Women with Polycystic Ovarian Syndrome (PCOS) can have a variety of symptoms including irregular/infrequent menstrual cycles, skin problems and weight gain. This creates a diagnostic challenge as many healthcare providers rely heavily upon these symptoms to make their diagnosis. New discoveries over the last two decades have demonstrated that PCOS is not a simple cluster of findings. Instead it is a spectrum of conditions with a variety of presentations. New information has provided greater understanding why some PCOS patients may present primarily with infertility alone and none of the other commonly associated symptoms.
PCOS is essentially a hormone imbalance. One of the most important hormones that is typically involved is one called Anti-Müllerian Hormone (AMH). What’s disappointing is that some physicians either don’t measure this hormone or don’t understand its implications. Many women with PCOS have very high levels of AMH. Having too much of this hormone may be their greatest obstacle to becoming pregnant.
A new study shows that AMH (referred to as Müllerian Inhibiting Substance or MIS in this article) can inhibit the maturation of eggs. In fact, it can be so potent that it may someday be used as a contraceptive. But most importantly, having a high AMH level can make a woman’s ovaries behave like a woman that has PCOS; even if she does not have any of the other common symptoms. Regardless of what we call this hormone imbalance; women with a high AMH often benefit from similar treatment recommendations as women with PCOS.
Robert Greene, MD, FACOG
Conceptions Reproductive Associates of Colorado
It has long been accepted that the primary reason that human eggs don’t age well is due to a dysfunction in when and how the chromosomes separate. This reduced chance of becoming pregnant associated with aging as well as the increased miscarriage rates. A new paper has now demonstrated that it’s not just the DNA separation that declines with time but also how the chromosomes are actually sorted and divided.
Within each egg are cable-like structures called microtubules. These microtubules not only help the egg maintain its shape but also are integral in sorting/separating the DNA. They are also in charge of cell division after fertilization is complete. In fact, some of the most powerful cancer fighting drugs are used to deliberately damage microtubules in order to prevent cancers from growing. This new information provides us with further insight into another important aspect of egg quality.
Although we don’t currently have any specific recommendations on what we can do to improve microtubule function; this information does provide us with more diagnostic information for patients that are going through In Vitro Fertilization (IVF). IVF is not only the treatment that provides patients with the highest pregnancy rates but when performed in a high quality setting; it also provides important diagnostic information. There is no accurate test for egg quality except to put a healthy sperm inside and see if/how well the process of fertilization and development takes place. We routinely use this information in discussing treatment options for patients that do not successfully conceive in their first IVF cycle at our center.
Robert Greene, MD, FACOG
Conceptions Reproductive Associates
Many patients that present to fertility centers are on thyroid supplements that are extracts from pig thyroid gland. Unfortunately, they have often embraced this treatment because it is presented as more “natural” then the synthetic thyroxine often prescribed by most healthcare providers. In reality, the human thyroid gland converts T4 (thyroxine) into T3 (the active form) very efficiently. The typical ratio of T4:T3 in humans is about 14:1. By contrast, pig thyroid extracts have a 4:1 ratio so that there is much more active T3 in the preparation. The problem with this high level of T3 is that the developing baby needs the T4 from a pregnant mom’s blood; not T3. High T3 levels during early pregnancy can impair healthy brain development. So I recommend the following:
–take a stable dose of thyroxine.
–If you still feel challenged; consider meeting with an endocrinologist to see if you might be a candidate for small supplemental dose of T3; two or three times per day.
Much of modern psychiatry is about using medications to try to normalize brain chemistry as a tool to help resolve mood disorders. Having been involved in considerable research on how hormonal shifts can cause changes in brain chemistry–I am always interested in trying to help my patients understand what may occur and what they may be able to do to take preventive actions. Here is a study that suggests that using a dietary supplement containing tryptophan (2 grams) and tyrosine (10 grams) may prevent postpartum blues without changing breast milk contents. Better still, this might interrupt the spiral to postpartum depression! Check out this link and then talk with your doctor before starting any program.
The lack of quality treatment has been something that we have taken on aggressively this year through our tele-medicine campaign. Since the new law was enacted in Colorado-making telemedicine fully reimburseable–we have been actively building our internet based services. If you’re one of the millions lacking care in your area, consider setting up a consultation. We’d love to meet you.
Women with Polycystic Ovarian Syndrome (PCOS) are faced with a dual challenge. First, their inherent hormone imbalance makes it more difficult for an immature egg to become a mature fertile one. But less often appreciated is that they also tend to produce eggs that are less likely to fertilize or can be more likely to miscarry if they do conceive. This second problem is believed to be linked to poor egg quality. New research suggests that the impact of this second problem may be reduced by decreasing exposure to dietary toxins.
Advanced Glycation End products or AGE’s are formed when proteins or fats are exposed to sugars—especially when prepared by high heat cooking methods. These glycotoxins have been linked to aging, heart disease, cancer and infertility because they promote inflammation, reduce blood flow and promote the production of free radical formation. In fact, there are specific receptors (RAGE or “receptors for advanced glycation end products”) for these unhealthy chemicals that are concentrated on the surface of the ovary and have been linked to ovarian aging and reduced egg quality. Women with PCOS seem to have at least two times the levels of AGE’s and more concentrated RAGE on their ovarian surface; linking the reduced egg quality in PCOS to diet.
Importantly, there are steps you can take to reduce the impact that AGE’s are having upon your ability to become pregnant. It has been demonstrated that some simple dietary changes can profoundly reduce your AGE levels and start improving the quality of the eggs that you’re producing. Here’s list of helpful suggestions:
- Dietary Recommendations:
- Reduce consumption of meat, poultry, fish and dairy—all rich sources of AGE
- Increase consumption of brown rice and mushrooms—which have been shown to help sequester these damaging chemicals after they already entered your body
- Lifestyle Recommendations:
- Adjust your cooking methods to reduce the production of AGE in your food before you eat
- High heat and drier cooking methods like broiling, searing, grilling and deep frying all dramatically increase the formation of AGE
- Lower heat and moist cooking methods like stewing, boiling and steaming minimize AGE production
- Stay away from tobacco smoke—a potent source of AGE
- Supplements to consider:
- Resveratrol—a chemical found in red wine and now available in supplement form, has been shown to reduce the effects of AGE
- Curcumin—a key product in the ginger-like spice turmeric—has also been shown to dramatically reduce the effects of AGE.
- Medications that might help:
- Metformin—a drug commonly given to women with PCOS and associated with higher pregnancy rates—has been shown to inhibit the activity of AGE
- Aspirin—has been shown to help reduce AGE attachment
At our center, we have long held that your circadian rhythm–how your biology responds to the day-night cycle–impacts your fertility. This is one of the many reasons we focus on optimizing vitamin D levels, melatonin (when necessary) and paying careful attention to our embryo transfer schedules. In case your fertility center hasn’t figured out how important that this is, check out the following recent study on miscarriage risk associated with time shifts. https://consumer.healthday.com/infertility-information-22/infertility-news-412/daylight-savings-time-may-lower-chances-of-ivf-success-for-some-study-719514.html