First things first, before we delve into the ins and outs of insulin-resistant PCOS and how it may affect fertility, we need to first understand what PCOS is, the many ‘functional types’ of PCOS and how you can ascertain which ‘functional type’ you may be experiencing.
According to Lara Briden, a leading naturopathic doctor in the area of women's health, PCOS can be categorised into 4 functional types - insulin-resistant PCOS, post-pill PCOS (temporary), inflammatory PCOS or adrenal PCOS. Each functional type of PCOS is driven by a different pathology and therefore the treatment changes according to the functional type.
See Lara Briden’s article on the 4 Types of PCOS here to understand if you fall into the insulin-resistant PCOS category.
Insulin-Resistant PCOS
Insulin-resistant PCOS is the most common type of PCOS, and is characterised by insulin-resistance (determined by a blood test of the hormone insulin) and high androgens (also determined by a blood test or salivary hormone test).
In the case of insulin-resistant PCOS, a complicated interplay of hormones, including insulin and luteinising hormone, drive excessive amounts of androgens, particularly testosterone, which causes common PCOS symptoms of possible abdominal weight gain, acne, hirsutism, and importantly annovualtion (resulting in missed or irregular periods).
How it Can Effect Fertility and What Can be Done?
Lack of ovulation and irregular periods characteristic of PCOS means that fertility and the ability to conceive is compromised. However, the good thing to know with insulin-resistant PCOS is that a lot can be done from a diet, lifestyle and nutritional perspective to reduce the effect on fertility, balance hormones and greatly increase the ability to conceive.
Addressing diet and lifestyle is one of the first and most simple treatment approaches to reducing insulin-resistance and its influence in PCOS.
Weight-loss - while not all patients with insulin-resistant PCOS are overweight, those that are greatly benefit from from realistic weight loss and it is therefore an essential component of PCOS treatment. Research has found that obese women with PCOS are less likely to conceive than lean women with PCOS. It is important to note here that long-term modest weight loss is the goal in PCOS, rather than drastic weight loss over a short period, as this can have a negative impact on reproductive function and fertility.
Mediterranean diet - diet can contribute significantly in the management of insulin-resistant PCOS. The Mediterranean diet, focused on high protein and mono-unsaturated and poly-unsaturated fat intake, has been shown to be effective in improving insulin-resistance in PCOS patients. One study found that 12 weeks of exercise and diet therapy was associated with a trend towards menstrual regularity and normalisation of hormone levels, in overweight, infertile women with annovulation.
Nutrients - several nutrients have been researched for their effect on insulin resistance and improvement in PCOS. Inositol and chromium are both important nutrients which have been shown to reduce insulin resistance in both lean women with insulin-resistant PCOS and overweight women, reducing excess androgens. Furthermore, inositol has been shown to increase ovulation, improving fertility and improving conception chances in women with PCOS.
Important takeaway - there is so much that can be done from a diet and lifestyle perspective when it comes to insulin-resistant PCOS which can greatly improve PCOS symptoms, regulate menstrual cycles and drastically improve fertility and conception outcomes. Don’t despair! If you are interested in finding out more about your PCOS diagnosis and you would like assistance in management and treatment, contact me for an in-depth look at your health and personalised treatment options.
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