Polycystic ovarian syndrome (PCOS) is a complex and multifaceted condition, and diagnosis can be more complex for some patients since it can present differently depending on each case. One thing we know about PCOS is that the inability to conceive can directly be related to the inability to ovulate, although this is not the only factor that impacts chances of conception in patients with PCOS.
What are the common treatments to help patients with PCOS ovulate?
Many treatments that are often prescribed to treat PCOS are designed to help patients ovulate, this if often referred to as 'ovulation induction.' Different medications can be utilized to help induce ovulation, and the medications are usually given during the follicular phase, typically from cycle days 3-7. Two commonly prescribed medications to help induce ovulation are clomiphene citrate (CC) and letrozole. They have different mechanisms of action in the body. CC prevents the binding of estrogen to receptors in the body and triggers the pituitary gland to secrete follicle stimulating hormone (FSH) to help support follicle maturation/growth. Letrozole on the other hand is an aromatase inhibitor. Aromatase is an enzyme present in various tissues, particularly the ovary and adipose tissues that converts androgen hormones to estrogen. Letrozole therefore reduces the production of estrogen by inhibiting the activity of this enzyme. The body responds to this decrease in estrogen levels by also increasing FSH production, and therefore stimulating follicle growth. Please speak to your physician if you would like to learn more about how these medications work and any questions regarding their use.
However, a significant number of patients with PCOS use these medications without success, or they stop responding after a few successful ovulatory cycles. And they may try higher doses of medications and end up seeing a similar decrease in effect with continued use. Why?
How one hormone may help determine likelihood of successfully ovulating with treatment:
A new scientific paper published in the Journal of Assisted Reproduction and Genetics found that there is a particular hormone, if elevated in patients diagnosed with PCOS, may predict a lower likelihood of ovulatory success with these medications. Anti-mullerian hormone (AMH) is produced by the follicles in the ovaries and in excessively high concentrations can prevent the recruitment of follicles to the dominant follicle pool. Essentially it is like hitting the brakes on ovulation. This new published paper found that patients with PCOS with elevated AMH levels are much more likely to fail treatment aimed at ovulatory induction using the above mentioned medications.
The impact of AMH on ovulatory function might not be written in stone:
It is very important to note that the impact of AMH on ovulation may be modifiable. More recent research has suggested that certain nutrients may be able to help reduce the inhibitory effect of AMH on ovulation, allowing patients with elevated AMH + PCOS to increase their likelihood of successfully ovulating, thereby increasing their chances of conception. Fertility acupuncture has also been studied for the treatment of PCOS and has been observed to increase spontaneous ovulation rates.
Reference:
Vagios, S., Sacha, C. R., Hammer, K. C., Dimitriadis, I., James, K. E., Bormann, C. L., & Souter, I. (2021). Response to ovulation induction treatments in women with polycystic ovary syndrome as a function of serum anti-Müllerian hormone levels. Journal of Assisted Reproduction and Genetics, 38(7), 1827–1833.
This article is being shared as educational content and is in no way a replacement for medical advice or medical care, it is advised that anyone concerned about their Health should speak with their Naturopathic Doctor. Please discuss with your healtcare provider and only make changes to your medications regimen if recommended by your doctor and under their guidance.