The word “diet” can mean “food or drink regularly consumed,” or “a regimen of eating and drinking sparsely so as to reduce one’s weight.” The latter definition is one that inspires fear in the hearts of many who have tried unsuccessfully to lose weight by “going on a diet.”One of the most common questions we get at Pulling Down the Moon is “how do general diet programs like Weight Watchers stack up for fertility?”   How diet impacts fertility was also the subject of a daylong symposium at the most recent meeting of the American Society for Reproductive Medicine.  Clearly, overweight is a challenge to fertility and can also block women from access to advanced medical fertility treatments like IVF.  But are diets the answer?

How Do Diets Measure Up?

In our view, for a diet to be fertility-friendly it must a) help women to attain and maintain a healthy weight for fertility b) target the specific ways in which overweight negatively impacts fertility:  poor blood sugar regulation, inflammation and the negative hormonal impact of excess body fat  c) eliminate overly-processed foods and encourage the consumption of minimally processed foods.  So how do “diets” stack up?

A) Help women to attain and maintain a healthy weight for fertility

While it may sound ridiculous, dieting does not seem to be the best way to lose weight.  An extensive 2007 review of weight-loss programs published in American Psychologist concluded that:

Dieters were not able to maintain their weight losses in the long term, and there was not consistent evidence that the diets resulted in significant improvements in their health. In the few cases in which health benefits were shown, it could not be demonstrated that they resulted from dieting, rather than exercise, medication use, or other lifestyle changes. It appears that dieters who manage to sustain a weight loss are the rare exception, rather than the rule. Dieters who gain back more weight than they lost may very well be the norm, rather than an unlucky minority.

Even well established programs like Weight Watchers struggle when we take a closer look at success and maintenance.  There is recent clinical data suggesting that Weight Watchers may be more effective than other diet programs at helping people lose weight and keep it off.   A 2008 study published in The British Journal of Nutrition reported looked at a sample of 976 “lifetime members”(defined as people who met and maintained their goal weight for at least 6 weeks) to see how many remained below their goal weight at 1 (26%), 2 (20.5%) and 5 (16%) years after they successfully completed the program.  On the surface this sounds encouraging but a closer look reveals this study has significant biases that make it next to impossible to generalize the findings.  Only about 6% of people who try Weight Watchers successfully attain and maintain their goal weight and meet the criteria to become lifetime members.  This study looked only at their most successful dieters and only 16% of that already small minority kept the weight off for 5 years.

The other problem with assessing the efficacy of WW is that we do not know what’s happening to the other 94% people who try the program and fail.  Are they experiencing the clinically relevant negative effects of dieting, including gaining back more than the weight they lost after a failed diet?

With these numbers in mind, there is a very good chance that many women who are told they need to lose weight in order to increase their odds of pregnancy have already failed at Weight Watchers.  Diets, it seems, are not the answer.

B) Provide ample amounts of nutrients that are important for good nutrition function and target the specific ways in which overweight negatively impacts fertility:  poor blood sugar regulation, inflammation and the negative hormonal impact of excess body fat

Major components of commercial diet programs – eating “low fat,” using artificial sweeteners, mass-prepared processed foods to support portion control and optimize convenience and emphasis on low fat dairy and “diet” foods – fly in the face of what we believe lie at the heart of healthy eating in general.  For women to find true success and optimal health they need to “un-learn” many of the dieting habits they have picked up over the years.  This means that frozen processed diet meals are out, as are the sugar-free and low-fat processed snacks.  Diet soda and artificial sweeteners are another crutch that needs to be discarded.  These overly processed food products may conveniently cut calories and “soothe the sweet tooth” (unfortunately artificial sweeteners may actually sharpen a sweet tooth in the long term) but they do not address the underlying causes of infertility – inflammation and poor blood sugar control – associated with overweight.

You can review a head-to-head comparison of a “healthy” low-fat diet versus a fertility-friendly menu in our blog A Tale of Two Diets to learn more about our contention that many of the “healthy” eating habits that have become conventional diet wisdom are simply wrong.   In our estimation an ideal fertility-friendly diet contains about 10% more fat and 10% less carbohydrates than a “typical” healthy diet.  The fats come from foods that naturally have fat in nature – full fat dairy in small amounts, fats from nuts, seeds and oils, as well as fats from grass raised meats and fish in small quantities.  Many of the fat-soluble nutrients and essential oils needed for optimal health are found in these natural fats.

C) Discourage overly processed foods and encourage the consumption of minimally processed foods.

We all seek convenience in our meal preparation but often to the detriment of the food we put in our bodies.  While Jenny Craig, Nutrisystem and Weight Watchers all provide recipes, they  also do a brisk trade in maximally processed meals and snack foods, none of which we feel we could endorse as fertility-friendly.  Processed, packaged in potentially toxic plastics and “fortified” with added vitamins and minerals – they aren’t true foods.  Read the ingredients of any of them for a tongue-twisting array of chemicals, preservatives and colorings.

Furthermore, we encourage women who are trying to conceive to eat organic and hormone-free as much as possible. The cardboard, plastic and Styrofoam packaging that wrap up convenience foods and snack-size packs are not good for our environment, either, and may be contributing to the chemical stew that is negatively impacting fertility in the first place.

What’s the Solution?

As we mentioned above, most women who have been told they need to lose weight in order to conceive or undergo IVF have likely tried dieting in almost every form possible and do not want to try another one.  So what to do?

Our answer lies in the concept of “nourishing up.” Nourishing up is the process of learning how to feed our bodies with real food that includes healthy fats and does not rely on processed low fat, sugar free or diet foods.  With nourishment come satiety, great digestion and optimal nutrition.  In obese and overweight women weight loss is not the goal of nourishing up but it is almost always a by-product.

Our therapeutic intervention for overweight and obesity, First Line Therapy for Fertility, introduces women to highly nutritious and satisfying eating guidelines based on the Mediterranean dietary pattern, which several studies have associated with potential protection against infertility (3, 4).  This dietary pattern emphasizes low-glycemic load, minimally processed foods and healthy oils from vegetable and fish sources.  Refined sugars and treats play a minimal role in this dietary pattern as do “diet foods” like processed low-fat dairy, and sugar free or fat free foods.  First Line Therapy has been shown to promote weight loss as well as improve markers of metabolic syndrome, such as decreasing LDL (bad) cholesterol, in women (5).

Dietitians who have received additional training in fertility nutrition and are up to speed on ART treatments lead the FLTF Program.  We educate women about Fertility Go (eat lots every day), Whoa (okay in moderation) and No (let’s skip these) foods, making it easy for women to customize their program to optimize sources of essential fertility nutrients (iron, omega-3 fats, B-vitamins and antioxidants).   In addition there is education and emphasis on foods and supplements that limit inflammation, which is implicated in many different infertility conditions including endometriosis, Polycystic Ovarian Syndrome (PCOS) and poor egg quality. With FLTF, we will help women choose foods that will nourish their bodies with the vitamins and minerals needed to maximize their fertility and help them feel satisfied, while at the same time helping them achieve a healthy weight.

Currently we have two groups of 5 women, one group in Chicago and one in DC Metro, who are participating in the FLTF program.  Stay tuned to our site for more information about their progress, to share their stories, challenges and successes, and to learn more about First Line Therapy for Fertility.

Sources

1.  Mann et al.  Medicare’s search for effective obesity treatments:  diets are not the answer. American Psychologist (2007), 62: pp 220 –233.

2.  Lowe et al. Weight-loss maintenance 1, 2 and 5 years after successful completion of a weight-loss programme.  British Journal of Nutrition (2008), 99: pp 925-930.

3.  Toledo et al. Dietary patterns and difficulty conceiving: a nested case–control study.  Fertility & Sterility (2011), 96: 1149-53.

4.  Vujkovich et al. The preconception Mediterranean dietary pattern in couples undergoing in vitro fertilization/intracytoplasmic sperm injection treatment increases the chance of pregnancy.  Fertility & Sterility (2010), 94: pp 2096-101.

5.  Jones et al. A Mediterranean-style low-glycemic-load diet improves variables of metabolic syndrome in women, and addition of a phytochemical-rich medical food enhances benefits on lipoprotein metabolism.  Journal of Clinical Lipidology (2011) , 5: pp. 188-96.

Click here to view the video on YouTube.

Margaret Wertheim M.S., R.D., L.D.N.

Margaret Wertheim, MS RD LDN

Here at Pulling Down the Moon, we are launching our new weight loss program entitled First Line Therapy for Fertility (FLTF). I couldn’t be more excited about this program, and in preparation I’ve been doing the program myself. I’m not trying to lose weight, but simply following the eating plan with a goal of maintaining my weight. First let me tell you a little bit more about how the program works, and then I’ll fill you in on my experience.

Once you enroll in FLTF, you will come in for an initial consultation with me in Chicago or with Laura in Rockville. During that consultation we’ll review your goals, medical and fertility history and current diet in detail. We will also take your weight, measure your waist and hip circumference and your body composition using near infrared or NIR. The NIR measurement will tell us what percent of your body is fat versus lean body mass, which means muscle, bone and everything else that isn’t fat. It will also give us your BMR or basal metabolic rate, which tells us how many calories your burn at rest. That number will be adjusted based on your activity level to a calorie amount to promote weight loss. Don’t worry, that’s where our attention to calories begins and ends. There will be absolutely no calorie counting in this program. Instead after we calculate your calorie goal, we’ll translate that into a certain number of servings from each of the different food groups. We’ll come up with a meal pattern that works for you. It’s entirely customizable and tailored to you.

So back to my experience.  I’ve been on a weight maintenance FLTF plan for about 4 weeks now and I feel great! I am a Nutritionist who walks the talk, and I’ve always been a great vegetable eater, but FLTF took even me to a whole new level.  Here’s what I’ve noticed while on the FLTF plan:

1. I have more energy and never feel tired after eating. You know that carb coma fatigue you feel after a large meal of pasta or pizza, where all you want to do is veg out on the couch. You won’t feel that at all during the FLTF program. The reason is your blood sugar is going to remain so well-regulated that your energy will be steady. The majority of your carbs will mostly be coming from fruits, vegetables and beans with very limited grains and dairy. You will also always pair carbs with protein, which slows the absorption of sugar (created by the breakdown of carbs) into your bloodstream and prevents blood sugar peaks and valleys. The peaks and valleys are what leave you feeling really good 15 minutes after eating candy and tired, cranky, and searching for the next sugar fix after that. Don’t be scared off by limiting your grains and dairy. You can do it, and I’m going to help you.

2. Not eating sweets isn’t as hard as you may think. This plan has no sweets in it. Many weight loss programs promote jelly beans, “skinny” frozen desserts or other low-fat or sugar-free sweets. Instead I’m going to ask you to pretty strictly limit your sweets, but you’ll have fruit as well as sweet-tasting low glycemic index protein shakes to satisfy that sweet tooth. It may be hard to limit sweets at first, but it will get better. Once you cut out those sweets, the cravings will gradually disappear and you’ll be so excited about how great you feel and look, you won’t want to go back.

4. I’m eating more fruits and vegetables than ever: We are all constantly being told to eat more fruits and vegetables to improve our overall health and prevent disease. When it comes to cancer prevention, the recommendation from the American Cancer Society is at least 2 ½ cups of fruits and vegetables daily. I bet that while doing FLTF you will not only meet with recommendation, but go well above and beyond.

Let’s take a look at what I ate yesterday  – oatmeal, full-fat yogurt, walnuts, grassfed beef, tomato sauce, spaghetti squash, cannellini beans, kale, garlic, apple, almond butter, grapes, lentil soup, Brussels sprouts, butternut squash, blueberries. This day was jam-packed with nutrients and antioxidants! Let’s see how I did with eating a variety of different colors – red (grapes, apple skin, tomato sauce), orange/yellow (spaghetti squash, butternut squash, carrots in my lentil soup), green (kale, Brussels sprouts), blue (blueberries), white (cannellini beans, onions, garlic), brown (lentils, mushrooms, almond butter).

Here’s something that’s very important. Much of this may sound hard. I’m going to ask you to limit some pretty common foods, but I will tell you to always remember the 80/20 rule. What you do 80% of the time is what really matters. The other 20% is less important. Here’s an example: I’ve been doing FLTF, and I went to my sister’s house for dinner, and she was serving homemade pizza. Pizza has 2 things that I’m limiting –grains and dairy. What did I do? I ate the pizza, and I enjoyed it. I loaded up on veggies on the side. I’d been sticking to the plan most of the rest of the time, so it’s fine. In the beginning, it’s best to stick to the plan as closely as possible for maximum benefit, but there will always be meals that you can’t control. One meal is not going to make or break anything.

Because I’ve done and continue to do this program, I know the challenges and I’ll be able to give you recipes and tips to guide you through. I know you can be successful and you’ll have my support as well as the support of the other program participants.  The program costs $210 and includes a one-on-one session with a Registered Dietitian and seven group follow-up sessions.

FLTF launches in Chicago and Rockville on May 1^st, so call 312-321-0004 (Chicago) or 301-610-7755 to get more information or to sign up. Can’t wait to meet you and guide you through this exciting journey.

Increasing evidence suggests that the way in which fat is distributed on a woman’s body may impact fertility.  While body fat is essential for reproduction  (a range of about 17-22% body fat is necessary for menstruation) too much body fat impairs a woman’s ability to conceive.

Body shape also predicts fertility.  Pregnancy rates, in both natural and assisted reproduction, go down with fat accumulation around the waist and trunk independent of overall body weight (1).  As opposed to the tush and thigh fat associated with the pear pattern, apple fat is more metabolically active.  It produces cytokines, chemicals that promote insulin resistance and low-level chronic inflammation.  These factors may lead to other disturbances in reproductive function.  The apple shape is also characteristic of women with Polycystic Ovarian Syndrome (PCOS), a condition associated with infertility.

Click here to access your waist/hip ratio and determine your relative health risk.

If your waist-to-hip ratio is in the less healthy range, don’t despair.  There are effective steps you can take to change your body fat profile.

• Exercise:  All forms of exercise, but particularly resistance training, has been shown to help decrease abdominal fat.  Strength training increases lean muscle mass throughout the body and this increased lean tissue boosts metabolism in a lasting way.  Spot training (hundreds of ab crunches) has not been shown to be effective.
• Weight loss is helpful for decreasing abdominal adiposity but this loss is greater when exercise is added.
• Relaxation training:  Stress has been shown to promote the accumulation of abdominal fat.  Yoga, meditation and breathing practices can help to lower the circulating stress hormones that promote the formation of abdominal fat deposits.  Massage can also help you learn to relax.

Making lasting changes is more effective with support and expert advice.  Our nutrition and other holistic programs including massage, fertility yoga and acupuncture can help you meet your goals and are available in person and by phone.  Call 312-321-0004 (Chicago) or 301-610-7755 (DC Metro) for more information!

1.  Kuchenbecker et al.  The Subcutaneous Abdominal Fat and Not the Intraabdominal Fat Compartment Is Associated with Anovulation in Women with Obesity and Infertility.  J Clin Endocrinol Metab, May 2010, 95(5):2107–2112

At the Moon we are constantly striving to increase our E.Q.I.Q. (Egg Quality I.Q.) and for years we have believed that nutrition can play a role in eqq quality.  However, until recently there were few studies to support this claim so we needed to temper our recommendations with the phrase “but there isn’t any clinical evidence for this yet.”   Now, several new investigations have shown that, yes, certain nutritional supplements may make a difference in egg quality.  The goal of this blog is to summarize the latest clinical news,  discuss the substances that are now showing potential benefits for women with poor egg quality and help you make choices about which supplements may be right for you.  As with any supplement protocol, you should always consult your physician before starting.

1.  Myo-inositol (MI)

Very recently two clinical trials were published that clarified a lot of the unknowns about myo-inositol, a product we use at PDtM under the name of FlowPro.   Myo-inositol (MI) is a part of the B vitamin complex and is a known insulin-sensitizer.  It has also been shown to improve both physical (hirsutism and acne) and reproductive (anovulation and amenorrhea) manifestations of Polycystic Ovarian Syndrome (PCOS).  In addition, myo-inositol plays a role in cell growth and early studies indicated that higher levels of MI in the follicular fluid was associated with better egg quality.

Several exciting new studies have emerged that have shed new light on MI and its role in fertility, particularly Assisted Reproductive Technology.  The latest study of interest demonstrated that treatment with 4 g per day of MI for three months prior to IVF improved egg quality in women who had failed a previous IVF due to poor egg quality. In this study the treatment also included 3g per day of melatonin, which I will talk about next.

But first, a note about inositol.  For some time there has been a debate as to the efficacy of d-chiro vs. myo-inositol for fertility.  We have chosen to use MI in our products because a) this is the form that has been used in all the clinical research we have seen to date on PCOS, egg and embryo quality and b) it is less expensive than the d- form.  Now, a new study confirms that myo-inositol seems to be more effective than d-chiro for egg and embryo-quality. On another happy note, MI  has also been shown to have a positive therapeutic effect on mood disorders that are responsive to SSRI’s (serotonin selective reuptake inhibitors) including depression, panic and OCD – a potential plus for the anxious, depressed fertility patient!

2.  Melatonin

Melatonin is a hormone that is secreted by the pineal gland.  It regulates our sleep/wake cycle as well as other hormones, in particular the hormones of the female reproductive cycle.  New studies like the one above suggest that melatonin supplementation at a level of 3 mg per day may help to improve egg quality when taken with MI for several months prior to IVF.

There are caveats to the use of melatonin.  Side-effects may include exacerbation of depression symptoms and patients who struggle with depression should make sure to  discuss this side-effect with their physician.  Melatonin should not be used with patients using thyroid medication as it can impact thyroid hormone levels.  It can also suppress ovulation at high doses so in general we only recommend this supplement for women who will be using ART and a trigger shot to stimulate ovulation and/or retrieval.

Finally, melatonin should NOT be taken while pregnant or nursing.  In general we do not recommend melatonin use for longer than 3 months without taking a break.  It can also cause marked drowsiness and is best taken just before bedtime.

3.  DHEA

DHEA (not to be confused with the omega-3 fatty acid DHA) is a hormone that serves as a precursor of steroid hormones testosterone and estrogen.  Research indicates it may also stimulate follicular development.  Several studies have shown supplementation with 75 mg of DHEA daily to improve egg quality and pregnancy outcome in women who were “poor responders” to IVF stimulation medication. Another study suggests that DHEA supplementation may reduce the risk of aneupoloidy.

DHEA should be used with caution as it is a pretty powerful hormone and when used at high levels and over a long term it may damage the liver.  Women who are pregnant or nursing should not take DHEA, nor should women with PCOS as this could exacerbate the condition.  Like melatonin, we recommend a three month treatment period.

4.  CoQ10

CoQ10 is a naturally occurring fat-soluble nutrient that is essential for energy production. CoQ10 has potent antioxidant properties and cell membrane stabilizing effects that make it beneficial for egg and sperm quality, specifically sperm motility. CoQ10 works within the mitochondria (the cellular power stations) in the cells and is essential for energy production. Until recently, CoQ10 was not thought to be a nutrient that required supplementation, as all normal tissue manufactures its own CoQ10; however, this production decreases naturally with age and is also lowered by certain drugs, including statins. When CoQ10 levels in the cells are low, energy production may be reduced and oxidative stress increased as a result.

CoQ10 has been shown to improve sperm quality and is now under investigation for potential use with women of advanced reproductive age undergoing ART to improve egg/embryo quality. The oocyte has among the highest concentrations of mitochondria of all body cells and uses immense amounts of energy in the process of maturation and ovulation. Researchers hypothesize that supporting the oocyte with CoQ10 may improve egg quality (Bentov et al. 2010).

The recommended dosage for overall health is 100-300 mg/day, or as directed by a nutritionist. The dosage under investigation in studies looking at egg quality is higher: 600 mg/day. CoQ10 appears to be a safe supplement: Studies have used supplementation of CoQ10 up to levels of 3,000 mg per day without adverse side effects. At present, the only risk to taking CoQ is the cost, as this supplement can be pricy, and no data currently exists on its usage in high doses during pregnancy.

5.  Omega-3 Fatty Acid (EPA/DHA)

There is still no direct clinical evidence that omega-3 fatty acids improve egg quality but we are convinced they are a good bet and include them in our Egg Quality Protocol.  Eicosapentaenoic acid (EPA) forms the backbone of many of the chemicals that halt inflammation in our body and also serves to support the health of our cell membranes.  Docosahexaenoic acid (DHA) (not to be confused with DHEA above) is important for brain health and adequate stores of DHA are thought to be beneficial for the early cognitive development of the fetus.  DHA may also be helpful for depression.   Look for purity-tested products.

This is exciting news indeed but you should always speak with your physician  before beginning a supplementation regimen of any kind. Of course, we would also be remiss if we didn’t mention that providing your body with the highest quality diet is also important for fertility.  If you are specifically seeking to improve your egg quality you should also consider re-thinking your diet to limit inflammation, achieve good blood sugar control and get ample antioxidant nutrients from food sources. Our nutritionists at Pulling Down the Moon are specialists and will tailor their recommendations to your fertility diagnosis.

For more information about any of the supplements or info in this blog, please feel free to contact me at beth@pullingdownthemoon.com.  These supplements and other fertility-related products are available at our online store.

According to yoga physiology, apana vayu is the downward flow of energy that governs the menses as well as elimination of toxins from the body.  In the yogic view of PCOS, the apana vayu has become stagnant and by stimulating apana we re-invigorate the menstrual cycle.  Poses that stretch and open the hips and lower back facilitate the flow of apana.   Strengthening apana energy flow is just one goal of our therapeutic yoga practice for PCOS.  A well-rounded practice for PCOS also includes twisting and folding poses to stimulate agni, back-bending poses to enliven the nervous system, restorative poses that induce the relaxation response and gentle inversions that stimulate the thyroid, hypothalamus and pituitary glands.

This series of poses to strengthen apana begins with a vinyasa of chair (utkatasana) and standing forward fold (uttanasana) for a simple flow that is both energizing and grounding.  Follow this sequence with warrior 2, to continue to build strength and open groin and hip muscles.  Finish with Supine Cobbler’s Pose, a gentle supported back-bend that stimulates the relaxation response.

Utkatasana

Uttanasana "Forward Fold"

Virabhadrasana 2 "Warrior Pose"

Supta Baddha Konasana - Supported Reclining Cobbler's Pose

Click here to view the video on YouTube.

Lifestyle treatment including diet, exercise, stress reduction and Traditional Chinese Medicine for PCOS makes sense.  If you have been diagnosed with PCOS, we encourage you to come in for a consultation and work with our expert practitioners.  Our comprehensive and targeted approach to PCOS includes specific dietary recommendations and supplementation, yoga and relaxation for stress reduction  and Traditional Chinese Medicine acupuncture treatment.  You do not need to be struggling to conceive to benefit from our expertise.  In fact, getting a handle on PCOS before you are “trying” is essential. PCOS is often under-diagnosed in teenage girls and the acne, irregular periods and weight gain are chalked up to puberty.

For more information about PDtM’s comprehensive approach to PCOS, call 312-321-0004 to book a complimentary face-to-face or phone session with our Patient Advocate.

A question I frequently get asked in my acupuncture practice is “Can acupuncture help improve egg quality?”  From my own clinical experience the answer is, it can.   Acupuncture and herbal therapy help improve the environment of the ovary enabling it to function optimally and properly, therein allowing it to make good quality eggs.  An example of this is with Polycystic Ovarian Syndrome (PCOS) where the problem is a functional disorder of the entire system that is affecting the ovary.  In other words, the issue is not with that single organ alone.  Since the body systemically is not working properly it is not able to nourish the ovary.  Therefore many immature follicles develop within the ovary impeding the process to fully grow one or two healthy quality eggs, as is the case in a normal cycle.  There are many treatment strategies that traditional Chinese medicine (TCM) offers to help regulate the body’s functioning in PCOS, so that the ovary is being supplied the energy and blood it needs to be able to produce an exceptional egg.

Another instance in which I have seen an improvement in egg quality is with endometriosis.  The explanation is a bit simpler to understand than in PCOS.  Generally speaking, with endometriosis the condition is one of blood stasis, a problem that can hinder fresh, oxygenated, nutrient rich blood from reaching the ovary thereby having a negative effect on its function of making a good quality egg.  Here again there are many options in which TCM can help treat blood stasis so that the ovary is being thoroughly supported to produce a good egg.

Though there is no data via research studies presently to support this claim directly, there is much that I have seen in my clinical experience to believe it to be true.  If you have any questions regarding egg quality and how TCM can help please feel free to contact me or book an appointment!

In a previous blog posting, I recommended that women with PCOS (Polycystic Ovary Syndrome) get screened for autoimmune thyroid disease as research has shown that women with PCOS are three times as likely to also have an autoimmune thyroid disease.  The autoimmune thyroid diseases are Graves Disease and Hashimoto’s Thyroiditis. In both cases, immune system antibodies attack the cells of the thyroid gland which can lead to the gland’s eventual destruction – producing symptoms which can include weight gain or loss, depression, anxiety, rapid heart rate, and in some cases infertility. While most Reproductive Endocrinologists routinely test for Thyroid Stimulating Hormone (TSH) which can determine an over-active thyroid gland (hyperthyroidism) or under-active thyroid gland (hypothyroidism), autoimmune thyroid disease needs to be tested by determining levels of antibodies that the immune system is producing such as anti-thyroid peroxidase antibodies (anti-TPO) or anti-thyroglobulin (anti-TG)antibodies.

In addition to the higher incidence of autoimmune thyroid disease in women with PCOS, a recent study showed that infertile women suffering from PCOS with anti-TPO values that exceeded the upper level of normal were significantly more likely to be resistant to Clomid compared to Clomid responders and Metformin responders. They went on to conclude that elevated anti-TPO levels (an indicator of autoimmune thyroid disease) are associated with poor treatment response in infertile women who suffer from PCOS.

So, why is it so common to see PCOS and Thyroid Disease together?  There is no definitive answer, but there are connections.  Both the thyroid gland and the ovaries are part of the endocrine system.  Insulin resistance, which is very common in women with PCOS, is also associated with thyroid function as studies have found that increased levels of TSH correlate with an increase in insulin resistance (read more about the insulin resistance and PCOS connection in a previous blog). There also may be specific nutritional deficiencies that PCOS and thyroid disease have in common.

While the research is still limited in the area of infertility, thyroid disease and PCOS, there is a link between all of them and getting tested and screened for both PCOS and thyroid disease may be beneficial in your fertility journey. Nutrition also plays a large role in the treatment of PCOS and thyroid disease including helping to lessen insulin resistance. To book a nutrition consultation at Pulling Down the Moon, call (312) 321-0004 or visit www.pullingdownthemoon.com.