Polycystic ovary syndrome (PCOS) is a hormonal, metabolic, and reproductive condition that affects up to 10 percent of women. PCOS is the most common ovulatory disorder, and is considered a leading cause of female infertility.
The good news is that many women with PCOS can conceive with the help of diet and lifestyle changes, certain nutritional supplements, medications, and fertility treatments. If you have PCOS, you should have your fertility evaluated as soon as you begin trying to conceive.
Why does PCOS affect fertility?
According to Dr. Greenhouse, about 40 percent of women struggling to get pregnant have fertility issues that may be related to PCOS. “There are two main reasons that women with PCOS have difficulty conceiving. They may have irregular menstrual cycles, or they may not ovulate at all. Infrequent ovulation makes it much more difficult to conceive. It is hard to time intercourse for conception, thus decreasing the chances of pregnancy,” says Dr. Greenhouse.
How is PCOS diagnosed?
Despite how common PCOS is, women often suffer for years before being diagnosed. Symptoms vary from woman to woman, making arriving at a PCOS diagnosis more difficult.
Although there is not complete agreement on the criteria for PCOS, it is often diagnosed by the presence of at least two out of the three following:
1. Blood tests or physical signs of elevated androgens (male hormones such as testosterone)
2. Absent or irregular menstrual cycles and ovulation
3. Polycystic ovaries (enlarged ovaries with numerous small follicles)1
“PCOS is a diagnosis of exclusion of other reasons for not ovulating on a regular basis, such as thyroid dysfunction, prolactin disorders, and other rare hormonal disorders. It can be somewhat of a subjective diagnosis,” explains Dr. Greenhouse.
What are the symptoms of PCOS?
Although symptoms vary, elevated androgen levels can result in acne, excess facial hair, thinning of hair on the scalp, darkening of the skin in certain areas, and skin tags.
PCOS is associated with insulin resistance. Insulin is a hormone that allows cells to use glucose (sugar) to produce energy. When insulin resistance occurs, cells do not respond normally to insulin, and more and more insulin is produced. High insulin levels trigger the ovaries to produce more testosterone, potentially worsening androgenic symptoms, and leading to irregular menstrual cycles and ovulation problems. Both obese and lean women with PCOS have some degree of insulin resistance.2
Women who are insulin resistant may experience weight gain or have difficulty losing weight. They may have intense cravings for carbohydrates, and potentially some episodes of hypoglycemia (low blood sugar). If not properly managed, PCOS increases the risk of gestational diabetes and other pregnancy complications, type 2 diabetes, metabolic syndrome, high blood pressure, and heart disease.3 “Insulin sets up an inflammatory response that can have negative effects not only on fertility, but also other aspects of health,” says Dr. Greenhouse.
How is PCOS managed?
PCOS is generally managed with lifestyle strategies such as a low glycemic diet, regular exercise, and certain nutritional supplements such as inositol powder. Some women will also need prescription medications and fertility treatment when trying to conceive.
According to Dr. Greenhouse, “if a woman is overweight and has polycystic ovaries, the most helpful thing that she can do is exercise and achieve weight loss.”
Studies show that lifestyle modification and weight management can reduce insulin and androgen levels, induce ovulation, and potentially improve fertility.1 Dr. Greenhouse explains, “Obesity compounds the insulin resistance that a woman with PCOS already has. The insulin resistance drives the increased production of testosterone within the ovary, which sets up an abnormal hormonal environment, preventing ovulation.”
“With weight loss and exercise, some women end up ovulating regularly on their own, or they respond better to fertility medications,” adds Dr. Greenhouse. Studies indicate that losing as little as 5 percent of body weight can restore regular menstrual cycles and improve response during fertility treatment.2
To watch our On-Demand Webinar on PCOS, click here. During this free, on-demand event, viewers will learn about the symptoms of PCOS, the role they play when trying to conceive, and treatment options that are available to help women overcome their infertility caused by this condition.
Low Glycemic Diet
“Although studies have not found that one specific diet is best for PCOS, there is evidence that a low glycemic index (GI) diet is beneficial for women with PCOS,” says Dr. Greenhouse.
The GI is a system of measuring how much a carbohydrate-containing food increases your blood sugar and insulin levels. Low GI foods result in a slower rise in blood sugar levels and less insulin production. Studies have shown less insulin resistance and more regular menstrual cycles in women with PCOS who follow a low-GI diet.4
The goal is to replace more processed, higher GI foods (cookies, crackers, most breakfast cereals, instant oatmeal, white rice, bread or bagel) with lower GI foods (dried beans, berries, 100% whole-grain breads, rolled or steel-cut oatmeal, sweet potatoes, quinoa, and non-starchy vegetables). Combining these with lean sources of protein and healthy fats is key for managing PCOS.
Regular exercise is very important and can help manage PCOS symptoms. Research has found that a type of cardio workout called high intensity interval training (HIIT) decreases insulin resistance and decreases body fat in women with PCOS.5 HIIT alternates between bouts of challenging, intense exercise and easy, low- intensity exercise.
Another study showed that vigorous activity improves insulin resistance and decreases the risk of metabolic syndrome among women with PCOS. For every hour of vigorous activity per week, metabolic syndrome risk decreased by 22 percent.6
Resistance (strength) training is also essential for women with PCOS. Resistance training increases muscle mass, which in turn increases the number of calories burned, even at rest. This can make it easier to maintain or lose weight. Muscle also uses glucose efficiently, which means less insulin is produced.
If you are just starting to exercise, any increase in movement each day is good, so start small and slowly increase to more intense exercise.
Inositol and Other Supplements
According to Dr. Greenhouse, “Supplements or medications are not the magic answer. They need to be used in conjunction with other lifestyle changes.”
Inositol is a nutrient that is found in fruits, beans, grains and nuts, and is also produced by the body. Research has shown that inositol decreases insulin resistance, reduces testosterone levels, regulates menstrual cycles, and promotes ovulation in women with PCOS.7, 8, 9
Two forms of inositol have shown benefit: myo-inositol (MI) and D-chiro-inositol (DCI). MI and DCI are thought to be out of balance in women with PCOS. A combination of these two forms, in the body’s naturally occurring ratio of 40 to 1, helps correct this imbalance. Studies have shown that taking this combination is more effective than taking either inositol form alone.10–11
“We now use inositol, which may improve the body’s use of insulin. The literature on inositol shows similar results to metformin, without the side effects such as nausea” says Dr. Greenhouse. When recommending an inositol supplement, the physicians at SGF choose Ovasitol because it contains the correct ratio of MI to DCI and is independently tested and certified by NSF International.
“We have had many women that, with dietary modification and weight loss, along with Ovasitol, have started ovulating and become pregnant,” adds Dr. Greenhouse.
Other nutritional supplements such as vitamin D, omega-3 fish oil, and coenzyme Q10 may also be of benefit for women with PCOS. Ask your physician which products you should consider.
Dr. Greenhouse reminds us of the importance of managing PCOS throughout a woman’s life. “We are here to help women become pregnant, but we have to remember that women with PCOS need to understand potential health consequences down the line such as diabetes, cardiovascular effects, abnormal bleeding, or, if left unchecked, development of abnormal cells in the lining of the uterus. These are all things that can be prevented or greatly reduced with management.”
To learn more about managing PCOS or to schedule an appointment with one of our reproductive endocrinologists, please call 1-877-971-7755 or click here to complete this brief online form.
- Williams et al. Am Fam Physician. 2016; 94(2):106-13.
- Goodman et al. Endocr Pract. 2015; 21(12):1415-26.
- Christensen et al. Fertil Steril. 2013; 100(2):470-7.
- Marsh et al. Am J Clin Nutr. 2010; 92:83-92.
- Almenning et al. PLoS ONE. 2015; 10(9), e0138793.
- Greenwood et al. Fertil Steril. 2016; 105(2):486-93.
- Artini et al. Gynecol Endocrinol. 2013; 29(4):275-9.
- Benelli et al. Int J Endocrinol. 2016:3204083.
- Costantino et al. Eur Rev Med Phamacol Sci. 2009; 13:105-10.
- Nordio and Proietti. Eur Rev Med Phamacol Sci. 2012; 16:575-81.
- Colazingari et al. Arch Gynecol Obstet. 2013; 288:1405-11