Dr. Kathy Wise MD, FRCSC • Olive Fertility Centre

Polycystic Ovary Syndrome (PCOS) is a common cause of infertility, affecting up to 15% of women in North America. An estimated 50% of women with PCOS go undiagnosed. This can have significant health implications as, in addition to being a leading cause of infertility, PCOS is associated with several other health problems for example diabetes, heart disease, and endometrial cancer. Some of the women that I see in my fertility practice have no idea they have PCOS until they discover they can’t get pregnant.
What is Pcos?
PCOS is a common hormonal endocrine condition in which insulin resistance seems to be a key factor. Early diagnosis and management of PCOS is important because PCOS has been linked to an increased risk of diabetes, heart disease, high blood pressure, metabolic syndrome, depression and anxiety, infertility, and endometrial cancer.
What are the Symptoms of Pcos?
The hormonal imbalance characterized by an excess of testosterone can produce a range of symptoms including:
• Irregular or absent periods
• Acne
• Excessive hair growth (hirsutism)
• High body mass index (BMI)
• Depression and anxiety
• Male pattern hair loss
• High insulin levels
• Infertility
What is the Role of Insulin Insensitivity in Pcos?
Insulin is a hormone that allows cells to use glucose (sugar) to produce energy. When insulin resistance occurs, cells lose their ability to respond normally to insulin. When this happens, more and more insulin is produced. Excess insulin causes a rise in androgens, which can lead to acne, excessive hair growth, weight gain, and ovulation problems. Excess androgens cause the follicles to develop too quickly and then to shut down prematurely before they produce an egg. To further complicate matters insulin insensitivity contributes to weight gain, especially in the belly area and makes it harder to lose the weight. If that wasn’t bad enough this excess fat sets up a negative feedback system where high blood levels of a fat derived hormone called leptin can inhibit the production of female fertility hormones.
How is Pcos Diagnosed?
PCOS is a clinical diagnosis based on physical symptoms, blood test results and ultrasound findings. It can be difficult to diagnose because there is no single diagnostic test and the signs and symptoms can vary.
Tests include:
• Hormone testing
• Transvaginal ultrasound (to examine the ovaries)
A diagnosis of PCOS is usually made if you have two out of the three following symptoms:
• Irregular, few, or absent menstrual periods
• Androgen excess–clinical or biochemical (excessive body hair, acne, loss of head hair, increased testosterone in the blood)
• Polycystic ovaries–the ovaries of women with PCOS usually have a distinctive appearance on an ultrasound
Treatment Options
To manage PCOS symptoms and potential infertility, a combination of treatment strategies is required. The first approach to treating PCOS should be changes in lifestyle including a low glycemic index (GI) diet to help control insulin levels, regular exercise, and weight loss if you have a BMI over 25.
The good news is that a small amount of weight loss can be very helpful. One study showed that 40% of women with PCOS with a BMI of 34 who lost just 5% of their body weight got pregnant naturally. Weight loss through exercise and diet has been proven to be effective in restoring ovulatory cycles and achieving pregnancy.
What is a Low Glycemic Diet?
The glycemic index (GI) is a measurement that ranks carbohydrates based on their ability to raise blood sugar after eating. Foods with a high GI (all refined carbohydrates including any kind of flour or sugar) break down quickly during digestion, causing a quick spike of sugar into the bloodstream. The rise in blood sugar results in higher insulin production which, over time, contributes to weight gain and increased diabetes risk. Studies have shown improved insulin sensitivity and more regular menstrual cycles in women with PCOS who follow a Mediterranean style, low GI diet.
Exercise • Exercise has been shown to be extremely effective in increasing insulin sensitively. Just moving your body for 30 minutes a day so that you break a little sweat is enough to help reset your insulin sensitivity. So, if you have PCOS, get on your bike, go for a walk/run, or hit the pool for a swim. You don’t need to do all three in one day (though there is a nice finisher’s medal if you do!) but try and move everyday. It’s the healthiest and cheapest way to improve your fertility and your overall health! Some research suggests shorter but more intense exercise (HIIT workouts) is most beneficial.
Exercise is good for you for many reasons including it:
• Burns calories
• Builds muscle, which in turn increases insulin sensitivity (reduces insulin resistance)
• Reduces insulin levels in the blood
• Makes weight loss easier as less glucose is converted to fat
• Reduces cortisol and visceral fat (abdominal fat)
• Reduces stress and promotes deep relaxation
Supplements • There are several supplements that have been shown to improve insulin resistance and help PCOS symptoms including:
• Omega-3 fish oils: These can help decrease inflammation, insulin resistance, and testosterone levels, improve lipid levels, and promote regular menstrual cycles in women with PCOS
• Vitamin D: Vitamin D deficiency is common among women with PCOS and has been linked to lower fertility and pregnancy rates, insulin resistance, irregular menstrual cycles, and other symptoms of PCOS
• Coenzyme Q10: CoQ10 is a naturally occurring antioxidant that is essential for cellular energy production
• Inositol: Inositol supplementation can help decrease insulin resistance, reduce testosterone levels, promote regular menstrual cycles, promote ovulation and healthy egg quality in women with PCOS
Medication • In addition to diet and exercise you might also be given one of several drugs to stimulate ovulation like Letrozole, or gonadotropins. Your doctor may also recommend Metformin to reduce insulin resistance.
PCOS is a common health condition that impacts your overall health and well-being as well your fertility. The good news is that there are lifestyle and diet changes along with supplements and medication that can help manage PCOS, reduce symptoms and improve your chances of getting pregnant.
Dr. Kathy Wise MD, FRCSC is an Obstetrician/Gynecologist working as a fertility specialist. She is a co-founder and Medical Director of Olive Fertility Centre Kelowna (formerly Kelowna Regional Fertility Centre). With clinics in Vancouver, Surrey, Kelowna and Victoria Olive Fertility Centre is one of Western Canada’s largest IVF and prenatal diagnosis centres. Olive Fertility provides comprehensive fertility care to couples, single women, and same-sex couples offering an advanced IVF lab and innovative programs that include PGT-A, specialized genetic testing, egg freezing, and prenatal NIPT testing.