What is the healthy food that we need to improve fertility in PCOS? Polycystic ovary syndrome (PCOS) is the most common endocrine system disorder in women of reproductive age . This condition is often characterised by excessive androgen production (a type of hormone that is normally high in men, but low in women),ovulatory dysfunction, polycystic ovaries and insulin resistance .
Insulin is a type of hormone that helps in the regulation of blood glucose level in the blood. In people with insulin resistance, the insulin is insensitive and cannot function normally, hence more and more insulin is produced and eventually, it leads to hyperinsulinemia (high insulin in the blood). This condition causes women with PCOS to be more prone to increased risks of complications such as diabetes, hypertension, cardiovascular diseases, breast and endometrial cancer [3,4].
The symptoms of PCOS include weight gain (especially around the waist), unusual and increased hair growth (on the face, chest, stomach, back, thumbs or toes), thinning of hair on the head, pelvic pain and acne . Besides, oligo-ovulation (lack of ovulation) is also one of the clinical manifestations of PCOS whereby the range of symptoms include infrequent menstrual periods, no menstrual periods and/or irregular bleeding, and infertility .
Besides lifestyle intervention such as increasing physical activity level and reducing weight, dietary intervention is also one of the primary treatments aim at improving insulin resistance, maintaining hormonal balance and improve fertility . The essence of eating to manage PCOS symptoms is to consume a healthy and balanced diet which comprises complex carbohydrates, fruits and vegetables, lean protein, a moderate amount of healthy fat such as Polyunsaturated fat (PUFA), essential vitamins and minerals and antioxidants.
Complex carbohydrate takes longer time to break down during digestion and absorbed slowly as compared to simple carbohydrate, and thus resulting in a more steady increase in blood glucose level. Complex carbohydrate foods are high in dietary insoluble, soluble fibre, and phytochemicals such as polyphenols which is beneficial in improving acute insulin secretion and insulin sensitivity, and reduce inflammation in the body. Moreover, diets rich in fibre have been shown to promote a healthy gut microbiota which can help in reducing insulin resistance and menstrual disorders in PCOS patients. In addition, complex carbohydrate food is also rich in inositol hexaphosphate, a nutrient that helps to improve insulin action, decrease androgen level, and improve ovulatory function in both lean and obese women with PCOS [7,8]. Examples of complex carbohydrate foods are wholegrain, legumes, starchy root vegetables, and fruits and vegetables.
Next, healthy fat such as polyunsaturated fat (PUFA) is beneficial in managing PCOS symptoms. Research suggested that omega-3 fatty acids, particularly Eicosapentaenoic acid (EPA) and Docosahexaenoic acid (DHA) are effective in improving insulin resistance, and possess anti-inflammatory and antioxidant effects. The rich sources of omega-3 fatty acids include King Mackerel (Ikan tenggiri), Ikan tongkol, Chub Mackerel (Ikan kembung),anchovy (Ikan teri/bilis), Sardines, Tuna and Salmon.
Moreover, it is also recommended to include plant-based foods such as nuts and seeds as they contain alpha-linolenic acid (ALA),
which is the precursor of EPA and DHA.
Besides, vitamins particularly vitamin D also play a primary role in the nutritional management of PCOS. It is well known that vitamin D plays role in insulin metabolism and reduce insulin resistance. Foods that are rich in Vitamin D are fatty fish, fish liver oil, egg yolk, dairy or cereals products fortified with Vitamin D, animal liver meat and mushroom. Another group of important vitamins is vitamin B12 and Folate. The deficiency of these vitamins is linked to greater Homocysteine level and insulin resistance as well as a higher risk of type 2 diabetes in women with PCOS. Foods rich in vitamin B12 and B9 are:
In addition to vitamins, minerals such as f zinc, magnesium and selenium are also involved in decreased production and/or activity of insulin. Both zinc and selenium are essential micronutrients that act as antioxidants reducing the oxidative stress involved in PCOS. The food rich in these nutrients are:
Lastly, recent research also suggested trace mineral called Chromium, in the form of chromium (III) supplementation (Chromium Picolinate) has been shown to effectively improve ovulation stimulation and insulin resistance reduction . However, there is still insufficient evidence to justify including chromium as a standard in the treatment of insulin resistance. Hence, further studies in this are warranted before a definite conclusion can be drawn.
Apart of the nutrients recommendation mentioned above, there is few dietary concern relevant to polycystic ovaries in women. Firstly, the intake of refined carbohydrates and high sugary food should be limited as these products increase blood insulin, which results in greater androgen production. Secondly, it is the caffeine intake. Some study has shown that caffeine intake is a risk factor for decreased fertility as it affects ovulation . Although not all studies have confirmed this finding, women with PCOS are recommended to take special precautions to avoid receiving very high doses of caffeine.
In a conclusion, it’s important to understand that PCOS symptoms and overall risk of developing long-term health problems can be greatly improved by losing weight and eating a balanced and healthy diet which are high in fibre, inositol, PUFA, and minerals and vitamins as mentioned above. By making these diet and lifestyle changes, it helps to improve fertility in women having PCOS. To know more, do consult your dietitians or nutritionists to get a personalised nutrition plan that helps to improve fertility in PCOS management.
Quiz for all the readers:
1) Is intermittent fasting helping in improving PCOS symptoms?
2)Gluten free foods helps in improving PCOS lady who wants to get pregnant?
3) Foods high in iron is crucial for PCOS patients who wants to get pregnant?
4) Give example of fiber foods and foods high in iron.
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- Escobar-Morreale HF. Polycystic ovary syndrome: definition, aetiology, diagnosis and treatment. Nature Reviews Endocrinology. 2018 May;14(5):270-84.
- Boyd M, Ziegler J. Polycystic Ovary Syndrome, Fertility, Diet, and Lifestyle Modifications: A Review of the Current Evidence. Topics in Clinical Nutrition. 2019 Jan 1;34(1):14-30.
- Shang Y, Zhou H, Hu M, Feng H. Effect of diet on insulin resistance in polycystic ovary syndrome. The Journal of Clinical Endocrinology & Metabolism. 2020 Oct;105(10):3346-60.
- Faghfoori Z, Fazelian S, Shadnoush M, Goodarzi R. Nutritional management in women with polycystic ovary syndrome: A review study. Diabetes & Metabolic Syndrome: Clinical Research & Reviews. 2017 Nov 1;11:S429-32.
- Sarah Klemm S. Polycystic Ovarian Syndrome [Internet]. Eatright.org. Academy of Nutrition and Dietetics. 2021 [cited 29 August 2021]. Available from: https://www.eatright.org/health/pregnancy/fertility-and-reproduction/polycystic-ovarian-syndrome
- Calcaterra V, Verduci E, Cena H, Magenes VC, Todisco CF, Tenuta E, Gregorio C, De Giuseppe R, Bosetti A, Di Profio E, Zuccotti G. Polycystic Ovary Syndrome in Insulin-Resistant Adolescents with Obesity: The Role of Nutrition Therapy and Food Supplements as a Strategy to Protect Fertility. Nutrients. 2021 Jun;13(6):1848.
- Polycystic Ovary Syndrome | Nutrition Guide for Clinicians [Internet]. Nutritionguide.pcrm.org. 2020 [cited 29 August 2021]. Available from: https://nutritionguide.pcrm.org/nutritionguide/view/Nutrition_Guide_for_Clinicians/1342095/all/Polycystic_Ovary_Syndrome#4
- Facchinetti F, Unfer V, Dewailly D, Kamenov ZA, Diamanti-Kandarakis E, Laganà AS, Nestler JE, Soulage CO. Inositols in polycystic ovary syndrome: An overview on the advances. Trends in Endocrinology & Metabolism. 2020 Jun 1;31(6):435-47.
Credit Author/ Co-Author:
Chan Mun Yee
Masfara Wahidah Binti Abdul Rahman
Diet Ideas’ Dietitian