“Can keto help with recovery from fertility treatments?”


Can keto help with secondary infertility? Can a keto diet be used for recovery from fertility treatments? Do you suggest adding estrogen? And, can high insulin levels be related to the development of HELLP?

Get the answer to these questions in this week’s Q&A with fertility specialist Dr. Fox:

Secondary infertility, can keto help me?

Dear Dr. Fox,

I am 34 years old and have been on a ketogenic diet for around two months now. My husband eats lower carb but does not wish to follow a keto diet. I started the diet for minor weight loss and because of secondary infertility. I lost around 8 pounds and my BMI is now 21.3.

I’m currently trying to give up caffeine entirely (at the moment 1 cup of decaf in the morning). I do not exercise except from longer walks with my dog, but I have been running around 5-8 miles weekly when I was in University (until around 7 years ago).

I have never been overweight, but I suffered from hirsutism since puberty.

I have a son who is almost two years old and was conceived without medical assistance after 1.5 years of trying. My husband and I have been trying for a second baby for around eight months now (we anticipated it would take some time). My cycles are very short (21-24 days) ever since my period came back after my son was born. I talked about this to my gynecologist, who told me that he would only do hormone or other diagnostic tests after one year of unsuccessful trying to get pregnant. The ultrasound he did showed a corpus luteum on one ovary (it was day 10 of my cycle). I have since then been charting a few cycles (trying to figure out whether my short cycles are due to lack of ovulation or to a short luteal phase) and the rise in body temperature was always around day 10 in those cycles. (I gave up charting because I found it too stressful)

Now my questions are: Do you think a ketogenic diet and eliminating caffeine can help me conceive? Which diagnostic tests would you do if I were your patient? (Alas, I live on a different continent…) What do you suspect is the cause of my problems conceiving?


Dr. Fox:

That’s a hard one. Ketogenic diet and shedding the caffeine will definitely improve your chances. You likely have other causes, though. With short cycles, we think of diminished ovarian reserve frequently caused by endometriosis. Ovulation occurs early because the FSH rises higher before your cycle starts. They can study you with an AMH value and or a Clomid challenge test.

It is our opinion that laparoscopy with treatment of endometriosis does increase your pregnancy rate through improving the endometrial receptivity. I definitely would not do excessive aerobic exercise and would try to eat frequently and avoid hypoglycemia. I definitely wouldn’t wait a year to evaluate. Good Luck…

Depo shot/adding estrogen?


I’m 37, with BMI of 41 (Started at 43, YAY!). Been doing LCHF for three months, and have lost about 20 lbs. Steadily in ketosis — was testing blood every day, but now just when I eat/do something different to make sure I don’t get knocked out. Background — I’ve been on hormonal BC of some sort constantly for 21 years. Never had kids, never want kids. No diagnosis of anything at all, but I’ve spent my whole life avoiding pregnancy, so I’ve never really been tested for anything. I do have ovarian cysts that were particularly bad with my Mirena IUD.

I’m on the Depo shot. I know it’s making it harder to lose weight. I have tried oral contraceptives, but I spot almost constantly on them and bleed periodically for no reason. I had the Mirena, but it fell out (seriously) after about 4.5 years, so I elected not to replace it. Depo works, and keeps my period mostly at bay- I still spot, but it’s nowhere near as bad as the pill was.

I see you suggest adding estrogen, but what exactly should I tell my doctor? Is adding estrogen the standard response to spotting on depo, or will she look at me like I’m crazy if I suggest/request it?

And, if it’s not the standard response, and she won’t do it, is there a particular question I can ask as I call around to try to find a doctor that’s on board with LCHF and supplemental estrogen?

I definitely don’t want to get pregnant, and I don’t much care for having a period at all, so if I can get the spotting under control and help improve my weight loss rate at the same time, I think that would be awesome!

Thanks so much!


Dr. Fox:

These are often tough issues. Depo provera or oral provera is the “worst” progestin (progesterone like drug) available from a negative metabolic standpoint. I would highly encourage another approach without provera. In my mind, the only use for that drug is in young teens with a high risk of pregnancy. Even balancing with estrogen might not completely reverse the negative metabolic effects. Ask your doctor to check your estradiol. I usually like to see levels at least 125 to 150 pg/ml. If you are not interested in children you could consider an endometrial ablation and then consider birth control + estradiol.

I don’t know really what to say, calling around looking for doctors. We have none in our area that think the way we do. Even in our specialty nationally I don’t know of anyone who is aggressive at normalizing estrogen levels in premenopausal women. Since there are only a handful of MD’s of any specialty that practice nutritional (ketogenic) medicine, the average hormone doctor or gynecologist really doesn’t consider metabolic consequences when prescribing hormones or birth control. Sorry, I can’t help you more.


Keto for recovery from fertility treatments?

For many years in my 30s, I ate a fairly solid paleo type of diet which then included IF and regular exercise. At 37, unable to get pregnant, we decided to go through fertility treatments. I went through 3 IUI, 2 IVF, and finally 1 FET in just under 1 year. I wouldn’t have changed that as we now have our son and couldn’t be happier. However, my health (of which I was in perfect health) has declined and the biggest problem was all the weight gain.

I gained approx 50# just from the fertility treatments alone and while pregnant, I was really quite strict with my Paleo eating. I didn’t gain any additional weight until I was able 7 months pregnant and then I put on approx 15# towards the end of the pregnancy. So about 65–70 pounds of total extra weight by the time I had my son…and the weight will not come off no matter what. I’ve gone back to Paleo/clean eating to zero results. Counting calories – nothing will get any of this weight to budge.

I’m a physical therapist so this aggravates me to no end as I have generally been fit for most of my life. I know I can’t go back to IF anytime soon because that could put more stress on me and it’ll backfire. My thyroid function was normal as was most of my labs. Does keto help in recovering from the physical and hormonal trauma of back to back to back fertility treatments?

Thank you,

Dr. Fox:

Melissa, this is a great question! My standard answer to such questions is, “the ketogenic diet is the best nutritional approach for all humans at all time points in life.” With that said, what you have proven to yourself is what many others experience, the paleo approach has too much carbohydrate for most with significant insulin resistance and metabolic dysfunction.

Now after your weight gain, you are by definition more insulin resistant and now are having trouble making progress. I am not a huge fan of intermittent fasting for women since some women, even keto adapted, may experience hypoglycemia with caloric gaps. I would definitely recommend this approach. Best of luck.


Can high insulin levels be related to the development of HELLP syndrome in pregnancy?

I got the HELLP syndrome five years ago with my son and have always been wondering why it happened to me. It would be really interesting to hear your take on this and if you think it has something to do with having high insulin levels…

I would be really grateful if you are able to answer.

Best regards, Johanna

Dr. Fox:

I think without a shadow of a doubt it is associated. I call pregnancy the ghost of Christmas future referring to the “Christmas Story” where Scrooge is shown his future in order to get him to reform his ways to change the negative future he is destined to realize.

Pregnancy and the associated hormones dramatically worsen insulin resistance. This is why people experience pregnancy induced hypertension, HELLP syndrome and gestational diabetes. If a pregnant woman follows a strict ketogenic diet this will most likely not occur or recur whatever the situation. We had a nurse practitioner who knew better but strayed from her diet. At 30 weeks gestation began spilling 4+ protein and her pressure went up considerably. I encouraged her to follow keto for the remainder of her pregnancy and she delivered at term without any hypertension, proteinuria, or edema. This was proof for me that the physiology is related to insulin resistance/elevation. Good Luck…

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