🎧 Episode 8: PCOS & Fertility: Root Causes, Supplements & Expert Insights with Dr. Cyntia Brown
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In this episode of The WOVA Circle, I sit down with Dr. Cyntia Brown, a clinical pharmacologist and integrative fertility specialist with over 13 years of expertise in fertility, personalized medicine, and metabolic health. We dive into why understanding the root causes of hormone imbalances, especially PCOS, is essential for fertility, and how a personalized approach to supplements, lifestyle, and genetics can transform your TTC journey.
This grounded conversation explores how PCOS often goes undiagnosed or misunderstood, why one-size-fits-all treatments fall short, and how addressing insulin resistance, inflammation, and genetic expression can restore ovulation and hormonal balance. Dr. Cyntia breaks down what supplements actually work (and which are just hype), how to confirm ovulation beyond LH tracking, and why lifestyle modifications matter more than restrictive fad diets.
What You'll Learn in This Episode
What PCOS really is and why it often goes undiagnosed or misunderstood
How insulin resistance, genetics, and hormone imbalances contribute to PCOS symptoms
Why ovulation tracking is more complex than just monitoring LH surges
How to better understand ovulation, progesterone, and luteal phase health
An evidence-based look at common fertility and PCOS supplements
Why personalized supplementation matters more than following generic protocols
How nutrition, blood sugar balance, and sustainable lifestyle habits support fertility
Why restrictive diets can backfire and what a more balanced approach looks like
The connection between stress, emotional health, and reproductive wellbeing
Practical ways to support fertility through a more whole-body, individualized approach
⏱ Listen time: 30 minutes
🎧 Format: Video & Audio
📍 Best for: Individuals and couples considering or undergoing IVF, those wanting to better understand fertility treatment, and anyone looking for a more informed, balanced approach to reproductive health
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Podcast Transcript
Introduction
Gabie: Welcome to The WOVA Circle: real talk on fertility, wellness, and trying to conceive. I'm Gabie Peytchev, founder of WOVA Health and fertility educator. This podcast is your community space for navigating the path to parenthood with evidence-based insights, authentic conversations, and genuine support. I'm dedicated to being here with you through every part of your journey.
Today's guest is Dr. Cynthia Brown, a pharmacist, clinical pharmacologist, and clinical researcher. With over 13 years of training and expertise, she bridges the gap between science and holistic care, helping women prepare their bodies for conception in the safest and most effective way. Cynthia specializes in understanding how medications and supplements interact, ensuring fertility support is personalized to each woman's unique genetics and metabolism. Her mission is to empower women with both knowledge and practical tools so they can make confident decisions on their fertility journey. Welcome, Dr. Brown.
Cynthia: Hi.
Gabie: Did I miss anything in my introduction?
Cynthia: It was very flattering — thank you. I just need to clear one thing up: I'm not working in chemistry. I'm a pharmacist by trade and a clinical pharmacologist, so I definitely understand how the drugs we take — whether supplements or fertility medications — interact with everything from your genes to the cells in your body, and how they move us toward better health.
Gabie: Amazing. Can you share a little about your journey? What inspired you to get into this field?
Cynthia: Honestly, it's because I was bad at other parts of pharmacy. I didn't enjoy retail pharmacy, didn't enjoy being in a hospital all day. I had a great mentor who saw I was really interested in laboratory science and experimentation, and he encouraged me down an alternative path for pharmacists — to go into big pharma and learn how we can implement what we learn in pharmacy school at a larger scale. I did my postdoc at IU School of Medicine, where I learned clinical pharmacology, and entered big pharma from there.
Gabie: So you found your calling. You're helping women maximize their health so they can get pregnant and have healthier children.
Cynthia: That is definitely a personal journey of mine. I had some fertility bumps in my road to motherhood. Because I experienced all of these things on my own — navigating the healthcare system even as someone who's part of the healthcare system — I was still getting jerked around. That really drove me to want to advocate for other women, especially those who might not know there are other options, or who are being treated as just another regular case. I really try to emphasize the importance of individualized, personalized medicine and advocating for you on a personal level — not simply as another patient or client.
Gabie: Thank you for doing what you're doing. I went through my own infertility struggles and saw how broken the system is. It's amazing that people like you are trying to make a change and really pay attention to what's going on.
Cynthia: It's a team effort.
Treating the Root Cause, Not Just Symptoms
Gabie: Many people manage symptoms without ever addressing the root cause. How do you approach identifying the underlying drivers of hormone imbalances?
Cynthia: As you know, I deal with a lot of clients who have PCOS, and that core driver is insulin resistance — fueling everything from the androgens to the physical symptoms like excess weight gain and hair developing in places we don't want it.
I try to educate and empower first: here is the underlying cause of all these other problems. When a client comes to me, they have a laundry list — here's what's bothering me, here's how this is affecting me — and commonly those symptoms can be isolated down to one or two core drivers. If we can nip it in the bud, we can eliminate or at least reduce the burden of those other problems.
I treat everyone as their own individual case study, looking at how lifestyle, cultural background, race, or genetic background could be influencing the expression of symptoms.
Genetics and the Expression of PCOS
Gabie: Can you talk more about this? When it comes to genetics and the expression of symptoms — many people don't understand epigenetics and how powerful it can be.
Cynthia: It's a unique field. Honestly, epigenomics was something we covered in pharmacy school, but it's still not always fully appreciated in the larger discussion.
For instance — PCOS is often driven by a number of genetic factors. Black women inherently carry some of those genes. That doesn't guarantee you'll have PCOS, but I try to explain to clients that both your father and your mother can be carriers, and that contributes to how PCOS expresses in you. That's why you see such variety of expression — lean PCOS, where someone very thin is having the same symptoms as a larger person with a more conventional expression of PCOS. No two cases are the same.
I once worked with two sisters — one with a PCOS diagnosis and one without — but they had the same symptoms: the same weight gain, the same hirsutism, the same fertility struggles. I told them: we diagnose PCOS based on criteria, a triad of symptoms. Just because you don't meet the criteria to qualify for a diagnosis does not mean nothing is going on. It's very interesting to me that your sister has a confirmed diagnosis and you do not — yet you're having the exact same problems. Same father, same mother. That opened up a conversation about genes and how, just because you don't fully express a gene to meet the diagnostic criteria, that doesn't mean you won't have similar difficulties — because you share a gene pool.
I try to empower women: just because you don't have a confirmed diagnosis does not mean nothing is going on. At times we can get gaslit. You might say, "Yes, I know my sister has cysts and fibroids, my mom does, my aunt does, my cousin does, but I don't — and yet I still feel X, Y, Z." There's something going on. Maybe your genes are a little different, but the core expression is still there. So let's look closer.
Why PCOS Is So Often Missed
Gabie: In PCOS: The Hidden Epidemic by Dr. Samuel Thatcher, he talks about how often this condition is undiagnosed. Why is PCOS missed so often? Is it because of what you just mentioned — how symptoms can vary? What signs do you wish more clinicians picked up on early?
Cynthia: A few things. One — we have a misunderstanding that PCOS means you'll be a larger person, you'll have acne, you'll have the worst-case scenario of symptoms. That isn't always the case. Because we have extreme ideas of what PCOS looks like, people don't seek help. They think, "Oh, I'm not that bad. I can't fit this." That's not how medicine works. So breaking down the stigma and stereotypes around what it means to have PCOS is step one.
Two — there's a real aversion to the healthcare system at large. People are not seeking guidance or a diagnosis.
Three — the numbers are big. Anywhere from 15 to 20% of women have a diagnosed case of PCOS, and that number changes based on the study you look at. Some studies show one in three women with infertility have PCOS. A lot of women aren't cognizant of this until they're trying to conceive — typically later in life, late twenties through forties. So we're getting later and later diagnoses. We patchwork-fix things along the way: I'm getting bigger — I'll do a weight loss diet or drug. My blood sugar is high — I'll cut back. We treat symptoms instead of seeing the underlying driver.
The number one thing I hear from women is that they're having issues conceiving because ovulation support isn't there. Ovulation support is like the final boss — when your PCOS has been so out of control and unmanaged for so long that your body stops ovulating and stops producing healthy eggs, all of a sudden it's: "Oh, I'm on fire — this is super crazy and all the symptoms I've had for years are actually this."
We need to encourage early intervention. Bring it up with your practitioner. Say, "Hey, assess me for PCOS." If I'm wrong, cool. But it's better to catch it the earlier you can so you don't have those bigger problems downstream — diabetes, infertility.
How to Know If You're Actually Ovulating
Gabie: You mentioned ovulation. Some people could have a regular period but not actually be ovulating. How do you know whether you're ovulating?
Cynthia: In a normal, healthy woman, it's actually common not to ovulate every single cycle. Data shows that within a three- to four-month window, a healthy woman may have one cycle where she doesn't ovulate. That's not alarming — try next month.
With PCOS clients, two things happen. One, their cycles are much longer — 40, 70, even 90 days at a time, compared to a normal 28- to 33-day cycle. Two, they have multiple recurring anovulatory cycles.
How do you know if you're ovulating? You have to assess your PDG levels. In a normal healthy cycle, you have your LH surge, which triggers ovulation. Some women feel their LH surge — I feel it when I'm ovulating, you can feel that little bracing as the egg releases. But three to four days later, you should see a rise in PDG (pregnanediol glucuronide, the progesterone metabolite), and that's what confirms you actually ovulated and completed a full cycle.
With PCOS and some other women, the PDG rise doesn't happen — meaning they didn't actually ovulate that cycle. You only get a PDG rise if you ovulated. So I have my clients track PDG. That's what I'm waiting for, not the LH — because LH only prompts you to ovulate. I need to know your body responded by releasing the egg.
Gabie: So if you do an ovulation kit, it only tracks LH surge.
Cynthia: Correct. I want to see the LH surge to know your body is initiating, but I need to know you completed the process — and that's PDG. For some people, the luteal phase can be very long — seven to ten days. In PCOS you might hear the phrase luteal phase defect, which means there's no proper PDG rise. Some practitioners prescribe progesterone at this point to support proper ovulation and help complete the process. It's very person to person.
I personally use the Inito monitor in my practice. It measures all your key hormones — estrogen, FSH, LH, and most importantly PDG — to confirm when you ovulate. For some people it even confirms you released two eggs and had two LH surges. Then I get extra happy because it could be twins this month.
I'm heavy on tracking. There are PDG test strips out there too, but I prefer more data. If you're trying to confirm you actually ovulated, LH alone isn't enough. It's just starting the conversation. I need to know you completed the process.
Lifestyle, Nutrition, and Epigenetics
Gabie: When we talk about genetics, we also have to talk about lifestyle. You touched on epigenetics and how lifestyle and nutrition can affect gene expression. I came across another book — PCOS and Your Fertility by Colette Harris — and in the book there's a lot of emphasis on lifestyle and self-care. In your practice, how much of a difference can stress management, nutrition, and sleep quality really make for someone with PCOS who's trying to conceive?
Cynthia: It's night and day, honestly. In terms of managing weight and managing insulin resistance, you can turn things around in a number of weeks with lifestyle modifications alone.
The important thing I always say: number one, we're walking into a new life, so we don't want to shock your system with any crazy diets or interventions you can't maintain. We're building a new body — a healthier body for you and your baby. Number two, the right lifestyle modifications and supplementation need to be on board. Not every supplement is for every body. Not every lifestyle change is for every body. It has to be individualized to what you can do consistently and what your goals are.
For example, with a client who has high cholesterol, I'll push heavier on fish oil compared to someone who doesn't, because I want to help regulate that internally. That can be done alongside current medications or with lifestyle interventions first. I collaborate with your PCP, OB, or RE — whoever is on your team — because I just need to get you across the line. I don't care who else is on the team, as long as we're hitting the problem from all angles.
The Diet Trap: Why Restriction Doesn't Work
Gabie: You touched on dieting, and that's an important topic. A lot of women trying to conceive feel everything is on their shoulders, and they often starve themselves or jump into different restrictive diets — soy-free, dairy-free, gluten-free. What do you think about all that?
Cynthia: All you really need to know is Mediterranean. What does that mean? Fish, seafood, protein, fiber. What that looks like to you is up to you, your lifestyle, your culture, your family — but I'm heavy on fish, seafood, protein, and fiber because those things will help regulate your hormones the best.
All the other stuff — dairy-free, gluten-free, this-free, that-free — sure, if you want to. But we can get too restrictive and cut out important macro- and micronutrients we actually need. As long as the foundation of your diet is healthy proteins, healthy fats, and fiber, the rest doesn't matter too much and can be customized to your lifestyle and cultural preferences.
I recently had a client I was encouraging to increase fiber. I said, "Nothing white." The husband heard that and went out and said, "I'm not going to eat any bread, any carbs." That's not what I said. I was trying to show good fibers, good carbs and bad. We don't need to overcorrect — we just need to implement things that hit your fiber quota for the day, that you'll enjoy and be able to maintain. I'm against heavily restrictive diets and extreme fad diets. If it has a trendy name, I generally don't care for it.
Stress, Trauma, and the Mind-Body Connection in PCOS
Gabie: There are discussions online suggesting PCOS could be related to chronic tension and stress patterns — to a Type A personality — rather than purely metabolic issues. Is there any evidence PCOS can be influenced by stress physiology or nervous system patterns, and how might it present in ways that aren't strictly metabolic?
Cynthia: I'm not aware of clinical studies that directly support that. But I think what you're also asking is: can stress and anxiety influence inflammation and the underlying metabolic issues of PCOS? Absolutely. All those things are factors that contribute to how PCOS manifests, and stress is definitely one of them.
Personally — and this is the holistic side of me coming out — I adhere to the teachings of Dr. Gabor Maté. I've read a lot of his books, and he talks about the interconnection of the spiritual and mental with the physical, and how the things you're describing — tension, clenching — are often manifestations of deeper-seated pains and traumas. Those can manifest as illness in our bodies. I strongly believe in that, and I try to do some spiritual work with clients as well, talking about where the pain and tension points are coming from.
I had a client recently dealing with infertility after her first child. I noticed she was doing a lot of masking. She was tense and stressed, but when her husband was in the room — at work, in conversation — everything was "kosher, happy, good." She needed to release some of that, not only to welcome her next child into her body but also for her own healing. One of her pain points was weight, and you can't address that when you're constantly tensed up and pretending.
I try to guide clients through the mental work that's part of healing, because I believe in the interconnection of soul and body. I don't think you can isolate the two. While I can't point to a study that says "if you're tense a lot, you'll have PCOS," I do understand how stress and pressure can worsen symptoms for a number of conditions, PCOS included.
The Supplement Rundown: What's Worth It and What's Hype
Gabie: There's a lot floating around the fertility world about different supplements and compounds. CoQ10 is a well-known one. There's also NAD boosters, shilajit, mushrooms. Can I walk through several and you give me a quick take — would you generally recommend it, is it scientifically proven or not? Let's start with the obvious one: CoQ10.
Cynthia: Well studied. It can't hurt. Sure, let's add it on board. I typically encourage clients to include it.
Gabie: PQQ?
Cynthia: Interesting early data. It might help with mitochondrial support, but it's not one of the staples. Take it or leave it.
Gabie: Shilajit?
Cynthia: Traditionally used, but there's very limited data in terms of fertility support. Seems to be more hype than evidence right now.
Gabie: Maca root?
Cynthia: Interesting one. You'll hear gossip about libido support — I think that might be more placebo than actual effect. But sex is part of fertility, so if it gets you going, sure.
Gabie: Even if it's placebo, if it works.
Cynthia: Honestly.
Gabie: Cordyceps — medicinal mushrooms?
Cynthia: Can help with some stress, but not much direct fertility-focused support. I'd be careful with herbals and mushrooms — they're not very studied to the best of my knowledge. Mostly anecdotal.
Gabie: Inositol?
Cynthia: Very strong data for PCOS and insulin resistance. It's a staple for many PCOS women. I tried it myself a year ago after I gave birth for my own insulin resistance. Inositol and berberine — those are go-tos for insulin resistance and PCOS.
Gabie: Melatonin?
Cynthia: Promising data for egg quality, especially in women told they have diminished reserve or poor egg quality. Some IVF clinics actually add it to the regimen as part of the cycle. There's good evidence it can provide support.
Gabie: NAC?
Cynthia: Great evidence for PCOS and insulin resistance. We're touching on a couple of PCOS staples here — but we should not over-stack. Remember: individualized. Don't go out and rush to get berberine, inositol, and NAC all at once. But yes, those are pretty good staples for PCOS.
Gabie: Alpha-lipoic acid?
Cynthia: Anecdotal data shows it can support the metabolic issues of PCOS. Doesn't hurt.
Gabie: Resveratrol?
Cynthia: Controversial. Mixed evidence. Some studies say it helps with inflammation, but not strong data.
Gabie: Glutathione? There's a lot going on with this on social media right now.
Cynthia: It's very sexy, very popular right now because it's an antioxidant — and that's important if you're trying to conceive, since it supports proper egg development. Not harmful, but I haven't seen strong clinical studies supporting its addition specifically for fertility. So: I don't think it would hurt.
Gabie: Methylene blue?
Cynthia: Now we're entering experimental territory. I would not recommend this for fertility. A little too in the danger zone for my comfort.
Gabie: Last one — fo-ti powder and TCM tonics?
Cynthia: Traditional medicine again — I don't see much about fertility support. I'd leave it. We've touched on others with more evidence behind them that will get you to the goal in a more structured way.
Final Word: It's the Whole Picture
Gabie: You talk a lot about a personalized approach, but also that supplements alone aren't going to be as helpful. It's about lifestyle, nutrition, real whole foods, even sun exposure for vitamin D. Supplements can be helpful, but we just want to make sure we get as much as we can from real sources.
Cynthia: It's the full picture. And personally, I don't discuss things I don't do myself — whether on my fertility journey or my postpartum journey when I had insulin resistance.
Closing
Gabie: Thank you so much, Dr. Cynthia, for sharing your expertise and wisdom with us today. I know our listeners will walk away with a deeper understanding of science and holistic care, what we need to know about PCOS, and how it all comes together to support fertility.
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