Dr. Ilana Ressler on how fertility and metabolism are connected

In our latest episode of Lexicon, we sat down with Dr. Ilana  Ressler, a reproductive endocrinologist practicing at Illume Fertility in Connecticut and New York. We discussed the intricate connections between metabolic health, fertility, and polycystic ovary syndrome (PCOS).

Dr. Ressler also provided invaluable insights into how lifestyle, genetics, and medication intersect within the complex realm of reproductive endocrinology.

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What is PCOS?

Our talk opened up with an overview of PCOS and how it impacts people. According to Dr. Ressler, it is “the most common endocrine condition that affects women of reproductive age, impacting up to about 15 to 20% of women,” she explained. 

Despite being classified primarily as a reproductive condition, she emphasized that PCOS is “really much more comprehensive and broad,” affecting various bodily systems and significantly impacting metabolic health.

Dr. Ressler provided clarity on the diagnostic criteria for PCOS, noting women must meet two of three factors: irregular menstrual cycles, elevated androgen levels (such as testosterone), and polycystic-appearing ovaries on ultrasound, which she clarified is somewhat misleadingly named. 

“It should be called polyfollicular syndrome,” she noted, emphasizing the presence of numerous follicles rather than actual cysts.

Delving into the underlying metabolic aspects of PCOS, Dr. Ressler explained the complex relationship between glucose, insulin resistance, and reproductive function. “Metabolic health and reproductive health have a lot to do with each other,” she added.

She also highlighted how disruptions in glucose and insulin metabolism can interfere with ovulation, contributing directly to fertility issues.

Regarding the hereditary nature of PCOS, she stated, “Just like someone is born with brown eyes, they might be born with PCOS—it’s always there in the background.” While lifestyle factors, including diet and exercise, play a critical role in managing symptoms, she clarified that “biochemical changes can still occur, even in women with super healthy lifestyles.”

The rise of GLP-1 medications

We next discussed GLP-1 receptor agonists, such as the highly publicized medication Ozempic. Dr. Ressler explained that these medications were initially developed to treat diabetes and insulin resistance. 

They later gained popularity partly due to widespread media coverage and celebrity endorsements. “They work by improving insulin secretion, slowing gastric emptying, lowering glucagon secretion, and promoting feelings of satiety,” she explained. 

Given their effectiveness at promoting weight loss, GLP-1 receptor agonists have increasingly entered conversations surrounding metabolic health and fertility. Dr. Ressler touched on the notion of “Ozempic babies,” explaining, 

“Women who weren’t ovulating regularly before might start ovulating due to the improvements the medication brings.” That said, Dr. Ressler emphasized caution, advising that the medications should ideally be stopped eight weeks before actively trying to conceive, given current recommendations.

Medication safety and misconceptions

On the potential risks to pregnancy, Dr. Ressler reassured listeners that there are no known direct risks to a fetus from GLP-1 medications, though she acknowledged that studying medication safety in pregnancy remains inherently challenging. Her advice to patients is clear: use contraception while taking these medications until actively preparing for conception.

Addressing misconceptions about weight management medications, Dr. Ressler highlighted an often-overlooked consideration: “While weight loss occurs on GLP-1 medications, there’s typically rebound weight gain once the medications are discontinued.” 

To this end, she added, it is essential to maintain lifestyle changes even after stopping the medication.

Personalized treatment for PCOS

Throughout the podcast, Dr. Ressler stressed the complexity of treating PCOS due to its variable presentation. “PCOS isn’t the same disease that affects everyone—10 different women could have 10 very different experiences with it,” she said. 

She added that an individualized approach focuses on addressing the specific symptoms that bother each patient most, from fertility issues to dermatological symptoms like acne or excess hair growth.

Dr. Ressler also shared valuable insights into managing PCOS through lifestyle. She advocated for balanced nutrition, “like a Mediterranean type of diet,” and regular, diversified exercise. 

“Lifestyle plays a big role in PCOS; you can’t totally eliminate it through lifestyle, but you can manage it so someone is symptom-free,” she added.

Future directions in fertility treatments

Discussing the future of reproductive endocrinology, Dr. Ressler expressed enthusiasm about potential breakthroughs, particularly those that address the fundamental challenge of egg aging. Highlighting IVF’s remarkable yet relatively recent history, she noted significant room for innovation, especially in technologies that preserve or enhance egg quality.

Dr. Ressler concluded with practical and compassionate advice for women facing fertility concerns. “If someone is having difficulty conceiving, it’s important to seek help sooner rather than later—time isn’t on the side of fertility,” she urged. 

Encouraging women to manage their metabolic health as part of fertility planning proactively, she noted, “Focusing on good nutrition and routine exercise will only help with fertility success.”

Overall, the podcast comprehensively explored reproductive endocrinology, emphasizing how closely metabolic health is with fertility and overall wellness. Dr. Ressler’s approachable style and clarity in explaining complex topics made it accessible and enlightening, delivering key takeaways beneficial for listeners of all backgrounds.