The Hemp Connection:
ovulation

Our Chicago network member Lesli Bitel-Koskela sent me this great article about myoinositol, a nutrition supplement that was recently studied in comparison to metformin for its effect on anovulation and infertility.

In a study with 120 women who were required to have both a PCOS diagnosis and confirmed 14 to 16 months infertility prior to starting the research protocol, half were randomly assigned to a regimen of 1,500 mg metformin daily, while the rest were assigned a combination regimen of 4 grams myoinositol and 400 mcg folic acid. Here's how their stories played out.

Metformin 50% restored spontaneous ovulation, and 18.3% of those who did, achieved pregnancy. Total pregnancies for the 60 women: 5.

Myoinositol 65% restored spontaneous ovulation, and 30% of those who did, achieved pregnancy. Total pregnancies for the 60 women: 12.

My thoughts:

1. Myoinositol is a metabolic intermediate, and it's relatively inexpensive (looks like about 78 cents per 4 g dose as described above).

2. It certainly makes sense to try this first before moving into metformin.

3. If it doesn't succeed in achieving ovulation and pregnancy on its own, it certainly wouldn't hurt to use it in conjunction with metformin, hopefully achieving more effects with metformin on lower doses less likely to cause the horrible side effects our readers consistently complain about.

4. If you choose to try this regimen, be sure to include both the myoinositol and the folic acid, as it was not clarified which of the two is the most active one, or whether they work in conjunction.

5. This is a different compound from d-chiro-inositol, a popular supplement with women who have PCOS. Both appear to have benefit, as research evolves, we'll understand the particulars.

Lesli, I can guarantee you made a lot of readers happy by sharing this!

Readers, if you do experience success with this, please come back and share with us so those coming along behind you can benefit.

If you're REALLY interested in this, over the weekend I'll talk about where you can find myoinositol in food.

Raffone E, Rizzo P, Benedetto V. Insulin sensitiser agents alone and in co-treatment with r-FSH for ovulation induction in PCOS women. Gynecol Endocrinol. 2010;26(4)275-280.

Chastetree berry is a very common supplement used by women with PCOS. Does it work? If so, how?

In order to better understand this interesting but complex herb, I thought I'd make this a series spread across several posts. I'm starting with the hormones affected by chastetree berry: luteinizing hormone (LH), estrogen, progesterone, and prolactin. Today I'll focus on LH.

Luteinizing hormone is the hormone that causes ovulation. It is also the hormone that promotes development of the follicle into a corpus luteum, the intermediary step between egg and embryo.

Luteinizing hormone is interesting in that what constitutes a"normal" level depends on what stage of a menstrual cycle you are referring to. Levels are low at the beginning of a cycle, they ramp up to a peak just before ovulation. After ovulation, they drop back down again. This graph shows a typical LH cycle in a woman who does not have PCOS.

In PCOS, there are two key variations on normal LH function to consider. First of all, when levels are supposed to be low, they tend to be high. Secondly, at the point they should be surging in order to induce ovulation, they are too low to do so. Here is a graph of LH function that is common to women with PCOS.

As you can see, restoring good LH function is not a matter of raising or lowering LH levels. It's a matter of restoring cyclicity…in other words, making sure LH is high when it should be high, and making sure it's low when it should be low. When you read information about vitex, or LH, in your own research, you should be looking for the word"normalize", rather than"raise" or"lower".

Next: a look at estrogen and ovulation.

Scientists have reported that myo-inositol can be a safe supplement to use to promote ovulation and fertility.

I have known about inositol for years, as it is also a supplement that can be helpful in the treatment of anxiety, obsessive-compulsive disorder, and panic disorder.

Since 80% of the women with PCOS coming to my website are reporting some kind of anxiety, depression, and/or mood swings, it seems that using inositol as part of your overall health and fertility program may not be a bad idea. Even if you don't have a DIAGNOSIS of anxiety, it's so easy to feel stressed out when all you want is to conceive!

The supplement can be a bit expensive…but it's far cheaper than in vitro fertilization. And it's simply a form of a water-soluble B vitamin. If it can't hurt, and it might help, at least one issue you are looking for help with…why not give it a shot?

Papaleo E, Unfer V, et al. A novel method for ovulation induction," Gynecol Endocrinol, 2007; 23(12): 700-3.

Harvey BH, Brink CB, Seedat S, Stein DJ. Defining the neuromolecular action of myo-inositol: application to obsessive-compulsive disorder. Prog Neuropsychopharmacol Biol Psychiatry. 2002 Jan;26(1):21-32.

Palatnik A, Frolov K, Fux M, Benjamin J. Double-blind, controlled, crossover trial of inositol versus fluvoxamine for the treatment of panic disorder. J Clin Psychopharmacol. 2001 Jun;21(3):335-9.

Here's an interesting Cochrane Review hot off the presses, evaluating the effects of insulin-sensitizing agents on fertility.

A group of 31 studies that compared the effectiveness of these agents to a placebo were evaluated for what they said overall about the potential benefit for their use in women with PCOS who are trying to conceive. Of these, 27 were studies about metformin (likely because it is the most widely researched/used and more studies exist in the first place).

What the researchers concluded:

There is no evidence that metformin improves live birth rates whether it is used alone or in combination with clomiphene. However, metformin does improve ovulation and pregnancy rates. (Interpreted, this suggests that metformin does not help to prevent miscarriage.)

Metformin was also associated with a significantly higher incidence of gastrointestinal disturbance, but no serious adverse effects were reported. (I don't know about those of you reading this blog post who have tried metformin, but I would question the assertion that the gastrointestinal disturbance this medication causes is not a"serious adverse effect"!

IN THE WORDS OF THE AUTHORS:"In agreement with the previous review, metformin is still of benefit in improving clinical pregnancy and ovulation rates. However, there is no evidence that metformin improves live birth rates whether it is used alone or in combination with clomiphene, or when compared with clomiphene. Therefore, the use of metformin in improving reproductive outcomes in women with PCOS appears to be limited."

D-chiro-inositol was not even mentioned in the abstract, suggesting that the findings were not significant.

As with any information shared in this blog, only you and your provider can make the ultimate decision. I can tell you what went through my own mind--and heart--as I read this, was that this medication may create a lot of false hope and hurt for those who trust that it has more power than it actually does. I wouldn't wish a miscarriage on anyone.

Tang T, Lord JM, Norman RJ, Yasmin E, Balen AH. Insulin-sensitising drugs (metformin, rosiglitazone, pioglitazone, D-chiro-inositol) for women with polycystic ovary syndrome, oligo amenorrhoea and subfertility. Cochrane Database Syst Rev. 2010 Jan 20;(1):CD003053.

Recently I read"Prodigal Summer" by Barbara Kingsolver. In it one of the characters noted that her menstrual cycle and the moon were related. I did some Internet research and found an interesting article in Wikipedia, from which this is excerpted.

Menstruation and the moon
Traditional sources agree that the menstrual cycle is linked to the cycle of the moon.[citation needed] These sources generally indicate that women menstruate at the time of the new moon, and ovulate at the full moon. Although scientific evidence for this has been weak, the problem may be that most women today live in urban environments where the moon is no longer a significant contributor to nocturnal light. The fact that women who work on night shifts, where they are exposed to strong light at night, often experience menstrual irregularities, is just one example of how rhythms of light and darkness do influence hormonal physiology, including the menstrual cycle.[22]

The word"menstruation" is etymologically related to moon. The terms"menstruation" and"menses" come from the Latin mensis (month), which in turn relates to the Greek mene (moon) and to the roots of the English words month and moon — reflecting the fact that the moon also takes close to 28 days to revolve around the Earth (actually 27.32 days). The synodical lunar month, the period between two new moons (or full moons), is 29.53 days long.

A 1975 book by Louise Lacey documented the experience of herself and 27 of her friends, who found that when they removed all artificial night lighting their menstrual cycles began to occur in rhythm with the lunar cycle. She dubbed the technique Lunaception.[23] Later studies in both humans[24] and animals[25] have found that artificial light at night does influence the menstrual cycle in humans and the estrus cycle in mice (cycles are more regular in the absence of artificial light at night), though none have duplicated the synchronization of women's menstrual cycles with the lunar cycle. One author has suggested that sensitivity of women's cycles to nightlighting is caused by nutritional deficiencies of certain vitamins and minerals.[26]

Some have suggested that the fact that other animals' menstrual cycles appear to be greatly different from lunar cycles is evidence that the average length of humans' cycle is most likely a coincidence.[27][28]

Note that the cycle reconnected itself to the lunar cycle with the removal of artifical night light. It's another way of saying what I've been saying all along: melatonin, which does not reach its normal levels in the presence of light, is crucial for normal functioning menstrual cycles.

Take a look around. Are you pulling the shades completely? Have you removed night lights? Taken the clock radio away from your nightstand? Avoided excessive computer and television in the evening hours?

Mother Nature has funny, yet insistent ways of reminding us that when we drift too far from her wisdom…things just don't work the way they should.

I received a very important call from one of my patients this morning…"yes, Michele I am pregnant!". The words that I LOVE to hear and recently been hearing a lot!! This experience marks the sixth consecutive client of mine who has conceived 4-8 weeks after starting to work with me! What makes this especially exciting is that all of these women have been trying for at least over a year with one who was trying for 2 1/2 years with a failed IVF.

My client who was trying for over 2 1/2 years, tried IVF and was working with one of the best reproductive medicine clinics in the city. She presented to me with concern that she might have PCOS and a desire to lose weight. She was sophisticated and well educated on treatments for fertility, however after 2 1/2 years she found herself depressed, exhausted and believing that she would never conceive. She never had any expectation that she would leave my office with a plan to promote ovulation, but that day we did exactly that and at her 5-week visit, she shared in tears that she was PREGNANT!

I used to always joke and say that I was single handedly responsible for milk consumption going up in the Twin Cities, now I believe that I might be responsible for a baby boom!

Michele Gorman, MS, RD, LD
Twin City Nutrition, LLC
www.twincitynutrition.com