What is PCOS?

Polycystic ovarian syndrome (PCOS), a common hormonal condition that affects women of childbearing age, is one of the most common causes of infertility in women. In PCOS, the ovaries form numerous small follicles that do contain eggs, but the eggs don’t mature; thus, the eggs aren’t released. The first symptom of PCOS might be abnormal menstrual cycles that can manifest in several ways:

  • Complete absence of periods (amenorrhea)
  • Infrequent periods (oligomenorrhea)
  • Longer than normal menstrual cycles – for example, a cycle lasts 38 days instead of 28 days
  • Abnormally heavy periods

The numerous undeveloped follicles result in infrequent or no ovulation and contribute to difficulty conceiving without medical intervention. Women with PCOS typically have elevated androgen hormones, such as testosterone. These hormone elevations can result in acne, hirsutism, and male-pattern baldness.

PCOS by the numbers

  • As many as 1 in 10 U.S. women of childbearing age (ages 15-50) has PCOS.
  • PCOS is one of the most common, but treatable, causes of female infertility.
  • PCOS is one of the most common endocrine disorders in women.
  • And here’s the kicker – half of women with PCOS are undiagnosed.

What are other health concerns associated with PCOS?

Although infertility is often the cause for a woman to seek medical advice, a woman with PCOS is also at higher risk for other health concerns – and, in some cases, it’s difficult to determine whether the condition is a result of or a cause of PCOS. Associated conditions include:

  • Difficulty managing weight. Excess weight can be a cause or an effect of PCOS. Sometimes PCOS symptoms don’t manifest until a woman gains significant weight. On the other hand, women with PCOS tend to gain weight easily. The extra weight can contribute to other health issues.
  • Metabolic syndrome. Many aspects of metabolic syndrome are also seen in women with PCOS – including insulin resistance, obesity in some cases, and elevated cholesterol. Statistics indicate approximately 30% of women with PCOS have impaired glucose tolerance, while an additional 8% have diabetes.
  • Inflammation. Evidence suggests low-grade inflammation causes the ovaries to produce excess androgens (testosterone and its precursors).
  • Cardiovascular disease. Excess androgen hormones and being overweight can increase the risk for diseases of the heart and blood vessels.
  • Sleep apnea. In one study, women with PCOS were 30 times more likely to suffer from disordered breathing when sleeping than women without PCOS.
  • Fatty liver. Numerous clinical studies point to the increased prevalence of non-alcoholic fatty liver disease (NAFLD) in women with PCOS, independent of weight or other metabolic syndrome factors.

Are there any PCOS fertility solutions?

Although several medications can increase chances of conceiving or decrease the risk for some of the associated conditions, making lifestyle changes for fertility support can also help. Some tips for managing PCOS symptoms include: 

  • Follow a healthy, anti-inflammatory diet. The best fertility diet plan is the one that addresses inflammation because it can inhibit fertility. It’s also worth noting thatweight problems can contribute to inflammation. The good news? The Mediterranean Diet supports weight management efforts, decreases exposure to inflammatory factors, can be beneficial for female reproductive health and PCOS. In fact, one study showed that women on the Mediterranean Diet compared to women on a Western diet (higher in meat, fried foods, and simple carbs) were less likely to have fertility issues. A similar study found the Mediterranean Diet increased chances of becoming pregnant by 40% in women undergoing in vitro fertilization. 
  • Say no to HFCS. Avoid high-fructose corn syrup (HCFS) – found in sodas, sweetened fruit drinks, condiments, and many other processed foods. Studies show that HFCS is associated with unwanted weight gain, which can interfere with ovulation and fertility. In addition, HFCS is associated with increased risk for fatty liver.
  • Increase dietary vitamin D. In a study of women with PCOS, increased daily vitamin D intake resulted in a significant decrease in testosterone.* Other research has shown vitamin D helps maintain healthy inflammatory markers (measured as C-reactive protein) and decreases oxidative stress in women with PCOS.*
  • Consider inositol. Studies suggest that inositol – an essential component of cell membranes – might support insulin sensitivity, reduce the time it takes to ovulate, and promote normal testosterone levels.* It might also support other metabolic factors, such as normal waist-to-hip ratio and healthy cholesterol and triglyceride levels.* In addition to folate, CoQ10, and plant polyphenols, Ovarian Care, one of the best supplements for fertility support*, contains the 40:1 ratio of myo-inositol to D-chiro-inositol found to be most effective for supporting women with PCOS.* 
  • Fertility test. If you suspect you might have PCOS, then contact your health-care practitioner to help you sort things out. Talk to your health-care practitioner about Thorne’s at-home Fertility Test. In addition to testing for testosterone and DHEA (which can be out of balance with PCOS), this tests for other reproductive hormones, thyroid hormones, and stress hormones.

References

  1. https://www.mayoclinic.org/diseases-conditions/pcos/symptoms-causes/syc-20353439 [Accessed 2.12.18]
  2. Sharpless J. Polycystic ovary syndrome and the metabolic syndrome. Clin Diabetes 2003;21:154-161.
  3. Vgontzas A, Legro R, Bixler E, et al. Polycystic ovary syndrome is associated with obstructive sleep apnea and daytime sleepiness: role of insulin resistance. J Clin Endocrinol Metab 2001;86(2):517-520.
  4. Targher G, Rossini M, Lonardo A. Evidence that non-alcoholic fatty liver disease and polycystic ovary syndrome are associated by necessity rather than chance: a novel hepato-ovarian axis? Endocrine 2016;51(2):211-221.
  5. Toledo E, Lopez-del Burgo C, Ruiz-Zambrana A, et al. Dietary patterns and difficulty conceiving: a nested case-control study. Fertil Steril 2011;96(5):1149-1153.
  6. Vujkovic M, de Vries J, Lindemans J, et al. The preconception Mediterranean dietary pattern in couples undergoing in vitro fertilization/intracytoplasmic sperm injection treatment increases the chance of pregnancy. Fertil Steril 2010;94(6):2096-2101.
  7. Ibrahim M, Bonfiglio S, Schlögl M, et al. Energy expenditure and hormone responses in humans after overeating high-fructose corn syrup versus whole-wheat foods. Obesity (Silver Spring) 2017 Nov 28. doi: 10.1002/oby.22068.
  8. Jamilian M, Foroozanfard F, Rahmani E, et al. Effect of two different doses of vitamin D supplementation on metabolic profiles of insulin-resistant patients with polycystic ovary syndrome. Nutrients 2017 Nov 24;9(12). pii: E1280. doi: 10.3390/nu9121280.
  9. Akbari M, Ostadmohammadi V, Lankarani K, et al. The effects of vitamin D supplementation on biomarkers of inflammation and oxidative stress among women with polycystic ovary syndrome: a systematic review and meta-analysis of randomized controlled trials. Horm Metab Res 2018 Feb 23. doi: 10.1055/s-0044-101355. [Epub ahead of print]
  10. Pkhaladze L, Russo M, Unfer V, et al. Treatment of lean PCOS teenagers: a follow-up comparison between myo-inositol and oral contraceptives. Eur Rev Med Pharmacol Sci 2021;25(23):7476-7485.
  11. Soldat-Stanković V, Popović-Pejičić S, Stanković S, et al. The effect of metformin and myoinositol on metabolic outcomes in women with polycystic ovary syndrome: role of body mass and adiponectin in a randomized controlled trial. J Endocrinol Invest 2022;45(3):583-595.
  12. Akbari Sene A, Tabatabaie A, Nikniaz H, et al. The myo-inositol effect on the oocyte quality and fertilization rate among women with polycystic ovary syndrome undergoing assisted reproductive technology cycles: a randomized clinical trial. Arch Gynecol Obstet 2019;299(6):1701-1707.
  13. Shokrpour M, Foroozanfard F, Afshar Ebrahimi F, et al. Comparison of myo-inositol and metformin on glycemic control, lipid profiles, and gene expression related to insulin and lipid metabolism in women with polycystic ovary syndrome: a randomized controlled clinical trial. Gynecol Endocrinol 2019;35(5):406-411.
  14. Nordio M, Basciani S, Camajani E. The 40:1 myo-inositol/D-chiro-inositol plasma ratio is able to restore ovulation in PCOS patients: comparison with other ratios. Eur Rev Med Pharmacol Sci 2019;23(12):5512-5521.