Lifestyle factors, including nutrition, play an important role in the management of PCOS and the severity of the symptoms. Therefore, it may not be surprising that there is emerging research into the field of supplementation to aid PCOS management, in particular for fertility.
With so much choice when you google best fertility supplements for PCOS it can be overwhelming. Let’s break it down for you here.
What is PCOS?
PCOS, or Polycystic Ovarian Syndrome is an endocrine or hormone disorder, affecting approximately 1 in 10 people with ovaries in the UK.
PCOS displays as a collection of symptoms including; acne, oily skin, lack of or irregular periods, lack of ovulation (anovulation), excess hair growth, insulin resistance, increased testosterone levels and fertility issues.
>> Read more | PCOS 101: A beginner’s guide to PCOS
PCOS and fertility: what’s the link?
Any concerns around fertility are multifactorial, meaning that there is no single cause, some out of our control. In people with PCOS experiencing anovulation or infrequent ovulation consistently this can be the likely cause of infertility. Further, there can be other conditions in relation to PCOS such as type 2 diabetes that can impact our sex hormones.
A 2022 study analysis reviewing the research found that although lifestyle interventions are encouraged, there is a lack of quality studies on the impact of lifestyle interventions on live birth, miscarriage, or menstrual patterns in people with PCOS.
>> Read More | PCOS and pregnancy: the ultimate guide to conceiving with PCOS
Best PCOS fertility supplements
There are many supplements with promising results on fertility outcomes in people with PCOS.
Inositol
Inositol is sugar alcohol belonging to B complex vitamins, it has 9 stereoisomers, with 2 in particular found to be beneficial for PCOS. Inositol-derived metabolites have been shown to play an essential role in insulin sensitivity, amongst other functions. Randomized control studies have found supplementing with inositol has improved a variety of pathological conditions in PCOS, including reproductive abnormalities, decreased androgen levels and improved insulin levels.
As mentioned there are two inositol isomers in particular that are of interest for PCOS. Firstly, Myo-inositol, which is involved in the function of FSH (follicle-stimulating hormone), and ovulation, has been found to improve egg quality and increase the chances of conception. Secondly, D-chiro inositol, which is involved in the synthesis of androgens, has been found to regulate testosterone production and reduce the risk of metabolic diseases.
There has been growing evidence supporting the supplementation of inositol in improving insulin resistance and sex hormone ratios for people with PCOS, which in turn provides a positive effect on fertility and ovulation.
A recent 2021 study detailed the use of inositol as a new treatment in improving the rate of ovulation and menstrual cycle, however, there are no studies on a better live birth rate.
>> Read more | What is inositol and do I need it to help manage my PCOS?
Vitamin D
Vitamin D is a fat-soluble hormone created within our bodies from direct sunlight on the skin. Whilst some foods contain a small amount, throughout autumn and winter in the UK, daily supplementation is recommended. Research has found vitamin D deficiency is more common in people with PCOS, compared to the general population.
Low levels of vitamin D can negatively impact symptoms associated with PCOS, including menstrual irregularities and infertility. Emerging research has begun to examine the effects of vitamin D supplementation in PCOS, for fertility in particular. One randomized controlled trial looked at surrogate markers of fertility in 180 PCOS people compared to 150 non-PCOS people. After 24 weeks, they found vitamin D supplementation had a significant effect on fertility markers, whereas no effect was seen in non-PCOS people.
An additional study looked at vitamin D supplementation in 40 people with PCOS who were found to be infertile. It was hypothesized supplementation may influence metabolic profiles and as a result, affect fertility outcomes. They found after 8 weeks there were beneficial effects on both insulin metabolism and lipid profile, however, this could not be concluded in those with pre-existing sufficient vitamin D levels.
Overall, more well-designed studies are required for vitamin D to be recommended to support infertility in those with PCOS. However, due to the increased risk of deficiency, daily supplementation may still be recommended. Plus, if you live in the UK, the NHS recommends daily supplementation during the Autumn and Winter months.
>> Read more | Vitamin D for PCOS: benefits, sources and supplements
N-acetyl-cysteine
N-acetyl-cysteine, known as NAC, is a mycolytic drug found to increase cellular levels of antioxidants and reduce glutathione at higher doses. Therefore, it has the potential to improve insulin receptor activity and insulin secretion in response to glucose.
A systematic review and meta-analysis found that people with NAC had a higher chance of ovulation and getting pregnant compared to placebo. However, this was less likely when compared with metformin. Although interesting results, the analysis found the findings need further confirmation from well-designed randomized controlled trials.
>> Read more | NAC for PCOS: benefits, dosage and evidence
Folic Acid
Folic acid, the synthetic version of Vitamin B9 or Folate, is a water-soluble vitamin vital for DNA formation, involved in protein metabolism and during periods of rapid growth. It is an essential nutrient for a baby’s development. Therefore it is crucial to supplement during preconception and early pregnancy.
Folate is commonly known to prevent neural tube defects such as spina bifida by enabling an embryo’s brain, skull, and spinal cord to develop properly. If you are planning to conceive, aim to build up stores with 400mcg dose daily 3 months prior to conceiving and continue until week 12 of pregnancy.
In regards to PCOS, interestingly, one study of 54 people with PCOS found that up to 70% of participants were at risk of insufficient intake of folic acid. Furthermore, another study found in those who suffered from infertility had improved symptoms and fertility outcomes when supplementing with myo-inositol and folic acid daily. 70% of 3602 participants had restored ovulation, and better fertilisation rates as well as embryo quality.
Although further research may be required for PCOS in particular, folic acid supplementation is required when conceiving.
>> Read more | Folic acid and PCOS: can supplementing support fertility?
Omega 3: fish oil
Fish oil contains omega-3 fatty acids, which are known as polyunsaturated fats. There are 3 types and these are essential, which means we must get them from our diet:
- ALA (alpha linolenic acid)
- DHA (docosahexanoic acid)
- EPA (eicosapentaenoic acid)
They are an integral part of cell membranes throughout the body. They provide the starting point for making hormones that regulate blood clotting, contraction and relaxation of artery walls, and inflammation. There is evidence to suggest that people with PCOS may have chronic inflammation.
A 2018 study on 60 people with PCOS found that supplementation of 2 × 1000 mg/day fish oil omega-3 fatty acid for 12 weeks had beneficial effects on mental health parameters, insulin metabolism, total testosterone, hirsutism and a few inflammatory markers. Although a small study, there is scope for further research.
78 people with PCOS were randomised to receive omega-3 or a placebo for 8 weeks in a 2013 study. Omega-3 supplementation was seen to regulate the menstrual cycle, which may be helpful to regulate ovulation and improve the chances of conception. Further studies with longer periods of supplementation and more participants are required.
Probiotics
Our gut microbiota living in our large colon is related to various metabolic pathways including our immune system, carbohydrate metabolism and influence insulin sensitivity. The influences on the billions and trillions of bacteria, both beneficial and bad, are vast.
A meta-analysis concluded that probiotics can influence various factors in people with PCOS including metabolic, hormonal and inflammatory parameters. The study concluded that probiotics may lead to an improvement in fertility.
As there are limited human studies on probiotics for PCOS and fertility, a key focus for fertility would not be on supplementing with a probiotic. Although, if there are concerns regarding a gut-related condition, focus on prebiotic or fibre-rich foods and fermented foods to feed our gut microbiota.
>> Read more | Probiotics for PCOS: best 3 probiotics
Zinc
Zinc is a trace mineral, meaning that it is an essential nutrient that the body requires in order to function properly, however much smaller amounts are needed.
Zinc is essential for the reproductive system because the cells in the reproductive system change form and multiply extensively. These cell processes are zinc-dependent which means the processes rely on zinc to be able to take place. When zinc is at optimal levels, it is thought to contribute to hormone balance, inflammatory processes, glucose metabolism and lipid metabolism, all of which have effects on the reproductive system.
In a review of 36 studies on reproductive health, zinc supplementation appeared to improve insulin resistance and lipid balance, which may contribute to fertility secondly.
>> Read more | Zinc for PCOS: food sources and supplements
Co-enzyme 10
Coenzyme Q10 (CoQ10), also commonly known as ubiquinone, is a fat-soluble antioxidant. It has a similar structure to vitamin K which is naturally present in the body, with the highest levels in the liver, kidneys, pancreas and heart. As an antioxidant, COQ10 supports cellular energy (or ATP) production.
It is thought oxidative stress (imbalance between free radicals and antioxidants in your body) is a major factor in PCOS. We do need free radicals to help us fight off pathogens, which can lead to infections, however, when there are more free radicals that can be kept in balance by antioxidants prolonged can lead to inflammation. Commonly known antioxidants are vitamin C, vitamin E and CoQ10.
There are limited studies on the impact of CoQ10 on fertility in people with PCOS. There are studies looking at using CoQ10 with medications like Clomid, but more high-quality research is required specifically on CoQ10, fertility and PCOS.
>> Read more | Does Coenzyme Q10 have benefits for PCOS?
What are the best supplements to buy for PCOS fertility in the UK?
Overall there is some promising evidence for supplementation to support fertility, amongst other symptoms in PCOS. It can be overwhelming to take
If you are considering supplementation, please consult with a healthcare professional beforehand.
Best prenatals for PCOS
Blend of myo-inositol, d-chiro-inositol, folate and chromium in optimal levels.
- 2000mg Myo-inositol, 300mg D-chiro-inositol, 400ug Folate (Quatrefolic®), 100ug Chromium Picolinate. Capsule Shell: Pullulan.
- Vegan, free from soy, gluten and additives
- Take 4 capsules daily, 2 in the morning and 2 in the evening
The popular Pregnacare brand has ‘Pregnacare Conception’ containing 400 µg folic acid and 50mg inositol as a complete supplement.
- Vitamin B12 (Cobalamin), Inositol, Coenzyme Q10, Vitamin D3 (Niacin), Vitamin B9 (Folic Acid)
- Vegetarian
- Recommended level of folic acid
- Take one tablet daily after the main meal
All-in-one myo-inositol and preconception combination supplement.
- Preconception includes 2000mg of Myo-inositol and a balanced blend of micronutrients, including Chromium, N-Acetyl Cysteine, L-Arginine, Alpha Lipoic Acid, and Coenzyme Q10. It also contains essential vitamins B12 and D3, and 400mcg of Folate.
- Take 2 tablets in the morning and 2 tablets in the evening
- Vegan
Key takeaways: best fertility supplements for PCOS
When we’re looking at the best fertility supplements for PCOS we could probably keep going and at times it could seem that you have to go and take them all at once. What’s important to remember is that these vitamins for your PCOS are to supplement your diet, and not the sole source. Let’s see where dietary changes can be made alongside trialling a fertility supplement for your PCOS that you feel comfortable with.
