Research indicates that a ketogenic diet (KD) can not only restore menstrual cycles but also significantly increase pregnancy rates in women with polycystic ovary syndrome (PCOS), offering hope for those facing infertility challenges.
A recent study published in Frontiers in Nutrition examined the impact of a KD on menstrual regularity and fertility in women with PCOS. The results showed that the diet notably improved menstrual regularity, with a pregnancy rate of 55.6% among those seeking to conceive, suggesting KD may be a promising option for enhancing fertility in this population.
The ketogenic diet
The ketogenic diet is a low-carbohydrate, high-fat diet that encourages the body to enter a state called ketosis, where it burns fat for energy instead of carbohydrates. This diet typically involves reducing carbohydrate intake to around 20-50 grams per day and increasing fats to make up about 70-80% of total daily calories, which can lead to weight loss and improved metabolic health.
PCOS
PCOS affects up to 20% of women of reproductive age and is a leading cause of infertility due to irregular ovulation. Obesity, present in up to 75% of women with PCOS, exacerbates hormonal imbalances and hinders ovulation. Diet and insulin-sensitizing treatments can improve fertility, and the KD, known for promoting weight loss and improving metabolic health, has gained attention as a potential treatment. While small studies have shown KD’s benefits for weight loss and hormonal balance in PCOS, its effect on fertility had not been thoroughly investigated until now.
About the Study
The study aimed to assess the use of a KD in restoring regular menstruation and achieving pregnancies in women with PCOS. Using medical records from a clinic’s weight management program (2017-2019), the study included women who participated in the program, which provided monthly group sessions with dietitians, exercise specialists, and endocrinologists.
The KD involved restricting carbohydrate intake to 20 grams daily, with specified protein and fat guidelines. Participants followed the diet for at least three months unless they became pregnant sooner. The study excluded those who did not adhere to the diet for three months, used contraception, or were postmenopausal, resulting in a total of 30 participants.
Participants received monthly check-ups to track weight, health, and menstrual cycles. Metformin and ovulation-inducing medications were available to those who required them. The study focused on the return of regular menstrual cycles and pregnancy rates, alongside the time to conception and weight changes, using statistical tests to compare outcomes based on treatments.
Findings
Participants had an average age of 31 and a body mass index (BMI) of 43.4. Sixty percent used metformin, and 60% aimed to become pregnant. After six months, 92% of participants regained regular menstrual cycles, and by 15 months, all had regular cycles. The average weight loss was 7.1 kg.
Among the 18 women desiring pregnancy, 55.6% conceived, with 63% achieving pregnancy within 12 months. Both those who became pregnant and those who did not experienced similar weight loss. Metformin use did not significantly affect the return of menstrual regularity, as all women, regardless of metformin use, eventually regained regular cycles. Interestingly, 100% of women who did not take metformin conceived, compared to 38.5% of those who did. Ovulation-inducing agents did not significantly enhance pregnancy rates.
Lower anti-mullerian hormone (AMH) levels were associated with difficulties in conceiving, even with fertility treatments, suggesting AMH’s potential role in predicting pregnancy outcomes in women with PCOS.
Conclusions
The study suggests that a KD can improve menstrual regularity and increase pregnancy rates in women with PCOS. Compared to previous research, the pregnancy rates observed were notably higher, irrespective of ovulation-inducing agents. The findings indicate that weight loss and improved insulin resistance, facilitated by the KD, are crucial in enhancing fertility.
As one of the first studies to explore KD’s effects on fertility in women with PCOS, it provides valuable insights. Even minimal weight loss combined with improved insulin resistance was shown to potentially increase pregnancy rates.
However, the study had a relatively small sample size and did not evaluate the long-term effects of KD on fertility. Additionally, it did not compare the KD with other dietary approaches or assess potential long-term adverse effects in women with PCOS. Larger studies are necessary to confirm the long-term impact of KD on fertility and to compare its effects with other diets. Further research into the physiological mechanisms, such as insulin resistance improvements and reproductive hormone regulation, could offer deeper insights into how KD influences fertility.
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