Study Identifies Ketogenic Diet as Ideal Choice for IVF Success in Patients with PCOS


For patients with polycystic ovary syndrome, 75% of whom have irregular or no ovulation, following a ketogenic diet improved IVF outcomes and metabolic health.

Polycystic ovary syndrome (PCOS) is the most common endocrine condition in females. Infertility is a common complication of PCOS, with about 75% of individuals with PCOS having irregular or no ovulation. Additionally, PCOS is associated with an increased risk of metabolic syndrome, cardiovascular disease, insulin resistance and type 2 diabetes.

These increased risks are thought to be due to greater visceral and subcutaneous fat observed in people with PCOS which are likely caused by increased androgen levels. Approximately 60% of individuals with PCOS have overweight or obesity (body mass index [BMI] of 25-29.9 or greater than 29.9, respectively), which can reduce response to in vitro fertilization (IVF). People with a high BMI are seven times more likely to have adverse effects, such as ovarian hyperstimulation syndrome (OHSS), during IVF.1 Having a higher BMI also causes issues with ovulation induction.

In patients with PCOS, it has been found that a body weight loss of 5% or more reduces symptoms and risks associated with PCOS. Weight loss has also been shown to improve fertility by regulating menstrual cycles and increasing the possibility of spontaneous ovulation.

A study published last month in the journal Nutrients sought to evaluate the effect of dietary interventions on weight, hormonal, and metabolic parameters and IVF outcomes in participants with PCOS and high BMIs (greater than 24.9).2 The study, led by Caterina Meneghini, M.D., from the physiopathology of reproduction and andrology unit at Sandro Pertini Hospital in Rome, Italy, enrolled 84 females with PCOS and a BMI greater than 24.9 who were seeking treatment for infertility at the hospital’s fertility unit.

The participants were given the option to follow a very low-calorie ketogenic diet (VLCKD) or a Mediterranean diet.3,4 Of the 84 participants, 24 received VLCKD therapy treatment, and 24 received Mediterranean diet therapy treatment. Study enrollees were evaluated at baseline and 90 and 120 days after beginning the diet intervention.

The study found that participants following the VLCKD intervention had a greater reduction in BMI at 90 and 120 days compared with those following the Mediterranean diet. Hip, waist, and abdominal circumferences (measures of visceral and subcutaneous fat) were also significantly reduced in patients on the VLCKD versus those on the Mediterranean diet.

Cholesterol and triglyceride levels declined significantly in the VLCKD group compared with the Mediterranean diet group, and HLD levels increased in both groups by 120 days but more significantly in the VLCKD group.

Regarding reproductive parameters, menstrual cycles were more regulated in about 50% of participants at 90 days and 70% at 120 days in the VLCKD group. In the Mediterranean diet group, those numbers were 17% and 26%, respectively. Additionally, patients in the VLCKD group had fewer incidents of OHSS compared with those in the Mediterranean diet group (27% versus 68%).

The authors conclude that, although both dietary regimens may reduce BMI and improve reproductive health, the VLCKD is an ideal choice in preparation for IVF, given the positive results achieved in the short time range of four months.

Meneghini and her colleagues wrote, “Our results show that greater weight loss, and thus greater visceral fat loss, is accompanied by a significant improvement in the metabolic profile in VLCKD PCOS patients.”

This article originally appeared in Managed Healthcare Executive.

1. Kumar P, Sait SF, Sharma A, Kumar M. Ovarian hyperstimulation syndrome. J Hum Reprod Sci. 2011;4(2):70-75. doi:10.4103/0974-1208.86080
2. Meneghini C, Bianco C, Galanti F, et al. The impact of nutritional therapy in the management of overweight/obese PCOS patient candidates for IVF. Nutrients. 2023; 15(20):4444.
3. Guarnotta V, Emanuele F, Amodei R, Giordano C. Very low-calorie ketogenic diet: A potential application in the treatment of hypercortisolism comorbidities. Nutrients. 2022;14(12):2388. Published 2022 Jun 9. doi:10.3390/nu14122388
4. Mediterranean Diet. Cleveland Clinic. Published November 20, 2022. Accessed November 6, 2023.
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