PCOS/PMOS and IVF: What Factors May Influence Treatment Outcomes?

For Healthcare Professionals Only

For women with Polyendocrine Metabolic Ovarian Syndrome (PMOS), previously known as PCOS, IVF outcomes can be influenced by a combination of hormonal, reproductive and metabolic factors.¹ 

PMOS is highly individual, so there is no single approach that works for everyone. In this article, we explore the factors that may influence IVF outcomes, what can potentially be modified and where the evidence is still emerging. 

What Is PMOS and How Does It Affect Fertility Treatment?

PMOS is a reproductive and metabolic condition. Symptoms may include irregular or absent periods, irregular ovulation, excess hair growth, weight gain or difficulty losing weight, acne, hair thinning and psychological symptoms. Some people experience several of these features, while others may have relatively few obvious symptoms.² 

The metabolic and hormonal features of PMOS may influence the wider reproductive environment in many different ways as well as how the ovaries respond to fertility medication, influencing fertility and IVF outcomes. 

Key Factors That May Influence IVF Outcomes With PMOS

There is no single factor that determines whether IVF will be successful. Outcomes are influenced by a combination of factors, some modifiable and others not. 

Age

Age is one of the strongest predictors of fertility and IVF outcomes, with ovarian reserve declining and the proportion of eggs with chromosomal abnormalities increasing with age. In PMOS, metabolic disturbances may also become more prominent with age, making metabolic health an important consideration.³ 

Weight

Higher BMI has been associated with poorer reproductive and pregnancy outcomes, including lower implantation, pregnancy and live-birth rates in some studies of women with PCOS undergoing ART. Higher body fat may contribute through insulin resistance, increased insulin and inflammatory signalling, potentially affecting the follicular environment.⁴ 

Insulin Resistance

Around 65–70% of people with PMOS are thought to have some degree of insulin resistance.⁵ Higher insulin levels can increase androgen production, affect follicular development and ovulation and have been associated with miscarriage risk.⁵˒⁶ Insulin resistance also increases longer-term risks such as type 2 diabetes and cardiovascular disease.⁵ 

Androgen Production

Hyperandrogenism is present in approximately 60–80% of people with PMOS and can cause symptoms including acne, excess hair growth, androgenic hair loss, irregular ovulation and irregular cycles.⁷ Insulin resistance can further increase ovarian androgen production, while higher insulin reduces SHBG, increasing circulating free testosterone.⁵ 

Inflammation

Inflammation may also influence the reproductive environment. Higher levels of inflammatory markers have been identified in the follicular fluid of women with PCOS and were associated with poorer oocyte maturation, high-quality embryo rates, implantation and clinical pregnancy.⁸ 

Nutrition and lifestyle can positively influence all of these factors. 

What Can Support IVF Outcomes for Women With PMOS?

Diet

There is no one-size-fits-all diet for PMOS, and no single dietary approach has been shown to be best for everyone. The most appropriate approach should reflect individual factors such as insulin resistance, nutritional needs, preferences and what can be sustained long term. 

Mediterranean-style and DASH dietary patterns may support insulin sensitivity and wider metabolic health. These generally emphasise vegetables, fruit, legumes, wholegrains, nuts, seeds, fish and unsaturated fats while limiting highly processed foods, added sugar and saturated fat.⁹ 

Carbohydrates do not need to be eliminated. For some people, particularly those with insulin resistance, adjusting the quantity and choosing higher-fibre, minimally processed, lower-GI sources may be helpful. Lower-carbohydrate diets or intermittent fasting may suit some individuals, but they are not necessary or appropriate for everyone.⁹˒¹⁰ 

Physical Activity and Lifestyle

Exercise is recommended for everyone with PMOS regardless of body weight.¹ 

Regular physical activity can improve insulin sensitivity, support body composition, contribute to weight management where appropriate and benefit psychological wellbeing.¹ 

For adults with PMOS, current recommendations include:¹ 

• 150–300 minutes of moderate-intensity activity per week, or 75–150 minutes of vigorous activity
• Muscle-strengthening activities on at least two non-consecutive days per week
• Reducing prolonged sedentary time 

There is also some evidence that exercise before IVF may support clinical pregnancy and live-birth rates.¹¹ 

Weight Management

For some women with PMOS, particularly those living with overweight or obesity, weight management may be relevant when preparing for IVF. 

One study in women with obesity and PCOS undergoing IVF found that losing more than 5 kg was associated with improvements in insulin resistance, ovarian response, embryo quality, implantation, clinical pregnancy and live birth.¹² 

Insulin resistance can make weight management more challenging as higher insulin levels can influence fat storage and the breakdown of stored fat for energy. 

The goal should be to improve overall health and metabolic function, not simply reach a particular number on the scales. 

Can supplements improve IVF success in PMOS?

When considering supplements, the priority should be correcting nutritional deficiencies and ensuring appropriate preconception supplementation rather than taking a long list of products in the hope of improving egg quality or implantation. 

Vitamin D

Around 58% of people with PMOS are reported to have vitamin D deficiency.¹³ 

Adequate vitamin D status has been associated with improved IVF outcomes in women with PMOS. Avoiding vitamin D deficiency prior to IVF is key, especially in PMOS.¹⁴ 

Probiotics

Probiotic supplementation may improve several metabolic markers in women with PMOS.¹⁵ In the context of IVF, one study found that eight weeks of combined vitamin D and probiotic supplementation improved insulin function and inflammatory markers in women with PCOS undergoing IVF.¹⁶ 

Myo-Inositol

Myo-inositol is particularly interesting in PMOS because of its role in insulin signalling. 

The 2023 international PCOS guideline states that inositol may be considered according to individual preferences and values, with potential benefits for some metabolic measures, but limited clinical benefits.¹ 

A 2024 meta-analysis of myo-inositol in women with PCOS undergoing ART reported positive effects on gonadotropin use and duration, oocyte and embryo quality, fertilization and clinical pregnancy rates.¹⁷ Taking a supplement such as Proceive Pure Myo-Inositol could be a beneficial pre-treatment supplement strategy. Check with your healthcare provider before adding to your regimen. 

The Bottom Line: Can You Improve IVF Success With PMOS?

PMOS can influence fertility through a combination of reproductive, hormonal and metabolic factors. However, these factors vary considerably between individuals. 

Metabolic health, insulin resistance, inflammation, nutrition, physical activity and nutritional status may all be relevant when preparing for IVF. 

There is currently no single PCOS fertility diet, supplement or lifestyle strategy proven to guarantee better IVF outcomes. Instead, the aim should be to optimise overall health, support metabolic function, correct nutritional deficiencies and develop sustainable habits that are appropriate for you. 

Frequently Asked Questions

1. How can PMOS influence IVF outcomes?

   PMOS may influence IVF outcomes through a combination of reproductive, hormonal and metabolic factors, including insulin resistance, androgen production, inflammation and how the ovaries respond to fertility medication.

2. Does insulin resistance affect fertility in women with PMOS?

   Higher insulin levels can increase androgen production and affect follicular development and ovulation. Insulin resistance has also been associated with miscarriage risk.

3. Is there a specific diet recommended for PMOS before IVF?

   There is no one-size-fits-all diet for PMOS. The most appropriate approach should reflect individual factors such as insulin resistance, nutritional needs, personal preferences and what can be sustained long term.

4. Can exercise support IVF outcomes in women with PMOS?

   Regular physical activity can improve insulin sensitivity, support body composition and weight management where appropriate, and benefit psychological wellbeing. There is also some evidence that exercise before IVF may support clinical pregnancy and live-birth rates.

5. Can supplements improve IVF success with PMOS?

   The priority should be correcting nutritional deficiencies and ensuring appropriate preconception supplementation rather than taking multiple supplements in the hope of improving egg quality or implantation. The article discusses vitamin D, probiotics and myo-inositol in relation to PMOS and IVF.