Infertility (PCOS)
Many of the younger men and women I know are concerned about fertility issues. After reading Countdown by Shanna Swan, I was shocked to find that Swan indicated that Homo sapiens ticked most boxes for species extinction. Infertility was at an all-time high due to our modern world threatening our sperm and egg production.
Today the leading cause of infertility in women is due to Polycystic Ovarian Syndrome (PCOS). The key driver of PCOS is insulin resistance, which stimulates the ovaries’ theca cells to make more testosterone. This disturbs the delicate balance of sex hormones and the menstrual cycle, and causes infertility.
Although insulin resistance often follows PCOS, I firmly believe that insulin resistance has developed 10 or more years before the diagnosis of PCOS. More than 75% of women with PCOS are overweight (a large percent are obese) – although many have hirsutism and are overweight, some women are TOFI’s – Thin On The Outside, Fat On The Inside and may not have hirsutism, so it’s best to check their insulin resistance (HOMA-IR score). High testosterone and high insulin are found in more than 80% of women.
The association of PCOS with diabesity is so strong that a 2012 NIH panel proposed that the PCOS name should be changed to the “Metabolic Reproductive Syndrome.” Evidence now suggests that PCOS now affects more than 20% of women worldwide (PCOS has increased more than 65% just in the past decade). Women with PCOS typically develop many small cysts on their ovaries – often between 10-100 small cysts. The maturation sequence of the eggs is disturbed so that there is a breakdown and ovulation doesn’t happen. These cysts are not dangerous and don’t need to be removed surgically as unlike other cysts do not develop cancer. Although 1 in 5 women in the US have PCOS, more than 70% don’t know it. I see this weekly at my Las Vegas medical clinic.
Nearly all women with PCOS share these 3 symptoms:
- Difficulty losing weight – mostly due to the high insulin levels they have that increase hunger and carb cravings.
- Rogue hair growth – Androgens stimulate the hair follicles to thicken and grow in unusual places (often having a male pattern).
- Inflammation – Women with PCOS have chronic low-grade inflammation throughout their body.
PCOS Across the Female Lifespan
| Prepuberty | Adolescence | Reproduction | Perimenopause | Menopause |
|---|---|---|---|---|
| Weight Gain | Irregular periods | Infertility | Diabetes | Heart-Disease |
| Early pubic hair or menarche | Obesity | Gestational diabetes | Obesity | Cancer |
| Acne | Acne | Preeclampsia | Stroke | Mental issues |
| High blood sugar | Hirsutism | Heart Disease | Abnormal liver enzymes | |
| Auto-Immune Disease |
Some experts suggest that obesity-associated insulin resistance alters the function of the hypothalamus and the pituitary gland in the brain, increasing the production of androgenic hormones, which contribute to PCOS. I have also seen several clients that have hypothyroidism.
Hypothyroidism leads to more serious insulin resistance. Obesity has seriously affected the health of modern people, and patients with hypothyroidism are prone to obesity. The patients with PCOS accompanied by hypothyroidism tend to have high BMI with a corresponding increase in metabolic disease burden. When the thyroid function of patients is restored with T3/T4 medication, their metabolic function improves. Therefore, patients with PCOS require rigorous thyroid function detection, monitoring, and correction over time, which will mitigate or perhaps fully prevent the further deterioration of PCOS symptoms.
Over 300,000 assisted reproductive technology (ART) procedures were performed in 2020. Very few of these women were ever informed about the root cause of their disease (insulin resistance).
It is important to recognize that infertility may be the problem of the male considering that testosterone and sperm counts have fallen 52-60% over the past four decades. There have even been anatomical changes in the male – the Anogenital Distance (AGD) has changed, and Shanna Swan and others have suggested that the increase in gender fluidity may well be due to these hormonal changes. Swan also reports that phthalates and other toxic hormonal disruptors all contribute to this increased infertility problem.
Remember, the more obese a male, the lower his testosterone due to an increase in an enzyme called aromatase that converts testosterone to estrogen. Dr. Benjamin Bikman notes that fat tissue in men acts like a big ovary causing high estrogen and low testosterone. With this high obesity and metabolic dysfunction, excess oxidative stress damages the sensitive sperm cell membranes and impairs sperm development, causing fragmentation of sperm DNA and increased risk of miscarriage.
Alcohol, smoking, obesity, aging, drugs, stress, processed food and seed oils, lack of sleep, certain medications, and the SAD (Standard American Diet) all impact fertility.
Our Las Vegas-based Eternity Erectile Dysfunction program shows that more than 58% of men over 40 and 60% of men over 60 have problems with erections. Considering that 74% of the population is overweight, and 66% have diabetes or prediabetes due to insulin resistance, it is not surprising that many men with ED are also at risk for heart disease. ED is the “canary in the coal mine” since the diameter of the artery to the penis is smaller than the coronary artery, it is essential that these men have a coronary artery scan to rule out incipient heart disease.
Special Diagnostics
- Total Testosterone
- Free Testosterone
- Estrogen
- Progesterone
- Thyroid Panel
- Inflammatory Markers (optional)
- Cortisol
- ANA (Antinuclear Antibody)
- Serum Iron
Other Special Diagnostics
- Ultrasound of Ovaries
- CIMT (optional)
- CAC Score (optional)
1. Diabetes Reverse Program (12 weeks with periodic visits to our Las Vegas Clinic)
2. Correct all Hormones
- Especially insulin, androgens, thyroid, cortisol, and DHEA.
- Caution: Use of birth control pills.
- The key is to implement a High Fat Low Carb Diet.
3. Decrease Dairy and Seed Oils (Linoleic acid)
- Both increase androgens. Fiber will help lower insulin too. Be sure to drink plenty of water.
4. Yoga is especially good exercise
- As it lowers the sympathetic nervous system, as does meditation.
5. Supplements
(i) In addition to Magnesium 7, Vit D3/K2, Magnesium, and Berberine, add 25 mg Zinc.
(ii) Cinnamon when added to diet will lower insulin.
(iii) D-chiro-inositol (DCI) and myo-inositol (MI).
(iv) Saw Palmetto decreases conversion of testosterone to more potent Dihydrotestosterone (DHT) and blocks androgen receptors.
(v) Biotin, Vanadium and Taurine can also help. Omega 3’s may help.
6. Medications
(i) For Hair Loss
- Before using pharmaceuticals for hair loss, be sure to implement a diet to reverse insulin resistance. You could also use a 3-month supply of Ozempic or other GLP agonists.
- You should also check your hormones, especially thyroid and also, your iron level.
- Once you have established this for a couple of months, you can try Minoxidil or Finasteride, which both will help reduce hair loss:
- Minoxidil (a blood pressure medication) will dilate blood vessels, allowing more blood, oxygen, and nutrients to reach the hair follicles.
- Finasteride reduces androgens by inhibiting the enzyme that converts testosterone to DHT (Dihydrotestosterone).
- If you have unwanted hair, you can use Lasers to eliminate unwanted hair growth.
- Spironolactone
can also block androgen receptors on hair follicles, which prevents testosterone from binding and retaining its hair-loss-causing effect.
Periodic monitoring will vary depending on the severity of insulin resistance.
● Subjective Symptoms
● Objective Signs
- Weight (WT)
- Body Fat
- Waist/Height Ratio
- HOMA-IR (Homeostatic Model Assessment of Insulin Resistance)
- Status of Hirsutism
- Thyroid Function
- Androgen and other hormones