A Ketogenic Diet may Restore Fertility in Women With Polycystic Ovary Syndrome: A Case Series

ABSTRACT Objective: Polycystic ovary syndrome (PCOS) is the most common cause of infertility in women. We report the clinical course of 4 women with PCOS trying to conceive while following a ketogenic diet and assess their fecundity after a period of 6 months. Methods: The patients were followed once monthly in a shared medical appointment setting for total of 6 months. During each visit, the patients were assessed for weight loss progression, menstrual regularity, and ovulation. Results: The patients' ages ranged from 24 to 29 years old, their body mass indexes from 30.75 to 42.46 kg/m2, and their duration of infertility from 1 to 4.5 years. All patients were interested in pregnancy. The diagnosis of PCOS was confirmed by an endocrinology consultation, and the patients initiated a protein-sparing modified fast (PSMF) diet. The PSMF diet entails a maximum daily total carbohydrate intake of 20 g, fat intake up to 50 g, and an approximate protein intake of about 1.5g for each 1 kg of ideal body weight. Metformin was continued if they were already taking it, otherwise it was initiated with the PSMF diet and titrated up to 500 mg twice daily. All 4 patients adhered to the PSMF diet and were able to lose weight (ranging from 19 to 36 lbs). All 4 also had irregular periods prior to the PSMF diet, and resumed regular menstruation shortly after starting the PSMF diet (ranging from 4 to 8 weeks). Two women were able to conceive spontaneously with no ovulation induction needed. Conclusion: The PSMF diet may have a promising benefit for women with PCOS by inducing weight loss and facilitating ovulation. Abbreviations: BMI = body mass index;HSG = hysterosalpingogram;PCOS = polycystic ovary syndrome;PSMF = protein-sparing modified fast;SMA = shared medical appointment