PCOS: A science-backed way to tackle this major cause of infertility....
PCOS is a common cause of infertility. Most people who have PCOS have insulin resistance which has been shown to cause many of the issues associated with infertility. We take a look at the science behind this and most importantly how exercise can help reduce this insulin resistance potentially relieving some of the road blocks that PCOS can put in the way of getting pregnant.
It is well known that Polycystic Ovarian Syndrome (PCOS) is one of the most common hormonal disorders for women and many people are not diagnosed until they have trouble getting pregnant. Click here for more. (1)
As with a lot of these disorders, there is no one single known cause and as usual it is often a combination of genetics and our environment and lifestyle (epigenetics) (1)
The question is, as usual, what can we do about it??
In order to tackle these things, it is always worth looking at the root. PCOS can be expressed differently for different people, however, one of the most common features is insulin resistance.
What does this mean? Well essentially it is when our cells fail to react as they should to insulin, leading to more being produced and in our blood - in fact 70% of people with PCOS have some form of insulin resistance (1) and it seems to apply to women who have normal as well as higher BMIs (insulin resistance is usually associated with a higher BMI - although having a higher BMI does make it worse).
‘Insulin resistance is inherent in women with PCOS’ (7)
Not everyone is affected, but if you suspect you have PCOS or have been told that you have, it is worth asking your doctor to assess your insulin sensitivity, even if you have a normal BMI. Knowledge is after all power and we are all individuals.
Why is insulin resistance important when it comes to fertility?
Insulin is the hormone that allows our cells to use sugar (glucose) for energy. When we have too much insulin (usually because our cells are not receptive to normal levels) then we get several potential issues, one of which is a negative impact on our fertility.
PCOS is associated with higher than normal levels of male hormones (known as androgens) in our blood and research is suggesting that one of the reasons women with PCOS suffer from this is due to insulin resistance:
How does this work and why is it important for fertility?
As I’m sure you can imagine, as a woman, whilst you want some male hormones in your body, but you don’t want too much washing around your body and recent research has linked higher insulin with higher levels of circulating testosterone which can cause issues like acne, excess hair, irregular periods and lack of ovulation which are common in PCOS.
Why does this happen?
When it comes to hormones, it is important that they are transported to the ‘right’ places in our body. In the case of testosterone the important ‘carrier’ to get it to the right place is known Sex Hormone Binding Globulin (also known as SHBG)
The trouble is: too much insulin can reduce the production of this vital carrier which can mean that testosterone is essentially allowed to get into places in the body it should not be and which is why we can get these undesirable symptoms.
An easy way to understand this: is with an excellent analogy from Dr Jason Fung who likens this to trying to get to a meeting in New York City without jumping in a cab. If you walk to your meeting you can easily get distracted by all sorts of things on the way, go into shops, get a coffee etc. Think of SHBG as the ‘taxi’ for testosterone - if you have enough ‘taxis’ then the testosterone can get directly to where it is supposed to go rather than going into all kinds of other places on the way! Read more from him on the subject here.
So, in a nutshell: If you don't have high enough levels of this transport compound (SHBG) then essentially the testosterone can ‘go rogue’ and exert its influence in other areas of the body which is one of the reasons people with PCOS can get things like excess hair/acne as well as lack of ovulation and irregular periods. (2, 3).
Ok so can this knowledge help us treat PCOS and reduce symptoms?
This is the good news, and is where knowledge and understanding can help us. So whilst not every person with PCOS has an issue with insulin resistance, a lot do (even people with low/normal BMIs) and it can be a major factor behind infertility. So if we know too much insulin is causing us a problem:
How do we reduce insulin/our body’s sensitivity to insulin effectively?
There is a strong link between insulin sensitivity and certain forms of exercise when done on a regular basis and the good news is that this can benefit not only those with a higher BMI (who will especially benefit particularly as weight reduces), but also those who have a normal BMI simply by increasing the body’s lean muscle mass which has been shown to play a really important role in helping the body control blood sugar and insulin sensitivity.
Here is what the research suggests:
‘Resistance exercise alone can reduce hyperandrogenism (when you have a dominance of the male hormones) and improve reproductive function and body composition by lowering visceral fat and increasing lean muscle mass.’ (4)
How does this work exactly?
Having lean muscle mass (which is what you build with resistance training) is believed to promote greater insulin sensitivity (which those with insulin resistance lack) because it is responsible for up to 80% of the insulin dependent glucose uptake. (5)
In fact, the American College of Sports Medicine has recommended strength training and progressive resistance training and studies have shown a real benefit to reducing serum concentrations of testosterone and fasting glucose levels (after 16 weeks) (5) and even better, within the study, those women who were experiencing issues with ovulation showed an improvement.
It is not isolated to one study either, ‘several other studies have reported improved menstrual and/or ovulatory frequency after progressive resistance training’ and this has been linked to changes in these male hormone levels.
‘Changes in serum testosterone and free androgen concentration after persistent resistance training might enhance ovarian function because elevated free-circulating androgen concentrations are associated with PCOS, which might lead to chronic anovulation (lack of ovulation),’ (5).
It doesn’t end there either: some other powerful benefits:
There are two additional other factors linked to PCOS which are pretty fascinating and can be helped by resistance training:
One study looked at the link between anxiety and stress hormones (ACTH) and actually argue that people with PCOS can have a ‘lower resistance to stress’ and higher anxiety (interesting!) which can exacerbate the symptoms. (4) We know that exercise and specifically resistance training can help relieve stress when done in the right way - click here for more. I mean most people feel better after a work-out thanks to those endorphins.
Secondly, resistance training has shown positive benefits when it comes to another associated condition linked not only to PCOS but also to endometriosis: inflammation (4, 6).
Click here for more on why chronic inflammation is not what you want, but, once again, if done in the right way (click here for more on how to do this from our resident expert Natalie Ferris) resistance training can be a powerful tool to reduce this inflammation in the body which has also been linked to issues with conception and having a healthy child:
‘Appropriate regulation of inflammation is critical for successful ovulation and implantation’ (6)
So - you may have thought you dont need more reasons to exercise, but if you are having trouble with fertility and in particular if you have PCOS and even Endometriosis then resistance based exercise which can build lean muscle in the body is a really powerful (and science-backed) way to manage some of the undesirable symptoms that can stop us having kids.
For other ways to tackle PCOS - check out:
Vitamin D: some research has linked a deficiency to exacerbating PCOS. Get your levels checked!
Komarowska H, Stangierski A, Warmuz-Stangierska I, Lodyga M: Differences in Psycological and hormonal presentation of lean and obese patients with Polycystic Ovarian Syndrome: Neuroendocrinology: 2013: 34(7) 669-74
Daka B, Rosen T, Jansson PA: Inverse association between serum insulin and sex hormone-binding globulin in a population survey in Sweden: Endocrine Connect: 2012 Nov 19:2(1) 18-22
Mimic Dm Popovic V, Nesovic M: Androgen levels during sequential insulin euglycemic clamp studies in patients with polycystic ovary disease: Journal Steroid Biochem: 1988 Dec 31(6)
Goyal M, Dawood AS: Debates Regarding Lean Patients with Polycystic Ovary Syndrome: A Narrative Review: Journal of Human Reproductive Sciences: 2017: Jul-Sep 10(3): 154-161
Ghislaine Satyko K, Miranda-Furtado CL, Rafael Costa S, Anderson Sanchez A: Resistance Exercise Impacts Lean Muscle Mass in Women with Polycystic Ovary Syndrome: Medicine & Science in Sports & Exercise: April 2016 (48) 4: 589-598
Radin R, Sjaarda LA, Schisterman EF: C-Reactive Protein in relation to fecundability and anovulation among eumenorrheic women: Fertility and Sterility: 2018 Feb: 109(2): 232-239
Toosy S, Sodi R, Pappachan JM: Lean Polycystic ovary syndrome (PCOS): an evidence-based practical approach: Journal of Diabetes and Metabolic Disorders: November 2018.
This article is for informational purposes only. This article is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment and should never be relied upon for specific medical advice. The information on this website has been developed following years of personal research and from referenced and sourced medical research. Before making any changes we strongly recommend you consult a healthcare professional before you begin.