PCOS NUTRITION CENTER BLOG

While no pill or drink can replace a healthy diet and lifestyle, emerging research has shown that taking certain dietary supplements can improve your fertility. Here’s our list of the Top rated dietary supplements people with PCOS should consider taking to improve their fertility.

Vitamin D

Recognized as a vitamin and a hormone, Vitamin D receptors have now been identified in almost every tissue and cell in the human body. This Vitamin has also been found to be involved in follicle egg maturation and development.

In a small trial study of 13 women with PCOS who were deficient in Vitamin D, normal menstrual cycles resumed within 2 months in 7 of the 9 women who had irregular menstrual cycles when given Vitamin D repletion with calcium therapy (1). Two women even established pregnancies. The authors of the study suggest that abnormalities in calcium balance may be responsible, in part, for the arrested follicular development in women with PCOS and may even contribute to the pathogenesis of the syndrome (1,2).

Low Vitamin D levels were found to be associated with lower rates of follicle development and pregnancy after stimulation with clomid in women with PCOS (3).

You can read more about the importance of Vitamin D for PCOS and fertility here

Fish Oil

Omega-3 fats, specifically long-chain eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) found in cold-water fish may help with fertility in women with PCOS. One study showed androgen concentrations in young women with PCOS were significantly reduced after supplementation of long-chain omega-3 fats (4).

Women with PCOS  were given 1,500 mg of omega-3 fats daily for six months. BMI plus insulin levels decreased significantly during treatment. Additionally, serum LH and testosterone levels decreased, and SHBG levels increased significantly (5).

Unless you eat cold-water fish (like tuna, trout, salmon) at least twice a week, you may want to consider supplementing your diet with fish oil.

High quality fish oil with vitamin D

To learn more about the benefits of fish oil for PCOS, check out our previous blog posts here

Check out Nordic Naturals ProOmega D, a high quality fish oil with added vitamin D.

Inositol

Inositol, specifically myo and d-chiro-inositol are perhaps the most researched nutritional supplement for PCOS. A relatives of the B complex vitamins, insositol has shown favorable results in improving nearly all aspects of PCOS, including insulin sensitivity, reproduction (restores ovulation and improves oocyte quality), hormonal imbalance, (improves androgens) and metabolic issues (inflammation, dyslipidemia, hypertension, and weight loss). There is also evidence that taking MYO in pregnancy can reduce the rates of gestational diabetes (6).

In regards to fertility, MYO improved oocyte quality better than d-chiro inositol (DCI). MYO has also been demonstrated to restore ovulation. Twenty-two of 25 women with PCOS had restored menstrual cycle with six months of MYO treatment; 72% of them maintained normal ovulation, and 40% became pregnant (7).

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One study compared ovulation rates in women treated with MYO versus metformin. Sixty women received 1,500 mg/day of metformin, while 60 women received 4 g/day of MYO plus 400 mcg of folic acid. Ovulation was restored in 65% of women treated with MYO vs. 50% in the metformin group. More pregnancies occurred in the MYO group vs. metformin (18% vs. 11%) (8).

New research shows that a combination of MYO and DCI works best for PCOS. Every tissue in the body has its own ratio of MYO to DCI (MYO is always much higher). DCI is produced from MYO when needed. New research has shown that a combination of MYO and DCI is a more effective approach for treating PCOS. Women with PCOS who took a combination of MYO and DCI with a physiologic ratio of 40:1 (as seen in plasma), had better results than taking one supplement alone. These positive results include reduced risk of metabolic disease in PCOS overweight patients and improved IVF outcomes, making some authors to suggest that “the combined administration of MYO and DCI in a ratio of 40:1, should be considered as the first line approach in PCOS.” To read more about the benefits of MYO and DCI, click here

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N-acetylcysteine

N-acetylcystine (NAC) is both an antioxidant and amino acid. Specifically, it’s a derivative of the amino acid L-cysteine, an essential precursor used by the body to produce glutathione, an antioxidant that protects against free radical damage and oxidative stress and is a critical factor in supporting a healthy immune system.

A study published in the European Journal of Obstetrics, Gynecology, and Reproductive Biology compared the effects of NAC and metformin in women with PCOS. In this prospective trial, 100 women were divided to receive either metformin (500 mg three times daily) or NAC (600 mg three times daily) for 24 weeks. Both treatments resulted in significant and equal decreases in BMI, hirsutism, fasting insulin, free testosterone, and menstrual irregularity (9).

Three randomized studies compared NAC or metformin with Clomid in women with PCOS. In two of the studies, Clomid plus NAC resulted in improved ovulation and pregnancy rates compared with placebo (10-12).

CoEnzyme Q10

Coenzyme Q10 is present everywhere in the human body. It is especially important for generating energy, as adenosine triphosphate (ATP) within the mitochondria which are the tiny “energy factories” inside most cells. For this reason, organs and tissues with high energy demands, such as the heart and liver, have the highest concentrations of CoQ10.

Emerging research is showing that coenzyme Q10 or CoQ10 may offer numerous benefits to women with PCOS, Coenzyme Q10 has been shown to be involved in improving fertility and pregnancy in women with PCOS. Newer research is showing the potential of Q10 to lower cholesterol, inflammation, testosterone and insulin levels.

A recent double-blinded, placebo-controlled randomized clinical trial showed that women with PCOS who took 100 mg/day of CoQ10 for 12 weeks improved mood (depression and anxiety), inflammation, total testosterone, DHEAS, hirsutism compared to placebo.

Women with PCOS who were randomized to take 200 mg CoQ10 per day for 8 weeks resulted in significant decreases in inflammatory markers and endothelial dysfunction compared with placebo.

Another randomized, double-blind, placebo-controlled clinical trial showed that coenzyme Q10 had beneficial effects on serum FBS and insulin levels, as well as HOMA-IR and total testosterone levels in women with PCOS.

As the quality of a woman’s eggs declines as she ages, there is also an age-related decline in CoQ10 utilization. According to a study published in the Journal of Fertility and Sterility, “decreased energy production in oocytes with aging may be related to a deficiency of CoQ10.” Additionally, with time, eggs are exposed to more damaging oxidative stress due to free radicals. As an antioxidant, CoQ10 has been linked to improving egg quality and ovulation by repairing free radicals.

Not sure what supplement is right for you? Take our PCOS Supplement Quiz and get matched with the right supplements based on your unique symptoms. Take the Quiz!

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References
1. Thys-Jacobs S, Donovan D, Papadopoulos A, Sarrel P, Bilezikian JP. Vitamin D and calcium dysregulation in the polycystic ovarian syndrome. Steroids 1999 Jun;64(6):430-5.
2. Lerchbaum E, Obermayer-Pietsch B. Vitamin D and fertility: a systematic review. European J Endocrinol. 2012;166(5):765-778.
3. Ott J, Wattar L, Kurz C, et al. Parameters for calcium metabolism in women with polycystic ovary syndrome who undergo clomiphene citrate stimulation: a prospective cohort study. European J Endocrinol. 2012;166(5):897-902.
http://eje-online.org/content/166/5/897.long
4. Phelan N, O’Connor A, Kyaw Tun T, et al. Hormonal and metabolic effects of polyunsaturated fatty acids in young women with polycystic ovary syndrome: results from a cross-sectional analysis and a randomized, placebo-controlled, crossover trial. Amer J Clin Nutr. 2011;93(3):652-662.
5. Oner G, Muderris, II. Efficacy of omega-3 in the treatment of polycystic ovary syndrome. J. Obstet Gynaecol. 2013;33(3):289-291.
6. D’Anna R, Di Benedetto V, Rizzo P, et al. Myo-inositol may prevent gestational diabetes in PCOS women. Gynecol Endocrinol. 2012;28(6):440-442.
7. Papaleo E, Unfer V, Baillargeon JP, et al. Myo-inositol in patients with polycystic ovary syndrome: a novel method for ovulation induction. Gynecol Endocrinol. 2007;23(12):700-703.
8. Raffone E, Rizzo P, Benedetto V. Insulin sensitiser agents alone and in co-treatment with r-FSH for ovulation induction in PCOS women. Gynecol Endocrinol. 2010;26(4):275-280.
9. Oner G, Muderris II. Clinical, endocrine and metabolic effects of metformin vs N-acetyl-cysteine in women with polycystic ovary syndrome. Eur J Obstet Gynecol Reprod Biol. 2011 Aug 8.
10. Salehpour S, Akbari Sene A, Saharkhiz N, Sohrabi MR, Moghimian F. N-acetylcysteine as an adjuvant to clomiphene citrate for successful induction of ovulation in infertile patients with polycystic ovary syndrome. J Obstet Gynaecol Res. 2012;38(9):1182-1186.
11. Abu Hashim H, Anwar K, El-Fatah RA. N-acetyl cysteine plus clomiphene citrate versus metformin and clomiphene citrate in treatment of clomiphene-resistant polycystic ovary syndrome: a randomized controlled trial. J Women’s Health (2002). 2010;19(11):2043-2048.
12. Rizk AY, Bedaiwy MA, Al-Inany HG. N-acetyl-cysteine is a novel adjuvant to clomiphene citrate in clomiphene citrate-resistant patients with polycystic ovary syndrome. Fertil Steril. 2005;83(2):367-370.