Episode #173: Natural or Assisted Fertility: Designing Your Path

Hi, and welcome back to the PCOS Repair Podcast. In today’s episode, we’re going to dive into a really important topic in the realm of PCOS and fertility. I get so many questions about what to do—what works and what doesn’t—when it comes to PCOS and getting pregnant.

Today, we’re talking about the difference between natural versus assisted fertility. I’ll outline different options and when different women choose different things. I know everyone listening is in a different place. Some women aren’t thinking about fertility yet—and that’s perfectly fine. This episode can still be really helpful. I encourage you to listen for future insight and also because when we’re talking about fertility, we’re really talking about regulating your cycle and optimizing your reproductive health.

Even if you’re not actively trying to conceive or don’t plan to for a while, what it really comes down to is this: Do you go about managing your hormones naturally, or do you get assistance? And this could even include birth control. When you think about “assisted fertility,” that could be fertility treatments, but it could also be birth control. So no matter where you are on your PCOS journey, this episode is still relevant.

Now, for those of you who are trying to get pregnant, I know you’re coming to this episode from all different places. Some of you have tried assisted fertility. Some have had children previously and are now struggling to conceive again. Some of you are planning to try in the next few months and are wondering what that will look like with PCOS. Others are currently trying naturally and feeling frustrated, wondering if assisted fertility is going to be necessary. You might have questions about what that would involve. And some of you may be in the middle of fertility treatments now or recently completed some rounds and feel like you need a break.

We’re going to explore all of those paths: what’s going on in your body, what your mindset may be like, and how you can design your own personal path forward. Because when we feel overwhelmed by options, like what we’ve already tried isn’t working, or like we’re not sure what’s next—it creates so much anxiety and mental clutter. But when those options are laid out in front of us clearly, it can feel a lot more manageable. That’s the goal for today.

Understanding PCOS and Fertility

Let’s start with what’s actually going on in the body when it comes to PCOS and fertility. The biggest hurdle to pregnancy with PCOS is unpredictable or insufficient ovulation. You may not be ovulating at all, or you may be ovulating sporadically. You might not know when you’re ovulating, even if you’re having what looks like a regular cycle.

Some women with PCOS have what we call a “regular” cycle, though it might not be the textbook 28 days. It could be 20 days, 35 days, or even 40 days. As long as it’s consistent for you, it’s still “regular”—but you may not be ovulating at the expected time. And even if you are, the egg may not be mature or viable.

Some women have no periods, and then occasionally, one will happen out of the blue. This can be frustrating because it’s hard to track, and it might mean you ovulated—or it might just be your endometrial lining shedding due to its thickness. Sometimes, a doctor will induce a period with Provera or progesterone if it’s been too long, which doesn’t indicate ovulation either.

Then there are those who have completely erratic cycles—20 days one month, 60 the next. Pinpointing ovulation in those cases is incredibly difficult.

So, the first major issue with PCOS fertility is ovulation.

The second major issue is implantation and maintaining pregnancy. Often, women with PCOS have elevated LH (luteinizing hormone) and low progesterone. The elevated LH makes ovulation more difficult. The low progesterone can make it harder for the embryo to implant and to maintain the pregnancy long enough for the placenta to form.

When pregnancy does occur, the body has to grow a placenta while also maintaining a thick enough uterine lining to support the embryo. Without adequate progesterone, there’s a higher risk of miscarriage before the placenta can take over.

This is why, even if you’re pursuing natural fertility, it’s still a great idea to have established care with a provider. You want to test your progesterone levels prior to getting pregnant and talk through whether supplementation might be needed during that two-week wait or once you get a positive test. Once the placenta forms, it takes over hormone production—but before that, the uterine lining needs extra support.

So again, the two big factors in PCOS fertility are ovulation and progesterone.

When it comes to whether or not to go assisted or natural, there are pros and cons to both. There’s no one right or wrong answer—it’s all about your personal situation, preferences, and needs.

Natural fertility options involve making lifestyle changes: improving nutrition, balancing blood sugar, reducing inflammation, lowering stress levels, improving sleep, adjusting exercise, and so on. It means supporting your body to ovulate regularly and improve hormone balance without external hormone treatments or fertility medications.

This path typically requires more time and patience. It’s less invasive, it supports your whole body, and often comes with fewer side effects. And it can be incredibly effective. In fact, many of the women I work with are able to restore their cycles and conceive naturally once we work through their root causes.

On the flip side, assisted fertility—whether that’s oral medications like Clomid or Letrozole, or more involved procedures like IUI (intrauterine insemination) or IVF (in vitro fertilization)—can help bypass some of the issues like irregular ovulation or low progesterone. These treatments are designed to stimulate ovulation, improve timing, and in some cases, support progesterone production as well.

Assisted fertility can offer a faster path to pregnancy, especially when time is a concern, such as with advanced maternal age or a short fertility window. But it can also be expensive, physically demanding, emotionally draining, and doesn’t always address the underlying PCOS root causes. In fact, if those aren’t addressed, treatments may be less effective—or if successful, can leave you feeling worse during pregnancy or postpartum.

For example, pregnancy often intensifies insulin resistance, and if that was a big factor in your PCOS, you may experience worsening fatigue, cravings, gestational diabetes, and a harder recovery.

That’s why, in many cases, even when assisted fertility is needed or chosen, I still recommend supporting your root cause health. It helps improve treatment outcomes and prepares your body for a healthier pregnancy.

So, when deciding between natural and assisted fertility, it’s not an either-or. You can absolutely combine them. You might work on restoring your cycle naturally while also consulting a fertility specialist. Or you might go straight to assisted methods and use natural strategies to support your body throughout the process.

Knowing When to Consider Assisted Options

If you’ve been trying to conceive naturally for several months (or longer) with no success, it’s very normal to feel frustrated, anxious, or even panicked. That doesn’t mean you have to rush into fertility treatments, but it may be time to evaluate what’s working, what’s not, and whether something is missing.

For example, are you actually ovulating regularly? Is your partner’s sperm health good? Are there other factors like thyroid, prolactin, or uterine lining thickness at play? That’s where diagnostic testing can be incredibly helpful, and a fertility specialist can help guide that process.

Also, if you’re older—mid-thirties or beyond—you may want to get more aggressive sooner to preserve your chances. Or if you’ve had multiple early losses, it might be time to look deeper into progesterone levels or other implantation issues.

Sometimes, women come to me feeling like they’ve tried everything. They’ve done the diets, tracked their cycles, taken the supplements, and still nothing. In those cases, assisted fertility might feel like a lifeline—and it can be. But I always recommend doing it from an empowered place, not from fear or desperation.

The Emotional Side of the Journey

Fertility struggles are incredibly emotional. There’s hope, disappointment, anxiety, pressure, grief—it’s a rollercoaster. That’s why designing your fertility path should never just be about data or protocols. It should be about your emotional wellbeing too.

Maybe you’re not ready to dive into treatments. That’s okay. Maybe you’ve just had a failed cycle and need a break. That’s okay. Maybe you want to give your body three months of natural support before re-evaluating. That’s okay.

I encourage you to honor where you are, take stock of what’s important to you, and make a plan that supports not just your fertility, but your health and happiness too.

Wrapping Up: Designing Your Fertility Path

Ultimately, the best fertility approach is the one that feels aligned with your values, your timeline, and your health goals. Whether you choose to start with natural methods, go directly to a fertility clinic, or use a combination of both, I want you to know that you’re not alone—and you don’t have to rush.

Take time to understand your cycle, uncover your root causes, and support your hormone health. That’s always a strong foundation, whether you’re preparing for conception, navigating treatments, or just wanting to feel better in your body.

If you haven’t yet explored your root causes or you want a step-by-step way to do that, make sure to check out the PCOS Root Cause Bootcamp. It walks you through how to uncover what’s holding back your hormones and how to restore your body’s rhythm so that fertility becomes a more natural result—whether or not you choose to go through assisted treatments.

And if you’re already in the thick of fertility treatments or actively trying to conceive and need support in building a more sustainable and nourishing lifestyle, the PCOS Root Cause Bootcamp is a great next step. It gives you ongoing tools, community, and coaching to support your body throughout this journey.

I know the fertility path with PCOS can feel overwhelming, full of pressure, and uncertainty. But you are allowed to slow down, to get curious, to listen to your body, and to take care of yourself as you move forward.

Thanks for hanging out with me today on the PCOS Repair Podcast. If you found this episode helpful, be sure to subscribe so you never miss one. And if you know someone who’s navigating this same path, feel free to share this episode with them.

Until next time, be kind to yourself. You’re doing great. Bye for now.