How to manage weight loss in women with obesity and PCOS seeking fertility?

Abstract

Obesity exacerbates the phenotype of polycystic ovarian syndrome (PCOS) including infertility as well as reducing the efficacy and access to fertility treatments. Weight management is, therefore, a key component of treatment for women with PCOS and coexistent obesity. Many women with PCOS describe significant difficulty losing weight and treatment options are limited. The first‐line treatment is lifestyle interventions though the weight loss and any impact on fertility are limited. No one dietary strategy can be preferentially recommended based on current evidence. While very low energy diets can result in significant weight loss the evidence for impact on fertility is limited. Pharmacotherapy, including a range of treatments can result in marked weight loss and there is some evidence of improved rates of conception including spontaneous and in response to assisted reproduction treatment. As with pharmacotherapy, data regarding bariatric surgery is largely from nonrandomized studies and though the significant weight loss is anticipated to improve fertility the available data prevents firm conclusions. Clinicians and patients must consider the magnitude of weight loss to be targeted as well as the anticipated fertility treatment required and the timeline of treatment when deciding upon the personalized weight loss strategy. Clinicians and patients should be confident in targeting the most appropriate treatment early in the patient's management to avoid unnecessary delays.

Therapy of obesity in women with PCOS using GLP-1 analogues — benefits and limitations [Terapia otyłości u kobiet z PCOS przy zastosowaniu analogów GLP-1 — korzyści i ograniczenia]

“…Bariatric surgery is an invasive method of treatment for morbidly obese patients. It may be an option for women with PCOS and severe obesity (BMI ≥ 40 kg/m 2 or ≥ 35 kg/m 2 with a high-risk obesity complication) if standard weight-loss strategies have failed [44]. As a result of the surgery, the following achievements are expected: weight loss, improvement in metabolic abnormalities, and amelioration of insulin resistance.…”

“…In the literature, there is a small group of studies referring to obese PCOS subjects who underwent bariatric procedures. However, very recently published data indicate improvement in the parameters of insulin resistance, hirsutism, and androgen profile as well recovery of menstrual cycles [44]. Nonetheless, bariatric surgery is associated with a high risk of complications both perioperative and postoperative, but it still could be a longer-term therapeutic option in selected cases.…”

“…Chirurgia bariatryczna jest inwazyjną metodą leczenia pacjentów z otyłością olbrzymią. Może być opcją dla kobiet z PCOS i ciężką otyłością (BMI ≥ 40 kg/m 2 lub ≥ 35 kg/m 2 z dodatkowymi czynnikami ryzyka), jeśli zawiodą standardowe strategie odchudzania [44]. Oczekuje się następujących efektów operacji: utrata masy ciała, poprawa zaburzeń metabolicznych oraz poprawa wrażliwości na insulinę.…”

“…Dotychczas opublikowano wyniki niewielu badań u otyłych pacjentek z PCOS, które przeszły zabiegi bariatryczne. Dane, które ukazały się niedawno, wskazują na poprawę parametrów insulinooporności, hirsutyzmu i profilu androgenowego oraz przywrócenie cykli menstruacyjnych [44]. Chirurgia bariatryczna wiąże się z wysokim ryzykiem powikłań zarówno w okresie okołooperacyjnym, jak i pooperacyjnym, ale w wybranych przypadkach może stanowić długoterminową opcję terapeutyczną.…”

Editorial for clinical endocrinology special issue on polycystic ovary syndrome (PCOS)

“…Jonathan Hazlehurst, Abd Tahrani and colleagues provide expert advice on how to manage weight loss in women with obesity and PCOS seeking fertility 7 . Chau Thien Tay, Anju E. Joham and colleagues evaluate the factors that impact whether women with PCOS achieve their ideal family size 8 .…”