What Is Letrozole?

Letrozole is a medication primarily used in the treatment of breast cancer but is also widely prescribed to women struggling with infertility, especially those diagnosed with polycystic ovary syndrome (PCOS). It works as an aromatase inhibitor, reducing the production of estrogen from precursor molecules like DHEA and other androgens. By lowering estrogen levels, Letrozole stimulates the release of follicle-stimulating hormone (FSH), which, in turn, promotes ovulation. Ovulation is essential for conception, and Letrozole helps correct the problem of excess estrogen (estrogen dominance) by regulating the brain-ovarian axis. However, the way it accomplishes this is by overriding an inborn system rather than helping to support the natural design of the body. Natural Letrozole alternatives accomplish the same goal without relying on prescription drugs that block hormone systems.

Doctors typically prescribe Letrozole to women who don’t respond to Clomid (clomiphene citrate) or for those who have PCOS but are looking for a less invasive alternative to injectable fertility drugs. It’s generally favored for its relatively mild side effects compared to other fertility medications. If you are looking for natural alternatives to Letrozole, you’re reading the right article.

Why Is Letrozole Prescribed for Fertility?

Letrozole is prescribed when women fail to ovulate on their own. Not ovulating is a key cause of infertility. However, the number one thing to consider when looking for natural alternatives to Letrozole and other fertility drugs is answering the question of why a person is not ovulating to begin with. I see three main reasons in my practice for lack of ovulation which include:

• Hypothalamic Amenorrhea (a condition in which the body’s stress response inhibits ovulation)
• PCOS (a condition in which high androgen levels prevent ovulation)
• Perimenopause (a condition in which aging of the ovary and reduce egg quality lead to irregular or absent ovulation)

There are many hormone imbalances that can cause lack of ovulation, including hypothyroidism and hyperthyroidism, though those are separate imbalances that typically don’t result in a Letrozole prescription.

The condition of hypothalamic amenorrhea, in my opinion, is not an appropriate time to use Letrozole because the body is already in a suppressed estrogen state. In this case, natural letrozole alternatives and addressing the root cause are much more effective. In perimenopause, FSH levels may already be high, and using Letrozole to further increase them may not actually help. However, estrogen levels are often also high in the early stages of perimenopause so advanced maternal age, in my clinical experience, is a more appropriate use of Letrozole. That being said, natural alternatives to Letrozole are often more appropriate and more effective. For PCOS, this would be the classic use of Letrozole because high estrogen and low FSH are common in this condition. That being said, understanding the root cause of PCOS is essential when treating the condition naturally and identifying viable natural alternatives to using Letrozole or other fertility drugs.

While Letrozole does its job effectively in many cases, it’s not without potential side effects like headaches, fatigue, and ovarian cysts. For those seeking to avoid pharmaceutical options, natural Letrozole alternatives provide a safe, non-toxic way to stimulate ovulation and improve fertility.

How Does Letrozole Compare to Other Fertility Medications?

Compared to other fertility medications like Clomid (clomiphene citrate) and injectable gonadotropins, Letrozole is less likely to cause multiple births (twins or more). Clomid, for instance, can lead to a higher incidence of multiple pregnancies, whereas Letrozole tends to result in single, healthy pregnancies. Letrozole is also often preferred over Clomid for women with PCOS due to its more favorable side effect profile.

Injectable gonadotropins, another common fertility treatment, stimulate the ovaries to produce eggs directly, often resulting in more aggressive stimulation and a higher risk of ovarian hyperstimulation syndrome (OHSS). Letrozole, however, works in a more controlled manner by stimulating the body’s natural hormone production.

Despite these benefits, Letrozole still relies on hormone manipulation, which can be taxing on the body and may result in rebound hormone imbalances after pregnancy. This is why many patients turn to natural Letrozole alternatives—herbal supplements that naturally support the body’s hormonal balance without the need for synthetic drugs.

The Mechanism of Action Behind Letrozole and Natural Alternatives

Let’s Review: Letrozole operates by inhibiting the aromatase enzyme, which is responsible for converting androgens into estrogen. As estrogen levels decrease, the body responds by increasing the production of follicle-stimulating hormone (FSH), which stimulates the ovaries to release mature eggs.

Natural Letrozole alternatives work by leveraging similar mechanisms to promote fertility. They either directly inhibit aromatase or support the body’s endocrine system to regulate hormone production, such as estrogen levels. While these alternatives don’t work as rapidly as prescription medications, they offer a gentler and sustainable way to address infertility.

Root Causes of Infertility and Letrozole Prescription

When Letrozole is prescribed, the root cause of infertility is often related to hormonal imbalances, specifically in women with PCOS. PCOS leads to an overproduction of androgens (male hormones) which are converted into estrogen at high levels. Very high levels of this nature contributes to the inhibition of ovulation seen in PCOS. Letrozole works by reducing estrogen, thus triggering ovulation and improving the chances of pregnancy.

For other women, infertility can result from issues like poor egg quality, irregular cycles, or insufficient progesterone. In such cases, Letrozole is used to support ovulation, but it may not address underlying hormonal imbalances or deficiencies. Natural Letrozole alternatives, however, take a more holistic approach by addressing the broader spectrum of hormonal imbalances contributing to infertility.

Natural Letrozole Alternatives for Fertility

1. Resveratrol
   
   • How It Works: Resveratrol functions as a direct and effective natural aromatase inhibitor. In women with estrogen-dominant conditions or polycystic ovary syndrome (PCOS), this conversion process becomes dysregulated, leading to suppressed ovulation and hormonal imbalance. Resveratrol blocks the activity of aromatase at the cellular level. It binds to the enzyme’s active site, reducing its ability to synthesize estrogen from androgen precursors. This inhibition lowers circulating estrogen levels, which signals the hypothalamus and pituitary gland to increase the release of follicle-stimulating hormone (FSH). Elevated FSH promotes the development and maturation of ovarian follicles, which directly supports ovulation and improves the chances of conception, acting in direct similarity to Letrozole and offering a natural Letrozole alternative.
   • Advantages: Unlike Letrozole, Resveratrol offers this action without the synthetic load on the liver or disruption of other hormonal systems. It also delivers strong antioxidant and anti-inflammatory support, which helps reduce oxidative stress in the ovaries and improves overall endocrine function. For women seeking natural Letrozole alternatives, Resveratrol provides targeted hormonal modulation. It mimics the clinical benefits of Letrozole—ovulation induction, estrogen control, and follicular development—through a plant-based, bioavailable pathway that supports the body rather than overriding it.
   • Typical Dosage:
     • Dose: 150–250 mg per day
     • Standardization: Choose trans-resveratrol supplements with 98–100% purity to ensure bioactive effectiveness
     • Form: Capsule or softgel, ideally in a micronized or liposomal form for increased absorption
     • Timing: Take once daily with food, preferably in the morning to align with cortisol rhythm and minimize GI upset
     • Duration of Use
       • Use for a minimum of 8–12 weeks to support estrogen clearance, normalize ovulation, and improve egg quality
       • Best applied during follicular phase or as part of a broader preconception protocol when preparing the body for ovulation
     • Synergistic Combinations
       • Combine with quercetin or EGCG to amplify aromatase inhibition and antioxidant protection
       • Pair with NAC or milk thistle to support phase I and II liver detox—crucial for estrogen metabolism
       • Use alongside inositol for added insulin regulation in PCOS-driven infertility
2. Green Tea Catechins (EGCG)
   • How It Works: EGCG, the active polyphenol in green tea, acts as a potent natural aromatase inhibitor. It directly suppresses the activity of the aromatase enzyme, which converts androgens into estrogens. EGCG not only inhibits estrogen synthesis by directly binding to and blocking aromatase (similarly to Resveratrol) but also modulates gene expression linked to estrogen metabolism. It downregulates CYP19A1, the gene encoding aromatase, further limiting estrogen production at the source. The result: restored ovulatory cycles, improved egg maturation, and increased fertility potential.
   • Advantages: Unlike synthetic drugs, EGCG delivers this hormonal recalibration without liver toxicity, ovarian overstimulation, or long-term endocrine disruption. There is also robust evidence regarding the benefits of EGCG for modulating other estrogen-dependent diseases, like estrogen-dependent cancers. EGCG offers a biologically intelligent solution—working with the body’s natural systems to correct the root dysfunction behind anovulatory infertility. As a natural Letrozole alternative, EGCG provides targeted, reliable aromatase inhibition. It shifts the hormonal environment in favor of ovulation and conception, while simultaneously reducing oxidative stress and inflammation—two major contributors to ovarian dysfunction.
   • Typical Dosage:
     • Therapeutic range: 300–400 mg per day, standardized to ≥90% EGCG
     • Form: Use decaffeinated green tea extract capsules or powders to avoid overstimulation
     • Timing: Divide the dose into two servings (e.g., 200 mg AM, 200 mg PM) to maintain stable blood levels
     • Duration: Use for at least 3 menstrual cycles to assess full impact on ovulation and hormonal balance
     • Critical Guidelines
       • Always take EGCG with food to reduce potential gastrointestinal irritation.
       • Avoid taking EGCG within two hours of iron or folate supplements—it interferes with absorption.
       • Combine with antioxidant cofactors like quercetin or vitamin C to enhance bioavailability and reproductive tissue protection.
     • Cautions
       • Doses exceeding 800 mg per day increase risk of liver stress, particularly in women with compromised detox pathways (e.g., MTHFR mutations, sluggish phase II liver detox).
       • Monitor liver enzymes if using alongside other herbs or medications.
3. Saw Palmetto
   • How It Works: Saw Palmetto delivers powerful endocrine modulation by directly inhibiting both aromatase and 5-alpha reductase—two key enzymes involved in hormonal imbalance. As a natural aromatase inhibitor, Saw Palmetto blocks the conversion of androgens into estrogens at the tissue level, particularly in adipose and ovarian tissue. By blocking this pathway, Saw Palmetto reduces DHT load, rebalances androgen levels, and removes one of the most common roadblocks to ovulation.
   • Advantages: Unlike synthetic drugs that override the endocrine system, Saw Palmetto reestablishes proper feedback between the hypothalamus, pituitary, and ovaries. It stabilizes estrogen and androgen levels, supports follicular development, and promotes timely ovulation without the side effects linked to pharmaceuticals like Letrozole. As a natural Letrozole alternative, Saw Palmetto addresses the same root dysfunction—excess estrogen production and androgen imbalance—through targeted, multi-pathway inhibition. It restores hormonal order and fertility function with precision and without compromise.
   • Typical Dosage:
     • Dose: 320–400 mg per day
     • Standardization: Use extracts standardized to 85–95% fatty acids and sterols—the active constituents responsible for enzyme inhibition
     • Form: Softgel or liquid extract for superior absorption
     • Timing: Take once daily with a fat-containing meal to optimize bioavailability
     • Duration of Use:
       • Use consistently for at least 8–12 weeks to see measurable shifts in hormonal patterns and ovulatory cycles
       • Best used as part of a comprehensive protocol that includes blood sugar regulation, adrenal support, and anti-inflammatory nutrition
       • Combine with zinc for enhanced 5-alpha reductase inhibition, or vitex/inositol to further regulate LH, FSH, and ovulatory signaling
       • Stack with EGCG or resveratrol when estrogen suppression requires broader enzyme inhibition
     • Cautions
       • Avoid use during active attempts at conception without supervision, as it may suppress DHT levels beyond optimal range if overdosed
       • Monitor for mild gastrointestinal discomfort or changes in menstrual flow—these reflect hormonal shifts, not toxicity
4. Grape Seed Extract
   • How It Works: Grape Seed Extract contains proanthocyanidins, which exert strong antioxidant effects while simultaneously blocking estrogen biosynthesis via aromatase inhibition. This dual action not only promotes ovulation but also protects ovarian tissue from oxidative stress—one of the hidden drivers of poor egg quality and anovulation.
   • Advantages: As a natural Letrozole alternative, Grape Seed Extract delivers precise hormonal recalibration without the synthetic overload of pharmaceuticals. Its high concentration of proanthocyanidins neutralizes free radicals and halts the oxidative stress that fuels chronic inflammation in reproductive tissues. This antioxidant activity protects ovarian follicles, preserves egg quality, and stabilizes the endometrial environment—critical factors for successful conception and implantation.
   • Typical Dosage
     • Dose: 150–300 mg per day
     • Standardization: Choose extracts standardized to 95% proanthocyanidins—the active compounds responsible for aromatase inhibition and antioxidant effects
     • Form: Capsule or powder; use encapsulated form for precise, therapeutic dosing
     • Timing: Take once or twice daily with meals to improve absorption and reduce gastrointestinal irritation
     • Duration of Use
       • Continue for at least 8–12 weeks to lower estrogen levels, support ovulation, and improve overall reproductive function
       • Integrate into the follicular phase of the cycle or use as part of a full preconception plan to reset hormonal balance before conception attempts
     • Synergistic Combinations
       • Stack with resveratrol or EGCG to intensify aromatase inhibition and estrogen detox
       • Pair with vitamin C to enhance antioxidant capacity and stabilize proanthocyanidin activity
       • Combine with inositol or chromium to simultaneously support insulin sensitivity and ovarian function in PCOS cases
     • Cautions
       • Avoid combining with blood thinners or high-dose NSAIDs without supervision, as Grape Seed Extract also promotes vascular flexibility
         Monitor menstrual cycle shifts—reduced estrogen load often triggers faster follicular development and earlier ovulation
       • Doses above 400 mg daily increase risk of gastrointestinal symptoms and do not increase therapeutic effect proportionally
5. Shatavari
   • How It Works: This botanical works on multiple levels. Its steroidal saponins bind to estrogen receptors and modulate their sensitivity, reducing the overstimulation caused by high estrogen levels. At the same time, Shatavari supports the adrenal glands and reduces cortisol output, protecting the reproductive system from stress-induced dysfunction, particularly relevant in cases of Hypothalamic Amenorrhea, PCOS and Perimenopause.
   • Advantages: Shatavari enhances follicular development, supports egg maturation, and improves cervical mucus quality—three non-negotiable factors for natural conception. It also stabilizes progesterone levels post-ovulation, supporting luteal phase health and implantation.
   • Typical Dosage:
     • Dose: 500–1000 mg per day
     • Standardization: Use standardized extracts containing 10–20% steroidal saponins, the bioactive compounds responsible for aromatase inhibition and hormonal support
     • Form: Capsule or tincture; choose high-quality, standardized extracts for consistent potency
     • Timing: Divide into two doses daily, preferably with meals to enhance absorption and minimize gastrointestinal discomfort
     • Duration of Use
       • Administer for at least 8–12 weeks to achieve meaningful hormonal recalibration and improved ovulatory function
       • Most effective when incorporated into a broader fertility protocol focused on stress reduction, blood sugar balance, and anti-inflammatory nutrition
     • Synergistic Combinations
       • Combine with ashwagandha or rhodiola to support adrenal function and reduce cortisol’s disruptive impact on reproductive hormones
       • Pair with vitex or inositol to enhance follicular maturation and regulate pituitary hormone signaling
       • Use alongside Grape Seed Extract or Resveratrol to strengthen aromatase inhibition and estrogen metabolism
     • Cautions
       • Avoid excessive dosing beyond 1000 mg daily to prevent hormonal overstimulation or digestive upset
       • Monitor menstrual cycle and ovulation patterns closely—Shatavari’s potent endocrine effects often manifest quickly in cycle regularity and luteal phase support
       • Not recommended during confirmed pregnancy without professional guidance due to its hormonal activity

The road to conception can be difficult and frustrating, but you don’t have to rely solely on pharmaceutical treatments like Letrozole to address infertility. Natural Letrozole alternatives offer an empowering way to regulate hormones, promote ovulation, and support overall fertility health. Whether you choose EGCG, Shatavari or other herbal remedies, these natural options provide a gentler, holistic approach to fertility, addressing the root cause of hormonal imbalances while avoiding the side effects of synthetic medications.

Incorporating natural Letrozole alternatives into your fertility journey is a step toward taking control of your reproductive health. With patience and proper guidance, these natural remedies provide an effective, safe, and sustainable solution to support your body’s ability to conceive.

I’m Dr. Alexandra MacKillop, a functional medicine doctor, food scientist and nutrition expert.

I specialize in women’s nutrition & hormonal health, addressing concerns like longevity, fertility, postpartum, PCOS, endometriosis, and gut symptoms like bloating, constipation, diarrhea and more.

If you’re looking for a new way to approach your health, I’m here to help you through it.

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Reminder: The information on this post or anywhere else on this blog or other writing is purely educational, and is not intended to diagnose, treat, prevent, or cure any health condition.

The post Natural Letrozole Alternatives: Holistic Fertility Treatment Through Functional Medicine appeared first on Dr. Alexandra MacKillop.

What Is Clomid?

Clomid (clomiphene citrate) is a pharmaceutical drug used to induce ovulation. It’s one of the most common fertility treatments in conventional reproductive medicine, often prescribed as a first-line treatment for intertility. Whether you’re of “advanced maternal age” (meaning above 35 years old), you have an ovulatory disorder such as hypothalamic amenorrhea or PCOS, or you simply have been trying to to conceive without luck, fertility specialists will likely prescribe Clomid for you. Its appeal is simple: force the body to ovulate. But that approach skips over the deeper question: Why isn’t ovulation happening in the first place? Answering that question is the key to finding a natural alternative to Clomid.

How Does Clomid Work?

Clomid binds to estrogen receptors in the brain—specifically, in the hypothalamus. It blocks the brain’s perception of estrogen, tricking it into thinking estrogen levels are low. The brain responds by producing more GnRH (gonadotropin-releasing hormone), which then stimulates the pituitary to release more FSH (follicle-stimulating hormone) and LH (luteinizing hormone). The result: follicle (egg) development and, ideally, realease of that egg for potential fertilization via ovulation.

It’s a pretty amazing system. But hijacking it with synthetic chemicals comes with risks: mood swings, hot flashes, ovarian cysts, thin uterine lining, and a higher rate of multiples. Not to mention, you might be uncomfortable with the thought of overriding your body’s own functionality. Is there a better way?

The Hormones Involved in the Clomid Pathway

To get pregnant without Clomid, it’s essential to understand how the body’s hormones work and what changes when Clomid enters the scene:

• Estrogen signals to the brain whether to stimulate or suppress reproductive activity.
• GnRH from the hypothalamus tells the pituitary to act.
• FSH promotes follicle (egg) development.
• LH triggers ovulation.

Clomid disrupts this communication loop to force ovulation. But instead of forcing, functional medicine offers options to support. And we do that using targeted, evidence-informed botanical tools that replicate the intended effects of Clomid—without its side effects.

Why Do Women Want a Natural Alternatives to Clomid?

Many of my patients seek functional medicine for natural alternatives to Clomid due to concerns about side effects, a preference for holistic approaches, or previous poor responses to the medication. Clomid, while effective for stimulating ovulation, can cause side effects such as mood swings, hot flashes, headaches, and thinning of the uterine lining, which may impact implantation. Individuals with conditions like PCOS often also worry that Clomid could further disrupt their hormonal environment, while others may have tried the drug without success and are exploring alternatives as a result. In some cases, natural approaches are also more accessible and affordable, particularly where fertility treatments are not covered by insurance.

Natural Alternatives to Clomid

In my pratice, I typically use the following three herbal strategies as natural Clomid alternatives. Sometimes, I prescribe these herbs truly as alternatives to Clomid but in other circumstances, I use them as part of a treatment plan designed to treat the root cause of hte health conditions that led to the Clomid prescription in the first place.

Black Cohosh as a Natural Clomid Alternative

Black cohosh (Actaea racemosa) acts as a natural alternative to Clomid by binding to estrogen receptors in the hypothalamus and pituitary, just like Clomid—but without chemically blunting the system. This herb increases FSH and LH levels, promoting ovulation naturally. Studies show black cohosh improves ovulation rates, especially when paired with lifestyle and nutrient interventions. It supports the body’s innate rhythm rather than overriding it. In other words, if the body is trying to ovulate on its own, black cohosh helps it along.

How to Use Black Cohosh as a Natural Alternative to Clomid: When I prescribe black cohosh to infertility patients in my practice as a natural alternative to Clomid, I recommend 250 mg twice daily during the follicular phase. (Need help identifying your follicular phase Read this.)

Salvia Miltiorrhiza as a Natural Clomid Alternative

Salvia miltiorrhiza (also known as the Chinese herb Dan Shen) acts as a natural Clomid alternative by stimulating the hypothalamus to produce GnRH. This drives the cascade of FSH and LH needed for ovulation. It also improves blood flow to the reproductive organs and supports endometrial health—critical for successful implantation. In functional medicine, we use Salvia to restore communication between the brain and ovaries, especially in women with irregular or absent cycles, such as in the case of hypothalamic amenorrhea or hypothalamic hypothyroidism.

How to Use Salvia (Dan Shen) as a Natural Alternative to Clomid: When I prescribe salvia to infertility patients in my practice as a natural Clomid alternative, I recommend 3-6 mL of tincture taken twice daily. Avoid taking in the second half of the luteal phase.

Maca (Lepidium meyenii) as a Natural Clomid Alternative

Maca works on both the brain and ovaries, providing a natural alternative to Clomid. It increases GnRH output and supports healthy estrogen receptor function, giving it a unique dual role. Unlike hormone replacements, maca acts as an adaptogen. It helps normalize the HPO (hypothalamic-pituitary-ovarian) axis, bringing balance whether estrogen is low or high. Research shows maca improves cycle regularity, egg quality, and libido—without disrupting hormonal feedback loops.

How to Use Maca as a Natural Alternative to Clomid: When I prescribe maca to infertility patients in my practice as a natural Clomid alternative, I recommend 500 mg Gelatinized Maca (Hypocotyl Concentrate) taken twice daily. Typically when prescribing maca, treatment plans involve its use in combination with other herbal strategies that target the root cause.

Root-Cause Medicine: The Key to Successful Conception

Whether you’re using Clomid or natural Clomid alternatives, the goal is the same: ovulation. But real, lasting fertility success comes when we ask why ovulation isn’t happening. Hormone imbalances are symptoms, not diagnoses. PCOS, hypothalamic amenorrhea, thyroid dysfunction, and chronic inflammation all disrupt fertility. Masking symptoms with a prescription skips the part where we solve the problem.

In functional medicine, we reverse infertility and offer alternatives to Clomid by restoring function. That means identifying and treating the root cause—whether it’s blood sugar dysregulation, nutrient deficiencies, poor gut health, or stress overload. Whether you’re using a pharmaceutical ovulation trigger or herbal support like black cohosh, salvia, or maca, your best chance of success lies in aligning with your body’s design.

Ovulation disorders don’t result from Clomid deficiency. Your body wants to conceive. When we remove the blocks and support the right pathways, fertility improves—naturally, predictably, and sustainably. That’s what I call real medicine. And that’s how we create not just pregnancies, but healthy mothers and babies.

If you need help unscrambling your hormones and understanding the root cause of infertility, check out The Hormone Hacker, a guidebook that helps you with exactly that. After all, guessing about your health won’t help you get pregnant.

I’m Dr. Alexandra MacKillop, a functional medicine doctor, food scientist and nutrition expert.

I specialize in women’s nutrition & hormonal health, addressing concerns like longevity, fertility, postpartum, PCOS, endometriosis, and gut symptoms like bloating, constipation, diarrhea and more.

If you’re looking for a new way to approach your health, I’m here to help you through it.

Become a Patient

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Reminder: The information on this post or anywhere else on this blog or other writing is purely educational, and is not intended to diagnose, treat, prevent, or cure any health condition.

The post Is There a Natural Clomid Alternative? appeared first on Dr. Alexandra MacKillop.

PCOS is diagnosed when a woman meets two of three criteria: elevated androgen levels on blood work, ovulatory dysfunction and polycystic appearance of ovaries on ultrasound.

1. Elevated Androgens: Testosterone and DHEA are the two androgen levels we test for in women with suspected PCOS. The tests we use to evaluate these include: free and total testosterone levels, sex hormone binding globulin, bioavailable testosterone and DHEA-sulfate. You don’t need to fast for these tests, but the test should be drawn on the third day of your cycle if you are having periods

2. Ovulatory Dysfunction: This is the driving force behind irregular periods in PCOS. Ovulatory dysfunction refers to irregular, anovulatory or absent menstrual cycles.

3. Polycystic Appearance of Ovaries on Ultrasound: First of all, this is not the same thing as true ovarian cysts. Rather, in PCOS, imbalanced hormone levels cause more than one follicle (immature egg) to develop on ovaries in any given cycle, and then they halt in an advanced but still underdeveloped stage of development. This makes the ovaries look bumpy when viewed with ultrasound. However, these cysts don’t become enlarged, burst, or bleed like the other medical condition of ovarian cysts.

Many factors contribute to an individual woman’s experience with PCOS and no two cases look exactly the same. However, there are certain similarities among the hormone imbalances and fertility problems seen in PCOS, so let’s dive into the root cause.

There Are Four Types of PCOS

Knowing which kind you have is fundamental to treating PCOS because it tells us how to get to the root cause.

Insulin-Resistant PCOS

An estimated 50-70% of PCOSis the insulin resistant type. In this category, women have difficulty regulating their blood sugar which leads to elevated insulin levels. This high insulin does a couple of key things:

1. High insulin makes the ovaries more sensitive to LH, a signal from the brain that begins maturing follicles (eggs). This causes a greater number of follicles to start differentiating.

2. High insulin also interferes with the ovary’s ability to choose a single dominant follicle, so the polycystic appearance progresses and no follicle reaches full maturity. As a result, the cycle usually ends up being anovulatory.

3. Because high insulin increases the ovary’s reactivity to LH, they produce more androgens than normal as a result. Because the FSH levels don’t match the LH levels, the ovary can’t keep up with converting this increased testosterone into other hormones so the levels keep rising.

4. These high testosterone levels feed forward into estrogen excess which stimulates the body’s fat cells to grow. As they do so, they produce even more insulin and the cycle continues.

To treat insulin-resistant PCOS, we need to interrupt the cycle, which usually involves addressing blood sugar control.

Adrenal PCOS

The adrenal glands regulate electrolyte balance, blood sugar and sex hormones. They produce small amounts of progesterone and estrogen, but relatively higher amounts of DHEA. They also produce cortisol.

1. High DHEA levels convert into high testosterone levels. This meets the criteria for elevated androgens.

2. Cortisol produces inflammation which disrupts the maturation process of ovarian follicles and can lead to arrested development…hence, a polycystic appearance.

3. High cortisol levels interrupt signaling from the brain to the ovaries, often getting in the way of ovulation. This results in anovulatory cycles and/or missed periods.

Treating adrenal PCOS necessitates finding out what’s taxing the adrenal system so much. Stress can be purely psychological and have this effect, or it may stem from many other forms.

Inflammatory PCOS

Inflammation is the culprit behind so many health problems, including PCOS. Sometimes inflammation is the driving force behind PCOS, especially if insulin is normal and DHEA/cortisol are not both elevated. However, all types of PCOS involve inflammation.

1. Inflammatory chemicals like cytokines directly stimulate the ovaries to produce androgens. [source]

2. Inflammation, especially coming from the chemical TNFα also stimulates adipocyte to produce higher levels of insulin. This higher level of insulin creates all the problems we already outlined in the previous section.

3. Inflammation disrupts follicular maturation and halts development, affecting ovulation rates and creating partially developed follicles—ergo, “polycystic ovaries”

Targeted anti-inflammatory nutrition and supplementation strategies are fundamental in treating PCOS cases that are predominantly characterized by inflammation. It’s also really important to figure out what’s going on beneath the surface that’s driving the inflammation.

Post-Pill

The whole point of the birth control pill is to override the body’s natural signaling to prevent ovulation. That’s how it gets its contraceptive function. But in many cases, ovulation remains suppressed even after a woman discontinues taking it.

1. This type of PCOS is primarily characterized by ovulatory dysfunction because the body needs to figure out how to start ovulating again after months, years or decades of being actively prevented from doing so. However, there’s also a bit more at play.

2. Coming off the pill often results in excess or “rebound” androgen production. This is especially common after using contraceptives that contain drospirenone.

Provided that periods and hormone levels were normal before using the pill, this type of PCOS is usually temporary. However, recovery can take months, sometimes up to even 2 years. I usually work with post-pill PCOS patients on detoxing from the pill in conjunction with treating the elevated androgens and utilizing anti-inflammatory lifestyle strategies.

Leave a comment below: which type of PCOS do you have?

If you loved what you read here, check out these related posts:

• How to Get Pregnant Naturally with PCOS
• Natural Alternatives to Fertility Drugs
• Progesterone Deficiency

I’m Dr. Alexandra MacKillop, a functional medicine doctor, food scientist and nutrition expert.

I specialize in women’s nutrition & hormonal health, addressing concerns like longevity, fertility, postpartum, PCOS, endometriosis, and gut symptoms like bloating, constipation, diarrhea and more.

If you’re looking for a new way to approach your health, I’m here to help you through it.

Become a Patient

Don’t miss out! Join the email list.

Sign Me Up!

Love this post Share it!

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Want more Grab a copy of my new book, The Postpartum Check-In !

Reminder: The information on this post or anywhere else on this blog or other writing is purely educational, and is not intended to diagnose, treat, prevent, or cure any health condition.

The post Are There Different Types of PCOS Understand Your Diagnosis and More appeared first on Dr. Alexandra MacKillop.

With IVF or egg freezing, the number one concern my patients have is how to ensure that the process will be worth it—the hormones, the injections, the lengthy procedure, and all the emotions that come with it. With starting a family in general, most feel a deep sense of urgency which begs the question of how to make pregnancy happen sooner and reduce the risk of complications or loss.

For many women, delayed conception, miscarriage, or failed IVF (or egg retrieval attempts) result from problems with egg quality. In many fertility circles, egg quality is seen as something that cannot improve, and can only decline due to age. But the good news is that the research tells a different story. As a functional medicine doctor, I help patients improve egg quality on a daily basis, whether using fertility supplements for egg quality, or other lifestyle strategies. Egg quality is something that should be on everybody’s radar, IVF or not, to ensure the healthiest possible outcomes.

Why Care About Egg Quality?

As a refresher from Sex Ed in high school, pregnancy = the implantation of an embryo, and embryos are formed when the sperm meets the egg. Sperm and eggs each contain half a set of DNA, so when the two meet and rendezvous, a person with a ‘complete’ set of DNA is formed. (Way cool!)

Although a woman is born with all the eggs she will ever have, they aren’t all mature. Eggs take about 3 months to mature, with one (typically) achieving full maturity over the course of one menstrual cycle. Of course, this process can be overridden for the purposes of IVF by using medication, and some women may occasionally release more than one mature egg in a given cycle. (If fertilized, this would result in fraternal twins.)

The entire process of egg maturation affects the resultant quality of the egg released in a given cycle (or harvested during an egg retrieval.) This means that each of the 90 days leading up to the egg release/retrieval is important in terms of nutrient quality and availability, exposure to toxins or inflammation, and the delicate balance of hormones that ebbs and flows to bring that egg to maturity. To say that preparation is important for egg quality is an understatement!

One of the most important factors when considering egg quality is not just the fertility supplements for egg quality that you take at the time of IVF, or at the time of TTC, but also for the 3 months leading up to that day of ovulation. Furthermore, the hormonal environment in those preceding three months (or years) also matters. So, if you’re looking to maximize egg quality, you need to also focus on your hormones.

Many factors contribute to egg quality, such as diet, lifestyle, and more. But today’s post is all about evidence-based supplements (supported by research) that can be used to maximize egg quality, ovulation, and fertility.

If you are trying to conceive, preparing for an egg retrieval for IVF or egg freezing, this post is for you!

How Do I Know if I Have Low Egg Quality?

Age is not a clear marker when it comes to egg quality. While we do know in the research that egg quality declines with age, and particularly rapidly after age 35, not all women in their 30’s have poor egg quality. What’s more is that plenty of women can and do have poor egg quality in their younger years.

Diagnosing Low Egg Quality/Ovarian Reserve

Egg quality is classically assessed using a blood test for anti-mullerian hormone, or AMH. In most cases, a low AMH level indicates poor egg quality/ovarian reserve, and a higher number relates to better egg quality. Note that in women with PCOS, AMH levels may become quite high due to the polycystic phenomenon occurring in the ovaries. This is not necessarily a sign of good egg quality but is more a reflection of the number of follicles on the ovaries. With age, women tend to have fewer quality follicles, which is why AMH levels drop.

While egg quality, ovarian reserve and AMH levels may vary, even among otherwise healthy women, we do tend to see a decline in AMH levels with age. Researchers have identified the following “median” AMH levels for women of different ages, summarized in the following table:

Antral Follicle Count

While AMH is more classically used as a marker of egg quality, counting the number of follicles on the ovaries through ultrasound imaging can also be used as a measure of ovarian reserve. With this type of imaging (typically only conducted through IVF retrieval cycles), the lower the number, the lower the likelihood of a quality, mature egg.

Lifestyle Strategies to Support Egg Quality

Across the board, research shows that lifestyle strategies are one of the best ways to reduce inflammation and oxidation of egg quality (and sperm quality). Here are a few key areas that I always extensively counsel my patients on, when trying to conceive:

• An antioxidant-rich, whole-food diet, limiting processed foods (especially processed carbohydrates and refined vegetable oils)
• Sleeping at least 8-9 hours per night
• Moderate exercise (30-45 minutes daily) such as brisk walking, light jogging, yoga, Pilates and weight training
• Stress management
• Social support, including counseling if necessary
• Avoid smoking/nicotine and other drug use, alcohol consumption, and excess caffeine
• Limit or avoid exposure to toxins, including endocrine toxins (such as VOCs, fragrance, plastic, BPA, phthalates, aluminum, mercury and other heavy metals, etc.)

Fertility Supplements for Egg Quality

There are many supplements on the market for fertility, but it can be challenging to know what will work and why. For example, some supplements serve as an alternative to fertility drugs, whereas others may serve to help regulate cycles in women who have irregular periods. These hormone-regulating supplements therefore also can be seen as fertility supplements for egg quality.

However, the second most important reason that egg quality declines is due to “aging,” or, more accurately, due to oxidative stress. With time, but also with exposure to toxins in the environment, oxidation reactions take place in the eggs, causing damage. The bad news about this is that toxins are everywhere and, when we view time as a “toxin,” it’s unavoidable. But the good news is that for most women, we can combat the effects of time by focusing on other aspects of egg quality degradation.

The majority of the following fertility supplements for egg quality focus on reducing cellular aging by acting as antioxidants. We are exposed to countless chemicals in our environments and through the natural processes of daily life that produce inflammation, so antioxidant power is everything when it comes to egg quality!

CoQ10

Ubiquinol (not to be confused with ubiquinone) is an antioxidant. This means that it reduces chemical stress in the body and supports mitochondrial function to prevent cell damage. When cells, especially oocytes or eggs, become damaged, it’s more likely that they will die prematurely or multiply into further cells that are not viable. While oxidative stress is a risk factor to all cells, it’s of particular importance with regards to egg quality and fertility.

CoQ10 is also beneficial in egg retrievals in individuals with decreased ovarian reserve. Supplementation with CoQ10 increases the number of healthy eggs that are harvested during a stimulation cycle, and makes it more likely that a healthy egg will be released during a natural cycle.

Ubiquinol is found in foods at very low levels, but these levels are not enough to produce a therapeutic effect. The research shows benefit from 600 mg of ubiquinol taken daily with food leading up to conception.

Note: it is dangerous to suddenly discontinue CoQ10 if it has been used as a supplement for a substantial period of time. If you are planning to discontinue CoQ10, such as in the case that a healthy pregnancy has been established, talk to your doctor about weaning off gradually.

Which type of CoQ10 should you use?

Ubiquinol is the active form that is used by cells to support egg quality. Ubiquinone, on the other hand, needs to be converted into ubiquinol by the body before being used, and this may or may not take place effectively. For this reason, studies are performed using ubiquinol, and that is the form that I recommend to my fertility patients.

Look for the Kaneka seal on ubiquinol suppleements to ensure that you are purchasing verified/tested ubiquinol. I recommend the brand Protocol for Life Balance, which carries this seal.

Dosages come in 100 mg, 200 mg, 400 mg, and 600 mg. The research is clear: the more the better. I recommend that my patients take 600 mg daily if they do not have any contraindications for doing so.

EPA and DHA (Omega 3 Fatty Acids)

EPA and DHA are two key omega-3 fatty acids that are of utmost importance for fertility, egg quality and pregnancy. Research has shown that dietary supplementation with omega-3s improves egg quality, delays ovarian aging, and reducing the risk of birth defects. Studies have shown that an excess of omega-6 fatty acids in comparison to omega 3’s leads to very poor egg quality, so supplementation of EPA and DHA is important for anyone whose diet does not already support healthy fatty acid balance. EPA and DHA are of particular importance as fertility supllements for egg quality for women over age 35 who are trying to conceive because fertility naturally starts to decline after this point.

In my practice, I recommend that my pateints use Prenatal DHA from Nordic Naturals.

NAC

NAC is a powerful antioxidant. Part of its job is to recycle glutathione, which is part of the body’s natural detoxification system which can be rapidly depleted with illness or use of acetaminophen. Because it is an antioxidant, NAC is important for egg quality, IVF, fertility and pregnancy for many of the same reasons as omega-3 and CoQ10 supplementation, however it accomplishes these outcomes through a different pathway. Like Omega-3s, NAC is safe to take during pregnancy, especially when periods of illness occur. Evidence in research demonstrates that NAC delays aging of eggs and ovaries, and improves blastocyst quality.

NAD+

NAD+ is a naturally occurring coenzyme involved in hundreds of metabolic processes in the body. One of its primary roles is in mitochondrial function, cell regeneration and reduction in oxidative stress. Because mitochondrial function is an essential factor in oocyte (egg) aging and quality, focusing on mitochondrial function is an important consideration for fertility and egg retrieval. Niacin (vitamin B3) is one of the main nutrients involved in regeneration of NAD in the body (also known as NAD+ and NADH), however supplementing with pure niacin can cause a flushing of the skin which is accompanied by intense itching. Nicotinamide is sold as an alternative to niacin without the risk of flushing, however it has the potential to inhibit other enzymes (sirtuins) involved in cellular repair.

One of the most recently discovered types of NAD-boosting vitamins comes from Nicotinamide Riboside, the main ingredient in the supplement “Tru Niagen.” Because supplements can be expensive, you may also consider using a low-dose combination of niacin and nicotinamide in combination with a diet rich in fish, green vegetables and mushrooms which are excellent food sources of vitamin B3.

Pterostilbene

You may have heard that red wine has antioxidant health benefits. Of course, alcohol is not high on the list of foods to consume when TTC, and the main antioxidant chemical found in red wine, resveratrol, hasn’t been proven for safety in pregnancy either. However, resveratrol’s blueberry-derived cousin Pterostilbene offers the same revolutionary antioxidant benefits as resveratrol itself. Specifically, this chemical increases the expression of proteins called sirtuins which are responsible for cellular repair and anti-aging in ovaries. When it comes to egg quality, this function is essential, and is a key reason that pterostilbene is such an important fertility supplement for egg quality, particularly among aging women.

Pycnogenol

Pycnogenol is an antioxidant which helps prevent the breakdown of nitrous oxide in the blood stream and at the ovarian level. Nitrous oxide dilates blood vessels, increasing blood flow and oxygen availability to cells. Poor oxygen availability harms cells and leads to cell breakdown whereas relaxed blood vessels, strong blood flow and plenty of oxygen helps prevent oxidative stress, promote cellular repair and prevent egg aging.

Melatonin/Inositol/Alpha Lipoic Acid

Additional antioxidant benefit has been shown in the reserach when using melatonin, inositol and alpha lipoic acid as fertility supplements for egg quality. There is some evidence that melatonin helps improve egg quality regardless of a PCOS diagnosis by forming a barrier between inflammatory chemicals and eggs themselves by accumulating in follicular fluid. However, melatonin should not be used long-term or during pregnancy. Like CoQ10, it’s not a good idea to abruptly discontinue melatonin use; it should be gradually weaned. Other considerations are to ensure that inositol supplements include a 40:1 ratio of myo-inositol and D-chiro inositol (many simply contain myo-inositol). Likewise, alpha-lipoic acid can act as an anti-inflammatory and protectant non-PCOS women against egg damage, oxidative stress, inflammation and neurotoxins both when TTC as well as during pregnancy.

DHEA

DHEA is unique because although it is not directly an antioxidant chemical, it reverses aging processes in ovaries. However, this hormone should be used with caution, particularly in women who already have elevated levels of DHEA or testosterone, as seen is PCOS. As with other hormones, there are risks both when the level is too low (accelerated ovarian aging) as well as when too high (irregular periods, delayed or absent ovulation, hair loss.) That being said, there is strong evidence that DHEA supplementation can both improve chances of natural pregnancy as well as IVF outcomes, especially in women over age 40.

A note of caution: excess DHEA supplementation may produce androgenic symptoms, like excess sweating, acne, hair loss and hot flashes. I always test my patients’ DHEA levels before supplementing, and monitor blood levels thereafter. I have seen many IVF clinics blindly recommend a 25 mg starting dose and while this may be appropriate for some women, a safer place to start is lower, around 5 or 10 mg.

Other Ways to Support Egg Quality Apart from Supplements

Supporting egg quality, as with anything in functional medicine, comes down to understanding the root cause and making a correct diagnosis for the underlying problem. While age-related ovarian decline is a great reason to seek out fertility supplements for egg quality, and is a big reason that I recommend these antioxidant strategies in my practice, it’s also important to keep in mind that ovarian aging is not simply a supplement deficiency.

Here are some other important ways that I have helped my patients reverse low AMH and poor egg quality:

• Identifying and treating underlying autoimmune disease (including Hashimoto’s and ANA+ autoimmunity)
• Eliminating food allergens
• Treating chronic infections (including viral and bacterial infections)
• Balancing the gut microbiome
• Supplementing with bioidentical progesterone
• Hormetic/mitochondrial strategies like red light, cold plunging and supervised fasting
• Correcting blood sugar imbalances

To sum things up…

If you’ve been told that your egg quality is low, know that this is not a hopeless diagnosis. While age and time do influence ovarian reserve, egg quality is dynamic and responsive to the environment you create in the months leading up to ovulation or retrieval. By focusing on the critical 90-day window of egg maturation, addressing inflammation and oxidative stress, optimizing hormones, and using targeted fertility supplements for egg quality when appropriate, you can meaningfully improve your chances of healthy conception. Fertility supplements for egg quality can be powerful tools, but they work best when combined with personalized testing, root-cause evaluation, and supportive lifestyle changes. Whether you are preparing for IVF, egg freezing, or trying to conceive naturally, taking proactive steps to support egg quality can help you move forward with greater confidence and clarity.

If you loved what you read here, check out these related posts:

• Natural Alternatives to Fertility Drugs
• Progesterone Deficiency

I’m Dr. Alexandra MacKillop, a functional medicine doctor, food scientist and nutrition expert.

I specialize in women’s nutrition & hormonal health, addressing concerns like longevity, fertility, postpartum, PCOS, endometriosis, and gut symptoms like bloating, constipation, diarrhea and more.

If you’re looking for a new way to approach your health, I’m here to help you through it.

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Reminder: The information on this post or anywhere else on this blog or other writing is purely educational, and is not intended to diagnose, treat, prevent, or cure any health condition.

The post Fertility Supplements for Egg Quality (and Egg Freezing) appeared first on Dr. Alexandra MacKillop.