One of the most common causes of infertility, Polycystic Ovary Syndrome (PCOS), affects 15% of women in North America. Yet, almost 50% of women with PCOS go undiagnosed, which can lead to severe health implications.
“As well as being a leading cause of female infertility, PCOS is associated with a number of other health problems, including diabetes, heart disease and endometrial cancer. Many people don’t know they have PCOS until they discover that they can’t conceive,” says Dr. Ginevra Mills MD, Reproductive Endocrinology and Infertility Specialist, Olive Fertility Victoria, and a Clinical Assistant Professor, UBC, Division of REI, Department of Obstetrics and Gynecology.
What is PCOS?
PCOS is a common hormonal endocrine condition in which high insulin resistance seems to be a key factor. There are two kinds of PCOS: non-ovulatory and ovulatory. Women with non-ovulatory PCOS do not get regular periods and may experience decreased libido (lack of sexual desire), increased hair growth on the face and body, irregular periods or no periods at all. Women with ovulatory type PCOS may experience irregular cycles or skipped periods if they are overweight.
How does insulin resistance affect fertility?
Insulin is a hormone that regulates the change of sugar and starches into energy for the body’s use or for storage. High insulin resistance means your body needs more insulin to process sugar, and excess insulin can cause a rise in male hormones (androgens), which can lead to acne, excessive hair growth, male pattern hair loss, weight gain (particularly in the belly area) and ovulation problems. Excess androgens can interfere with normal follicle development, often resulting in no egg being released.
How is PCOS diagnosed?
PCOS can be difficult to diagnose because there is no one single diagnostic test and the signs and symptoms vary from patient to patient.
Clinically, if you have two out of three of the following symptoms, you will most likely be diagnosed with PCOS:
1. Irregular, few, or absent menstrual periods
2. Androgen excess – clinical or biochemical (excessive body hair, acne, loss of head hair, increases testosterone in the blood)
3. Polycystic ovaries – the ovaries of women with PCOS usually have a distinctive appearance on ultrasound
Treating PCOS with lifestyle changes
While there is no magic bullet for treating PCOS, studies show that lifestyle changes, such as following a low glycemic Mediterranean-style diet, and incorporating high-intensity exercise, can reduce androgen levels, improve ovulation, and decrease insulin resistance.
A low glycemic diet
The glycemic index (GI) is a measurement that ranks carbohydrates based on their ability to raise blood sugar after eating. “Foods with a high GI (all refined carbohydrates including any kind of flour or sugar) break down quickly during digestion, causing a quick spike of sugar into the bloodstream,” says Dr. Ginevra. “The rise in blood sugar results in higher insulin production which, over time, contributes to weight gain and increased diabetes risk.”
Studies have shown improved insulin sensitivity and more regular menstrual cycles in women with PCOS who follow a Mediterranean style, low GI diet, which includes:
- Reducing or eliminating processed carbohydrates (anything made with flour)
- Increasing complex carbohydrates and fiber
- Increasing high-quality protein from fatty fish, meats, poultry, or plants
- Increasing fruit and vegetables (5-10 servings per day)
- Eating mono- and poly-unsaturated fats in their natural forms (as much as possible)
Exercise for PCOS
Exercise has been shown to be extremely effective in increasing insulin sensitivity. Studies have shown that moving your body for 30 minutes a day so that you break a sweat is enough to help reset your insulin sensitivity. One study showed that vigorous activity improved insulin resistance and decreased the risk of metabolic syndrome among women with PCOS.
Research suggests that certain nutritional supplements may also help manage PCOS.
Omega-3 Fish Oil
Omega-3 fish oils can help decrease inflammation, insulin resistance, and testosterone levels, improve lipid levels, and promote regular menstrual cycles in women with PCOS.
Vitamin D deficiency is common among women with PCOS and has been linked to lower fertility and pregnancy rates, insulin resistance, irregular menstrual cycles, and other symptoms of PCOS.
Coenzyme Q10 (CoQ10)
CoQ10 is a naturally-occurring antioxidant that is essential for cellular energy production. CoQ10, along with the medication clomiphene citrate, may help increase ovulation and pregnancy rates more than clomiphene alone.
Inositol supplementation can help decrease insulin resistance, reduce testosterone levels, regulate menstrual cycles, and promote ovulation in women with PCOS.