Ask Dr. Michael D. Fox about nutrition, low carb and fertility


Are you having problems with your menstrual cycle? Perhaps you’ve been diagnosed with PCOS or you suspect you have it? Are you interested in how low carb diets can help and how to maximize the benefits? If so you could ask your questions to our expert on the subject, Dr. Fox.

Ask Dr. Fox about nutrition, low carb and fertility – for members (free trial available)

Here are three new questions answered by Dr. Fox:

Fasting, Insulin Resistance and Infertility

Dr Fox,

What is your opinion on alternate day fasting to try to lose weight along with LCHF way of eating?

I’ve been trying to conceive for 5 years and have been told I have unexplained infertility after having two suçcessful pregnancies. Since my last pregnancy I have had multiple miscarriages. I had one miscarriage between my two suçcesful pregnancies and after 4 miscarriages and one tubal pregnancy leading to a ruptured tube. At this time I’ve been told to decrease my bmi to try Ivf. Any suggestions would be helpful.

Also I was diagnosed with PCOS 6 years ago. I have been eating low carb high fat for the past 3 years. Trying to keep the carbs under 20 grams per day. What forms of fat do you suggest and how much per day?

I just recently have learned about insulin resistance and think I could have high resistance since I have ate low carb and not reached my weight loss goals in these past few years. For a year and half of those years I went through 6 iuis and was on a lot of different infertility medication I know could stall weight loss. That is why I’m asking about incorporating fasting to try and lose additional weight.

My current weight is 40 pounds (18 kg) lighter than I was when I conceived and had my 2nd child five years ago. I’m currently 34. Besides being overweight I have no other medical problems. With one tube now I’ve been told I must do ivf to conceive. I worry about the success rate for ivf with my history of miscarriage. Thanks again for taking the time to reply. Truly thankful for your research and help in this matter.


Staci, please read my answer to Patti immediately above your question. Miscarriages can be recurrent tubal pregnancies that go undetected. If they were definite miscarriages, you should have a recurrent pregnancy loss evaluation. PCOS and insulin resistance can cause miscarriage as well. I am assuming your BMI is still above 35 based on the doctors recommendation to lose weight to lower your BMI.

A couple of thoughts: 1. If you have been on the LCHF with a BMI above 35, your pregnancy rate would be better than someone whose BMI was 28 and on a high carb diet. This is where the state of nutritional research in medicine is so lacking. The only measure of metabolic dysfunction for mainstream medicine is BMI. It has no clue about insulin elevation and what that means. All weight loss is not equal. If one loses via a starvation diet the same % of weight as someone on LCHF, the starving person will only be, say, 20% healthier, while the LCHF person is 100% healthier. The key is insulin reduction both for chronic disease prevention and fertility.

With that said, I am worried for you that you are stimulating insulin to some degree and need to figure out the stimulus and eliminate it. Lastly, caffeine is a very bad actor and should be eliminated. Not decaf, but eliminated. The answer to the fat question is mostly animal fat and as much or as high a % of calories as possible to still maintain your requirement for protein (1-1.5gms / kg ideal body weight).

Intermittent fasting is fine. Remember again, you need water, electrolytes (sodium, potassium, calcium, magnesium etc), and minimum protein requirements. Take your vitamin. There is no doubt that weight loss goes faster when calories are reduced in a ketoadapted person. This becomes similar to starvation in the starvation diet, but the difference is that the ketoadapted person can immediately access fat stores for energy without an intervening drop in blood sugar that triggers a life threatening stress response including cortisol elevation. Good luck on the pregnancy front……. Hope this helps!

Best of luck

Progesteron and Menopausal Symptoms


This is not a question about fertility but whether the progesterone cream I am using might be causing the high post-prandial BG levels despite having a low(ish) carb diet?

I’m 56 and 7 years post-menopause. I still have horrendous hot flushes, causing poor sleep. I recently started using a progesterone cream (100 mg morning and evening) and have had improvements in my sleep and reduced severity and number of hot flushes (although not disappeared by any means). I also recently purchased a blood glucose monitor, so I don’t know what my BGs were before starting the cream.

I fast for around17-18 hours daily and consume under 100g carbs per day. I’ve lost 88 lbs. (40 kg) in weight and am now BMI 24, waist:height ratio 0.42. I’ve been maintaining my weightloss for 2 years. My PPBGs are often around 8mmol/l at 2 hours (the peak seems to be later than expected), but FBG is around 4.4. I have today stopped the cream as I understand that one should take a break once a month and am interested to see if my PPBGs improve.

I would love your thoughts on this and what is the next step to control my hot flushes and poor sleep (waking due to hot flushes). I take magnesium citrate before bed (300mg) and vitamin D in the mornings (5000IU). I’ve not slept well for around 10 years and I am worried that despite the weightloss and carb reduction, this is compromising my health.

Thanks in advance for any insights you can offer!


Hey Caroline,

You are suffering from menopausal symptoms. Progesterone has been used to treat menopausal symptoms but it just covers up the symptom failing to treat the underlying cause, estrogen deficiency. I am a huge proponent of estrogen replacement therapy. Estrogen deficiency results in so many negative effects on all body systems. Your sleep is being disrupted by vasomotor dysfunction and the sleep disturbance is furthering the insulin resistance. It’s a vicious cycle! We would recommend not fasting for so long during the day, especially in the face of so much carbohydrate. We would recommend less than 20-40 grams per day for ideal health. Fasting is useful once ketosis has been successfully established.

To answer the sugar ?’s: Progesterone does make you more insulin resistant, an effect that would tend to raise blood sugar. The ultimate answer though is in a carbohydrate free high fat environment, there would be an absence of glucose elevation in the blood.

You are well on your way to health, but if you add estrogen, further drop the carbohydrates, and eat frequently, you should feel much better.

Best of Luck!

Staying Keto Adapted While Pregnant?

Hi Dr Fox,

I am getting ready to embark on the IVF journey. I started a Keto lifestyle two weeks ago. My embryo transfer will happen mid March, I’m wondering if it’s still safe to lose weight before the implantation of the embryo. Hoping the meds don’t make a gain too much weight.

Once I get pregnant are there any Keto foods I should avoid, or anything I should add more of? What about supplements? I want to remain keto adapted.

What are your thoughts on dairy?



Great questions. Weight loss in and of itself is not bad for fertility or pregnancy. As long as you are taking in appropriate calories to prevent nutritional (starvation) stress and the proper trace elements and minerals you will absolutely be fine. The cave woman was ketotic and that was her only choice. We survived the evolutionary test of time.

Pregnancy is fine and there are really no dietary restrictions. My personal recommendation is to eat some form of organ meat like liver 2-3 times per week. It is exceptionally rich in trace elements, vitamins and minerals.

Best of Luck and hope to hear some good news!!

More Questions and Answers

Read all earlier questions and answers – and ask your own! – here:

Ask Dr. Fox about nutrition, low carb and fertility – for members (free trial available)

More with Dr. Fox

What to Eat to Get Pregnant – Dr. Michael Fox
Stressing Less to Get Pregnant – Dr. Michael Fox
Is Coffee Bad for You? – Dr. Michael Fox
The Cure for Morning Sickness
Women, Hormones and Nutrition – Presentation by Dr. Michael Fox


  1. Enkay
    Hi Dr. Fox,
    Pls am embarking on IVF, and this is my 4th week on LCHF, can I do IF, again what else can I do to acheive success this time since I ve had failed IVF before I started LCHF.
  2. Peter Biörck Team Diet Doctor
    Hi Enkay!

    You can direct your questions to Dr FOX here (soon) :

  3. Michael Stanbrook
    Can i purchase a recipe book please . ( a paper book thanks.)
    kind regards
    Michael Stanbrook.
    Reply: #4
  4. Peter Biörck Team Diet Doctor
    Hi Michael!

    Sorry we don't have a recipe book (for the time being)..

    Can i purchase a recipe book please . ( a paper book thanks.)
    kind regards
    Michael Stanbrook.

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