Seed Cycling and Hormonal Balance: A Case Study of Successful Fertility Intervention in Polycystic Ovarian Syndrome

ABSTRACT

This case study discusses the treatment of primary infertility in a 29-year-old female with a case of polycystic ovarian syndrome (PCOS) who presented to the Infertility Clinic at Wardha, Maharashtra, with a 2-year history of failed conception. The female patient complains about irregular menstrual cycles, mild acne, hair thinning weight gain, and hormonal imbalances characterized by high luteinizing hormone (LH), low levels of follicle-stimulating hormone (FSH), and a raised LH: FSH ratio. Following the initial evaluations, they were put on a comprehensive fertility treatment plan that incorporated Myo-inositol and folic acid supplementation, and seed cycling as a dietary intervention. The seed cycling protocol involved the consumption of ground flaxseeds and pumpkin seeds during the follicular phase and sunflower and sesame seeds during the luteal phase to balance estrogen and progesterone, respectively. After 6 months, the patient experienced notable improvements such as regular menstrual cycles, a reduction in body mass index ranges from 29 to 24 kg/m², normalized hormone levels, and the male partner’s semen analysis representing results within normal limits. The couple moved forward with intracytoplasmic sperm injection, which led to the development of high-quality embryos and a confirmed clinical pregnancy outcome. This case highlights the effectiveness of integrating pharmacological treatment with seed cycling to improve fertility outcomes in patients with PCOS.

INTRODUCTION

As defined by the World Health Organization (WHO), infertility is a disease of the male and female reproductive systems. It is characterized by the inability to achieve pregnancy despite engaging in regular, unprotected sexual intercourse for a period of 12 months or more.[1] WHO considers infertility as one of the five most important disabilities in young populations, with around 10% of the world affected by infertility. Although infections such as gonorrhea and sexually transmitted diseases were the major causes of infertility in the past, factors such as stress, male reproductive problems, unhealthy lifestyle habits, and obesity causing polycystic ovarian syndrome are the most prevalent ones nowadays.[2] Almost 7–15% of women of reproductive age are affected by polycystic ovarian syndrome (PCOS), which is a multifarious endocrine and reproductive disorder. The etiology of PCOS is multifactorial, involving genetic, environmental, and lifestyle factors; thus, its exact cause is still a continuous subject of research and debate. The Rotterdam criteria define PCOS as a syndrome identified by the presence of at least two of the following features: oligo-anovulation, clinical or biochemical hyperandrogenism, and polycystic ovarian morphology, described by an ovarian volume greater than 10 ml and/or the presence of more than 12 follicles per ovary.[3] As a result, 5% to 10% of these infertile couples opt for assisted reproductive technology (ART) each year. The most common infertility treatment is in vitro fertilization as an alternative to the normal fertilization of the egg and sperm within the uterus.[4] Myo-inositol (MI) treatment, a recent breakthrough in treating PCOS, is a naturally occurring compound known for its insulin-sensitizing properties and broad safety profile.[5]

Seed cycling is a nonpharmacological intervention in which a combination of pumpkin and flaxseeds, sesame, and sunflower seeds are given to female patients at different menstrual cycle phases. Lignans and omega-3 fatty acids are present in flaxseeds, which help relieve the symptoms of polycystic ovaries. Sesame and sunflower seeds are a rich source of fatty acids and lignans that balance female hormonal dysfunction.[6]

CASE PRESENTATION

Patient details

An infertile couple visited an infertility clinic in Wardha, Maharashtra. The couple, a female aged 29 years and a male aged 30 years, displayed primary infertility, trying to conceive for 2 years. The female patient complaints about an irregular menstrual cycle (45–60 days), mild acne, hair thinning, and weight gain for the past 1 year. They were given a detailed explanation of processes, benefits, and drawbacks. Informed consent was obtained from both partners.

Medical/surgical history

No surgical intervention was taken by the couple in the past. The male partner had no medical history, while the female partner was clinically diagnosed with PCOS via ultrasound findings. This was their first visit to the infertility clinic.

Physical examination

The body mass index (BMI) of a female patient is measured as 29 kg/m², representing the category of overweight according to established BMI categories, while the BMI of a male patient is measured as 22 kg/m², which falls within the normal weight range.

Investigation

To find out the primary cause of their infertility, both male and female patients undergo extensive assessment.

The male partner’s semen analysis report shows a 90 mil/ml count, 80% motility, and 5% morphology. According to the laboratory investigation, the report was normal.

Laboratory investigation of the female patient revealed slightly increased luteinizing hormone (LH) levels at 15 mIU/mL and decreased somewhat follicle-stimulating hormone (FSH) levels at 5mIU/mL, an increased LH: FSH ratio of 2.3:1. Total testosterone levels were moderately elevated at 80 ng/dL. Serum prolactin levels and thyroid stimulating hormone (TSH) lie within the normal range. The glucose tolerance test showed borderline impaired glucose tolerance, with a glucose fasting of 99 mg/dL. Ultrasound findings revealed the presence of enlarged ovaries with more than 10 follicles measuring 2–9 mm bilaterally.

Treatment

The patient was directed to take myo-inositol (2000mg) and folic acid supplements (200μg) twice daily along with seed cycling to improve hormonal imbalance and enhance ovulatory function and overall metabolic function of the body. Metformin (250mg) was also advised to the patient to improve glucose fasting levels and improve insulin sensitivity. We executed this treatment plan for a total of 6 months.

Seed cycling intervention

The seed cycling was introduced as a primary dietary intervention in the patient’s routine. The regimen consists of consuming specific seeds during the follicular phase (days 1–14) and the luteal phase (days 15–28). During the follicular phase (days 1–14), the patient consumed 1 tablespoon each of ground flaxseeds and pumpkin seeds daily to maintain estrogen production through ligan and zinc content as shown in Table 1. Flaxseed contains ligan content which is high in phytoestrogens that modulate estrogen metabolism reducing the excess androgen and regulating the menstrual cycle. Pumpkin seeds are rich in zinc and magnesium content which reduces testosterone levels, improving symptoms of mild acne and histruism; magnesium content helps in managing blood glucose levels and improves insulin sensitivity. In the luteal phase (days 15–28), the patient consumed 1 tablespoon of each ground sunflower and sesame seeds daily as shown in Table 1. Sunflower seeds are rich in vitamin E, and studies suggested that it might increase progesterone levels, the hormone that is essential for maintaining early pregnancy. Due to the presence of high zinc content in sesame seeds, they act as hormone regulators and enhancers, supporting ovulation.

Table 1.

Details of seeds advised to the patient

PHASES	Days of menstrual cycle	Seeds	Intake
Follicular Phase	Day 1-14	Flaxseeds and Pumpkin Seeds	1 tablespoon each daily
Luteal Phase	Day 15-28	Sunflower and sesame seeds	1 tablespoon each daily

This regimen would be accompanied by a balanced diet focusing on low-glycemic-index foods, and light physical activity like walking and yoga should be incorporated for 30 minutes. Stress management should also be taken care of as it would decrease cortisol levels, which is a part responsible for weight gain.

Follow-up during seed cycling

The patient revisited the IVF clinic after 6 months of seed cycling and reported menstrual regularity with a shortening of the cycle to 32–35 days; a reduction in histruism was also seen. The patient was advised for repeated hormonal evaluation, which indicated a reduction in LH, 8.5mIU/mL; LH: FSH ratio, 1.8:1; total testosterone, 50ng/dL; and glucose fasting, 80mg/dL levels. The report also revealed a reduction in BMI to 24kg/m².

Transition to intra-cytoplasmic sperm injection (ICSI)

The patient further proceeded for intra-cytoplasmic sperm injection (ICSI) as a part of their fertility treatment after the significant improvement in hormonal levels and menstrual regularity. The patient was triggered with gonadotrophin releasing hormone agonist (GnRH) for follicular aspiration on day 13 of the menstrual cycle. Ovum pickup was scheduled after 36 hours of the trigger; nine oocytes were retrieved (4 MII, 3 MI, 2GV). On the same day, ICSI was performed, where good quality of sperm and oocytes were taken. Day 5 embryos were formed, and freezing was carried out afterward. After 3 months, embryo transfer was scheduled, and embryos were thawed. Consequently, embryos were transferred having a high quality of 4AB and 3AA.

Follow-up

After 14 days of embryo transfer, a clinical pregnancy was confirmed by taking a blood sample of the patient to test for serum human chorionic gonadotropin (β-hCG); the report revealed 1620 mIU/mL as positive. The patient was advised to visit regularly for follow-ups for a successful pregnancy.

DISCUSSION

PCOS is one of the most common endocrine disorders, affecting 8% to 13% of women of reproductive age. PCOS is a common and complicated disorder that causes major challenges in diagnosis and treatment. PCOS presents diverse clinical features across age groups as these features evolve over a lifetime, contributing to the intricacies of its diagnosis. Furthermore, due to various presentations of the same disease with different pathogenesis in each case, the management of PCOS requires a very personalized, context-specific approach to treatment according to the specific symptoms and the individual case presentation of every patient.[7] Our case report represented a 29-year-old female patient suffering from PCOS with an increased BMI, complaints about mild acne, histruism, hair thinning, and elevated LH: FSH ratio.

PCOS is considered one of the prevalent and treatable causes of infertility, especially among young women, and accounts for about 70% of cases of anovulatory infertility. Insulin-sensitizing interventions such as metformin therapy or weight management strategies are the first line of treatment established for PCOS.[8] LH: FSH ratio, total testosterone levels, and glucose fasting levels were taken every 6 weeks to check the medication’s efficacy. In the present case study, we advised the patient to take specific seeds in different phases of the menstrual cycle with Myo-inositol and also monitored their progress throughout the journey of 6 months.

Seed cycling has a promising outcome on LH: FSH ratio and total testosterone levels as suggested by the research. Every seed has its own significant impact on particular parameters including LH, FSH, testosterone levels, and ovulatory function. Pumpkin seeds are considered the nutrient powerhouse that contributes to regulating the menstrual cycle and hence reproduction. Flaxseeds elevate the level of sex hormones. Sesame seeds facilitate the production of progesterone and also contain lignans which deal with excess estrogen. Sunflower seeds contain vitamin E and selenium, which contribute to the production of progesterone, and selenium aids in the detoxification of the liver.[9]

PCOS affects the reproductive system causing infertility as well as resulting in many complications that last lifelong if not treated, including diabetes mellitus, hypertension, and abnormal lipid profile.[10] To prevent this, seed cycling is best noninvasive, with no side effects, and an easy-to-consume alternative in treating PCOS patients in resolving complications related to pregnancy.

CONCLUSION

The case study emphasizes the significant impact of seed cycling on female patients dealing with infertility related to PCOS. This approach combined with myo-inositol and seed cycling remarkably bettered hormonal levels, menstrual regularity, and enhanced ovulatory function, leading to successful assisted reproductive technology (ART) resulting in clinical pregnancy. According to the case study, couples dealing with infertility related to PCOS may find seed cycling combined with lifestyle modifications, stress management, and medical care, to be a comprehensive solution.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.