Tools to Increase Success Rates of IVF with PCOS

Polycystic ovary syndrome (PCOS) is the most common cause of infertility in females. The hormonal imbalances experienced by women with PCOS prevent ovulation from occurring at all. Without ovulation, pregnancy cannot occur without the use of fertility treatments. Others experience irregular menstrual cycles, which makes it challenging to know when ovulation is occurring and when the woman is most fertile.

There are a variety of fertility treatment options, but those who struggle with fertility often end up pursuing in vitro fertilization.

20 Quick and Easy Ideas for PCOS-Friendly Snacks

If you have polycystic ovary syndrome (PCOS), you likely have at least some degree of insulin resistance that is driving your PCOS symptoms. Nutrition and lifestyle changes can be highly effective at improving insulin sensitivity, which will also improve PCOS symptoms like acne, irregular periods, excessive facial and body hair, hair thinning, and weight gain.

Many of the snacks we've often been told are healthy (a piece of fruit, a granola bar, a handful of crackers, or low-fat yogurt with added sugars) are actually not that great for women with PCOS. All of them are "naked carbs," carbs eaten on their own, which will cause blood sugar spikes and worsen insulin resistance. They will also lead to blood sugar crashes a couple of hours later, and this low blood sugar will tell your brain to eat some more to bring your blood sugar levels back up. This blood sugar rollercoaster often leads to eating more food than you actually need.

So let's talk about what makes up a good snack!

What Are the Best Takeout Options for Females with PCOS?

I’m currently working on a nutrition plan for a one-on-one PCOS nutrition and wellness client who is a busy MBA student. She lives on campus in a dorm room with limited cooking options and is often just short on time. In addition to providing her with personalized meal plans, I’m providing her with good options for when she just needs to grab something quickly or when she wants to meet up with friends for a quick lunch.

I realized that this would be useful information to share more broadly, so I decided to write up the options here as well. I hope you find this information helpful! If you’ve got a favorite PCOS-friendly option that I’ve missed, please include it in the comments below!

I also want to note that while I try to eat PCOS-friendly foods most of the time, about once or twice a week, I’ll enjoy a meal out with friends and just order whatever looks most delicious. Our health is determined by what we do most of the time, but there is room for choices being made simply because they bring us joy.

The options included below are intended as good options for those who eat out regularly, not as the only options you should ever choose at these locations.

Okay… on to the list!

PCOS-friendly options from Chipotle (and other mexican restaurants)

Mexican restaurants are one of my favorite PCOS-friendly options. They pretty much always have a salad option that you can load up with delicious toppings while still consuming a blood-sugar friendly meal.

My top suggestion would be:

Salad with:

  • Your choice of protein (carne asada, steak, carnitas, chicken, barbacoa)

  • Skip the rice (rice is a high glycemic index/load carb option that is not ideal for those with PCOS)

  • Black or pinto beans (beans are great lower glycemic index sources of carbs as well as soluble fiber)

  • Fajita veggies

  • Toppings of your choice, including guacamole (a great source of healthy fat!), any of their salsa options, cheese (if you and dairy get along), sour cream (again if you and dairy get along)

  • I’d suggest skipping or going light on their salad dressing because it’s pretty high in sugar and our bodies absorb liquid sugar really quickly. Blood sugar spikes cause insulin spikes, which worsen PCOS symptoms.

A platter of tacos covered with avocado

Taco salad and tacos with corn tortillas are decent PCOS-friendly options at places like Chipotle. Skip the rice and flour tortillas! But definitely add avocado or guacamole!

My second suggestion would be:

Tacos with:

  • Crispy corn tortilla (corn tortillas, both crispy and soft, have a lower glycemic index than flour tortillas, which will help keep blood sugar more stable)

  • Your choice of protein (carne asada, steak, carnitas, chicken, barbacoa)

  • Black or pinto beans (beans are great lower glycemic index sources of carbs as well as soluble fiber)

  • Fajita veggies

  • Romaine lettuce

  • Toppings of your choice, including guacamole (a great source of healthy fat!), any of their salsa options, cheese (if you and dairy get along), sour cream (again if you and dairy get along)

PCOS-friendly options from Panera

Panera has three great salad options that include protein, lots of veggies, and healthy fats:

  1. Green Goddess Cobb Salad with Chicken with apple or seasonal fruit cup side

  2. Greek Salad with chicken added, and with an apple or seasonal fruit cup side

  3. Southwest Caesar Salad with Chicken with apple or seasonal fruit cup side

I’d skip the sandwiches at Panera because all of their bread options are high glycemic load options.

Their warm bowls are preferable to the sandwiches because they use a blend of brown rice and quinoa. Quinoa is a great PCOS-friendly carb source, but brown rice has a high glycemic load and can derail blood sugar. If you opt for a bowl, you might consider just not eating some of the rice/quinoa mix to lessen the total glycemic load of the meal. Of the bowl options, the Mediterranean Bowl with Chicken would be my pick because it’s got a good protein source, veggies, and healthy fats.

PCOS-Friendly options from chick-fil-A

I’ll admit that I didn’t really think Chick-fil-a would have anything PCOS-friendly, but they do!

My top picks include:

  1. Grilled chicken nuggets with zesty buffalo sauce or garden herb ranch sauce (their lowest sugar sauce options) and paired with the kale crunch side.

  2. Market salad with grilled fillet - I’d skip the harvest nut granola and sub in avocado lime ranch dressing, creamy salsa dressing, garden herb ranch dressing, or light Italian dressing for the zesty apple cider dressing to lower the sugar content.

PCOS-Friendly Options from subway

Subway salads used to be a quick go-to travel option, and now they’ve upped their game to add No Bready Bowls to their menu!

My top options are:

pcos-Friendly Options from burgerFi

Most burger places, as you’ll read below, are not super PCOS-friendly. They have limited menus that include burgers and fries, neither of which are so great for PCOS. BurgerFi has burger bowls, including a cheeseburger bowl, so you can enjoy a cheeseburger-esque meal without the bun and without having to feel like a weirdo ordering a burger with a lettuce wrap or without a bun (not that you should feel like a weirdo, but… sometimes I feel that way!).

pcos-friendly options from in-and-Out/Five guys/etc.

Burger places are a little tricky. Some have gluten-free buns, and I definitely enjoy a burger on a gluten-free bun on occasion.

However… as a frequent meal option, gluten-free buns are really no better than wheat buns in terms of blood sugar.

If you’re headed to a burger place, I’d check to see if they have a lettuce wrap option (In-and-Out and Shake Shack do!). That’s going to be your best bet. If they don’t, I’d just be prepared to eat it with a fork and knife and toss the bun. I’d recommend adding as many veggies toppings as they’ve got, cheese if you eat dairy, and maybe even splurging for a slice of bacon on top.

For sides, if French fries are your only option (and they often are!), I’d suggest skipping a side unless it’s a special treat. If they offer a side salad option, you can pile your burger and toppings on the side salad and make a burger salad out of it.

Sadly, a burger and fries is a less-than-PCOS-friendly option. You should totally enjoy it on occasion, but it’s probably best avoided as a staple of your diet.

PCOS-friendly options from starbucks

Let’s talk beverages to start! If I had to provide only a single piece of nutrition advice for PCOS it would be to avoid drinking sugar. This includes naturally occurring fruit sugar, honey, maple syrup, agave, coconut sugar, and plain old white sugar. Our bodies absorb liquid sugar very quickly, which spikes blood sugar, and thus insulin, and worsens all of our PCOS symptoms. Looking at my own continuous glucose monitor data, as well as data from various clients, I’ve seen time and time again, that liquid sugar affects blood sugar more than anything else. And most Starbucks beverages contain a LOT of sugar! As a treat every so often, this is totally cool! As your daily morning beverage, it’s probably not ideal.

My favorite PCOS-friendly Starbucks beverages are:

  • Coffee or Americano with cream (no sugar at all!)

  • Coffee or Americano with half and half (milk has a decent amount of naturally occurring sugar, so half and half is a slightly less preferred than cream, but still a good option)

  • Latte with whole milk (A tall latte with any kind of dairy milk contains 14 g of naturally-occurring sugar. The fat in whole milk helps to slow the absorption of that sugar and lessen the possible blood sugar spike.) or almond milk (only 8 g of sugar!)

Starbucks is actually my go-to airport spot for easy snacks to throw in my bag for the flight.

Our coffee habits can be a contributor to PCOS symptoms. My #1 tip for PCOS is to avoid drinking sugar (in any form - honey, maple syrup, white sugar, coconut sugar, agave, etc.), which means sugary coffee beverages are best saved as special treats every so often.

My top suggestions are:

  1. Eggs and cheddar protein box - I skip the muesli bread and use the peanut butter on the apple slices (such a good combo!). The cheese and eggs provide good sources of protein and some nutritious fat. Both apples and grapes are low glycemic load items, so they’re good sources of carbs that won’t wreak havoc on my blood sugar when paired with protein and fat.

    1. Note - Their other protein boxes contain dried fruit, which have moderate to high glycemic load. I generally avoid snacking on dried fruit.

  2. String cheese - If you’re not sensitive to dairy, string cheese is a great snack and easy to pack, not to mention fun to eat. Pair this with the buttered popcorn listed next, and you’ve got a solid, blood-sugar friendly snack.

  3. Starbucks buttered popcorn - I generally recommend avoiding “naked carbs” aka carbs eaten without a source of protein, fat, and/or fiber, but popcorn is a food that tends to work well for most people. Popcorn itself has a decent amount of fiber, the carbs in popcorn are more complex carbohydrates, and when topped with butter, a good source of fat, popcorn is usually pretty blood-sugar friendly, and thus PCOS-friendly.

  4. Turkey Jerky - This one is only #4 because I’ve noticed that jerky with added sugar can cause substantial blood sugar spikes. This option is still far preferable to a sugary coffee beverage or one of their sugary pastries, but probably not as good as the options listed above for at least some people.

General rules of thumb

The best meal options include a protein source, veggies, and a healthy fat source (avocado, olives, olive oil, nuts, seeds, and even cheese are good options).

The best low glycemic load carb options, ranked in order, include:

  1. All legumes (beans, peas, lentils, chickpeas)

  2. Black wild rice (rarely served in restaurants, but maybe someday you’ll see it!)

  3. Quinoa

  4. Boiled sweet potatoes - this would include mashed sweet potatoes, but make sure they haven’t added sugar or maple syrup, which is common.

White potatoes are a very common side item and are commonly blood sugar kryptonite for people. Mashed potatoes have a lower glycemic load than baked potatoes and potatoes that have been allowed to cool down to room temperature have a lower glycemic load than freshly cooked potatoes (the starches change forms in the cooling process).

So if you’re going for a potato side, I’d recommend choosing mashed potatoes, and eating them last so they’ve had time to cool down. Eating them last also allows the rest of your meal to enter your stomach first, which will slow the digestion of the potatoes and help keep blood sugar more stable.

As noted above for Chipotle, corn tortillas are better options than flour tortillas.

A lot of options that we deem as healthy are actually not so great. Common examples include:

  • Yogurt with granola, fruit, and honey

  • Wraps with flour tortillas

  • Really any kind of sandwich on most commercially available breads

  • Bagels

  • Smoothies

  • Acai bowls

All of these have high glycemic loads that are not ideal to eat on a regular basis if you have insulin resistance, and if you have PCOS, you very likely have insulin resistance.

Take home points

A lot of common restaurants have great PCOS-friendly options!

Focus on protein, veggies, and healthy fats.

Choose lower glycemic load carbohydrates when possible.

Every so often, eat whatever the heck you want, just because it’s delicious.

Is Polycystic Ovary Syndrome (PCOS) Associated with Mental Health Challenges?

Polycystic ovary syndrome (PCOS) has historically been considered a reproductive hormone issue. However, females with PCOS have elevated risks of metabolic and cardiovascular health issues. In fact, insulin resistance is an underlying cause of PCOS for the vast majority of females with the syndrome.

I’m currently reading Dr. Christopher Palmer’s book Brain Energy. Admittedly, I haven’t gotten too far into the book, but from hearing him on several podcast episodes, I know that his main theory is that metabolic issues are an underlying cause of most, if not all mental illness.

Given the prevalence of metabolic dysfunction among females with PCOS, if Dr. Palmer’s hypothesis is true, it is unsurprising that females with PCOS would also experience increased rates of things like depression and anxiety. This article explores some of the research on this association as well as some of the research on tools that can improve mental health indicators for PCOS.

The Great Potato Debate - Potatoes and Polycystic Ovary Syndrome (PCOS)

When I first launched this Instagram account, a nutrition coach reached out to me for advice for her PCOS clients who were having a hard time losing weight. I told her that managing insulin resistance is usually the most important thing for PCOS.

And she responded, “So, you mean like eating sweet potatoes for carbs?”

Ehh…. It’s a little more nuanced than that.

Plant-Based Diets and PCOS

This is the final post in a series of posts on popular diets and their effects on PCOS symptoms. So far, we have covered ketogenic diets, the Mediterranean diet, low glycemic index/load diets, and bean-based diets.

Given the rising popularity of plant-based eating, I thought it was important to include this way of eating. Unfortunately, the literature is seriously lacking on the topic. For nutrition interventions, we can best trust the results of randomized control trials. In these trials, a large group of people are recruited. Then half of the group is randomly assigned to the diet of interest and the other half are assigned to the control group (usually just continuing to eat as they had previously). For a plant-based diet intervention, we’d ideally recruit a large group of meat eaters, and then randomly assign half of them to switch to a plant-based diet. We’d measure important metrics before and after the intervention period to see if anything changed in those people who switched diets. We’d also track the same metrics in the control group, in case there are factors that affect both groups that also affect outcomes. For example, maybe the intervention spans the holidays and both groups end up eating more food than normal. We can net out the effects of these external factors by comparing the changes across the two groups.

Using a Bean-Based Diet for PCOS

During summer 2020, I tried once more to come off of hormonal birth control. It went well for several months, and then my cycle started getting longer and longer. Around the same time, Karen Hurd was featured on a podcast I listened to regularly. The podcast host had used Karen’s bean protocol to help with her own health issues.

Beans and other legumes are filled with soluble fiber. When our bodies are trying to get rid of anything it doesn’t want in it (excess hormones, pesticide residues on food we’ve eaten, pollution we’ve inhaled, etc.), it packages them up in bile. Our liver sends this bile to our gallbladder where it’s stored until we consume fat. When we consume fat, the gallbladder releases the bile into the small intestine, where it helps us digest that fat.

Following a Low Glycemic Index Diet for Polycystic Ovary Syndrome (PCOS)

The next diet in our series (following posts on the ketogenic diet and the Mediterranean diet) is the low glycemic index diet. While the first two diets are fairly well-defined and well-known, what constitutes a low glycemic index diet is less clear and the concept is much less well known.

But this post will clear things up!

First, I’ll explain what the glycemic index and the glycemic load are. Then I’ll talk about several studies that vary in how they implement a low glycemic index diet. From there, we’ll be able to see what features of the diet are most effective at helping with PCOS symptoms.

Does The Mediterranean Diet Help Women with Polycystic Ovary Syndrome (PCOS)?

This is the second post in a series that discusses the peer-reviewed research on the potential of popular diets to address PCOS symptoms. The first post discussed the ketogenic diet, while this post will discuss the Mediterranean diet.

What is the Mediterranean Diet?

The Mediterranean diet was first proposed as a possible healthy way of eating in the 1950s when researchers began to observe that life expectancies were higher in the Mediterranean region than in other developed countries. The region’s diet and lifestyle were hypothesized as the reason for this longevity. It should be noted (and if you’ve traveled to the region, you've observed) that diets vary tremendously across countries in the Mediterranean region.

The Use of the Ketogenic Diet for Polycystic Ovary Syndrome (PCOS)

The post is the first in a series that will discuss the peer-reviewed research on the potential of popular diets to address PCOS symptoms.

Due to the prevalence of insulin resistance among women with PCOS, the ketogenic diet is often suggested for women with PCOS. Insulin resistance impairs the body’s ability to regulate blood sugar, and this is particularly problematic when large amounts of carbohydrates are consumed. The body has to pump out large amounts of insulin, and these large amounts of insulin cause increased production of testosterone in women with PCOS. Keeping carbohydrates minimal is one (but not the only!) way to keep blood sugar stable without the need for a large release of insulin, and this can reduce many of the symptoms of PCOS.

Altering Caloric Timing to Manage PCOS

While we often think about fasting as a way to improve insulin sensitivity and manage PCOS, simply shifting the distribution of your caloric intake may yield benefits. For many women, the idea of fasting can be daunting and/or create feelings of restriction that may cause undo anxiety (this is the case for me!). So, I love that there is an easier way to achieve the hormonal benefits of fasting! The study that follows also considered lean women with PCOS, a subset of PCOS patients who are often ignored in the literature and who rarely receive nutrition or lifestyle counseling for the management of their PCOS. Finally, there’s something out there tested specifically on us!

Intermittent Fasting/Time-Restricted Eating & PCOS

Last week, I listened to Dr. Aviva Romm’s On Health podcast episode on intermittent fasting and time-restricted eating (which she refers to as time-based eating). On the podcast, she talks about how helpful she has found time-based eating to be for her female clients. Many years ago, I tried time-based eating as part of a “body composition challenge” being offered at my crossfit gym, and I found it to be pretty horrible for me! If I recall correctly, I think I started with 12 hours of fasting with a 12-hour feeding window (this is a VERY liberal feeding window for this kind of fasting) or perhaps it was 14 fasting, 10 eating. I’m not sure! In either case, it was not as long of a fasting period as is generally recommended, and it was pure torture for me. As I was anxiously awaiting the start of my feeding window, I was full-on “hangry” and couldn’t focus on anything.

The Effects of Meditation on Anxiety and Depression

This is another post in celebration of World Meditation Day, and it covers a study near and dear to my heart… because it’s my own study!

In fall 2020, serving as my department’s graduate coordinator, I was observing firsthand the impact that the pandemic was having on our students’ mental health. There are many studies that show meditation has positive impacts on mental health in both students and the general population. However, most of these studies either used time-intensive interventions where participants met regularly or were targeting health-related students (med students, nursing students, etc.). I knew that the last thing our students needed was another meeting on their calendar (and a Zoom meeting at that!), and I wasn’t sure if the effects found for health-focused students would carry over to our own students.

So I set out to find out!

The Effects of Transcendental Meditation on Metabolic Syndrome

In honor of World Meditation Day, we’ve got a second post on the impacts of meditation on health issues that often plague women with PCOS. The study discussed here (Paul-Labrador et al. 2006) considers transcendental meditation, a very different kind of meditation than the walking meditation discussed in the previous post.

The Impact of Walking Meditation on PCOS-Related Health Conditions

World Meditation Day is just days away, and I’m a big fan of meditation! I’m pretty certain my meditation practice is the primary reason why my more recent attempt at managing my PCOS without birth control was more successful than prior attempts. And there are some cool studies that support my hypothesis! This post will discuss one particular form of meditation, but don’t worry, more posts on other meditation practices are coming soon!

PCOS and Exercise: Which Kind of Exercise Is Best?

Most people who know me know that I love working out. So I’m often asked what the best form of exercise is. I always reply with, “The one you will do consistently.” And I firmly believe this. But if you’re someone who enjoys different kinds of exercise, and in particular, if you’re someone who is troubleshooting a medical issue, some forms of exercise might be better than others, and that is the case for women with PCOS.

PCOS & Insulin Resistance: Part II

When I first started using a continuous glucose monitor (CGM), my blood sugar control looked excellent for the first couple of weeks. Then one day, when I was competing in a K9 Nosework Trial with my dog, by blood sugar was soaring all day long. I assumed it was a stress response from the nerves I always feel when trialing. But the next day, my blood sugar was still spiking easily and staying high for an extended period of time.

Confused, I turned to Google. Realizing that I was in the phase when I usually start experiencing PMS, I googled “PMS insulin resistance,” and sure enough, it was a thing! (Note, this applies to women who are cycling natural, without hormonal birth control. There’s a whole literature exploring hormonal birth control and its impacts on insulin resistance, and that is a post for another day.)

PCOS & Insulin Resistance: Part I

It is estimated that about 75% of women with PCOS have some degree of insulin resistance (Moghetti and Tosi 2021). From my own experiences, I have a working hypothesis that this is an underestimate of the incidence, and that perhaps all women with PCOS have some degree of insulin resistance, during at least some portion of their cycle. I say this because for about 75% of my cycle, my blood work looks amazing. And indeed, whenever I’ve had blood drawn, it’s (not surprisingly) fallen in this larger portion of my cycle. Wearing a continuous glucose monitor for the duration of my cycle, however, tells a very different story.

Given my hypothesis that insulin resistance underpins pretty much every woman’s experience with PCOS, I’m devoting a few posts on different aspects of the problem (and there will surely be plenty more coming in the future).

This first post provides an overview of the basic problem of insulin resistance.