K. J., Aqaarwal, S., Krishna, A., & Pandey, L. K. (2004). Effects of metformin treatment on luteal phase progesterone concentration in polycystic ovarian syndrome. Brazilian journal of medical and biological research, 37(11), 1637-44. Retrieved from

Moderate exercise boosts fertility, study says. (2012, March 21). Huffpost Daily Living. Retrieved from boosts-fertility_n_1354796.html

Omega 3 fatty acids. (n.d.). Retrieved from 3-000316.htm

Patel, S. R., Malhotra, A., White, D., Gottlieb, D., & Hu, F. (2006). Association between reduced sleep and weight gain in women. American journal of epidemiology, 164(10), 947-54. doi: 10.1093/aje/kwj280

Patient fact sheet: Stress and infertility. (n.d.). Retrieved from

Polycystic ovarian syndrome FAQ. (n.d.). Retrieved from

Reversing infertility with sleep apnea treatment. (2011). Retrieved from

Saldeen, P., & Saldeen, T. (2004). Women and omega 3 fatty acids. Obstetrical and gynecological survey, 59(10), 722-30.

Understanding ovulation. (n.d.). Retrieved from

U.S. Department of Health and Human Services, National Institute of Child Health and Human Development. (2008). Beyond infertility: PCOS (08-5863). Retrieved from National Institute of Health website:

U.S. Department of Health and Human Services, Office on Women's Health. (n.d.). Poly cystic ovary syndrome (PCOS) fact sheet. Retrieved from website: ovary-syndrome.pdf

Wang, J.X., Davies, M.J., Norman, R.J. Polycystic ovarian syndrome and the risk of spontaneous abortion following assisted reproductive technology treatment. Hum. Reprod. (2001) 16 (12): 2606-2609.

What causes female infertility? (n.d.). Retrieved from Ways of Making Babies/Causefem.htm

Xu N, Kwon S, Abbott DH, Geller DH, Dumesic DA, et al. (2011) Epigenetic Mechanism Underlying the Development of Polycystic Ovary Syndrome (PCOS)-Like Phenotypes in Prenatally Androgenized Rhesus Monkeys. PLoS ONE 6(11): e27286. doi:10.1371/journal.pone.0027286

-----------------------

[1]

[2]

[3]

[4]

[5]

[6]

[7]

[8] Wulffele MG, Kooy A, Lehert P, Bets D, Ogterop JC, Borger Van Der Burg B, Donker AJ, Stehouwer CD, ‘Effects of Short-term Treatment with Metformin on Serum Concentrations of Homocysteine, Folate and Vitamin B1[pic][9]+3Q]‰›Ÿ²¶¸ìÝ˹˹§•?o[C12 in Type 2 Diabetes Mellitus: a Randomised, Placebo- controlled Trial’, Journal of Internal Medicine, 254(5), November 2003, p455-p463

[10]

[11]

[12]

[13] (04)00257-X/abstract

[14]

[15]

[16]

[17]

[18]

[19]

[20]

[21]

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download