Unlocking Fertility: How Inositol Can Help PCOS-Related Ovulation Struggles

Polycystic Ovary Syndrome (PCOS) is a common hormonal disorder that affects 5-6 million women and can often be a leading cause of fertility challenges. While PCOS presents various symptoms and complexities, the role of inositol has emerged as a promising solution for many. Today, we'll delve into what inositol is, its potential benefits for PCOS, its various forms, and its impact on the fertility and pregnancy journey as well as things to watch out for when considering using inositol.

Understanding the Rotterdam Criteria for PCOS:

The Rotterdam criteria, established in 2003, is a set of guidelines used to diagnose PCOS. According to these criteria, a woman may be diagnosed with PCOS if they have at least two of the following three characteristics:

1. Irregular or absent menstrual periods (Amenorrhea or Oligomenorrhea).
2. Clinical or biochemical signs of hyperandrogenism (such as hirsutism, acne, or elevated androgen levels).
3. Polycystic ovaries observed via ultrasound.

These criteria are valuable in identifying PCOS and guiding appropriate treatment.

Understanding Inositol:

Inositol is a naturally occurring sugar alcohol that plays a crucial role in cellular signaling and insulin sensitivity. It comes in several forms, with myo-inositol (MI) and D-chiro-inositol (DCI) being the most studied in the context of PCOS. Although we used to consider it important to supplement with a ratio of both myo and D-chiro inositol for the best results, we are now learning that the previous observations seen in research may have been skewed. Although it is true that women with PCOS are observed with have abnormal levels of DCI in their urine and serum, this does not relate the levels specifically seen at the levels of the ovaries. In fact, what we do see is in women with PCOS is that they appear to have abnormal levels of myo-insitol, not DCI, at the levels of the follicular fluid. We also now have evidence that DCI and MYO have different actions and that DCI may have actions at the level of the ovaries that are not desirable (or even harmful) for women with PCOS. This why although you may have read or seen combination MYO and DCI inositol products being represented on the internet as the BEST options, this is actually opposite from what we know from the recent research. Good news is, MYO inositol is a cheaper and more effective option. 

Why Inositol Can Be Helpful for PCOS:

1. Improved Insulin Sensitivity: Individuals with PCOS often struggle with insulin resistance. Inositol, particularly myo-inositol, has been found to enhance insulin sensitivity, helping to regulate blood sugar levels and hormonal imbalances.The majority of inositol in the human body is in the form of MYO. MYO can be syntheized into DCI by the enzyme eperimase. DCI is highest in tissues that store glucose as glycogen such as muscle and liver tissue. 
2. Ovulation Support: Research indicates that inositol, especially in the MI form, may promote regular ovulation, making it a valuable tool for those trying to conceive.
3. Reduced Androgen Levels: MYO inositol  has shown potential in reducing elevated androgen (male hormone) levels, a common issue in PCOS, which can lead to symptoms like hirsutism and acne. In fact, MYO inositol increases aromatase activity in the ovaries and increases estrogen, an important factor in stimulating ovulation. DCI, on the other hand, inhibits aromatase enzyme in the ovary and can INCREASE testosterone levels, making PCOS symptoms worse. Some studies have even shown that DCI supplementation can impair blastocyst formation, another important aspect to your fertility and pregnancy journey, whether you conceive naturally or use ARTs, like IVF. 

Inositol and Fertility:

For women with PCOS, inositol has shown promise in increasing the chances of conception by restoring regular ovulation, reducing hormonal imbalances, and improving egg quality. Myoinositol has also shown benefits in: 

• Improving metabolic parameters in PCOS 
• Can be combined with certain medications like oral contraceptive pills (OCP) to lower androgen (testosterone) levels. 
• Improve ovulation rates
• Useful prior to assisted fertility treatments, like IVF to improve egg quality. 
• Reduces the incidence and severity of GDM. 

Important Note: Inositol and Non-PCOS Cases:

While inositol has demonstrated remarkable benefits for PCOS, it's crucial to note that there is limited research on its efficacy for individuals without PCOS. It is not a universal solution for fertility challenges. Therefore, it's recommended to consult with a healthcare provider to determine the most appropriate treatment based on your unique circumstances.

Inositol, especially in the forms of myo-inositol, has demonstrated its potential in alleviating PCOS symptoms and improving fertility outcomes. However, its application should be personalized to individuals with a PCOS diagnosis. If you suspect you have PCOS or are considering inositol supplementation, consult a healthcare provider who can provide tailored guidance to support your fertility and overall health journey.

About the Author: Meet Dr. Zen

Alissia Zenhausern- Pfeiffer, NMD, FABNE, (commonly known by her patients as Dr. Zen), is a licensed naturopathic doctor board certified in naturopathic endocrinology and the founder of NMD Wellness of Scottsdale, a premier naturopathic medical practice that focuses on helping women to take a proactive approach to their hormone and fertility health. Dr. Zen has been featured as a lead expert in Forbes, Shape Magazine, and Instyle and is deeply passionate about bridging the gap between traditional and natural medicine in the world of fertility. She works with a variety of hormone related issues including PCOS, endometriosis and unexplained infertility. Her goal is to help more women get back into the driver’s seat of their own health to make lasting transformational changes to their health to bring more cute and adorable babies into this world. Read More About Dr. Zen...