PCOS and oocyte quality

Polycystic ovary syndrome (PCOS) is a common disorder, affecting up to 10% of women of reproductive age. In PCOS, severe hormonal dysbalances lead to a whole lot of symptoms, ranging from skin problems to irregular menstrual cycles, from overweight to depression, and the eponymous ovarian cysts.

For women planning for pregnancy, one major issue is the fact that PCOS frequently leads to ovulatory infertility. Luckily, meanwhile, there is a range of options to support the body with this problem: In addition to a gentle orthomolecular approach with inositols, there is a choice of different drugs to induce ovulation.

However, fertility experts have reported that PCOS patients have less success when opting for assisted reproduction than other patients. Problems with oocyte quality have been suspected.

Recent research has confirmed this: follicular fluid (the oocytes’ environment) of PCOS patients is different from the one of healthy controls. There are signs that PCOS may induce dyslipidemia, low-grade inflammation, and disorder of glycolysis, pyruvate and amino acid metabolism in follicular fluid (Zhang et al, 2017). Particularly in PCOS patients with metabolic syndrome, oocyte quality is diminished and the follicular fluid shows elevated lipolysis condition (Niu et al, 2017).

In addition to this, increased oxidative stress has been observed and in the murine model, researchers were able to show that this contributes to epigenetic changes in oocytes (Eini et al, 2017).

How to improve oocyte quality in PCOS?

In addition to following the general recommendations to avoid exposure to harmful substances and follow a healthy lifestyle, a study from 2016 is really interesting for every woman with PCOS who would like to conceive: In this study, researchers supplemented PCOS patients with N-acetyl-cysteine (NAC).

NAC had first been examined for use in PCOS in an older study from 2011 by Oner and Muderris: Here the authors evaluated the clinical, endocrine and metabolic effects of metformin and N-acetyl-cysteine (NAC) treatments on patients with polycystic ovary syndrome (PCOS). One hundred women were enrolled in the study. Metformin is a drug frequently used in diabetes patients. Unfortunately, many women do not tolerate it very well and have digestive issues. NAC on the other hand is a very well tolerated micronutrient known for its strong antioxidant capacities. Both metformin and NAC resulted in a significant decrease in body mass index, hirsutism score, fasting insulin, HOMA index, free testosterone and menstrual irregularity compared with baseline values, and both treatments had equal efficacy.

In the 2016 study, the scientists not only looked at effects of NAC supplementation on these parameters, but also assessed possible effects on oocyte and embryo quality. To cut a long story short, the results were really good news: The number of immature and abnormal oocytes decreased significantly in the NAC compared with placebo group, with a concomitant increase in the number of good-quality embryos in the NAC group.

In summary, the data showed that NAC – most probably due to its ability to reduce oxidative stress – can help to improve oocyte and embryo quality in PCOS patients.

In a combination with other micronutrients important for women with PCOS, NAC is contained in Fertilovit® F PCOS, an innovative dietetic food for special medical purposes, developed specifically for PCOS patients planning for pregnancy.

Cheraghi E, Mehranjani MS, Shariatzadeh MA, Esfahani MH, Ebrahimi Z. N-Acetylcysteine improves oocyte and embryo quality in polycystic ovary syndrome patientsundergoing intracytoplasmic sperm injection: an alternative to metformin. Reprod Fertil Dev. 2016 Apr;28(6):723-31. doi: 10.1071/RD14182.

Eini F, Novin MG, Joharchi K, Hosseini A, Nazarian H, Piryaei A, Bidadkosh A. Intracytoplasmic oxidative stress reverses epigenetic modifications in polycystic ovary syndrome. Reprod Fertil Dev. 2017 Apr 26. doi: 10.1071/RD16428. [Epub ahead of print]

Niu Z, Ye Y, Xia L, Feng Y, Zhang A. Follicular fluid cytokine composition and oocyte quality of polycystic ovary syndrome patients with metabolic syndrome undergoing in vitro fertilization. Cytokine. 2017 Mar;91:180-186. doi: 10.1016/j.cyto.2016.12.020. Epub 2017 Jan 9.

Oner G, Muderris II. Clinical, endocrine and metabolic effects of metformin vs N-acetyl-cysteine in women with polycystic ovary syndrome. Eur J Obstet Gynecol Reprod Biol. 2011 Nov;159(1):127-31. doi: 10.1016/j.ejogrb.2011.07.005. Epub 2011 Aug 9.

Zhang Y, Liu L, Yin TL, Yang J, Xiong CL. Follicular metabolic changes and effects on oocyte quality in polycystic ovary syndrome patients. Oncotarget. 2017 Jul 6. doi: 10.18632/oncotarget.19058. [Epub ahead of print]

About the author

Dr. rer. nat. Birgit Wogatzky

For many years now, biologist and nutritionist Dr Birgit Wogatzky, has been focusing on the special needs of fertility patients. For the readers of this blog, she sums up interesting novel information and developments from current research projects regarding lifestyle and nutrition of fertility patients.

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