Getting pregnant with PCOS: should I take supplements?
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If you have been diagnosed with PCOS, and are considering having a child or think you may want to have children in the future, it is likely that you may have concerns about your fertility. The condition is estimated to affect one in five women in the UK,1 and infertility, or problems conceiving, is just one of the numerous unpleasant symptoms it can cause, others of which include hirsutism (excessive growth of body hair), acne, and weight gain.
Fortunately, there is plenty of help at hand if you do have PCOS, both in terms of managing symptoms and improving fertility, so you can rest assured that just because you have received a diagnosis, it doesn’t necessarily mean you won’t be able to conceive.
The reasons why PCOS affects fertility are numerous and complicated, but at their most basic they relate to an imbalance of hormones, meaning that you don’t ovulate, or only ovulate infrequently. In order to ovulate, your body goes through a chain reaction of causes and effects involving your hormones, so when one of these is compromised it can put the whole system into disarray. PCOS can also increase your levels of “male” hormones, (for example, testosterone) which can compromise egg development.
This all sounds complicated, but in terms of getting pregnant it is important to focus on maximising your chances and ensure you are ovulating.
One of the key things you can do is to ensure you maintain a healthy weight and lead a healthy lifestyle, including exercising regularly. It is also important to ensure you are obtaining all the key nutrients you need to optimise your chances of conceiving and having a healthy pregnancy.
Which nutrients are important for pregnancy in PCOS?
PCOS has been linked to a deficiency in certain nutrients which are vital if you wish to conceive. In women with PCOS, having a vitamin D deficiency is associated with a 40% reduction in your odds of having a live birth, independent of the effects of obesity, insulin resistance, or even ovulation induction treatment.2
Vitamin D plays an important role in reproduction, including ovarian follicular development, follicle-stimulating hormone (FSH) sensitivity, and progesterone production. However, 67-85% of women with PCOS are believed to suffer from vitamin D deficiency, which can exacerbate PCOS symptoms, including menstrual irregularities.3 Having low vitamin D levels is also related to insulin resistance in women with PCOS, and insulin resistance in itself can impact fertility.4
Research has also shown that taking iron supplements can make you more fertile. In one study, women who took iron supplements made from plant sources experienced a 70% reduction in risk of infertility related to ovulation.
Iron, too, is an important nutrient if you wish to conceive, yet an estimated 20% of women of childbearing age have iron deficiency anaemia, partly related to blood loss during menstruation.5 If you previously weren’t menstruating regularly, and now are thanks to treatment, it is important that you get enough iron to optimise your chances of conception.
On top of this, once you do conceive, your iron requirements will increase during pregnancy.6 Iron is needed for proper development of the placenta, brain development in the baby, and to form iron stores for the first six months of a baby’s life. Iron deficiency has been linked with infertility,7 miscarriage, low birth weight babies, and many more symptoms.8
Research has also shown that taking iron supplements can make you more fertile. In one study, women who took iron supplements made from plant sources experienced a 70% reduction in risk of infertility related to ovulation.9 Given that infertility in PCOS is predominantly caused by irregular ovulation, iron may be important for those with PCOS.
This being said, there is some research showing that people with PCOS-related abnormal glucose tolerance may get too much iron due to menstrual dysfunction, insulin resistance, and a decrease in hepcidin (a protein that regulates iron entry into circulation), leading to them absorbing more iron than normal.10 For this reason, women with PCOS should check with their doctor before taking a supplement containing iron.
Another supplement which you will no doubt be familiar with if you are trying to conceive is folic acid. Folic acid (vitamin B9) helps to make and repair DNA, and produce red blood cells, is recommended for all women trying for a baby, not just those with PCOS. Not having enough folic acid in your diet can lead to a folate deficiency in just a few weeks, which can lead to anaemia. It is particularly important that pregnant women, and those trying to conceive, get enough folic acid, as deficiencies can lead to birth defects.
Taking in enough omega-3 fatty acids is also important if you are trying to conceive. Studies have shown that omega-3 improves egg quality in older women and, should you conceive, omega-3 is important for the health of the foetus.
There is evidence to show that supplementing your diet with folic acid can be helpful in treating ovulatory infertility (infertility relating to disorders with the functioning of the ovaries) – the primary cause of infertility in women with PCOS.
One study showed that women who took a multivitamin containing folic acid six times a week reduced their infertility, with researchers coming to the conclusion that women with PCOS might improve their chances of conceiving by taking a multivitamin containing folic acid at least three times a week.11 The same study suggested that taking a multivitamin could also contribute to the beneficial effects on fertility if they are experiencing ovulatory infertility.12
Other nutrients which may improve fertility
Folic acid aside, other B vitamins are also important if you have PCOS, regardless of whether or not you are trying to conceive. For example, B vitamins can help control weight as they affect how much energy you uptake from food, and any deficiencies in them can affect metabolism.13
If you are trying to conceive, B vitamins are all the more important — not only can maintaining a healthy weight increase your chances of conceiving, but there have been suggestions that vitamins B1, B2, B6, and B12 are inversely related to the risk of ovulatory infertility.14
Taking in enough omega-3 fatty acids is also important if you are trying to conceive. Studies have shown that omega-3 improves egg quality in older women,15 and, should you conceive, omega-3 is important for the health of the foetus.16
When you factor in PCOS as well, there is some limited evidence that taking enough omega-3 can help regulate your menstrual cycle, which in itself could improve your chances of conceiving.17 Furthermore, omega-3 may bring down the testosterone levels of women with PCOS, further improving fertility.18
Can I combine supplements for best results?
If you do have PCOS, adding one supplement to your diet alone may not be sufficient to ensure conception, and it is worth speaking to your doctor to see which combinations of supplements are best for you.
One treatment option that has been shown to have beneficial effects is myo-inositol (MI), which may have even more success when taken in combination with folic acid.19 Myo-inositol is a vitamin-like substance found in plants and animals that is vital for the normal functioning of the reproductive system, but some people with PCOS have been shown to have low levels of MI in the ovaries.20
Studies have shown that taking MI causes women with PCOS to ovulate more frequently, and tackles other symptoms of PCOS.21 On top of this, a trial looking at women with PCOS who took MI and folic acid every day found that those who had had irregular periods previously started experiencing normal menstrual cycles after just 12 weeks.22
Of course, with all those recommended vitamins and minerals, it can be difficult to keep track of what you have taken and when, so you may want to consider taking supplements in the form of a multivitamin. StrongStart, for example, contains folic acid, vitamin D, vitamin B3, and 20 other vitamins and minerals, all chosen to maximise your chances of conceiving a healthy baby.
As with any supplement, it is important to keep your doctor informed of any supplements you are taking and to ensure they won’t interfere with any medication or other supplements that you are already taking.
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- NHS Choices Health A-Z, ‘Polycycstic ovary syndrome’, [website], 2016, https://www.nhs.uk/conditions/polycystic-ovary-syndrome-pcos/, (accessed 11 June 2018).
- S. Butts et al., ‘Vitamin D deficiency is associated with poor reproductive outcomes in PCOS but not unexplained infertility’, Fertility and Sterility, Vol. 108, Iss. 3, Supp., 2017, pp. e69-e70
- M. Lin and M. Wu, ‘The role of vitamin D in polycystic ovary syndrome’, Indian J Med Res., Vol. 142, No. 3, 2015, pp. 238-240.
- Healthline, ‘Iron Deficiency Anemia’, [website], https://www.healthline.com/health/iron-deficiency-anemia, (accessed 13 June 2018).
- WebMD, ‘Are you getting enough iron’, [website], https://www.webmd.com/baby/are-you-getting-enough-iron#1, (accessed 13 June 2018).
- J.E. Chavarro et al., ‘Iron intake and risk of ovulatory infertility’, Obstet Gynecol., Vol. 108, No. 5, 2006, pp. 1145-52.
- N. M. Abu-Ouf and M. M. Jan, ‘The impact of maternal iron deficiency and iron deficiency anemia on child’s health’, Saudi Med J., Vol. 36, No. 2, 2015, pp. 146-149.
- J. E. Chavarro et al., ‘Iron Intake and Risk of Ovulatory Infertility’, 2006, pp. 1145-1152.
- H. F. Escobar-Morreale, ‘Iron metabolism and the polycystic ovary syndrome’, Trends in Endocrinology & Metabolism, Vol. 23, Iss. 10, 2012, pp. 509-515.
- J. E. Chavarro et al., ‘Use of multivitamins, intake of B vitamins and risk of ovulatory infertility’, Fertil Steril., Vol. 89, No. 3, 2008, pp. 668-676.
- E. Huskisson et al., ‘The Role of Vitamins and Minerals in Energy Metabolism and Well-Being’, The Journal of International Medical Research, No. 35, 2007, pp. 277-289.
- J. E. Chavarro et al., ‘Use of multivitamins, intake of B vitamins and risk of ovulatory infertility’, 2008, pp. 668-676.
- D. Nehra et al., ‘Prolonging the female reproductive lifespan and improving egg quality with dietary omega-3 fatty acids’, Aging Cell, Vol. 11, No. 6, 2012, pp. 1046-54.
- J. M. Coletta et al., ‘Omega-3 Fatty Acids and Pregnancy’, Rev Obstet Gynecol., Vol. 3, No. 4, 2010, pp. 163-171.
- B. Khani et al., ‘Omega-3 supplementation effects on polycystic ovary syndrome symptoms and metabolic syndrome’, J Res Med Sci., Vol 22, 2017, p. 64.
- A. Nadjarzadeh et al., ‘The effect of omega-3 supplementation on androgen profile and menstrual status in women with polycystic ovary syndrome: A randomized clinical trial’, Iran J Reprod Med., Vol. 11, No. 8, 2013, pp. 665-672.
- P.A. Regidor et al., ‘Management of women with PCOS using myo-inositol and folic acid. New clinical data review of the literature’, Horm Mol Biol Clin Investig., Mar 2018.
- V. Unfer et al., ‘Myo-inositol effects in women with PCOS: a meta-analysis of randomized controlled trials’, Endocr Connect., Vol. 6, No. 8, 2017, pp. 647-658.
- S. Gerli et al., ‘Effects of inositol on ovarian function and metabolic factors in women with PCOS: a randomized double blind placebo-controlled trial’, Eur Rev Med Pharmacol Sci., Vol. 7, No. 6, 2003, pp. 151-9.
- P. G. Artini et al., ‘Endocrine and clinical effects of myo-inositol administration in polycystic ovary syndrome. A randomized study’, Gynecol Endocrinol., Vol. 29, No. 4, 2013, pp. 375-9.