A new study published last month in the Endocrine Society's Journal of Clinical Endocrinology & Metabolism demonstrated that lifestyle modification intervention helped improve ovulation in women who have polycystic ovarian syndrome (PCOS). Until now few studies has supported its benefit; however this is common sense from an epigenetic standpoint.  Lifestyle choices and environmental influences filtered through genetic predisposition are fundamental factors in the expression of disease and a successful treatment approach must address these factors.

PCOS is the most common cause of female infertility. The condition occurs when a woman's body produces slightly higher than normal amounts of testosterone and other sex hormones. This imbalance can cause irregular menstrual periods weight gain acne excess body hair and/or balding. Many women with PCOS are prescribed birth control pills to regulate their menstrual cycle and reduce the excess androgens in their body. However this does not address the issue of infertility and often has many unwanted side effects. 

In this study researchers confirmed that exercise and a healthy diet can improve fertility in women who have PCOS. The researchers examined the pregnancy outcomes among 149 women with PCOS who either took birth control pills underwent lifestyle modifications or followed a combination of the two interventions over a four-month period.  The next step of the study had the participants undergoing four cycles of medication-induced ovulation. All of the participants were overweight but had no other health issues. 

Five women gave birth among the 49 women assigned to the birth control intervention whereas 13 babies were delivered among the 50 women in the lifestyle intervention group. The combination group gave birth to 12 babies.

As a result women who participated in the lifestyle modification group and took birth control pills were more likely to ovulate than women who were assigned to take birth control pills. Furthermore women in the lifestyle and combination groups had much better insulin sensitivity as well as lower triglycerides compare to the women who took birth control pills.

This research demonstrates that exercise helps to improve women’s reproductive and metabolic health and that using oral contraceptives alone may worsen the metabolic profile without improving ovulation. Thus lifestyle change is an essential part of any fertility treatment approach for women with PCOS

Nutrients to Consider

Studies have shown that an inositol deficiency is common in women with PCOS. A distinctive characteristic feature of this condition appears to be a reduced ability to process metabolize and effectively use inositol from foods. As a result the nutritional requirements of PCOS patients may not be met by a simple change in the diet and therefore inositol should be viewed as a conditionally essential nutrient in these women.

Myo-inositol and D-chiro-inositol two inositol isomers are both essential for patients with PCOS. The conversion of myo-inositol to D-chiro-inositol is of interest because errors here have been seen in PCOS patients. Strong evidence suggests that the body makes D-chiro-inositol from myo-inositol however some people are less able to make this conversion than others.  Along this spectrum people who are completely unable to convert myo-inositol to D-chiro-inositol are only going to benefit from supplementation with D-chiro-inositol. Other people who make the conversion but with less than optimal efficiency may benefit from large doses of myo-inositol. And individuals who do not fall into either of these two categories might see the best results from a blend of the two form of inositol. Since this conversion is impaired in those with PCOS it is important to always include D-chiro-inositol with myo-inositol. D-chiro-inositol is the more potent form of inositol for supporting insulin resistance; however myo-inositol is need for oocyte quality and maturation. Therefore supplementing with D-chiro-inositol alone cannot fulfill myo-inositol’s roles that are specific and different from D-chiro-inositol since it does not convert to myo-inositol.

Also essential fatty acids should be considered as most individuals with insulin resistance are deficient in health-promoting omega-3s. Fish oils are an important choice for helping to improve insulin sensitivity and reduce inflammation in the body.

By Michael Jurgelewicz DC DACBN DCBCN