8 Steps to Reverse PCOS with Dr. Fiona McCulloch

In this episode of the Conscious Fertility Podcast, host Dr. Lorne Brown welcomes Dr. Fiona McCulloch ND, a leading expert in naturopathic fertility treatment, to explore the intricate challenges of polycystic ovary syndrome (PCOS) and its effects on women’s health and fertility. Together, they break down the symptoms, underlying causes, and misconceptions of PCOS, highlighting the critical role of insulin resistance and hormone imbalances.

Dr. McCulloch shares her innovative eight-step plan designed to reverse the impact of PCOS, which includes managing insulin levels, combating inflammation, and hormonal regulation. This conversation not only sheds light on effective strategies for improving egg quality and boosting fertility but also emphasizes the importance of a holistic approach to health for those affected by PCOS. Tune in to gain empowering knowledge and practical tips to take control of your fertility journey.

Key Notes

  • Understanding PCOS: Overview of symptoms and hormonal imbalances, including irregular periods and acne.
  • Insulin Resistance: Importance of managing insulin resistance for better fertility and health in PCOS.
  • Reducing Inflammation: Addressing inflammation to improve egg quality and reproductive health.
  • Hormonal Balance: Key strategies for balancing hormones and reducing androgens to enhance fertility.
  • Holistic Approaches: The value of combining medical and natural treatments to manage and potentially reverse PCOS.

By listening to the Conscious Fertility Podcast, you agree to not use this podcast as medical advice to treat any medical condition in either yourself or others. Consult your own physician or healthcare provider for any medical issues that you may be having. This entire disclaimer also applies to any guest or contributors to the podcast. Welcome to Conscious Fertility, the show that listens to all of your fertility questions so that you can move from fear and suffering to peace of mind and joy. My name is Lorne Brown. I’m a doctor of traditional Chinese medicine and a clinical hypnotherapist. I’m on a mission to explore all the paths to peak fertility and joyful living. It’s time to learn how to be and receive so that you can create life on purpose.

Lorne Brown

Welcome to the Conscious Fertility Podcast, and today our guest is my colleague and friend, Dr. Fiona McCulloch. She has been a practicing licensed naturopathic doctor since 2001 after she graduated from the Canadian College of Naturopathic Medicine. She’s the founder, medical director of White Lotus Integrated Medicine in Toronto, which is a busy urban clinic focused on endocrinology and women’s health. Fiona’s also the author of the bestselling book Eight Steps Reverse Your PCOS. I’m holding up a copy for those that are watching this on the video aspect, a proven program to reset your hormones, repair your metabolism, and restore your fertility. And Fiona has also served as a board member of the Endocrinology Association of Naturopathic Medicine since 2018, and we got to know each other well because she has spoken at a couple of the integrative fertility symposiums that I chaired in Vancouver, BC and also on the platform that I moderate healthy seminars. Fiona, I’m so glad that we’re going to talk about fertility and PCOS. Welcome to the Conscious Fertility Podcast.

Fiona McCulloch

Thank you so much, Lorne. It’s such an honor to be here. I’ve known you for so long and it’s just been cool to see your evolution through all the years and this podcast looks like such a great, has so many great topics and speakers, so I’m excited to have a listen and follow you

Lorne Brown

And our listeners are going to love you again. I got to say your book one more time. You got to get a copy of her book, Eight Steps to Reverse Your PCOS. My listeners know that a lot of the topics are on consciousness and then some of the episodes are very fertility based. This is going to be one of those episodes that is very fertility based, but the MINDBODY aspect comes into this because often those that are diagnosed with PCOS because of this metabolic disorder will struggle with depression anxiety. So some of those MINDBODY tools that we talk about in other episodes are very relevant here. Fiona, I thought we would talk about, first of all, can you kind of define what PCOS is? And I find the title kind of misleading, PCOS. So can you kind of give it your version of really what’s happening? How would women know they could have this syndrome, PCOS, why should they be concerned? And then we’re definitely going to talk about what they can do to manage these symptoms.

Fiona McCulloch

Yeah, so PCOS is called, it stands for polycystic ovary syndrome. And so you would think that it revolves around ovarian cysts. However, there are sometimes cyst- like appearances to the ultrasound in PCOS, but it really is not at all about ovarian cysts. It’s actually an endocrine condition, so it’s a hormone imbalance. And at its center, what it revolves around is too much of hormones like testosterone and the most obvious symptoms are. And not everybody has all of these symptoms at the same time throughout their life, so they can change, which also makes this very confusing, but they are irregular periods, so often the periods are far apart or absent sometimes. And then symptoms of too much testosterone, which can be acne, hair growth on the face or hair loss from the scalp. So these are the main symptoms really to look out for. And sorry, I should mention acne as well. These symptoms are the center of PCOS and sometimes people have infertility, especially if they’re not ovulating with PCOS. So that’s really how I would define it. And it’s an endocrine condition. So it also is thought to be genetic and epigenetic, which means that we inherited from our family members.

Lorne Brown

So a lot of the individuals only find out that they could have this condition when they’re trying to conceive and they’re having difficulty. But there are some signs that you shared. So I just want to emphasize that if you have irregular cycles, so your cycles are very delayed, like more than 35 days apart, you’re suggesting or you’re not having cycles, this could be an indication that you have this syndrome, especially if you have those high androgens like you talked about testosterone symptoms like acne and harem and male pattern baldness. What is the reason, or actually, let me phrase it this way. In your practice, I’m assuming individuals that come to you often will have had a workup from their endocrinologist, the reproductive endocrinologist coming to you. Can you discuss kind of the western approach, what they’re doing, and then kind of the natural approach? And I would like you to share, because for this podcast, a lot of our listeners are looking for natural approaches. What are the fertility risks? I guess I should say, why should somebody care if they have this metabolic disorder? How can this impact egg quality or implantation? And can these western approaches fix that or is it better to have an integrated approach?

Fiona McCulloch

Yeah, and I love that you brought up metabolic disorder because even though it’s not considered the main part of PCOS, a lot of patients with PCOS have something called insulin resistance, and this causes basically weight gain around the stomach. It increases the risk for diabetes, heart disease. So there is also a lot of this type of thing going on in PCOS as well. So when we think about fertility with PCOS, part of this is about there might be problems with ovulating because these irregular cycles happen because there’s less ability to ovulate. So sometimes patients don’t even ovulate at all, and this is because the testosterone blocks the ovulation. So one of the things to think about is that element ovulation. But the other thing to think about is that what we know now is that PCOS, it is really inherited. So there’s a lot of genes that are linked to this condition, and a lot of those genes are really about conserving energy.

And in times where we might not have had enough food, but in our current environment we have a lot of really good food that’s very high in sugar or fast food and things like that. Patients with PCLS, the genes they have are actually conservation genes. So they tend to over store energy from this type of environment that we live in. So some of it is really when we are exposed to that environment, those genes are more activated. So when we’re thinking about fertility with PCOS and working on those natural elements to improve our health, we’re actually really helping our future generations’ health by preventing some of the expression of the PCOS genes or metabolic problems like type two diabetes. So it really goes pretty deep into things that way because we know very much that it is very much affected by our environment. PCOS

Lorne Brown

Can we unpack that a little bit? So if there’s a genetic component and you have PCOS, are there things that you can do now while you’re trying to conceive, so leading up to conception and in your pregnancy that could even though your child say your daughter may have this gene, they may not express PCOS, or are there things that you can do now to impact your future child?

Fiona McCulloch

Yes, definitely. So with PCOS, when we’re working on that condition, if somebody happens to have insulin resistance for example, there’s a variety of different supplements that can help in, ACETOL is probably one of the best known ones, but the nutrition that we take into our body, the food that we eat, the exercise we do, all of those things really impact the expression of PCOS. And as embryos are developing in pregnancy, those genes are less activated when we’re taking care of those parts of our environment. So there isn’t quite a lot you can do.

Lorne Brown

You should mention PCOS. I want you to continue on this, but we should mention because you said those embryos develop while you’re pregnant, because for our listeners that if you’re carrying a female child, her ovaries have all the follicles in them already. So that’s what you’re talking about when you say you can impact the embryos or not the embryos, but the follicles inside that developing baby.

Fiona McCulloch

Exactly. And also, yeah, so that’s such a great point. The future generations, if you have a female baby, the ovaries of that baby are developing, and that is sort of what seems to turn on those PCOS genes and then that babies are in the ovaries. So it’s pretty profound if you think about it, because what they found is if you can do things like manage diabetes in pregnancy or improve all of these elements before pregnancy, a lot of this can improve. So yeah, there’s a lot that can be done when you think about it, it’s quite mind boggling.

Lorne Brown

And I apologize for interrupting you there, but as you say certain things, I want to highlight things and it keeps me thinking of other questions for you. So we’ll go back to some of our original questions, but I want to go back to our listeners who right now are like, I can’t even get pregnant right now, so I’ll worry about what I’m going to do when I’m pregnant. Once I’m there, can you help me get pregnant? So in the west, they’ll use auditor drugs like Zoro, Clomid or if needed IVF to help women often that have this diagnosis of PCOS. But in your practice, have you found that sometimes they may get pregnant and they miscarry, and if so, how is that related to this PCOS condition?

Fiona McCulloch

Yeah, there’s definitely an increased risk of miscarriage. It’s partly the egg quality. So in PCOS, there’s a lot of eggs. So when we test the antimalarial hormone level in PCOS, it’s often very, very high. So there’s usually a lot of eggs in the ovary, but these eggs don’t function optimally because of the testosterone. The good news is a lot of these different things can be changed, but unfortunately sometimes that can cause a miscarriage. If that egg quality isn’t as good, then there can be an increased risk of that. But also insulin resistance, which is what we see very commonly in PCOS with increased weight gain, especially around the midsection, high blood sugar, those types of symptoms that’s also associated to miscarriage risk. And then finally as well, there’s sometimes low progesterone, which can increase the risk of miscarriage in PCOS as well. So there’s a few different reasons.

Lorne Brown

I think I remember in your book you shared how the high androgen, so the testosterone and the insulin resistance, even high A MH can alter the structure and function of the follicle. So there’s your egg quality. So more reason to do that preconception care before you go into an auditor drug like Letrozole or clot or IVF cycle. So you can have the embryo at its peak fertility potential. And then also I believe in your book you talk about inflammation, insulin and its clotting and other hormonal metabolic dysregulation that impacts the lining. So it can also impact the uterine receptivity and the embr ability implant as well. This syndrome

Fiona McCulloch

Definitely, yes, it can definitely implant the lining. In many ways, the lining is dependent on the hormone balance, so that is usually often PCOS, and then inflammation definitely affects the lining. Insulin resistance also can affect the endometrial lining. So personally, I feel more than almost any other condition. Sometimes patients with PCOS are put into fertility treatment because they have good A MH. They’re like, oh, you’re going to do very well because your A MH is so great, you don’t need to do anything, just go right in and do it. But if they work on egg quality in their overall health first, the difference is massive in the results that they get when they do fertility treatment.

Lorne Brown

So that’s kind of our approach in our practice as well. In Vancouver, we tend to want to help support the environment to help the egg reach its peak fertility potential and the UNI receptivity. Do you have any stories you want to share? And then I thought we could talk about some of the steps that you like to manage the symptoms of PCOS, but do you have just to share how you would use a story to address this in the clinic? I’m sure somebody’s come to you saying, I got to do the IVF right away, or I’m going to do this letrozole, or they’ve done cycles before and they haven’t been successful. What is your approach and do you have any stories to cheer us up to show us that there are things that can be done to help these individuals?

Fiona McCulloch

Yeah, definitely. So I can give an example of one of my patients. She has extremely high A MH. I always look at  MH if it’s extremely high. That is not a good thing with PCOS. So this patient, her AMH I think was 95 or something. It’s really, really, really high. 

Lorne Brown

That’s in Canadian vows, MOL per liter. We have a lot of American listeners.

Fiona McCulloch

Yeah, sorry. That’s right. That is that one. And yeah, but it’s really astronomically high. And she had never ovulated on her own ever. And a lot of these patients, they’ll never have ovulated naturally. And so sometimes when you are diagnosed with PCOS, you’re told right off the bat you’re not going to be able to get pregnant. So just like, come on back whenever you’re ready. And so this patient goes to the fertility clinic and goes through a cycle and there’s so many eggs, but none of them are good. And she gets a hyper stem, which is another risk. She does it again another time, same result. And then she’s told that she’s going to have to do egg donation. And this is a young woman, maybe 28 I think at the time. So it’s a little really, does this person really need egg donation at this age?

They have a lot of eggs, but unfortunately a lot of patients are told that their eggs are all bad and they’ll never be good. And that’s absolutely not true in PCOS. So then this patient came in and we just started on her PCOS in a general sense. So we worked really intensely on egg quality with enol. We also did cyclic progesterone for about six months of that, and we were able to get her testosterone much lower. Her A MH was around half by the time we finished around six months, and she actually ovulate on her own and got pregnant naturally. So there you go. And I see stories like that frequently. It’s not an uncommon story.

Lorne Brown

I imagine for me it’s one of my, and I’ll use this word loosely, but favorite conditions when it comes into my practice because it’s something I think we can manage really well using diet nutraceuticals like supplements, herbs, acupuncture, low level laser therapy. We just see if we have time, I’ll share some stories like yours. So for the listeners, there is a lot of things you can do. And you and I, the patients we see are the more challenging cases because the ones that have A-P-C-O-S and they use Zoro, Clomid, they get pregnant right away. We don’t see them because the drug forced ovulation and the quality was good enough. Implantation happens. You and I and people like us that have naturopathic Chinese medicine practices, we see those that the Letrozole and the Clomid and the IVF have not worked, and then they come to us and then we still sometimes are able to manage reverse those symptoms where they go on to conceive either naturally or sometimes their next I I Letrozole cycle works.

So we’ll talk more about that or maybe we’ll get into kind of like, so what can we do? You mentioned the nasals. I’d like to read out your eight steps that you share in your book and then maybe we can talk about a few of them. So in Dr. Fiona McCulloch’s book eight Steps to Reverse Your PCOS, she lists them as address inflammation, treat insulin resistance, address adrenals, and improve mood, treat excess androgens, address hormonal imbalances, balance your thyroid, create a healthy environment, eat a balanced diet. So can you touch a little bit about inflammation? So what is your concern with inflammation?

Fiona McCulloch

Yeah, inflammation is basically, I’ll just sort of define it first, but say if we get an infection, our body uses inflammation to kill bacteria and to resolve tissue damage and different things like that. So we do want to have inflammation, but we don’t want to have it all the time because this is a process that’s supposed to turn on and off to take care of different problems in the body. But in PCOS, there’s a predisposition to chronic inflammation, and this means that there’s just inflammation there all the time. That inflammation, if you think about it, it’s normally used to kill bacteria and different organisms that can actually cause damage to our cells. And that’s what we know to be true is that most chronic diseases have inflammation in this and inflammation is not great for our egg quality at all because this causes what we call oxidative stress to the eggs, which decreases their quality overall.

But also it can damage our heart or blood vessels. It can cause insulin resistance, it can cause depression and anxiety as well, depression and anxiety. So there’s a lot of different things that inflammation can cause. So in PCOS, the number one element that causes inflammation I would say is insulin resistance. But there’s also a lot of people who have PCOS who have other types of inflammation too. So they might have autoimmune diseases, they could have some kind of a histamine problem, that sort of inflammation. So there’s just a lot of different types of inflammation in PCOS and the ways that we can manage that are to look for any causes of that. So there’s say somebody has Hashimotos managing their Hashimotos, if they have insulin resistance, helping them manage that, and we can use antioxidants to help with inflammation. So it really depends on the person, how you would address that, the inflammation overall. So yeah, there’s a lot of different approaches

Lorne Brown

And I think our listeners will learn that we’re going to talk about a few of these steps, but it’s always been my experience now that it’s kind of a multidisciplinary holistic approach, meaning each of the things that we talk about, like the insulin resistance, the inflammation, the androgens, the hormones, the thyroid, it’s diet, we use diet, we use lifestyle, sleep, rest, exercise, stress reduction. Then there’s nutraceuticals, there’s herbs, there’s acupuncture and low level laser therapy and other things. So there’s all these things that are addressing all these different aspects that can impact cellular health in this case, the A quality or uni receptivity. So we talked a little bit about inflammation. Insulin resistance is obviously one of the common things that we see. And back to the inflammation. I’ve heard you talk in some of our lectures, I’ve seen you do, the gut microbiome can impact inflammation as well, right? So many things, like you said, it’s not just inflammation. You have to find the cause and then address it, and it can come from autoimmune conditions. You talk often about, and I’ve seen in my practice, when we do our workup, we often see a vitamin D deficiency and thyroid antibodies show up with our women with PCOS. And that’s been your experience as well. Has that been correlated? Is that a common thing now known in the literature?

Fiona McCulloch

Yes, there is definitely a lot more deficiency of vitamin C, and we actually use more vitamin D when we have inflammation, insulin resistance. So there’s a link between vitamin D deficiency and PCOS for a bunch of reasons. So it’s always super important to make sure that you take your vitamin D.

Lorne Brown

Going back to our list, so address inflammation. I’m going to ask this question a little differently. You talk about treating the insulin resistance, look at the adrenals in are mood access androgens, hormonal imbalances, the thyroid? Can you share that in your practice when somebody comes in and how do you walk them through? Is there a certain testing you always do and kind, what is your approach? Then maybe we’ll talk about some of the specifics, but do you do supplements? Do you do acupuncture? I’m curious what you do in your practice to manage those that have PCOS and how do you often assess it as well in your practice?

Fiona McCulloch

Yeah, so I think it really depends on the stage they’re at in life. I get people coming for all different reasons, some are teenagers, some are fertility and some are perimenopause and that sort of thing. So I always go through a full case review and I look at all the old labs that they’ve ever had done because PCOS is a lifelong condition. So it’s really interesting to look at the entirety, how they’ve started off and where they’ve gone. So I always do a really detailed review of all of their history, and then I look at everything that they’re currently taking, and then I assess all the different areas. So I’ll usually run lab tests for inflammation, insulin resistance, hormones like androgens, and cortisol symptoms, which are very important because stress and mood disorders are very common in PCLS. So we’ll assess all those different areas. Some people might, for example, have a chronic gut infection, so we would attest that.

So it’s very individual, depending on the person. So we look for any sources of inflammation, then basically we just go through all of that and correct. There are certain things that you’d want to kind of correct first. Insulin resistance takes a very long time to treat compared to other things. So I’ll start treating that earlier in the process. If somebody’s goal is to get pregnant, we always start working on an egg quality right away as well, because that does take longer. And I do use a lot of cyclic progesterone therapy for PCOS because this is basically giving natural progesterone for 14 days on and 14 days off every month. And this is a way to lower the LH hormone. This is a hormone that is often very high in PCOS that causes us to make testosterone. So it does address that. So I tend to use that therapy a lot. But yeah, it’s very individual, lots of nutrition lifestyle, but again, everyone’s different. Some patients with PCOS have eating disorders, so many individual considerations.

Lorne Brown

And some of that, if it’s binge eating or eating disorders, some of it comes from the hormonal imbalance. Correct. It’s how it’s impacting the brain and what we

Fiona McCulloch

Yeah, it really is, it’s so common and there’s a lot of blood sugar imbalances and changes in our appetite hormones in the brain with PCOS. So it is very physical because a lot of the time you’ll see these things improve. But then again, society is terrible right now, especially with social media. So there’s a lot of stress and pressure around that as well.

Lorne Brown

And then can you tie into the mechanism and how this impacts fertility? Because in your eight steps you talk about treating insulin resistance and treating excess androgens. So can you talk a little bit about why you want to do that and then again, some of your approaches?

Fiona McCulloch

Yeah, the insulin resistance, it’s so important because the insulin actually drives the production of these androgens like testosterone, and it also is probably one of the strongest elements that doesn’t get better with age. So with many patients with PCOS, I am pretty sure you’ve probably seen this too, Lorne, they start ovulating when they get a bit older. So when they’re around 35, they might actually start having regular cycles, whereas before they didn’t. And that’s great, but unfortunately the insulin resistance part does not tend to get better as patients with PCOS get a bit older. So that one is really important to address because it’s a bit, I always call it like a snowball. The bigger it gets, the harder it is to roll it back the other way. So if you can see it and start working on that earlier, then I would consider that one to be a really important area to focus on.

Lorne Brown

And then you talk often about the andron access, and maybe you can talk about the name PCOS, why it is confusing for many because in my practice, the majority of the women I see actually don’t have polycystic ovaries, so they’re confused and I know. Can you share how the androgens create that, how it suppresses your ovulation and why sometimes they’ll have what looks like these strings of pearls and how are they different from somebody that has an ovarian cyst then?

Fiona McCulloch

Yeah, so the cysts in polycystic ovary syndrome are basically follicles. They’re basically the eggs that didn’t fully ovulate. So they’re sort of accumulated around the outside of the ovary. They’re not really cysts, so they’re actually eggs. The younger we are, the more eggs we have. So you tend to see ultrasound in young women, especially teenagers. And unfortunately you can see this in a lot of people that don’t have PCOS when they’re young because they have a lot of these eggs and especially if they have any reason at all that’s interfering with their ovulation, even just being a normal teenager, it’s normal not to ovulate regularly. They often will have that look. So it’s very important not to diagnose it because as you get a bit older, many patients don’t have this look, but the cause of that, so I don’t really worry about the cysts themselves, but the testosterone, so the androgens are really the problem and they actually block the ovulation.

So as the eggs are growing, the androgens are actually made by the eggs and the brain, the LH hormone that’s too high in PCOS. This causes the egg to grow parts of itself that make too much testosterone, and that just stops the eggs from developing. So they kind of get stopped and blocked by the androgens. So it is quite important to manage that. My favorite way is with progesterone, but another really important thing to know is that when you have insulin resistance, all the androgens you make become instantly more intense and powerful because the way that they’re bound up, they become more free when you have insulin resistance. So that is a really powerful way to work on androgens, is to work on insulin resistance.

Lorne Brown

And we should talk a little bit about some of your favorite supplements that you are using in your practice. I know there’s many, and you go over a lot in your book, but are there some of the common ones that you’re like, yeah, if somebody has a diagnosis of PCS, I’d be thinking of a handful of these supplements.

Fiona McCulloch

So I think it depends on if you’re looking for fertility treatment, but I’m going to go through some of my favorite ones. And inositol, it’s such a staple, it’s really helpful for insulin resistance and for egg quality. So that one is almost essential for almost anyone with PCOS. There’s N-Acetyl cysteine, which is an antioxidant. This can help with insulin resistance and egg quality and androgen excess. It’s not a strong anti-androgen, but it does help to a degree with that. Berberine is another favorite supplement. This one’s really good for insulin resistance and inflammation, so that’s definitely a favorite. I also use herbs quite a lot. So P and E licorice, black cohosh are a few favorites that I’ll use. Sometimes I use saw palmetto. There’s quite a

Lorne Brown

Lots of supplements. There’s a lot you can use. So similar in common, the OSCEs and NAC are kind of my staples often. I like vitamin D as well for those that have been, if we test it, if they’re low, then we’ll go to a higher dose. But yeah, similar ideas. And then I love the low level laser therapy because it helps regulate blood sugars, it helps regulate inflammation, increases blood flow, improves mitochondria function. So a lot of things, especially the systemic effect on inflammation. And then there’s the acupuncture as well. And I know you’re trained in acupuncture as well as an RAC. So things that we can, again, that multidisciplinary approach, are we addressing the, because when we talk about the fertility aspect, we’re looking at uni receptivity, we’re looking at egg quality, and there’s, as you said, a lot of the women we see are young in the reproductive age still, and they have high MH or lots of follicles, but hey, they’re not getting pregnant or they’re getting pregnant and they’re miscarrying.

And so the message I see in your book is to support the cellular environment so the fall can reach its peak potential. And you do this by addressing inflammation, by addressing insulin resistance, the adrenals, the androgens, hormonal imbalances. And so that follicle during those hundred days leading up to ovulation or an IVF retrieval, they’re in that good cellular environment. And you like dieting, you got supplements, there’s herbs, and as I share acupuncture and low level laser therapy, you mentioned progesterone as well, natural progesterone. Can you differentiate then, because when you talk about cyclical progesterone, I’m thinking some of the individuals are saying, well, I do a progesterone withdrawal every once in a while to get my bleeding. Is that what you’re talking about? Or is this something a little different?

Fiona McCulloch

Yeah, it’s a little different. So the withdrawal to get the bleed is using synthetic progestin, which is called hydroxyprogesterone. And that’s a good way to just shed the lining. One time cyclic progesterone is using natural progesterone. So this is actually the same type that fertility clinics use in suppositories. It’s not the same type that’s in birth control. And the way that this is done is it’s given every month for 14 days on and off, and it can lower the LH hormone that causes you to make testosterone. This is what happens actually naturally in our cycles every month to keep our LH from being very high at the beginning. But if a patient doesn’t ovulate, they actually don’t make any progesterone. So this is part of their imbalance. It’s almost like training the wheels for their ovulatory cycle between their brain and their ovary. So it’s a really cool treatment specifically though for patients that don’t ovulate regularly. So usually this works well for patients with far apart cycles or who have high testosterone. It will work for them as well.

Lorne Brown

In my practice, a lot of the younger individuals go on birth control pills to manage acne, and then they come off the birth control pill and they don’t ovulate, and that’s when they go for more investigation. So I’ve always thought, and I don’t want to put words in her mouth, but we both know Dr. Lyn Pryor and I think it was at one of her lectures, but the idea is that the birth control pill doesn’t treat PCOS. It’s a strategy to help symptoms with acne, but I think she shared it can actually aggravate insulin resistance. And so there’s other ways to address this than just the birth control pill. Do you have anything to share on that? That was like over a decade ago. I heard her say something like that maybe 15 years ago. So lots of things have happened since, but what about young women that are going to go on the birth control pill to manage their cycle acne? Is there a risk that it can aggravate PCS or regardless? When you get off the birth control pill, that’s when you’ll start to find out you have it.

Fiona McCulloch

So this is actually super common. A lot of people are put on birth control pills very young, and then they don’t even know they have PCOS and they learn that when they come off of it. There’s a lot of problems with that. I think one is not knowing the full extent of the situation you’re dealing with. If you go on it very young, there’s a certain window of time that your cycles become regular within. And if you kind of go on the pill in that time, you didn’t mature your reproductive axis fully. So you may need to do that when you come off the pill regardless of having PCOS. But secondly, if somebody does have PCOS, we don’t really know because a lot of the time they’re not testing for insulin resistance. We don’t know the full extent of what’s actually going on there. So when they come off of it, then we’re going to see the situation, but it takes time for that to really present itself.

So that’s one of the issues. And then there’s androgen rebound, so when you come off of the pill, your androgens can become even higher. So that’s another potential issue. So yeah, it’s something that I’m not against the pill at all in any way if people need to use it for whatever reason. But I think sometimes people are not explained why they’re taking it or what really they’re not getting to, because when you’re on it, you really can’t test your hormones at that point. They all look low. So it’s just missing that opportunity, not treating it when you’re younger. And then having to do that later is, in my opinion, one of the worst problems with giving the pill to young teens.

Lorne Brown

So you or you’re giving the birth control pill to a young teen to manage, say like acne, severe acne. That’s the most common reason we see people go on it. There’s still things you can be doing while they’re on the birth control pill. So when they go off it, hopefully those symptoms don’t come back. And for those that have found out that they’re not ovulating or they have PCOS since they’ve come off the birth control pill, Fiona has shared that there’s at least eight steps and more that you can do to help manage these symptoms. So you can still deal with it and work with what you have is what I’m hearing.

Fiona McCulloch

Oh yeah, absolutely. There’s always stuff that you can do, especially with PCOS.

Lorne Brown

I have a couple rapid fire questions that I’ve received that I want to ask you, but before, if you have another story, I’d love to hear it. I shared one when I interviewed our colleague Sandra, on the podcast, also on the PCOS. And in that one I talk about somebody who never ovulates even with ovulation drugs. So she did IVF and the first one was a chemical it miscarried and the second one didn’t work. And she came for a frozen embryo transfer. She wanted me to help balance her hormones. She wanted her androgens to be lowered. She thought it could be impacting with her implantation. And I shared what we do here. If it helps, she may start to ovulate on her own. So we’ll see what happens if we’re able to regulate her hormones. So we did the diet, the lifestyle, supplements, herbs, acupuncture, and low level laser therapy.

And she saw all these changes in her health. She lost weight without counting calories. Her herm reduced, her acne was gone, her mood stabilized, her gut got better, and she ovulated and conceived naturally. She never got to use that frozen embryo transfer. And so that’s kind of my favorite story because without, even with medication that couldn’t force ovulation and then just through all these changes, naturally her hormones came back on. It kind of reminded me of your story, but I always find that it’s nice to hear some stories. So do you have another example of somebody that came in and that you’re able to support on her journey?

Fiona McCulloch

Yeah, some of the neat stories I have are patients who basically went with PCOS, sometimes it’s worse when you’re younger and it gets better when you’re older. So a lot of the time people are like, well, I can’t get pregnant. I was trying my whole twenties, and nothing happened, so there’s no chance. And then some of the patients will come in after having really severe insulin resistance. I can think of one patient in particular. She had been through so many things, and some of the patients, the way they eat and the exercise and everything they do is amazing compared to your average person. They’re doing so much more, but they’re still not losing weight and everyone is judging them. But this one patient she had been working with, being told to just lose weight is a common thing that patients are told. She had been trying for her whole twenties, had done literally everything, still had never ovulated, was doing withdrawal bleeds with hydroxy, finally came in.

She was like, I don’t even think I can get pregnant. It’s not a thing. Now I’m older now I’m too old and my egg quality is no good anymore. And in my mind I’m thinking, well, actually it’s probably a lot better than it used to be. But she’s like, I just want to work on insulin resistance. I want to work on my mood. There’s a lot of mood disorders, depression, anxiety with PCOS, not just being dismissed for decades is part of it I’m sure. But just generally the condition itself, having a lot of inflammation can cause mood disorders. So we worked on a lot of different things with her, and I find with insulin resistance, a really individual approach is best. Just working with someone, helping them figure out their daily life of what are the things they’re going to eat, what’s going to help them get their required sleep for the night and these types of things. So just gradually working with this patient over probably six to nine months, she had done so well. She started to gain a lot of muscle mass, was able to lose a lot of the abdominal fat that she had and then started ovulating and having cycles and spontaneously conceived again. So it’s really one of those ones where if you just work on the health elements, you can see really amazing miraculous things. So even for patients who feel like they can’t conceive, it’s really surprising to see the results sometimes.

Lorne Brown

And again, why really, when this comes into my clinic, somebody diagnosed with PCOS, I usually am optimistic usually because it’s something that both the west and natural, like naturopathic Chinese medicine has a really good approach. And then often those ovulation drugs will work for them as well. That’s their goal to get pregnant and IVF. So usually either natural works, either the western works or sometimes they need the integrative, usually there’s a good chance they’re going to be able to get a take home baby. Some of the questions I have are metformin compared to taking berberine and an acetal. Can you do them together? Some people are on metformin for the insulin, but yet the red or have been recommended berberine and the natals, can they be combined or is it kind one or the other?

Fiona McCulloch

Yeah, a lot of people ask that, so they actually can be combined. I always just do one at a time, just slowly, but I have many patients on them together, even all three.

Lorne Brown

Okay. And then the thyroid and thyroid, Hashimoto’s, thyroid autoimmune conditions and PCS. Is there a connection? That was a question somebody has sent me.

Fiona McCulloch

Oh yeah, definitely Hashimoto’s, an increased incidence for sure. So I think it’s a 35% increase in Hashimoto. I think it depends on the study you look at, but it’s definitely more common. And what I find is that other inflammatory autoimmune, all of the autoimmune disorders are more common with PCOS because of the inflammatory elements that it has.

Lorne Brown

And then something to remind those that have Hashimoto’s thyroid condition and PCOS get pregnant, have a baby you talk about in your book, to look at doing some testing about six months after giving birth because what this condition can do is some of the postpartum issues just so they can be proactive. Can you share a little bit, I know it’s in her book, everybody, so do check out her book, but you, I love to talk about this part, just there’s so many people that struggle after giving birth and with PCOS or with PCOS or Hashimoto’s, there is some testing and things, interventions you can do, so you can really enjoy your postpartum and your baby.

Fiona McCulloch

Yeah, because a lot of the time we’re told, oh, postpartum is normal to feel horrible. You’re just going to feel like a zombie and just expect that. So that isn’t entirely true. So if you don’t feel well after having a baby, there is a much higher incidence of developing a thyroiditis, which is an inflammation of the thyroid. Usually it’s within six months of having a baby. So this is more common in anyone who has Hashimoto’s or PCOS. So I always recommend checking the thyroid TSH, T three, T four, and the two thyroid antibodies around six months after or sooner. If you don’t feel well, definitely have a check of that because it’s normal to be tired, but not to be extremely tired or to feel terrible after having a

Lorne Brown

And then if you could name this condition, because polycystic ovarian syndrome seems to be confusing and misleading, as you shared as we chatted, that many of the individuals don’t actually have the cystic ovaries, these polycystic ovaries. What do you think is a better name for it? Or what’s the latest that they’re using as their diagnostic criteria and naming it?

Fiona McCulloch

I believe I’m not entirely convinced that the name should be changed at this moment. And the reason is that people are starting to recognize it, and if we change it, it’s going to be more confusing. Okay, forget

Lorne Brown

The branding, not for the branding awareness, but based on what it is in the body. How’s that? How does it show up in the body?

Fiona McCulloch

So they have two names. One of them is metabolic. It’s metabolic. There’s one, it’s called metabolic androgen access, and the other one is reproductive androgen access. I don’t can’t remember the exact names of them. But those two keys, there’s almost two types. Key one is metabolic androgen access, and the other is reproductive. So they actually have two possible names. And I think that personally the androgen access should be included in the name and that it’s difficult to know if the word metabolic should be because 70% of patients have that issue and 30%. So I think, yeah, I it’s, I don’t know personally what the name should be.

Lorne Brown

And as we wrap up that androgen access, which seems to be a key component, it is both lab value, so from serum blood tests and symptomatology. So what is common, because you could have normal Andros in your labs, but you could have symptoms, and that would be considered part of the diagnostic criteria. What are the key high androgen signs? So somebody could start to consider, maybe I have this and consult their naturopathic doctor or their medical doctor?

Fiona McCulloch

Yeah, the androgens in the lab test. So the first thing is that these androgens, the reference ranges that they have, a lot of people are right up at the top of the range. And that’s actually still pretty high because if you look at where people are on average, there’s usually a certain level that people are at at their age, and testosterone goes down with age. So even if it’s up at the top in somebody’s 35, that’s actually pretty high. So with PCLS, that’s why they include both the lab value and the clinical signs, because sometimes as we get older, that’ll never be above that range, but it still might be causing hair growth on your face or acne or hair loss. That’s why they do include both of those criteria because the lab testing for androgens is not super accurate, unfortunately.

Lorne Brown

And the last question I have for you, one of those rapid fire ones that I didn’t do during rapid fire. So if these androgens are an issue in an IVF process, the priming is often AndroGel and androgen. So how do I get my head around this? I don’t want to hurt my egg quality, but yet my IVF clinic says I need to take AndroGel. Is this different from high androgens in PCOS? What’s the mechanism? Why are they using it in an IVF? And then why are we trying to address it in PCOS?

Fiona McCulloch

So with androgens, there’s a sweet spot and your eggs need them, but not too much. So if there’s a deficiency of testosterone, that’s also bad for egg quality. And we’ll tend to see that as women get older, not so much in PCOS. And that’s why we see there is an extension of the fertile window in PCOS where the egg quality, it’s better a little bit later. And it’s thought that the androgens are part of that reason, but we wouldn’t usually give androgens to patients with PC os. But the patients who don’t have it, who have low androgens and low egg quality, they’re the ones who could benefit. They’re raising them up into that sweet spot where they’re deficient

Lorne Brown

And it’s used in a priming cycle to help recruit a few more follicles. Right. Yeah, and I heard an REI once say, part of the difference as well is in PCOS, it’s chronic, having it for months and years, this high androgenic environment, and in an IVF, it’s a month before weeks or months only. So it’s an acute phase, and like you said, there’s a sweet spot. So it’s a little bit different there as well. Yeah,

Fiona McCulloch

It’s very different.

Lorne Brown

So I want to encourage people to check out Dr. Fiona McCulloch’s website. Go to a white Lotus clinic.ca. Also pick up a copy of her book, Eight Steps to Reverse your P-C-O-S- A proven program to reset your hormones, repair your metabolism, and restore your fertility. Fiona, thank you so much for joining me today on the Conscious Fertility Podcast.

Fiona McCulloch

Thanks for having me on, Lorne.

Lorne Brown

And I just want to add again, for our listeners from the conscious aspect, as Fiona mentioned, PCOS, often there’s that inflammatory component and it can lead to anxiety and depression. So a lot of the tools that I do in my practice with the conscious work and that we share on our podcasts can be beneficial because when we lower that stress response, that can help then lower inflammation and those stress hormones and also impact your blood sugars. Same with getting good sleep. If you’re not sleeping well, then find a natural approach to support your sleep because that can impact cortisol levels, which impacts insulin resistance and impacts inflammation and your androgens. So if you’re looking for that holistic approach, and hopefully the message we got across here is that there’s an integrative approach that’s often most beneficial. A lot of people can go ahead with an ovulation drug like Letrozole or Clomid, and that works, and they’re able to get pregnant.

Our goal has always been to have a healthy baby. And as Fiona talked about at the beginning, there’s an epigenetic impact, meaning that genes get turned on and off and what’s happening to you in the months leading up to conception and during conception can impact your child’s expression of PCOS or this syndrome. And so our goal is not just to get pregnant, so even before you would do ovulation drugs, we would recommend implementing the dietary strategies, the lifestyle, the stress reduction, some of the supplements and if needed, herbs and acupuncture and low level laser therapy to help create that environment so you maximize or reach your peak fertility potential before doing those drugs. In clinical reality, most people come to us because those have not worked, and so they’re looking for another avenue to support them. And in my practice, many of these individuals go on to conceive naturally, or after three to six months, it does take some time to address these symptoms and change that environment.

They go and do another medicated cycle, and then that one works. And we’ve seen people even after, as I shared earlier, unsuccessful IVF work. Our clinic and other clinics do this naturally and six months later they’re that much older, but they do another IVF cycle and that one works. So as usual, unfortunately in the reproductive world, I’ve never heard of a magic bullet that you do this and it always works. However, when it comes to those that have auditor disorders related to poly polycystic ovarian syndrome, I have seen and received more research that implements these natural approaches, which includes diet, lifestyle, which would be exercise, rest, and good sleep, and then implementing certain supplements. My faves are N-Acetylcysteine and inositol, and then we’ll add other ones like vitamin D and omega threes, and there’s other supplements we can add, but NAC and N-Acetylcysteine and Berberine are some of our favorites can help change that cellular health and follicular environment.

So you can go on to either conceive naturally or have a different response when you use an arbitrary drug or go through an IVF both from the embryo quality and the uterine receptivity and that environment that the baby’s going to grow in over those nine months, which is going to impact their genetic blueprint. So last time, I’ll mention this because the podcast is ending, but check out Fiona’s book, Eight Steps to Reverse Your PCOS and on the Acualance.ca website if you use their search function. We have multiple blogs on PCOS. We have women sharing their stories being treated with PCOS, and we have a few recipes that you can download as well for PCOS specifically. And we have our fertility diet that’s free to download as well. The Diet book. Wish you all the best of luck

If you’re looking for support to grow your family. Contact Acubalance Wellness Center at Acubalance. They help you reach your peak fertility potential through their integrative approach using low level laser therapy, fertility, acupuncture, and naturopathic medicine. Download the Acubalance Fertility Diet and Dr. Brown’s video for mastering manifestation and clearing subconscious blocks. Go to Acubalance dot ca. That’s Acubalance dot ca.

Thank you so much for tuning into another episode of Conscious Fertility, the show that helps you receive life on purpose. Please take a moment to subscribe to the show and join the community of women and men on their path to peak fertility and choosing to live consciously on purpose. I would love to continue this conversation with you, so please direct message me on Instagram at Lorne Brown official. That’s Instagram, Lorne

Brown official, or you can visit my website, lornebrown.com and acubalance.ca. Until the next episode, stay curious and for a few moments, bring your awareness to your heart centre and breathe.

Dr. Fiona McCulloch ND, has been practicing as a Licensed Naturopathic Doctor since 2001 after graduating from the Canadian College of Naturopathic Medicine. She is the founder and medical director of White Lotus Integrative Medicine in Toronto, a busy urban clinic focused on endocrinology and women’s health. Fiona is also the author of the best-selling book “8 Steps To Reverse Your PCOS”: A proven program to reset your hormones, repair your metabolism, and restore your fertility.  Fiona has served as a board member of the Endocrinology Association of Naturopathic Physicians since 2018.

–      www.whitelotusclinic.ca/practitioners/
–      Book: 8 Steps to Reverse Your PCOS
–      instagram.com/drfionand
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