Dr. H. Singh, ND
Overcoming Challenges in PCOS and Improving Pregnancy Rates
It is estimated that around 10% of the population suffers from polycystic ovarian syndrome (PCOS), and some studies have suggested even higher rates in specific international populations. This makes PCOS an incredibly common condition, yet, it can take years before it is properly diagnosed in patients from the day they first show up with symptoms at their doctor´s office. One study had suggested that it takes on average, 7 years, from the first day a patient shows up with symptoms before it is diagnose. Why the delay?
One of the factors that impacts the diagnosis of PCOS is that not all cases look the same. Classically, a healthcare provider looks to see if a patient is not getting their periods or if they are overweight or if the transvaginal ultrasound reveals cystic ovaries. Yet, many patients reach the stage of infertility treatments and find out quite late that they may have PCOS. When they are checking for follicle counts and the average natural follicle count is way above the normal range. And not all patients present the same. For example, patients with PCOS may be quite lean and yet still have significant insulin resistance (which affects up to 40% of patients with PCOS).
We have spent quite some time in earlier posts talking about some of the root causes of PCOS, including the gut microbiome, genetics, and lifestyle. Today, I would like to share with you a powerful treatment option that impacts many of the difficulties PCOS presents.
Enter Inositol: this substance comes in two different forms myo-inositol and d-chiro-inositol. They are similar in structure but have very different functions. In general, inositol stimulates the activity of inositolposphoglycans (IPGs) in cells, mimicking the action of insulin. In this way, it works as an insulin sensitizer. This is crucial because the reduced insulin (the hormone responsible for glucose transport from the blood to the tissues) sensitivity propagates the hormonal imbalance that defines PCOS. It stimulates the release of androgen hormones from the ovaries, and in return the androgen hormones worsen the insulin sensitivity. Increased levels of insulin also reduce the concentration of sex-hormone binding globulin (SHBG) which is responsible for holding extra testosterone in the blood as inactive and unable to easily stimulate any of its hormone receptors in the body, thereby making testosterone more readily available.
Myo-inositol has a role in sensitizing the ovaries to follicle stimulating hormone (FSH), supporting follicle growth and development, and D-chiro-inositol helps to produce more androgens. Usually the ovary has a ratio of 100:1 of Myo-inositol : D-chiro-inositol. It has been observed if the ratio falls to 70:1, there is an observed decline in egg quality. In PCOS this ratio can sit around 0.2:1, meaning the amount of d-chiro-inositol is greatly increased than where it should normally be, and this is thought to significantly contribute to symptoms of PCOS.
Supplementing with PCOS has been shown to increase cycle regularity, increase ovulation rates, reduce symptoms of elevated androgen hormone, reduce the amount of IVF meds needed during a treatment cycle due to increased sensitivity to medication, increase the size of follicles during IVF, increase the quality of embryos during IVF, and some studies have found it can actually increase the clinical pregnancy rate as well all while reducing the risk of ovarian hyper-stimulation syndrome (OHSS) - a severe complication of IVF. However, the dose of inositol supplements seems to vary in studies as does the ratio of myo-inositol to d-chiro-inositol that provides optimal results in fertility outcomes. The dose and ratio may also depend on each patient case and it is recommended to speak to a licensed Naturopathic Doctor before supplementing with anything to check for safety, interactions with medications, and to discuss the optimal dose for your case.
This article 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.