I have PCOS, can inositol help me get pregnant?
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PCOS, or polycystic ovary syndrome, is estimated to affect one in five women in the UK.1 It is an endocrine disorder that causes numerous symptoms among women of reproductive age. These include small follicles (‘cysts’) within the ovaries that haven’t developed into eggs, acne, excess body hair (hirsutism), irregular periods, and infertility or difficulties getting pregnant. Your doctor will diagnose you with PCOS if you have at least two of the three main symptoms — high levels of male hormones, irregular periods, and ‘cysts’. These symptoms can have a hugely detrimental effect on a woman’s day-to-day life, but fortunately, there are ways of managing them.
There is currently no ‘cure’ for PCOS, but symptoms can be well-managed, or occasionally eliminated entirely, with the right treatment. Options include taking the hormonal contraceptive pill and lifestyle changes such as weight loss. If you do find yourself diagnosed with PCOS there is no reason to panic — many women manage their symptoms effectively enough to barely notice they have the condition.
A big cause for concern among many with the condition is whether or not they will be able to conceive. This is because having PCOS means that you don’t ovulate as regularly as you should, if at all. If you are of childbearing age and thinking about having a family, it is worth looking into what you can do to ensure your fertility is the optimum it can be.
One supplement that may appear a lot when you are researching solutions is ‘inositol’. But what is it, and will it help you conceive?
What is inositol?
Put simply, inositol is a vitamin-like compound found in many plants and animals and is also produced in the human body. It is commonly used for treating metabolic syndrome — a term used to describe a combination of diabetes, high blood pressure, and obesity — and symptoms associated with PCOS such as anovulation, as well as high levels of testosterone. It is suspected that inositol helps insulin to work better. Research shows that taking one or both of two particular forms of inositol (myo-inositol or d-chiro-inositol) can have a number of positive effects, including lowering testosterone levels, decreasing blood pressure, and improving ovarian function in overweight or obese women with PCOS.2 Some inositol can be obtained through diet, with key sources including whole grains and citrus fruits such as oranges.
Each type of inositol has slightly different effects when it comes to symptom relief. Myo-inositol (MI) has been found to improve the number of good quality oocytes (cells in the ovaries), clinical pregnancies, and delivery rates in overweight women with PCOS, thus having a marked effect on fertility. As well as being a proven safe means of encouraging ovulation in women, MI has been shown to lower testosterone, reduce the risk of ovarian hyperstimulation syndrome, and reduce concentrations of luteinising hormone (LH), prolactin, androstenedione, and insulin. It can also reduce insulin resistance.3
Myo-inositol (MI) has been found to improve the number of good quality oocytes (cells in the ovaries), clinical pregnancies, and delivery rates in overweight women with PCOS, thus having a marked effect on fertility.
Studies have shown that up to 70% of women with PCOS have insulin resistance.4 Insulin is the hormone that makes cells let in glucose, for energy. If someone is resistant to insulin, this means their cells are less efficient at letting in glucose, but their body carries on producing more and more insulin because it is still getting signals from the cells saying that they need glucose. This causes the ovaries to overproduce testosterone, while insulin resistance also reduces levels of sex hormone-binding globulin (SHBG) in the body, which normally acts to prevent excess testosterone from causing problems.5
D-chiro-inositol (DCI), on the other hand, has been found to reduce insulin and testosterone levels in lean women, while also decreasing blood pressure. It was also noted to achieve a higher rate of ovulation, but the difference is not deemed statistically significant.6
Which type of inositol is more effective?
It has been shown that low levels of DCI may contribute to or cause insulin resistance, particularly in obese people, but as MI converts to DCI in the body, some patients with PCOS actually have a deficiency of MI in the ovaries.7
On top of this, MI has a beneficial effect on the ovaries, whereas oocyte quality and ovarian response can be worsened by increased dosages of DCI.8 As MI competes with glucose for cellular transporters, low MI levels can lead to high blood glucose levels.9 As MI improves insulin sensitivity, it is important for improving PCOS symptoms, and it has been recommended that MI is taken either alone, or in combination with DCI.10
How does myo-inositol reduce symptoms and improve fertility?
MI has been shown to positively affect insulin resistance, meaning that cells will uptake and use insulin more easily, and studies have shown significantly decreased blood insulin levels after MI supplementation. MI is also shown to have a beneficial effect on the ovaries, and it has been shown to increase levels of SHBG after at least 24 weeks of supplementation.11
Studies have shown that taking 2000mg of MI, alongside folic acid, for at least three months can have impressive results in improving fertility.Another study found that, of overweight women with PCOS who were given myo-inositol and folic acid during IVF, 32% had a successful pregnancy within the 12 month study period.
When it comes to pregnancy, it is not known exactly how insulin resistance and PCOS affects fertility, but insulin has been shown to affect the ratio of LH and follicle stimulating hormone (FSH), a set ratio of which is needed for ovulation.12 On top of this, increased levels of testosterone prevent follicles from developing properly, but MI lowers testosterone, preventing or reducing this symptom.13
How do I take myo-inositol?
You don’t need a prescription for myo-inositol, and you can take it in powder supplementary form, purchased from a pharmacy or nutritional supplement store. However, it is important to consult with your doctor before taking any supplement to ensure it won’t interfere with any other medication you are taking. As the beneficial effects of MI take several weeks to come into play, it is important to start taking it as soon as possible if you are trying to conceive.14
Studies have shown that taking 2000mg of MI, alongside folic acid, for at least three months can have impressive results in improving fertility.15 Another study found that, of overweight women with PCOS who were given myo-inositol and folic acid during IVF, 32% had a successful pregnancy within the 12 month study period.16
Myo-inositol is generally well-tolerated with few side effects. No adverse effects of MI have been found in studies that looked at doses of 4000mg a day throughout pregnancy. However, doses higher than 12,000mg a day may have some mild gastrointestinal effects such as nausea, flatulence, and diarrhoea.17
Of course, if you do decide to take myo-inositol, it is advised that you continue with any lifestyle treatments you have been using to manage your PCOS, such as maintaining a healthy diet, and doing exercise, as this will further improve your chances of conception.
As with any supplement, however, always consult your doctor before taking to ensure that there is nothing that means taking it may be a hindrance rather than a help in your own personal circumstances.
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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).
- B. Kalra et al., ‘The inositols and polycystic ovary syndrome’, Indian J Endocrinol Metab, Vol. 20, No. 5, 2016, pp. 720-724.
- M. L. Traub, ‘Assessing and treating insulin resistance in women with polycystic ovarian syndrome’, World J Diabetes, Vol. 2, No. 3, 2011, pp. 33-40.
- R. Deswal et al., ‘Sex hormone binding globulin – an important biomarker for predicting PCOS risk: A systematic review and meta-analysis’, Syst Biol Reprod Med, Vol. 64, No. 1, 2018, pp. 12-24.
- B. Kalra et al., ‘The inositols and polycystic ovary syndrome’, 2016, pp. 720-724.
- V. Unfer et al., ‘Myo-inositol effects in women with PCOS: a meta-analysis of randomised controlled trials’, Endocr Connect, Vol. 6, No. 8, 2017, pp. 647-658.
- B. Kalra et al., ‘The inositols and polycystic ovary syndrome’, 2016, pp. 720-724.
- S. Franks et al., ‘Follicle dynamics and anovulation in polycystic ovary syndrome’, Hum Reprod Update, Vol. 14, No. 4, 2008, pp. 367-78.
- V. Unfer et al., ‘Myo-inositol effects in women with PCOS: a meta-analysis of randomised controlled trials’, 2017, pp. 647-658.
- E. Papaleo et al., ‘Myo-inositol may improve oocyte quality in intracytoplasmic sperm injection cycles. A prospective, controlled, randomized trial’, Fertil Steril, Vol. 91, No. 5, 2009, pp. 1750-4.
- 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.
- P.A. Regidor et al., ‘Management of women with PCOS using myo-inositol and folic acid. New clinical data and review of the literature’, Horm Mol Biol Clin Investig., 2018.