Dr Alannah Smith MD FRCSC
Dr. Smith is a fertility expert at Olive Fertility Victoria. She trained at the University of Alberta and Dalhousie University, specializing in reproductive endocrinology and infertility. Passionate about compassionate patient-centered care, her interests include reproductive genetics, fertility preservation and early pregnancy. In this article, Dr. Smith explains the impact of polycystic ovary syndrome (PCOS), its effects on fertility and overall health and the treatment options available to patients.
What is PCOS?
Polycystic Ovary Syndrome PCOS is a common hormonal endocrine condition in which insulin resistance plays a key role.
PCOS is one of the most common causes of infertility, affecting up to 15 per cent of women in North America. Yet almost half of women with PCOS go undiagnosed. This has serious health implications as, in addition to being a leading cause of infertility, PCOS is associated with a number of other health problems, including diabetes, heart disease and endometrial cancer. Some women are unaware they have PCOS until they face challenges getting pregnant.
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 storage. High insulin resistance means the body needs more insulin to process sugar. Excess insulin can increase 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.
Diagnosing PCOS
PCOS can be difficult to diagnose because there is no single diagnostic test, and the signs and symptoms vary from patient to patient.
Clinically, if an individual has two out of three of the following symptoms, they will most likely be diagnosed with PCOS:
- Irregular, few or absent menstrual periods.
- Excess clinical or biochemical androgen – (excessive body hair, acne, loss of head hair or increases testosterone in the blood)
- 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 like following a Mediterranean or low glycemic diet, incorporating exercise and some medications and supplements can reduce androgen levels, improve ovulation and decrease insulin resistance.
A low glycemic diet
The glycemic index (GI) ranks carbohydrates based on their ability to raise blood sugar after eating. Foods with a high GI, including (all refined carbohydrates like flour and sugar break down quickly during digestion and spike blood sugar. This spike triggers higher insulin production, which over time, contributes to insulin resistance, weight gain and increased diabetes risk. Studies show women with PCOS who follow a Mediterranean-style, low GI diet experience improved insulin sensitivity and more regular menstrual cycles.
Exercise
Exercise has been shown to be extremely effective in increasing insulin sensitively. Studies indicate that 30 minutes of movement a day, enough to break a sweat is sufficient to help reset insulin sensitivity.
Supplements
- Omega-3 Fish Oil: Reduces inflammation, insulin resistance and testosterone, while supporting lipid levels and regular menstrual cycles
- Vitamin D: Deficiency is common in PCOS cases and linked to lower fertility and pregnancy rates, insulin resistance and irregular cycles
- Coenzyme Q10 (CoQ10): An essential antioxidant in cellular energy production. When combined with fertility medication (clomiphene citrate), it may improve ovulation and pregnancy rates
- Inositol: Shown to decrease insulin resistance, lower testosterone, regulate cycles and improve egg quality.
Medication
In addition to diet and exercise, fertility specialists recommend ovulation-stimulating drugs such as Letrozole or gonadotropins. Metformin is also commonly prescribed to reduce insulin resistance.
Ozempic and weight loss for fertility
For some patients with a BMI over 30 and irregular cycles, even a 5% reduction in total body weight can help restore ovulation. In some cases, Ozempic can help with weight loss, though it must be discontinued at least two months before trying to conceive.
PCOS is a common health condition that affects not only fertility but also long-term health and well-being. The good news is that lifestyle and diet adjustments, supplements and medical treatments can help manage PCOS, reduce symptoms and improve chances of getting pregnant.
