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Nutrition and Fertility Connection

Fertility is achieved and maintained by a carefully orchestrated, complex process that can be disrupted by a number of factors related to body weight and dietary intake’. (Nutrition throughout lifecycle, 2004).

Infertility is defined as a lack of conception after one year or more of unprotected intercourse. This article will introduce the ‘polycystic ovary syndrome’ which is mostly related to being overweight. The follow up article will be on eating disorders (anorexia nervosa, bulimia, binge eating), which leads to infertility by causing patients to be underweight.

The article will explain the causes, complications, and prognosis associated with infertility and focus on dietary treatment.

Symptoms of Polycystic Ovary Syndrome (PCOS)
PCOS could be the reason behind the appearance of unwanted hair on your body, a rash of pimples, and irregular or no menstrual periods. If you are gaining weight with the same eating habits and physical activity level as before, you may have a serious problem. Don’t waste time! Please visit your gynecologist! You might have Polycystic Ovary Syndrome (PCOS).

Internationally PCOS affects about 6-10% of women. In Pakistan approximately 5% of women (4 million women) have PCOS. (US census bureau, international data base, 2004).shud we add this?

What is PCOS ?
PCOS happens when your eggs can’t be released from ovaries, which causes an increase in testosterone (male sex hormone). PCOS affects only women and can be treated. If not treated, PCOS can lead to serious problems such as:

  • Infertility
  • Cardiovascular diseases (due to hypertension and dyslipidemia)
  • Increasing risks of type 2 diabetes (due to insulin resistance)
  • Increasing chances of endometrial carcinoma.

Causes: The medical community has not clearly identified the causes of PCOS. Genetic inheritance is generally blamed, but this has not been conclusively proven as the root cause. What has been proven is that children that are obese are likely to suffer from PCOS when they are older. Women with PCOS are also generally overweight. It is unclear whether obesity causes the PCOS or vice verse.

Diagnostic Criteria for PCOS
The Rotterdam criterion is used for diagnosis which examines for;

  • Elevated androgens ( testosterone and androstenedione male sex hormones)
  • Ultrasound findings of cysts on the ovaries
  • Irregular menses

At least two of these must be present for PCOS to be diagnosed. Additional clinical signs typically associated with PCOS include abnormal facial and body hair growth, acne and weight gain.

High blood pressure, high cholesterol, and upper body obesity –– waist-to-hip ratio of 0.85 or greater –– are common among women with PCOS. In addition there are greater incidences of pre-diabetes, type-2 diabetes, hypertension and dyslipidemia among the PCOD affected population.

Treatment Approaches
Pharmacological treatment, carried out in parallel with lifestyle modification and a professionally planned diet, is the most successful PCOS treatment strategy. Diabetes medications are usually prescribed to improve insulin sensitivity and glucose metabolism. Unfortunately, this approach alone is not guaranteed to succeed. On the other hand, several studies have shown that weight loss in overweight women with PCOS improves the endocrine profile, the menstrual cycle, the rate of ovulation, and the likelihood of healthy pregnancy. Even a modest loss of 5% of total body weight can lead to a reduction of central fat, an improvement in insulin sensitivity, and restoration of ovulation. Women should be encouraged to lose weight before undergoing pharmacological treatments to induce ovulation. This strategy also side-steps the effects of the drugs on the body. As a bonus, the enhanced self-image facilitates the patients in achieving their goal of successfully conceiving.

Diet Plan for Overweight Women
Before beginning diabetes medication, women with PCOS should try a custom dietary plan. Overweight women with PCOS should follow a diet suitable for diabetic patients. Diet should have a low ratio of omega-6 to omega-3 fatty acids, low trans fatty acids, and be high in antioxidants. Omega-6 fatty acids are rich in animal protein and vegetable oil. Omega-3 fatty acids are found mainly in fish, nuts and vegetable. Both omega-3 and omega-6 fatty acids are essential, i.e. we must consume them in the diet. Researchers believe that the ideal omega-6 intake should be no more than 4-5 times than that of the omega-3 intake. Generally, meat from grass-fed animals contains more omega-3 than meat from grain-fed animals (which produce more omega-6). Recent studies have found that fish oil has insulin-sensitizing effects, which can help to address the insulin resistance seen in many patients with PCOS. Trans fats are found in fried foods, packed snacks, commercial baked goods and other sources increase the risk of diabetes and decrease the insulin sensitivity. Citrus fruits, deep green, yellow and orange color fruits and vegetables are high in antioxidants. It is important to include ALL food groups in your daily diet, in the appropriate portions of course.

As nutritionists, we encourage our patients to work with their body’s natural systems rather than trying to impose impossible requirements on them. If a patient is craving for sweets, we don’t try and eliminate that craving (which originates in the brain and is impossible to suppress without leading to other problems). Instead we work with the patient to change the fatty acid balance in the diet by substituting other less-fatty foods (which are still desirable to the patient) for normally consumed foods that the patient may be indifferent to. To achieve this ratio, nutritionists recommend that the patient should follow a high fiber, low sugar carbohydrates diet. By increasing vegetable, fish and nuts in the diet we can reduce the risk of many chronic diseases. The diet should be individualized according to a person’s requirement. It must include a carbohydrate-controlled diet with an emphasis on whole foods; small frequent meals; and extra omega-3 fatty acid rich foods such as tuna, mackerel, sardine and salmon. If a diet is not properly designed for a woman with PCOS, symptoms can worsen.

Your fertility treatment may be easier to achieve than you thought, and can start with a close look at your lifestyle and diet, under the supervision of a qualified nutritionist. If you cannot find a food and nutrition professional with experience treating PCOS, seek out the services of a dietitian with type 2 diabetes and gestational diabetes experience, as the treatment in many instances is similar.


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