Reference
Chen JT, Tominaga K, Sato Y, Anzai H, Matsuoka R. Maitake mushroom (Grifola frondosa) extract induces ovulation in patients with polycystic ovary syndrome: a possible monotherapy and a combination therapy after failure with first-line clomiphene citrate. J Altern Complement Med. 2010;16(12):1295-1299.
Study Design
Open label, no placebo control
Participants
Eighty subjects with a diagnosis of PCOS. Inclusion was established by the following criteria:
- 18–35 years of age
- PCOS diagnosis, indicated by the presence of oligomenorrhea, and hyperandrogenism, and/or elevated basal luteinizing hormone (LH) and normal basal follicle-stimulating hormone (FSH), polycystic ovaries revealed by ultrasonography
- No diabetes mellitus; and
- No hypercholesterolemia.
After dropouts or noncompliance, 72 women participated in the study. Group 1 (n=36) were assigned to receive SX-fraction from Maitake mushroom (MSX) containing 250 mg of dried maitake mushroom powder and 18 mg of MSX per tab at a dose of 3 tabs 3 times daily between meals. Group 2 (n=36) was assigned to receive clomiphene citrate (CC), 50 mg daily on days 5–9 of menstrual cycle. The study duration included 3 menstrual cycles. Due to dropout and deviation from protocol, 12 participants were not included in the ovulation analysis.
Key Findings
After 3 menstrual cycles, the MSX group (26 women) had an ovulation rate of 76.9% and the CC group (31 women) had an ovulation rate of 93.5%. Fifteen subjects who failed to respond to either CC or MSX alone were then given a combination therapy of CC and MSX. With this combined therapy, 100% of the failed MSX group ovulated and 75% of the CC group ovulated.
Practice Implications
As a naturopathic physician, the majority of my PCOS patients come to me because they want alternatives to clomiphene citrate and metformin. Foundational measures in all patients with PCOS include modifying insulin regulation through exercise and dietary measures that lower serum glucose. In addition, many patients may need specific nutrients and herbs to modify the effects of hyperandrogenism and hyperinsulinemia. Nutrients such as chromium, lipoate, B vitamins, and magnesium, along with herbs such as peony, licorice, and saw palmetto may also be indicated depending on symptomology.
The proposed mechanism of action of the SX fraction from the maitake mushroom is to modulate blood glucose levels and enhance insulin sensitivity.
This study by Chen et al establishes another possible alternative to enhance insulin sensitivity and induce ovulation. The proposed mechanism of action of the SX fraction from the maitake mushroom is to modulate blood glucose levels and enhance insulin sensitivity.1,2 It has been established that by enhancing insulin sensitivity and thereby lowering insulin levels, women with PCOS will have lower androgen levels and consequently, regular ovulatory cycles. While the study group was small, it is exciting to have another natural agent to help our PCOS patients. Clinically, one drawback of MSX is possibly the dosing required. In this study, women were taking 3 capsules 3 times per day for 3 months. There were no adverse effects reported, save mild epigastralgia noted in 2 women taking MSX. However, the question of cost and compliance comes into question. Maitake is an inherently expensive supplement, and in this study was taken daily. In contrast, the clomiphene only needed to be dosed for 4 days during the follicular phase—a much easier regimen. In reality, the naturopathic treatment for a patient with PCOS is already difficult for the patient, as the dietary restrictions that need to be observed can be quite challenging for many. One wonders if the addition of 9 pills a day is feasible long term. Nonetheless, maitake extract represents a novel natural agent that shows promise for those patients who choose not to use pharmaceuticals to induce ovulation. Further studies are needed to substantiate this small, open-labeled trial.
