PCOS and infertility: Dr. Perloe interview

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Lotus Flower PCOS had the great honor to interview Dr. Mark Perloe, one of the most important reproductive endocrinology & infertility specialist in Atlanta, GA. He has extensive experience treating conditions related to infertility including polycystic ovary syndrome, recurrent pregnancy loss, menstrual disorders, fibroids, male factor infertility, endocrine disorders, and other reproductive health problems.Dr. Perloe has served as principal investigator in numerous reproductive health research studies including innovative IVF treatments, ovulation induction, polycystic ovary syndrome, as well as investigational medications for the treatment of male erectile dysfunction. He has served as consultant and a task force member to the Womens Initiative of the American International Health Association and was active in establishing the first approved endoscopy-training center in the former Soviet Union at the Russian National Institute of Womens Health.

Dr. Perloe is a frequent speaker at community and professional educational seminars, blogs regularly on Facebook, and has created a YouTube PCOS Awareness Channel.


LOTUS FLOWER PCOS: First, I would like to thank you for yourkind readiness to answer the questions of lotusflowerPCOS. This interview will be very useful and will help a lot of women from all over the world.The women who suffer from the Polycystic Ovary Syndrome really concern themselves with being unable to get pregnant, we aim at giving them some hope and making them aware of the solutions they may find. Dr. Perloe, which is the rate of PCOS women who manage to get pregnant and have a successful pregnancy?

Dr. PERLOE:This is a difficult question to answer. If metabolic abnormalities can be addressed successful and obesity is addressed, up to 85% will end up with regular cycles and 65% can get pregnant, usually within 6 months. Each person is different. As such, expectations for one person would not be helpful for another.

LOTUS FLOWER PCOS: How much does the body weight affect fertility?

Dr. PERLOE:I’m not really sure whether the issue is weight, BMI or simply the metabolic abnormalities that are associated with obesity. Losing weight is usually not easy, but regardless of how weight affects fertility, losing weight can improve the odds.

LOTUS FLOWER PCOS: According to your personal specific experience, would you suggest any natural supplements which may improve the quality of the ovulation (at the supplementsextent, of course) and balance the period before undergoing a pharmacological therapy? 

Dr. PERLOE: There is an increasing body of evidence supporting the use myoinositol and d-chiroinositol together in a 40:1 ratio. While many other supplements may offer benefits, there is little or no quality data that supports their use.

LOTUS FLOWER PCOS: If a woman cant manage to get pregnant naturally, which specialist does she have to turn to and what type of diagnostic screen does she have to undergo?  

Dr. PERLOE: Many physicians offer a superficial approach to managing PCOS with clomiphene without a comprehensive, holistic approach. While an reproductive endocrinologist is well trained in the hormonal aspects, not all are focused on holistic PCOS care. As such, you may turn to online support groups to get a referral to someone who will take the time to listen and personalize your care.

LOTUS FLOWER PCOS: What is the ratio between the anti-mullerian factor (AMH), which women find in their blood tests, and PCOS? 

Dr. PERLOE:There is not really a ratio. But, if you view the PCOS ovary on US, you see what is called a necklace sign, which is the ovary filled with small follicles that produce AMH. The more follicles, the higher the AMH.

LOTUS FLOWER PCOS: According to your experience, which are the most effective fertility treatment options for women with PCOS?

Dr. PERLOE: Actively working to restore metabolic balance before considering ovulation treatment. Starting clomid beforehand addresses these abnormalities can achieve pregnancy, but they are associated with a greater risk of miscarriage. After restoring balance, I consider ovulation induction with letrozole, a combination of letrozole and FSH or IVF. Your individual situation may point to one method/treatment over another.

LOTUS FLOWER PCOS: Do PCOS women with average weight show significantly different percentages of success of assisted conception treatments from overweight or obese ones? 

Dr. PERLOE: Yes, as they generally are beginning the process with lower testosterone, insulin levels, inflammation and the like.

LOTUS FLOWER PCOS: I am a nutritionist, and I strongly recommend a healthy and balanced diet, most of all before the conception, to PCOS women. Could you suggest any specific dietary plans which may support the fertility treatment?  

Dr. PERLOE:Nope. I think it requires meeting with a dietician to explore what you are eating now and how you can modify your diet. There is not a one size fits all. Any dietary changes should be based on sustainability. If you go to a 400 cal ketogenic diet, you will lose weight, but you will feel awful and end up putting the weight back on. BTW, strength training exercise is equally important. If women choose to participate in Aerobic classes more than 30 minutes,3-4 times a week. Losing weight may be more difficult.

LOTUS FLOWER PCOS: What complications should a woman be concerned about when pregnant, the most beautiful period of her life? How can she control and prevent them? 

Dr. PERLOE: Prenatal vitamins, diet, exercise, check for genetic carrier risks, continue insulin sensitizers like metformin and Ovasitol into the third trimester if ok with your physician.

LOTUS FLOWER PCOS: What pieces of advice may you give a woman who wants to undergo a fertility treatment?

Dr. PERLOE:You need to be an active and educated participant in the process. Please dont sit back and let fertilitybe done for you. If you cant have thoughtful discussion with your medical team it is time to find another team.

About Stefania Cattaneo

I am Stefania Cattaneo and I am a Nutritionist Biologist. I have always been fond of sports and nutrition most of all related to the women. I work in my private office near Turin, there I see every sort of patients with really different problems and needs. Actually, I mainly deal with sports people and women who suffer from hormonal ailment linked to the Polycystic Ovary Syndrome. I'll do my best to widen your knowledge (and mine as well) about this hard, difficult awkward but fascinating topic: PCOS.