Polycystic Ovary Syndrome (PCOS) is one of the leading causes of fertility challenges, but it’s also one of the most misunderstood. To help unpack the truth, we spoke with Dr Haleema Sheikh, a GP with over 16 years of experience in women’s health. She specialises in PCOS, PMS, perimenopause, and fertility, combining her medical background with a functional medicine approach.
With her deep knowledge of hormonal health and passion for addressing root causes, Dr Sheikh sheds light on how PCOS affects fertility, what you can do to support your body, and how to care for your mental health on the journey.
PCOS is one of the most common causes of fertility challenges, but there’s still a lot of misunderstanding. Can you explain how PCOS actually affects ovulation and fertility?
At the heart of PCOS is a hormonal imbalance, and that has a direct impact on ovulation. Dr Sheikh explains why cycles can be disrupted, and how this affects egg quality and the chances of conception.
PCOS is essentially a metabolic condition; there is an imbalance of hormones with high levels of androgens (male type hormones such as testosterone and DHEA) and insulin which controls glucose levels in the blood. The body becomes 'resistant' to the insulin signal, and the hormonal imbalances prevent the follicles (sacs where eggs develop) in the ovary from maturing and releasing an egg regularly each month. The quality of eggs is also affected, and these two factors significantly impact fertility.
Many people with PCOS feel pressure or fear around whether they’ll ever be able to conceive. What are some of the most important truths or myths you’d want to clear up for them?
Fear and misinformation often make living with PCOS harder than it needs to be. Dr Sheikh highlights the role of lifestyle changes and reminds us that insulin resistance - a key part of PCOS - is reversible.
The lifestyle pillars of health - nutrition, sleep, movement and relaxation are powerful and absolutely key to supporting women with PCOS to address the root cause of insulin resistance which is REVERSIBLE. This ultimately improves ovarian hormonal balance to allow ovulation and potentially conception.
Beyond medication, what lifestyle or hormonal support approaches do you find most effective in helping people with PCOS improve their fertility?
Medication can help, but it’s not the only route. Dr Sheikh shares how changes in nutrition, supplements, and bioidentical hormone support can all play a role in rebalancing the body and improving fertility.
Addressing insulin resistance with a low carb diet and losing as little as 5-10% body weight can re-establish a regular menstrual cycle and ovulation in overweight/obese women with PCOS.
Supplementing with myoinositol which is a sugar alcohol found in the brain and other tissues is a safe and effective option to address the underlying issues of insulin resistance and high testosterone levels. It improves hormonal balance and ovulation, increasing insulin sensitivity and enhancing egg quality.
Cyclical progesterone support with bioidentical progesterone therapy for two weeks on and two weeks off mimics the 'normal' pattern of progesterone release after ovulation and can help entrain the body to ovulate and support fertility.
Trying for a baby can be emotionally tough - especially with PCOS in the mix. What advice would you give someone to protect their mental and emotional wellbeing while navigating this journey?
Fertility struggles don’t just affect the body - they can weigh heavily on the mind. Dr Sheikh explains why managing stress is vital and shares practical ways to protect emotional wellbeing while living with PCOS.
Our thoughts have a physiological impact on our body's cells influencing gene expression and the balance of hormones. Our bodies cannot tell the difference between real and perceived threat and so excessive worry/anxiety puts the body into a survival state where it is not safe to procreate and hormonal disruption increases.
The way we respond to our thoughts makes a difference. Noticing anxious thoughts without judgment, gently reframing them, and using grounding tools like breathwork or journaling are very helpful. Small shifts in mindset can calm the body and protect emotional health during the fertility journey.
Final Thoughts on PCOS and Fertility
PCOS and fertility are complex, but with the right information and support, there’s reason to feel hopeful. As Dr Sheikh reminds us, focusing on lifestyle, nutritional support, and emotional wellbeing can make a meaningful difference - and many of the challenges of PCOS are reversible with care. Most importantly, no one should feel they have to go through this journey alone. Talking openly about PCOS and fertility is the first step to breaking the stigma and empowering people with the tools they need.
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PCOS - Polycystic Ovary Syndrome