Treating Infertility in PCOS

Polycystic ovarian syndrome (PCOS) is a diagnosis that affects one in ten women, but often goes undetected until it causes infertility. Fortunately, natural treatments have been shown to be extremely effective for treating PCOS, thereby improving fertility outcomes.

To effectively treat PCOS two underlying aspects of the condition need to be addressed. First, insulin resistance needs to be corrected in order to reduce excess testosterone levels and improve other fertility parameters. Second, hormones need to be balanced, often by reducing excess androgens, in order to promote healthy ovulation. The following is an overview of the most well-researched and effective natural treatments for PCOS within the context of infertility.

1. Reduce Insulin Resistance

Exercise

Exercise improves the ability of each cell in the body to respond to insulin. This improves blood sugar levels, and reduces the excess testosterone being released. Exercise also helps with weight loss, which is important for improving fertility outcomes. Moderate exercise of 30 minutes 3x per week is effective in PCOS.

Dietary Changes

Eating a diet designed to keep blood sugar balanced is extremely important(1). Make sure to include good sources of protein, fat, and fibre with each meal. Have more frequent, smaller meals throughout the day to keep blood sugar stable. Avoid sugar, pop, and other carbohydrates, as this spikes blood sugar and worsens insulin resistance. Your Registered Dietitian or Naturopathic Doctor can help design a dietary plan that’s right for you.

Supplements

Inositol increases the body’s sensitivity to insulin(2), but it has many more positive benefits for PCOS patients who are experiencing infertility. Increased inositol in the ovaries is associated with improved egg follicle maturity and quality. Inositol also helps to reduce free and total testosterone, insulin, triglycerides, blood pressure, and weight(2). Up to 72% of women with PCOS taking inositol experience complete normalization of ovulation(2).

Gymnema (Gymnema sylvestre) is a herb that improves blood sugar control by improving insulin uptake at 400mg per day(3). As a result, it helps to lower blood sugar, lower cholesterol, and support weight loss. This herb has been shown to be as effective for PCOS insulin control as metformin, without the harmful side effects(3).

2. Balance Hormones

The first step to balancing hormones in PCOS is to reduce testosterone levels. This leads to improved FSH levels, egg development, and ovulation. Subsequent treatment may be needed to improve estrogen and progesterone levels, depending on each individual case.

Saw palmetto (Serenoa repens) is a herb that contains phytosterols. It is shown to be a safe and effective way to reduce testosterone levels(4).

Spearmint (Mentha spicata) reduces levels of free testosterone in the blood(5). When drank as a tea twice daily for five days during the first half of the menstrual cycle, it was shown to decrease free testosterone enough to allow an increase in FSH and estradiol.

White peony (Paeonia lactiflora) increases the activity of an enzyme called aromatase, which converts testosterone into estrogen(6). It therefore reduces testosterone levels and rebalances sex hormones.

3. Other Fertility Support

Fish oil

Fish oil contains the omega 3 fatty acids EPA and DHA, which are anti-inflammatory and often deficient in the diet. Fish oil reduces insulin resistance and lowers inflammation in PCOS patients(7). It also reduces free testosterone and LH levels, which improves the development of a healthy follicle for ovulation(7).

N-acetyl-cysteine (NAC)

NAC is a precursor for the antioxidant glutathione, which helps to reduce oxidative stress in women with PCOS. NAC increases insulin sensitivity, reduce testosterone, and regulate menstruation(8). NAC has been shown to increase induction of ovulation in infertile women with PCOS when used with Clomid when compared with Clomid use alone(9).

Vitamin D

Vitamin D supplementation in women with PCOS improves menstrual frequency and fertility(10). Vitamin D reduces testosterone, and reduces insulin resistance by lowering fasting glucose and insulin levels.

The Bottom Line

There are many different dietary, lifestyle, nutrients, and herbal treatments that can help to promote natural ovulation in a woman with PCOS. However, PCOS is a complicated condition, and requires a detailed workup and an individualized treatment plan. It is also important to note that many of these treatments can interact with pharmaceuticals and fertility drugs. Always speak with your Naturopathic Doctor to ensure your treatment plan will be safe and effective for promoting fertility with a diagnosis of PCOS.

References

1 Liepa GU, Sengupta A, Karsies D. Polycystic ovary syndrome (PCOS) and other androgen excess-related conditions: can changes in dietary intake make a difference? Nutr Clin Pract. 2008; 23(1):63-71.
2 Papaleo E, et al. Myo-insositol in patients with polycystic ovarian syndrome: a novel method for ovulation induction. Gynecol Endocrinol. 2007; 23(12): 700-3.
3 Hywood A. Phytotherapy for polycystic ovarian syndrome. Aust J Herbal Med. 2012;24(3):81-6.
4 Boyle P, Robertson C, Lowe F, Roehrborn C. Updated meta-analysis of clinical trials of Serenoa repens extract in the treatment of symptomatic benign prostatic hyperplasia. BJU Int. 2004;93(6):751-6.
5 Grant P. Spearmint herbal tea has significant anti-androgen effects in polycystic ovarian syndrome. A randomized controlled trial. Phytother Res. 2010;24(2):186-8.
6 Takeuchi T, Nishii O, Okamura T, Yaginuma T. Effect of paeoniflorin, glycyrrhizin and glycyrrhetic acid on ovarian androgen production. Am J Chin Med. 1991;19(1):73-8.
7 Vargas ML, Almario AU, Buchan W, Kim Y, Karakas SE. Metabolic and endocrine effects of long chain vs. essential omega-3 polyunsaturated fatty acids in polycystic ovarian syndrome. Metabolism. 2011;60(12):1711-8.
8 Fulghesu AM, Ciampelli M, Muzju G, Belosi C, Selvaggi L, Layla GF, Lanzone A. N-acetyl-cysteine treatment improves insulin sensitivity in women with polycystic ovarian syndrome. Fertil Steril. 2002;77(6):1128-35.
9 Salehpour S, Sene AA, Saharkhiz N, Sohrabi MR, Moghimian F. N-acetylcysteine as an adjuvant to clomiphene citrate for successful induction of ovulation in infertile patients with polycystic ovarian syndrome. J Obstet Gynaecol Res. 2012; 38(9):1182-6.
10 Tehrani HG, Mostajeran F, Shahsavari S. The effect of calcium and vitamin D supplementation on menstrual cycle, body mass index and hyperandrogenism state of women with poly cystic ovarian syndrome. J Res Med Sci. 2014;19(9): 875-80.


By: Dr. Hilary Booth, ND

Dr. Hilary Booth, ND is a licensed and registered Naturopathic Doctor with a specialty in women’s health, fertility, and pregnancy care. She uses leading-edge evidence-based treatments to provide personalized, compassionate care for her patients. You can reach Dr. Booth at www.drshawnadarou.com.

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