Fertility in women with PCOS improves with weight loss, exercise

Ovulation in women with polycystic ovary syndrome improves with weight loss and exercise, according to recent study findings published in The Journal of Clinical Endocrinology & Metabolism.

“The findings confirm what we have long suspected — that exercise and a healthy diet can improve fertility in women who have PCOS,” Richard S. Legro, MD, vice chair of research and professor of obstetrics and gynecology and public health sciences at Penn State College of Medicine, said in a press release. “Making preconception lifestyle changes is beneficial, either alone or in combination with other pretreatment options.”

Richard Legro

Richard S. Legro

Legro and colleagues evaluated 149 women aged 18 to 40 years with overweight or obesity and infertility due to PCOS to determine the efficacy of preconception intervention on reproductive and metabolic abnormalities. Main outcome measures were weight, ovulation and live birth.

During the preconception intervention, women were randomly assigned to 16 weeks of one of the three following treatments: continuous oral contraceptive pills (pills; n = 49); lifestyle modification consisting of caloric restriction with meal replacements, weight-loss medication and increased physical activity to promote a 7% weight loss (lifestyle; n = 50); or combined treatment with both oral contraceptive pills and lifestyle modification (combined; n = 50).

Participants underwent standardized ovulation induction with clomiphene citrate, as well as timed intercourse for four cycles after the intervention, and pregnancies were followed at trimester visits until delivery.

Compared with the pill group, the lifestyle and combined groups achieved weight loss (P < .0001) and a decrease in waist circumference (P = .03) after intervention.

Compared with baseline, there was a significant increase in metabolic syndrome within the pill group (OR = 2.47; 95% CI, 1.42-4.27); no changes were found with the lifestyle or combined groups.

The combined group achieved ovulation more commonly than the pill group (P < .05). The rate of live births nearly reached statistical significance after combining the lifestyle and combined groups compared with the pill group (P = .05). Among patients who ovulated, fecundity was higher among the lifestyle group compared with the pill group (P = .04).

“The research indicates preconception weight loss and exercise improve women’s reproductive and metabolic health,” Legro said. “In contrast, using oral contraceptives alone may worsen the metabolic profile without improving ovulation. Lifestyle change is an important part of any fertility treatment approach for women with PCOS who are overweight or obese.” – by Amber Cox

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