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Weight loss and PCOS

Weight loss and exercise improve fertility in PCOS

Clinical trial compares preconception treatments for common cause of infertility

Weight loss and exercise improve ovulation in women who have polycystic ovary syndrome (PCOS), according to a study, ‘Randomized Controlled Trial of Preconception Interventions in Infertile Women With Polycystic Ovary Syndrome.’, published in the Journal of Clinical Endocrinology & Metabolism. PCOS is the most common cause of female infertility. The condition occurs when a woman's body produces slightly higher than normal amounts of testosterone and other androgens, sex hormones associated with male traits. The resulting hormone imbalance can cause irregular or absent menstrual periods, weight gain, acne, excess hair on the face and body, or thinning hair on the scalp. As many as five million women in the US have PCOS, according to the US Department of Health and Human Services' Office of Women's Health.

"The findings confirm what we have long suspected -- that exercise and a healthy diet can improve fertility in women who have PCOS," said one of the study's authors, Dr Richard S Legro, Vice Chair of Research and Professor of Obstetrics and Gynecology and Public Health Sciences at Penn State College of Medicine. "Making preconception lifestyle changes is beneficial, either alone or in combination with other pre-treatment options."

Women with PCOS often take birth control pills to regulate the menstrual cycle and reduce the level of androgens in the body. Past research has indicated that pretreatment with a short-term course of birth control pills can raise pregnancy rates among women with PCOS. The study was designed to compare preconception interventions and their impact on fertility.

The randomised open label study examined the differences in pregnancy outcomes among 149 women with PCOS who either took birth control pills, underwent lifestyle modification or a combination of the two interventions for a four-month period. The participants were between the ages of 18 and 40. The women were either overweight or obese, but had no other major medical conditions.

Women were randomly assigned to receive either 16 weeks of 1) continuous oral contraceptive pills (OCPs) (ethinyl estradiol 20 mcg/1mgnorethindrone acetate) (“OCP”); 2) lifestyle modification consisting of caloric restriction with meal replacements, weight loss medication (either sibutramine, or orlistat),and increased physical activity to promote a 7% weight loss (“Lifestyle”); or 3) combined treatment with both OCP and lifestyle modification (“Combined”). After preconception intervention, women underwent standardized ovulation induction with clomiphene citrate and timed intercourse for four cycles. Pregnancies were followed with trimester visits until delivery.

A total f 149 women were randomly assigned to one of the three groups (Lifestyle: n=50; OCP: n=49; Combined: n=50). The results showed significant weight loss was achieved with both Lifestyle (mean weight loss,-6.2%;95%confidence interval (CI), -7.4–-5.0; and Combined (mean weight loss, -6.4%; 95% CI, -7.6–-5.2) compared with baseline and OCP (both p<0.001). There was a significant increase in the prevalence of metabolic syndrome at the end of preconception treatment compared with baseline within OCP (odds ratio [OR, 2.47; 95% CI, 1.42-4.27) whereas no change in metabolic syndrome was detected in the Lifestyle (OR, 1.18; 95% CI, 0.63-2.19) or Combined (OR, 0.72; 95% CI, 0.44-1.17) groups. Cumulative ovulation rates were superior after weight loss: OCP, 46%; Lifestyle, 60%; and Combined, 67% (p<0.05). Live birth rates were OCP, 12%; Lifestyle, 26%; and Combined, 24% (p=0.13).

Women in the lifestyle and combination arms of the study had better insulin sensitivity and lower levels of triglycerides, than women who took birth control pills.

"The research indicates preconception weight loss and exercise improve women's reproductive and metabolic health," said Legro. "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."

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