How Can Insulin Resistance in PCOS influence fertility?
PCOS, or polycystic ovary syndrome, is a leading cause of infertility.
Up to 80% of women with PCOS will have difficulty conceiving.
PCOS is characterized by irregularities in, or the absence of, a regular menstrual cycle, polycystic ovaries on ultrasound, high androgenic hormones like testosterone, DHEA or androstenedione, acne, hirsutism, hair loss. These irregularities are caused by a hormonal imbalance, with sex hormones being secreted rapidly instead of at a steady, constant rate.
This abnormal secretion of hormones not only causes changes in the menstrual cycle but also inhibits proper ovulation. Women with PCOS are more prone to insulin resistance then others. High levels of insulin in the bloodstream will make ovaries to misbehave and produce androgens like testosterone; more testosterone will cause disruption with ovulation.
PCOS is not, however, just an infertility issue. It is a total-body metabolic and endocrine disorder that has been closely linked with insulin resistance.
Insulin is a hormone secreted by the pancreas that stimulates the body to absorb sugar from the bloodstream and convert it into energy. After this process, blood sugar levels fall, along with insulin levels. Under normal circumstances, both blood sugar and insulin will remain at constant levels under fasting conditions.
When someone has insulin resistance, they maintain normal blood sugar levels but have high insulin levels. High insulin levels indicate that the body does not process the ‘message’ from insulin properly. The pancreas releases insulin to tell the body to store and convert sugar, but the body doesn’t receive the message.
It requires more and more insulin to initiate the conversion process. Inflammation, weight gain, Type 2 diabetes, and heart disease are common complications of insulin resistance. A high insulin level is also considered a pre-cursor to PCOS. On average, 75% of women with PCOS also have insulin resistance.
Treatment options for both PCOS and insulin resistance are focused on lifestyle. Reducing dietary sugar intake, particularly fructose, can increase insulin sensitivity. Antioxidant-rich diets, high in unsaturated fats but low in refined and processed foods, help reduce inflammation and insulin levels. Thirty minutes of regular, daily exercise has also been shown to reduce insulin levels and encourage proper ovulation. Nutritional supplements, such as Magnesium and Vitamin D, show positive results, as well.
Pharmacological treatments are also sometimes used to improve fertility and increase insulin sensitivity. Metformin, a drug used in type 2 diabetes treatment, is commonly used. The increase in insulin sensitivity resulting from Metformin treatment has also been shown to improve menstrual regularity.
However, it should be noted that the FDA does not approve Metformin for the treatment of infertility, and there is no current evidence supporting an increase in pregnancies after treatment. Clomid and Femara are first-line treatments to increase ovulation when lifestyle changes are unsuccessful.
Clomid has been shown to have a pregnancy rate of 60-70% within six menstrual cycles. Both Clomid and Femara work by regulating estrogen levels and follicle-stimulating hormone levels, respectively.
Other options for women struggling to conceive with PCOS include surgery, Intrauterine Insemination (IUI), and In Vitro Fertilization (IVF). These are invasive and costly procedures and are usually reserved for cases where other treatment options have been unsuccessful.
In my clinic in Caversham Reading, I am specialising in treating fertility issues and I have seen plenty of patients with PCOS who are struggling to conceive if you would like to know a bit more on how acupuncture can help with PCOS and how it can support your body during fertility journey please contact me or call 07766735714.