Study Looks at Ketogenic Diet to Treat PCOS and Infertility

Women with polycystic ovary syndrome (PCOS) often struggle with weight gain and infertility. However, conventional treatment options for infertility are not designed for PCOS patients. These treatments are associated with a high failure rate and a high risk of pregnancy complications. In addition, medications such as birth control pills often cause unwanted side effects.

Cleveland Clinic researchers led a study of a fertility treatment tailored to PCOS patients that targeted one of the main causes — insulin resistance. Patients with insulin resistance have high levels of insulin, which suppress ovulation. The goal of the study was to see if the ketogenic diet would improve the outcome of fertility treatments by significantly reducing insulin levels and their harmful effects to the ovaries. Ula Abed Alwahab, MD, leader of the PCOS program within Cleveland Clinic’s Obesity and Weight Management Program, was the principal investigator.

Monthly monitoring and patient education

Dr. Abed Alwahab’s team recruited four women with PCOS and infertility and had them follow a proven ketogenic program, which Cleveland Clinic doctors have used to promote weight loss for decades. Throughout the six-month study, the patients attended monthly shared medical appointments with Dr. Abed Alwahab and a dietitian. “Since the ketogenic diet is quite restrictive, close monitoring is vital to ensure that patients are following it correctly without experiencing side effects (e.g., dehydration) or injury,” notes Dr. Abed Alwahab. Monthly monitoring included checking each patient’s labs.

In addition to health monitoring, the shared medical appointments focused on patient education. “Each month, we covered different topics related to PCOS, including diet and women’s health issues,” explains Dr. Abed Alwahab. “We are constantly educating patients on potential pregnancy, so they fully understand how to manage the diet and avoid gaining too much weight.”

After six months, patients were switched to a low-carb nonketogenic program. Patient monitoring was extended to once every two to three months.

Rapid menstrual regulation and spontaneous conception

All four patients successfully adhered to the keto diet and were able to lose weight (between 19 and 36 pounds). All four patients had irregular periods prior to starting the diet. Within just four to eight weeks of starting the diet, they resumed regular menstruation. Two women were able to conceive spontaneously without ovulation induction.

“Previous data in medical literature explained how weight loss helps manage PCOS. However, no one identified the superior weight loss program to achieve this,” explains Dr. Abed Alwahab. “While this study is just the beginning, our initial results are quite promising, indicating the ability of the keto diet to resolve the symptoms of PCOS earlier than other methods.”

Period control without pills

Conventional treatment for PCOS, including birth control pills and ovulation induction, are often used — even if the patient isn’t trying to regulate periods. “Our research reveals that the keto diet helps facilitate ovulation with minimal weight loss,” notes Dr. Abed Alwahab. “These women were losing weight and getting regular periods without the health risks associated with taking extra hormones.”

Ongoing care and weight loss monitoring

Dr. Abed Alwahab’s team typically keeps PCOS patients on the keto diet for about a year with the goal of resolving symptoms, primarily menstrual regulation. “We also monitor weight loss and focus on helping the patient reach a healthy BMI,” explains Dr. Abed Alwahab. “Once this happens, then we can start transitioning the patient to a low-carb nonketo program. We hope that patients stay on the low-carb program to help maintain weight loss and regular periods.”

In addition to dietary and nutritional support, Dr. Abed Alwahab’s team provides referrals to psychological support services if eating disorders or depression may be involved.

Future research with expanded patient demographic

According to Dr. Abed Alwahab, many factors play a role in stopping the keto diet during pregnancy — the first of which is safety. A healthy pregnancy requires a variety of whole grains and fiber. “Through our research, we know that keto is not harmful to a patient under medical supervision, but we need more data to determine the optimal balance of carbs and other nutrients for pregnant women with PCOS.”

Future studies are underway that involve larger patient populations at Cleveland Clinic. “We are not only looking for fertility data but also trying to regulate periods and resolve PCOS symptoms (e.g., hirsutism and insulin resistance) with diet alone,” says Dr. Abed Alwahab.