Does the Keto Diet Improve Fertility in Women With PCOS?

Introduction

Polycystic ovary syndrome (PCOS) is a hormonal disorder that many women of reproductive age experience. PCOS is a condition where women may have irregular periods, difficulty processing insulin, obesity, and higher levels of male hormones (androgens), which can cause cysts to form on the ovaries. These imbalances in hormones can contribute to difficulties with fertility and conceiving. Therefore, women with PCOS often try different methods and changes to their lifestyle to increase their chances of becoming pregnant.

What Is the Keto Diet?

The keto diet, also known as the ketogenic diet, has become increasingly popular in recent times. It entails decreasing the consumption of carbohydrates while elevating fat intake. It is designed to induce a state of ketosis, in which the body primarily uses fat for energy instead of carbohydrates. In a typical keto diet, macronutrient distribution is approximately 70 to 75 percent fat, 20 to 25 percent protein, and five to ten percent carbohydrates. The objective is to limit the consumption of carbohydrates to a point where it triggers the generation of ketones, which serve as an alternative energy source for the body.

Is the Keto Diet Good for PCOS?

The keto diet has many benefits for women with PCOS. Proponents of the diet argue that it may have several mechanisms that could benefit women with PCOS and their chances of conception.

Weight Loss and Insulin Sensitivity:

Obesity is a common concern for women with PCOS, and losing excess weight can improve insulin sensitivity and hormone regulation. By reducing carbohydrate intake, the keto diet can lead to reduced insulin levels. This may help reduce insulin resistance. Improved insulin sensitivity can have a positive impact on ovulation and menstrual regularity, thus enhancing fertility in women with PCOS.

Anti-Inflammatory Effects:

Chronic inflammation is a concern for women with PCOS and can worsen symptoms. The keto diet may have anti-inflammatory properties due to reduced sugar and refined carbohydrate consumption. By reducing inflammation, the keto diet may provide a favorable environment for conception in women with PCOS.

Improved Egg Quality:

The keto diet is proposed to improve egg quality by providing a more stable energy source for cells, potentially reducing oxidative stress. Oxidative stress negatively affects egg quality and reproductive outcomes. However, scientific evidence on the direct impact of the keto diet on egg quality in women with PCOS is limited.

Appetite Control:

The elevated fat content in the keto diet has the potential to enhance the feeling of fullness and diminish hunger, helping women with PCOS manage their calorie intake and achieve a healthier weight. A 2019 study found that a ketogenic diet significantly reduced appetite and calorie intake in overweight women with PCOS, which can be a helpful tool in managing obesity and related fertility issues.

What Do Recent Studies Show About the Keto Diet’s Effects on Reproductive Hormones and Ovulation in Women With PCOS?

A recent study examined the effects of a ketogenic diet on women with PCOS and their reproductive hormones. The research included 170 subjects from various clinical trials.

The key findings include:

• LH (luteinizing hormone) and FSH (follicle stimulating hormone) Ratio: Women with PCOS often have an abnormal LH/FSH ratio. A ketogenic diet appeared to improve this ratio, essential for ovulation.

• Free Testosterone: PCOS is linked to high levels of free testosterone, contributing to various health issues. The study showed that a ketogenic diet helped lower these levels.

• SHBG (sex hormone binding globulin): Serum SHBG is important for metabolic health. Women with PCOS often have low SHBG levels. The ketogenic diet increased SHBG, potentially improving metabolic and ovulatory problems.

• Progesterone: Progesterone is necessary for a healthy menstrual cycle, but women with PCOS often have low levels. The study did not find a significant change in progesterone levels with a ketogenic diet, but more research is needed.

• Weight Loss: All studies included in the analysis reported significant weight loss in women following a ketogenic diet. This weight loss was attributed to reduced appetite, improved metabolic efficiency, and increased fat utilization.

Another study aimed to assess the impact of a very low-carbohydrate ketogenic diet (VLCKD) on metabolic and ovulatory issues in obese, non-diabetic women with PCOS.

The following are the findings:

• The study showed that a three month VLCKD significantly reduced BMI, waist circumference, and the HOMA index (a measure of insulin resistance). It also led to an improvement in SHBG levels, indicating positive changes in metabolic parameters.

• The study found that after three months of VLCKD, the Anti-Müllerian hormone (AMH) levels decreased, potentially indicating improved ovulation rates. AMH is associated with ovarian reserve, and its elevated levels are often seen in women with PCOS.

• A significant increase in progesterone levels was observed on day 21 of the menstrual cycle after the VLCKD. This improvement may be related to the increased SHBG (resulting in reduced androgens) and reduced insulin levels, improving ovulatory function.

Does the Keto Diet Improve Fertility in Women With PCOS?

The ketogenic diet has shown positive effects on the management of PCOS. Many recent studies suggest the potential benefits of the keto diet in improving fertility in women with PCOS. However, more rigorous research, including randomized controlled trials, is needed to establish a definitive link between the two. Research on women with PCOS has shown improved glucose and insulin levels, reduced LH/FSH ratio, and testosterone levels, while estradiol, progesterone, and SHBG increased. The long-term effects of the keto diet on PCOS remain to be fully understood. An alternative, very-low-calorie ketogenic diet (VLCKD) has also shown promise in improving glucose levels and insulin sensitivity in women with PCOS and obesity.

What Are the Concerns Associated With Keto Diet in Women With PCOS?

While the keto diet holds promise for women with PCOS seeking to improve their fertility, there are several potential concerns and considerations to keep in mind:

• The keto diet restricts many food groups rich in essential nutrients, including fruits, whole grains, and legumes. Long-term adherence to the diet without careful planning can lead to nutrient deficiencies.

• Following the keto diet for an extended period can be difficult due to its highly restrictive characteristics.

• Not all women with PCOS will respond the same way to the keto diet. Personalized approaches to nutrition and lifestyle modifications are essential, as individuals may have varying nutritional needs and preferences.

• Short-term research has displayed encouraging outcomes, but there needs to be more extended-term data regarding the impact of the keto diet on fertility and well-being.

Before embarking on the keto diet or any significant dietary change, women with PCOS should consult with their doctors or registered dietitians.

Conclusion

Keto for PCOS shows promise as a potential non-pharmacological strategy for improving fertility and managing insulin resistance. The ketogenic diet's impact on fertility and PCOS is a subject of growing interest, with evidence suggesting improvements in insulin sensitivity, hormonal balance, and metabolic health. While more research is needed, the keto diet holds potential as a valuable tool for improved fertility in women with PCOS.