PMOS and Fertility: An Evidence-Based Naturopathic Approach

Irena Bergmann

6 hours ago

7 min read

If you've been diagnosed with PMOS (formerly known as PCOS) you may have already received a long list of advice about what you should - and shouldn't be eating, taking and doing.

Cut out carbohydrates. Stop eating sugar. Take inositol. Take berberine. Lose weight. Take a long list of supplements. Exercise more.

It can become overwhelming very quickly.

The truth is that there is no single protocol that works for everyone.

PMOS can affect your health in different ways, and the right approach depends on your individual symptoms, cycle patterns, metabolic health, laboratory findings, menstrual and fertility history.

This is where I believe an evidence-based individualized approach is what works best.

My goal is not to give you 20 things to do.

It is to identify the areas where we may be able to make a meaningful difference—and then build a plan that is realistic and individualized.

Diet: Supporting metabolic and reproductive health

One of the most common questions I hear is:

"What is the best diet for PMOS?"

Interestingly, the current international evidence-based guideline does not support one specific diet composition as being superior for PMOS outcomes. Instead, it recommends sustainable, healthy eating that is individualized to the person's preferences, nutritional needs and goals.

This is important because I don't want my patients to feel that they need to follow an extremely restrictive "PMOS diet." There are certain considerations that are important especially if you have been told that you have insulin resistance.

Here is what I generally focus on:

Balanced meals

Including protein, fibre, healthy fats and carbohydrates can help create more balanced meals and support overall metabolic health.

Adequate protein

Protein is important for satiety, muscle health and regulating your blood sugar and insulin levels. It can be particularly helpful when someone is trying to reduce frequent snacking or large fluctuations in hunger.

High-fibre carbohydrates

I generally prefer emphasizing minimally processed, fibre-rich carbohydrates rather than eliminating carbohydrates altogether.

Think:

vegetables
berries and other fruit
legumes
whole grains
oats
quinoa
sweet potato

Healthy fats

Foods such as olive oil, avocado, nuts, seeds and fatty fish can be incorporated into a fertility-supportive eating pattern.

Reducing highly processed foods

This isn't about never eating dessert or a hamburger and french fries.

It is about making nutrient-dense, minimally processed foods the foundation of the diet.

Weight Management with PMOS and fertility

This is an area where I think if you are undergoing fertility care there needs to be a more thoughtful approach.

Metabolic health matters in PMOS, and for some individuals, weight management may be an appropriate part of their healthcare plan. However, healthy lifestyle changes can provide benefits even when they don't result in weight loss. The international guideline specifically emphasizes this and also recommends avoiding weight stigma in PMOS care.

My focus is on metabolic and reproductive health—not creating another restrictive diet.

Here are some things to keep in mind when targeting weight management with PMOS:

A weight loss of just 2–5% can reduce hyperinsulinemia, restore ovulation, and improve hyperandrogenism symptoms (hirsutism, hair loss)
As little as 5% weight loss can restore ovulatory function
For modest weight loss, a minimum of 250 minutes per week of moderate-intensity exercise or 150 minutes per week of vigorous-intensity activity is recommended
Combining diet and exercise (behavioural synergy) is more effective than either alone

Supplements: Targeted, rather than a "kitchen sink" approach

This is probably one of the areas where I see the most confusion online.

There are countless supplements marketed specifically for PMOS.

But more supplements does not necessarily mean better.

I prefer to ask: What is the reason for using this supplement?

Depending on the individual, supplementation may be considered to support nutritional status, metabolic health, ovulation or other specific concerns.

Inositol

Inositol is one of the most commonly recommended supplements for PMOS.

There is evidence that it can have some metabolic benefits, but the fertility evidence is much less definitive than social media often makes it sound.

The international guideline states that inositol may be considered based on individual needs, but evidence for clinical outcomes such as ovulation, pregnancy and live birth remains uncertain.

That doesn't mean I don’t use it. It means I don't believe everyone with PMOS automatically needs it. Much of me recommending inositol really depends on whether your PMOS presenting symptoms requires inositol to help.

Vitamin D

Vitamin D status is important to investigate, particularly when you’ve previously had a deficiency.

Vitamin D deficiency is commonly observed in women with PMOS. Contributing factors include obesity and geographic location (particularly in North America). Body weight and BMI are correlated with vitamin D status, making testing an important step in the management of PMOS patients.

Clinical Effects of Vitamin D in PCOS:

Reduction in HOMA-IR scores (insulin resistance marker)
Improved follicular development and cycle regularity
Improvements in mood symptoms when used in combination treatments
In women with baseline vitamin D levels below 75 nmol/L, treatment had a significant effect on FSH levels and LH/FSH ratio
A minimum of 6 months of use is needed to see changes in BMI, hirsutism, and endometrial thickness

Vitamin D and Fertility/Birth Outcomes:

Each 2.5 nmol/L increase in vitamin D was associated with a 2% increase in live birth rate (LBR).
Women with vitamin D levels above 112 nmol/L had a 4x higher live birth rate.
Women with vitamin D levels below 75 nmol/L had a 44% reduced live birth rate.
Vitamin D levels above 95 nmol/L decreased the risk of miscarriage by 82%.

Omega-3 fatty acids

Omega-3s can be useful when dietary intake of fatty fish is low and may be considered as part of an overall cardiometabolic and preconception plan.

The existing evidence suggests the most notable benefit is on mood improvement in women with PMOS.

Cholesterol/Cardiovascular health: Benefits have been observed in the general population, suggesting it could be helpful for PMOS patients who often face cardiovascular risks.

Fatty liver: Fish oil is considered one of the best supplements for fatty liver disease, which is a concern for many women with PMOS.

Insulin sensitivity: Fish oil is commonly associated with improvements in insulin-related conditions.

Other nutrients

Depending on the individual, I may also look at:

iron and ferritin
vitamin B12
folate
magnesium

The goal isn't to supplement for everything. Many nutrients can be supported with dietary improvements.

The goal is to identify actual deficiencies, insufficiencies or areas where nutritional support makes sense.

What about berberine?

Berberine is another supplement that is frequently promoted online for PMOS because of its potential effects on glucose metabolism.

Berberine has shown several beneficial effects for patients with PMOS, particularly in the following areas:

Metabolic & Hormonal Effects:

Reduction in androgens (testosterone, free androgen index)

Improvements in LH to FSH ratios
Improvements in cholesterol levels
Improvements in glucose levels
Improvement in insulin resistance, which indirectly helps lower androgens

**Remember - Supplements should be individualized and reviewed as you move from preconception into fertility treatment and pregnancy.

Acupuncture: Supporting the fertility journey

Acupuncture is another tool that I frequently incorporate into fertility care.

For someone with PMOS, acupuncture may be used alongside nutrition, lifestyle changes, supplements and conventional fertility treatment.

Potential goals may include:

supporting cycle regulation
supporting ovulation
addressing stress and nervous-system regulation
supporting overall wellbeing during fertility treatment
complementing ovulation-induction treatment
supporting patients undergoing IUI or IVF

The research around acupuncture and PMOS is still evolving, so I think it is important to be realistic about what we know.

A 2026 systematic review and network meta-analysis of acupuncture for infertility in patients with PMOS found that acupuncture used alongside medications such as letrozole or clomiphene was associated with improvements in some reproductive outcomes, including pregnancy rates, compared with medication alone.

There is also emerging evidence specifically in women with PMOS undergoing IVF. A 2026 systematic review and meta-analysis of 13 randomized controlled trials involving more than 1,200 patients reported improvements in clinical pregnancy, live birth and high-quality embryo rates with acupuncture, although these findings need to be interpreted in the context of the limitations of the individual studies.

Recommended Treatment Frequency:

Acupuncture 1x per week and up to 2x/week during IVF stims
1 session 2-5 days post-IVF transfer or 5-7 days post ovulation/IUI to help with implantation
Acupuncture may be continued during the first trimester, especially if there is a history of recurrent pregnancy loss or nausea/vomiting of pregnancy

Lifestyle: More than just "eat better and exercise"

Lifestyle recommendations for PMOS should extend beyond diet.

The international guideline recommends healthy lifestyle behaviours and physical activity for all individuals with PMOS, with benefits that extend beyond weight loss. It also notes that there isn't one specific type or intensity of exercise that is clearly superior for PMOS.

That means your exercise program doesn't need to look a certain way.

Walking counts.

Strength training counts.

Cycling counts.

Running counts.

Yoga counts.

The best exercise is often the type you can actually maintain.

Sleep is another important consideration. If you are sleeping poorly, constantly stressed and exhausted, adding another restrictive diet and intense workout schedule isn't necessarily the answer.

Sometimes the most helpful intervention is actually creating a plan that is more sustainable. This is a conversation that we have to come up with the best plan for you.

What about medication?

This is an important part of an evidence-based conversation about PMOS.

Working with a naturopathic doctor does not mean medication is off the table.

For people with PMOS who are not ovulating regularly and are trying to conceive, letrozole is recommended as first-line pharmacological ovulation induction when appropriate.

Metformin may also have a role for some individuals, particularly in the context of metabolic features.

My role is not to tell you that you should or shouldn't take these medications.

My role is to work alongside your medical and fertility team and help address the factors that may be relevant to your overall fertility health.

The most important part: PMOS is not the same for everyone

Two people can have the same diagnosis and have completely different health and fertility challenges.

One person may have irregular ovulation and insulin resistance.

Another may have relatively regular cycles but elevated androgens.

Their naturopathic plans should not look identical.

Your diagnosis is a starting point—not your entire fertility story.

My approach is to look at the bigger picture and ask:

What are the factors we can actually influence?

What can we optimize?

What needs to be investigated further?

What supplements are actually warranted?

Where might acupuncture be helpful?

And when is it time to bring in medical or fertility treatment?

That is what evidence-based naturopathic fertility care should look like.

Not doing everything.

Doing the things that make sense for you.

This information is for educational purposes only and is not intended to diagnose or treat an individual. Fertility treatment, medications and supplementation should always be individualized in collaboration with your healthcare providers.

Let's Connect – Book a Free Consultation

If you have questions about your fertility, hormone health, or want personalized guidance, I’d love to help. I offer virtual consultations as well as in-person appointments at Pollin Fertility in Mid-Town Toronto. Together, we can create a tailored plan to support your fertility and overall well-being.

PMOS and Fertility: An Evidence-Based Naturopathic Approach