Top 3 Ways to Optimize Fertility for Patients With PCOS

Polycystic ovarian syndrome (PCOS) is a condition that predominantly affects women during their childbearing years. Current statistics show that PCOS effects up to 10% of women in North America and is often undiagnosed. Common symptoms of PCOS include:

• Excess and rogens
• Insulin or blood sugar regulation concerns
• Acne
• Anovulation or irregular ovulation
• Irregular menstrual cycle
• Heavy periods
• Weight gain
• Hirsutism
• Infertility

PCOS is diagnosed based on a combination of presenting symptoms, a hormonal panel preformed via a blood test and a transvaginal ultrasound to look at your ovaries. It is a condition that often isn’t diagnosed until a woman presents at her doctor struggling with fertility.

The 3 best places to start to make an impact on PCOS symptoms include:

1. Dietary changes

Part of the concern with PCOS is blood sugar and insulin regulation.

• Ensure every meal has a protein source. Most patients with PCOS will do significantly better on a higher protein diet.
• Eliminate refined carbohydrates and minimize totally carbohydrate intake to less then 40% of diet. Insulin is proinflammatory in the body which can make PCOS symptoms worse.
• Stop snacking. Most patients with PCOS will thrive with eliminating snacking. Eating 3 balanced meals per day will help allow insulin levels to drop between meals. When insulin levelsdrop, this allows other hormones including cortisol and estrogen, progesterone and testosterone to resume their natural rhythm.
• Consider intermittent fasting. This goes along the same lines as the stop snacking. At 12 hours fasted the body enters full lipolysis and this stops secretion of insulin. When insulin drops other inflammatory mediators will also reduce so this is a great strategy for both PCOS andlong term health.

2. Supplementation

Myo-inositol

Myo-inositol has a wealth of research supporting its benefits in women with PCOS. The typical dose in the most studies is 4g per day. Studies have shown that in 8 weeks, women taking this dose begin to ovulate regularly, have less sugar cravings, better blood sugar regulation, improved acne, and higher pregnancy rates, in women who had been previously infertile.

In a placebo controlled study by Lesoine and Regidor (2016) women with PCOS who were also undergoing IVF treatment, where given 4g of inositol and 400 micrograms of folic acid per day or placebo for 8 weeks before doing their IVF cycle. Women who receivedinositol and folicacid had better quality oocytes, a significantly higher fertilization rate. They also needed less medications during the retrieval cycle than women in the placebo group. 

CoQ10

CoQ10 has been shown to support healthy egg quality in women and is also a support for energy production. CoQ10 supplementation has been studied in women with PCOS and in one 12 week trial by Samimiet al. (20017),womenwith PCOS were given 100mg of CoQ10 daily withbeneficial effects on glucose metabolism, serum cholesterol levels (both total and LDL-cholesterol).

CoQ10 can also improve outcomes in combination with clomiphene-citrate, even if the patient has been clomiphene-citrate resistant in previous cycles. A study by A El Refaeeyet al (2014) compared two groups of women with clomiphene resistant PCOS.Women received either clomiphene citrate on its own (control group) or clomiphene citrate in combination with CoQ10. The group receiving the combination had a higher number of viable follicles, improved endometrial thickness, 65.9% ovulated versus 15.5% in the control group and the clinical pregnancy rate was 37.3% versus 6.0% in the control group.

CoQ10 is an important antioxidant that can improve the environment that the oocyte develops in, increase the number of viable follicles, improve ovulatory function, endometrial tissue and results in higher pregnancy rates in women with PCOS.

3. Exercise

Regular daily movement is one of the most important ways to manage symptoms of PCOS long term. I encourage women to find an activity they really enjoy because this will be sustainable to maintaining a regular routine.

High intensity exercises a few days per week is helpful for regulating hormonal balance and increasing growth hormone. High intensity can mean choosing an exercise and doing as many repetitions as you can for a brief period. As a starting point, I find most women can easily commit to 5 minutes per day. An example of what this looks like can be doing push-ups or lunges for 40 seconds taking a 20 second break and repeating that 5 times. There are several classes at most gyms that follow this style usually called HITT (high intensity interval training) or Tabata.

In a review article by Cameron and Hakimi (2016) that looked at the impact of exercise on ovulation,researchers found that vigorous exercise between 30-60minutes per day could prevent anovulation. When they looked specifically at studies including exercise and PCOS, they found that even without making dietary changes women who exercised regularly often resumed ovulating regularly. Exercise helps to improve ovulation by helping to balance the HPA (hypothalamus pituitary axis). Moderate exercise helps to lower cortisol, this allows the androgens to drop and progesterone to increase to balance progesterone to estrogen ratios. 

PCOS is a combination of both a metabolic and hormonal dysregulation. Starting the above-mentioned lifestyle and dietary changes will go a long way to help patients manage their PCOS.

References:

Lesoine B, Regidor PA.Prospective Randomized Study on the Influence of Myoinositol in PCOS Women Undergoing IVF in the Improvement of Oocyte Quality, Fertilization Rate, and Embryo Quality.Int J Endocrinol. 2016Aug; 4378507.

Samimi M, ZarezadeMehrizi M, Foroozanfard F, Akbari H, Jamilian M, Ahmadi S, Asemi Z.The effects of coenzyme Q10 supplementation on glucose metabolism and lipid profiles in women with polycystic ovary syndrome: a randomized, double-blind, placebo-controlled trial.Clin Endocrinol (Oxf). 2017 Apr;86(4):560-566.

El Refaeey A, Selem A, Badawy A.Combined coenzyme Q10 and clomiphene citrate for ovulation induction in clomiphene-citrate-resistant polycystic ovary syndrome.Reprod Biomed Online. 2014 Jul;29(1):119-24

Hakimi O, Cameron LC.  Effect of Exercise on Ovulation: A Systematic Review.Sports Med. 2016 Dec 29. doi: 10.1007/s40279-016-0669-8. [Epub ahead of print]