Benefit of Delayed Fertility Therapy With Preconception Weight Loss Over Immediate Therapy in Obese Women With PCOS

Overview

Journal J Clin Endocrinol Metab

Publisher Oxford University Press

Specialty Endocrinology

Date 2016 May 13

PMID 27172435

Citations 46

Authors

Richard S Legro

William C Dodson

Allen R Kunselman

Christy M Stetter

Penny M Kris-Etherton

Nancy I Williams

Carol L Gnatuk

Stephanie J Estes

Kelly C Allison

David B Sarwer

Michael P Diamond

William D Schlaff

Peter R Casson

Gregory M Christman

Kurt T Barnhart

G Wright Bates

Rebecca Usadi

Scott Lucidi

Valerie Baker

Heping Zhang

Esther Eisenberg

Christos Coutifaris

Anuja Dokras

Affiliations

Soon will be listed here.

Abstract

Context: In overweight/obese women with polycystic ovary syndrome (PCOS), the relative benefit of delaying infertility treatment to lose weight vs seeking immediate treatment is unknown.

Objective: We compared the results of two, multicenter, concurrent clinical trials treating infertility in women with PCOS.

Design, Setting, And Participants: This was a secondary analysis of two randomized trials conducted at academic health centers studying women 18-40 years of age who were overweight/obese and infertile with PCOS.

Intervention: We compared immediate treatment with clomiphene from the Pregnancy in Polycystic Ovary Syndrome II (PPCOS II) trial (N = 187) to delayed treatment with clomiphene after preconception treatment with continuous oral contraceptives, lifestyle modification (Lifestyle: including caloric restriction, antiobesity medication, behavioral modification, and exercise) or the combination of both (combined) from the Treatment of Hyperandrogenism Versus Insulin Resistance in Infertile Polycystic Ovary Syndrome (OWL PCOS) trial (N = 142).

Main Outcome Measures: Live birth, pregnancy loss, and ovulation were measured.

Results: In PPCOS II, after four cycles of clomiphene, the cumulative per-cycle ovulation rate was 44.7% (277/619) and the cumulative live birth rate was 10.2% (19/187), nearly identical to that after oral contraceptive pretreatment in the OWL PCOS trial (ovulation 45% [67/149] and live birth: 8.5% [4/47]). In comparison, deferred clomiphene treatment preceded by lifestyle and combined treatment in OWL PCOS offered a significantly better cumulative ovulation rate compared to immediate treatment with clomiphene. (Lifestyle: 62.0% [80/129]; risk ratio compared to PPCOS II = 1.4; 95% confidence interval [CI], 1.1-1.7; P = .003; combined: 64.3% [83/129]; risk ratio compared to PPCOS II = 1.4; 95% CI, 1.2-1.8; P < .001 and a significantly better live birth rate lifestyle: 25.0% [12/48]; risk ratio compared to PPCOS II = 2.5; 95% CI, 1.3-4.7; P = .01 and combined: 25.5% [12/47]; risk ratio compared to PPCOS II = 2.5; 95% CI, 1.3-4.8; P = .01).

Conclusions: These data show the benefit of improved ovulation and live birth with delayed infertility treatment with clomiphene citrate when preceded by lifestyle modification with weight loss compared with immediate treatment. Pretreatment with oral contraceptives likely has little effect on the ovulation and live birth rate compared with immediate treatment.

Citing Articles

Ketogenic diet improves fertility in patients with polycystic ovary syndrome: a brief report.

Tsushima Y, Nachawi N, Pantalone K, Griebeler M, Alwahab U Front Nutr. 2024; 11:1395977.

PMID: 39328462 PMC: 11424527. DOI: 10.3389/fnut.2024.1395977.

Nutritional and exercise interventions to improve conception in women suffering from obesity and distinct nosological entities.

Gitsi E, Livadas S, Argyrakopoulou G Front Endocrinol (Lausanne). 2024; 15:1426542.

PMID: 39006367 PMC: 11239444. DOI: 10.3389/fendo.2024.1426542.

Effectiveness of preconception weight loss interventions on fertility in women: a systematic review and meta-analysis.

Caldwell A, Gorczyca A, Bradford A, Nicklas J, Montgomery R, Smyth H Fertil Steril. 2024; 122(2):326-340.

PMID: 38408693 PMC: 11384273. DOI: 10.1016/j.fertnstert.2024.02.038.

Reduction in the Free Androgen Index in Overweight Women After Sixty Days of a Low Glycemic Diet.

Zapala B, Marszalec P, Piwowar M, Chmura O, Milewicz T Exp Clin Endocrinol Diabetes. 2024; 132(1):6-14.

PMID: 38237611 PMC: 10796197. DOI: 10.1055/a-2201-8618.

High prevalence of medical conditions and unhealthy lifestyle behaviours in women with PCOS during preconception: findings from the Australian Longitudinal Study on Women's Health.

Tay C, Loxton D, Bahri Khomami M, Teede H, Harrison C, Joham A Hum Reprod. 2023; 38(11):2267-2276.

PMID: 37740685 PMC: 10628491. DOI: 10.1093/humrep/dead190.

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