Medical Contribution By Mark Perloe, M.D.

Mark Perloe, M.D. of Shady Grove Fertility’s Atlanta, GA location was recently interviewed by a nutritionist blogger regarding the most common questions surrounding polycystic ovary syndrome (PCOS) and how to manage symptoms in women trying to conceive.

What percentage of women with PCOS manage to get pregnant and have a successful pregnancy?

Dr. Perloe: “This is a difficult question to answer. If metabolic abnormalities can be addressed successfully and obesity is addressed, up to 85% will end up with regular cycles and 65% can get pregnant, usually within 6 months. Each person is different. Therefore, expectations for one person would not be helpful for another.”

How much does your body weight affect fertility?

Dr. Perloe: “I’m not really sure whether the issue is weight, body mass index (BMI), or simply the metabolic abnormalities that are associated with obesity. Losing weight is usually not easy, but regardless of how weight affects fertility, losing weight can improve the odds.”

Do you suggest any natural supplements that can improve ovulation and regulate a woman’s menstrual cycle?

Dr. Perloe: “There is an increasing body of evidence supporting the use myoinositol and d-chiroinositol together in a 40:1 ratio. While many other supplements may offer benefits, there is little or no quality data that supports their use.”

What is the ratio between anti-Müllerian hormone (AMH), which can be found through a blood test, and PCOS?

Dr. Perloe: “There really is no ratio. But, if you view the PCOS ovary on ultrasound, you see what is called a necklace sign, which is the ovary filled with small follicles that produce AMH. The more follicles, the higher the AMH.”

According to your experience, what are the most effective fertility treatment options for women with PCOS?

Dr. Perloe: “It’s important to actively work to restore metabolic balance before considering ovulation treatment. Starting clomid beforehand addresses these abnormalities and can help achieve pregnancy, but it is associated with a greater risk of miscarriage. After restoring balance, I consider ovulation induction with letrozole, a combination of letrozole and follicle-stimulating hormone (FSH) or in vitro fertilization (IVF). Your individual situation may point to one method/treatment over another.”

Do women with PCOS who maintain an average weight have better success with assisted conception treatments compared to overweight or obese women?

Dr. Perloe: “Yes, as they generally are beginning the process with lower testosterone, insulin levels, inflammation, and the like.”

Do you suggest any specific dietary plans that may support fertility treatment for women with PCOS? 

Dr. Perloe: “No. I think it requires meeting with a dietitian to explore what you are eating now and how you can modify your diet. There is not a one-size-fits-all solution. Any dietary changes should be based on sustainability. If you go to a 400 cal ketogenic diet, you will lose weight, but you will feel awful and end up putting the weight back on. Also, strength training exercise is equally as important. If women choose to focus on aerobic exercise instead, losing weight may be more difficult.”

Are there any pregnancy complications that women with PCOS should be concerned about? How could she control and prevent them?

Dr. Perloe: “Prenatal vitamins, diet, exercise, and check for genetic carrier risks, continue insulin sensitizers like metformin and Ovasitol into the third trimester if ok with your physician.”

Do you have any advice for woman who are starting fertility treatment?

Dr. Perloe: “You need to be an active and educated participant in the process. If you can’t have a thoughtful discussion with your medical team, it is time to find another team.”

To learn more about PCOS or to schedule an appointment, please contact our New Patient Center at 1-877-971-7755 or fill out this brief form.