Top 6 Treatments for Insulin Resistance and Fertility
With obesity on the rise, insulin resistance is a major cause of infertility. Patients with PCOS and Type 2 diabetes also exhibit issues with insulin regulation. It can greatly affect fertility in a number of ways:
- Inhibit ovulation.
- Can compromise egg quality.
- Promote testosterone production over estrogen production.
- Egg maturation is delayed, leading to a smaller fetus.
- Low-grade inflammation associated with insulin resistance can impact implantation rates and cause recurrent miscarriages.
Insulin resistance can be diagnosed using a clinical exam and specific medical tests that determine if a patient has PCOS or diabetes. It is worth noting as well that patients with PCOS always have insulin resistance issues, regardless of whether a woman is slim or overweight.
Top 6 treatments for insulin resistance:
1) Diet and Exercise
I highly recommend doing a carbohydrate-restricted diet to manage insulin resistance. Common foods to eliminate: bread, grains, rice, pasta, oats, most fruits, and any foods containing added sugars (ie. pop, fruit juices, candy, chocolate). There is also promising research doing a ketogenic and/or paleo type diet. This diet includes all vegetables, meat, fish, specific fruits, nuts and seeds, and excludes grains, sugar, beans, legumes, and dairy.
An increase in dietary fiber can also benefit patients struggling with insulin resistance. Typical foods recommended are ground flaxseeds, chia seeds, dark leafy greens, and lentils. Aim for at least 25-30 grams of fiber daily.
Exercise can be extremely effective for treating insulin resistance. At least 3-4, 30-45 minute sessions are recommended, consisting of weight training, high interval training, stationary bike, and/or cardio. Hiring a personal trainer can be a great investment not only for your fertility but also for long-term optimal health.
2) Myo-inositol
A favorite in all my insulin resistance patients. Many studies have been done in patients with PCOS, showing improved ovarian activity, insulin sensitivity, decreased testosterone levels, which is a marker of good egg quality. A typical dose is 4 grams/day. Depending on each case, adding in D-chiro-inositol at a 4:1 ratio, myo-inositol being at the higher dose, can improve insulin markers and ovarian function.
3) Alpha-Lipoic Acid
Not only has alpha-lipoic acid been shown to improve insulin resistant and diabetic markers, it is a beneficial antioxidant. At a dose of 600mg, twice per day, patients with PCOS exhibited a reduction in triglycerides, improved menstrual regularity and insulin sensitivity.
4) NAC (N-acetyl-cysteine)
Has been shown to improve insulin resistance and ovulation rates in women with PCOS. It also has potent anti-inflammatory effects that may mitigate some of the consequences of chronic low-grade inflammation associated with obesity and high insulin.
It can also increase cellular glutathione levels, improving egg quality.
Co-administration with Clomid at a dose of 1.2 grams had better ovulation and pregnancy rates when compared to clomid alone.
5) Omega 3 fatty acids (EPA and DHA)
Both EPA and DHA from fish oil have been shown to increase adiponectin, which improves insulin resistance. Its ability to lower inflammatory markers can benefit patients struggling from implantation failure. A typical dose is a minimum of 1.5g of EPA, 500g of DHA per day.
6) Manage Stress
Our stress hormone, cortisol, can raise blood sugar levels, therefore managing stress can be an important long-term solution for insulin resistance. Incorporating meditation, yoga, deep breathing can all be beneficial for the stress response. Using specific supplements and botanical herbs can be another way to manage the stress response acutely. My favorites include: ashwagandha, phosphatidylserine, rhodiola, l-theanine, licorice, and magnolia bark. A blend of herbs are used based on each specific case.
Identifying and treating insulin resistance can greatly benefit patient’s fertility outcomes. Depending on each patient, a specific diet, supplements, and lifestyle changes are recommended to promote insulin sensitivity. This not only benefits conception rates, it can improve egg quality and development, and promote a healthy birth to term.
In good health,
Dr. Kirti Deol