Over the last two decades, a large number of patients have participated in controlled or pragmatic trials using either the QALY® supplement, or its separate constituents, for the treatment of male [1] or female infertility [2]. Overall the complementary intake of QALY® increased the spontaneous pregnancy rate and the success rate of intra-uterine insemination (IUI) of infertile couples with number needed to treat of 4. When given before conception of In Vito Fertilization (IVF) the clinical pregnancy rate increased from 35% up to 50% per treatment cycle [3]. Two out of every 3 patients suffering from myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) or from the post-COVID syndrome (also called “long-COVID”) [4] experienced benefit from this nutraceutical with the result of the Fatigue Severity Scale significantly decreasing by an average of 14% after one month. QALY® was also given with the aim to correct the presumed mechanisms of ageing [5] and to prevent, or delay the progression of Alzheimer dementia [6].

Momordica plus® prescribed to patients with the metabolic syndrome or type II diabetes, reduced insulin resistance during follow-up of up to 6 years in over 90% of cases [1].

The results of these personal pragmatic studies were challenged against scientific publications recruited through search in the usual electronic programs (Pubmed, Google) and associated references. The considerations based on our clinical experience, as described in the references cited above, and on the literature search are given in separate paragraphs related to the intended biological effects being relevant to the pathology of PCOS.

Oxidative stress is an important contributing factor to the pathogenesis of PCOS [7] [8]. Antioxidant treatment has, therefore, been recommended in these patients [9].

The biomass of the microscopic algae Haematococcus pluvialis is a natural source of Astaxanthin, which is a strong antioxidant, with complementary anti-inflammatory activity. Astaxanthin belongs to the group of the carotenoids, and it has no toxic nor teratogenic effects. It protects against oxidative damage to the cell membrane and to DNA, and has favourable effects in various diseases [10].

The oxido-reductase co-enzyme ubiquinol Q10 (CoQ-10) mainly acts as an antioxidant at the mitochondrial level and improves their function [11]. CoQ-10 has successfully been given for the treatment of patients with PCOS [12].

The extract of the bark of the Mediterranean pine tree (pine bark extract) is rich in flavonoids, anthocyanidins in particular. Pine bark extract exerts strong activity against inflammation [13], which is an important aspect of PCOS [14], and has anti-oxidant effects as well.

Many patients with PCOS suffer from insulin resistance. Pine bark extract improves this condition [15] and reduces the health risks associated with it [16].

In PCOS patients with the metabolic syndrome, either or not associated with obesity, Momordica charantia extract improves cellular insulin receptivity by activating the adenosine monophosphate-activate protein kinase (AMPK). Its efficacy is enhanced by alfa lipoic acid that facilitates multiple steps of glucose/pyruvate metabolism at the post-receptor level [17].

Hyperandrogenism, imbalance of the gonadotropin secretion, and deregulation of the hypothalamic-pituitary-adrenal (HPA) axis are well-known and typical endocrine phenomena in the majority of PCOS patients [18]. The extract of Rhodiola rosea is a strong adaptogen attenuating adrenal hypersecretion through several pathways [19].

The plasma homocysteine concentration is commonly increased in PCOS patients [20]. Administration of B-group vitamins [21], folic acid in particular [22], reduces circulating homocysteine in patients with PCOS.

Elevated serum homocysteine is associated with increased homocysteine concentration in follicular fluid, which affects oocyte fertilization [3]. In addition, hyper-homocystëinemie is an independent risk factor for cardiovascular disease and osteoporosis, which are both more common in PCOS patients [23].

Selenium-dependant glutathione peroxidase has anti-tumour properties [24] and is relevant to PCOS patients [25]. Indeed, lower levels of selenium have been found in women with PCOS [26]. Food supplementation with selenium-salt was associated with improved metabolic response in these patients [27], and might reduce cancer risk.

Mitochondrial dysfunction and long-term metabolic imbalance are present in many PCOS patients [11] [28]. This can be corrected by zinc supplementation [29], especially when given together with Ubiquinol Q10.

The long-chain poly-unsaturated (PUFA) omega-3 fatty acids docosohexaenoic acid (DHA) and eicosapentaenoic acid (EPA) do attenuate PCOS complications through a number of mechanisms [30]. Krill oil is a rich source of these PUFA’s that are esterified in phospholipids. The oral absorption of esterified DHA and EPA is better than that of the pure fatty acids, and Krill oil is more environmental friendly than fish oil.

Recently the importance of epigenetic interactions between microRNA and DNA methylation has been highlighted in patients PCOS [31]. Hypermethylation of certain DNA domains was found to play a pivotal role, as it does in many diseases and in carcinogenesis [32].

Food supplementation with QALY® reduces the methylation of the human telomerase reverse transcriptase (hTERT)-promoter region by an average of 14%. In particular, the second dinucleotide (CpG2), which has been associated with an increased risk of several types of cancers [3], is lowered. It can be speculated that decreased methylation, in synergism with reduced hyperinsulinemia and increased selenium-dependant glutathione peroxidase activity will benefit PCOS patients and will lower their risk of tumorigenesis.