Obesity and the Risk of Infertility, Gestational Diabetes, and Type 2 Diabetes in Polycystic Ovary Syndrome

Abstract

This review describes the relationship between obesity and the most common reproductive (infertility) and metabolic (gestational diabetes mellitus [GDM] and type 2 diabetes mellitus [T2DM]) consequences in polycystic ovary syndrome (PCOS). It also describes the vital role of lifestyle management for PCOS. PCOS is a heterogeneous endocrine disorder common in reproductive-age women. Consensus on the exact etiological mechanisms of PCOS is unreached. Overweight or obesity is present in at least 60% of the PCOS population, but the condition occurs irrespective of BMI, with excess BMI increasing both the prevalence and severity of clinical features. Use of lifestyle therapies (nutrition, physical activity, and/or behavioral) for the prevention and management of excess weight gain, infertility, GDM, and T2DM is a vital component of best-practice PCOS care. Lifestyle management is recommended for all women with PCOS as the first-line treatment with or without medications. Due to a lack of high-quality trials demonstrating the efficacy of specific lifestyle approaches, PCOS lifestyle recommendations are as those for the general population. This review summarizes current knowledge relating to obesity and its impact on fertility, GDM, and T2DM. It also summarizes the lifestyle recommendations to best manage these conditions in women with PCOS and obesity.

Overweight, obesity and excessive weight gain in pregnancy as risk factors for adverse pregnancy outcomes: A narrative review

“…The cause of fertility problems in PCOS is elevated androgen concentrations, but this is secondary to insulin resistance 27 . Although more common in obese women 28,29 , PCOS also occurs in women who are not obese and risk is related to visceral fat mass 30,31 . PCOS and its associated menstrual cycle disorders are readily treated with metformin to improve insulin sensitivity, or through weight loss of approximately 5% body weight 32 .…”

The Effect of Time-Restricted Eating on Insulin Levels and Insulin Sensitivity in Patients with Polycystic Ovarian Syndrome: A Systematic Review

“…Time (1) "ovary polycystic disease"/exp (2) ("stein leventhal syndrome" OR "cystic ovar * " OR "micropolycystic ovar * " OR "multiple follicle cyst * " OR "ovar * polycystic disease" OR "ovar * polycystic syndrome" OR "polycystic ovarian disease" OR "polycystic ovar * " OR "polycystic ovar * disease" OR "polycystic ovar * syndrome" OR "stein cohen leventhal syndrome" OR "stein leventhal disease" OR "syndrome stein leventhal"):ti,ab (3) #1 OR #2 (4) "insulin"/exp OR "hyperinsulinism"/exp OR "insulin response"/exp (5) insulin:ti,ab (6) ("hyperinsulinism" OR "hyperinsulism" OR "hyperinsulinaemia" OR "hyperinsulinema" OR "hyperinsulinemia" OR "insulinaemia" OR "insulinemia" OR "insulin hypoglycaemia" OR "insulin hypoglycemia"):ti,ab (7) #4 OR #5 OR #6 (8) "fasting"/exp (9) (1) (MH "Polycystic Ovary Syndrome") (2) TI ("stein leventhal syndrome" OR "cystic ovar * " OR "micropolycystic ovar * " OR "multiple follicle cyst * " OR "ovar * polycystic disease" OR "ovar * polycystic syndrome" OR "polycystic ovarian disease" OR "polycystic ovar * " OR "polycystic ovar * disease" OR "polycystic ovar * syndrome" OR "stein cohen leventhal syndrome" OR "stein leventhal disease" OR "syndrome stein leventhal") OR AB ("stein leventhal syndrome" OR "cystic ovar * " OR "micropolycystic ovar * " OR "multiple follicle cyst * " OR "ovar * polycystic disease" OR "ovar * polycystic syndrome" OR "polycystic ovarian disease" OR "polycystic ovar * " OR "polycystic ovar * disease" OR "polycystic ovar * syndrome" OR "stein cohen leventhal syndrome" OR "stein leventhal disease" OR "syndrome stein leventhal") (3) S1 OR S2 (4) (MH "Insulin+") OR (MH "Insulin Sensitivity") OR (MH "Hyperinsulinism+") (5) TI (insulin OR "hyperinsulinism" OR "hyperinsulism" OR "hyperinsulinaemia" OR "hyperinsulinema" OR "hyperinsulinemia" OR "insulinaemia" OR "insulinemia" OR "insulin hypoglycaemia" OR "insulin hypoglycemia") OR AB (insulin OR "hyperinsulinism" OR "hyperinsulism" OR "hyperinsulinaemia" OR "hyperinsulinema" OR "hyperinsulinemia" OR "insulinaemia" OR "insulinemia" OR "insulin hypoglycaemia" OR "insulin hypoglycemia") (6) S4 OR S5 (7) (MH "Fasting") ( 8 (abstinence or fast * )) ( 14) TI (Ramadan or Ramadhan) OR AB (Ramadan or Ramadhan) (15) TI ("16 8 method" OR "5 2 diet") OR AB (" 16 8 method" OR "5 2 diet") (16) S7 OR S8 OR S9 OR S10 OR S11 OR S12 OR S13 OR S14 OR S15 (17) S3 AND S6 AND S16 Cochrane Library (268) (1) [mh "Polycystic Ovary Syndrome"] (2) ("stein leventhal syndrome" OR "cystic ovar * " OR "micropolycystic ovar * " OR "multiple follicle cyst * " OR "ovar * polycystic disease" OR "ovar * polycystic syndrome" OR "polycystic ovarian disease" OR "polycystic ovar * " OR "polycystic ovar * disease" OR "polycystic ovar * syndrome" OR "stein cohen leventhal syndrome" OR "stein leventhal disease" OR "syndrome stein leventhal"): ti,ab,kw (3) #1 OR #2 (4) [mh "Insulin"] OR [mh "Hyperinsulinism"] (5) (Insulin OR hyperinsulinism OR hyperinsulism OR hyperinsulinaemia OR hyperinsulinema OR hyperinsulinemia OR insulinaemia OR insulinemia OR "insulin hypoglycaemia" OR "insulin hypoglycaemia"):ti,ab,kw (6) #4 OR #5 (1) TS �("ovary polycystic disease" OR "stein leventhal syndrome" OR "cystic ovar * " OR "micropolycystic ovar * " OR "multiple follicle cyst * " OR "ovar * polycystic disease" OR "ovar * polycystic syndrome" OR "polycystic ovar * " OR "polycystic ovar * disease" OR "polycystic ovar * syndrome" OR "stein cohen leventhal syndrome" OR "stein leventhal disease" OR "syndrome stein leventhal") (2) TS �(Insulin OR "hyperinsulinism" OR "hyperinsulism" OR "hyperinsulinaemia" OR "hyperinsulinema" OR "hyperinsulinemia" OR "insulinaemia" OR "insulinemia" OR "insulin hypoglycaemia" OR "insulin hypoglycemia") (3) TS �((Time NEAR/1 restrict * NE...…”

“…Women with PCOS are more likely to have postprandial hyperglycaemia owing to the peripheral insulin resistance rather than fasting hyperglycaemia due to intact endogenous glucose production mechanism [23]. Overall data suggests that 1 in 3 women with PCOS have impaired glucose tolerance and 1 in 10 have type 2 diabetes, with the majority (60%) being overweight or obese [1].…”

“…Polycystic ovarian syndrome (PCOS) a ects up to 10% of premenopausal women and is characterised by multiple ovarian cysts, hyperandrogenism causing hirsutism, hyperinsulinemia, insulin resistance, obesity, infertility, and mood disturbances [1]. A ected women have an increased risk of developing endometrial cancer, cardiovascular disease, hypercholesterolaemia, and type 2 diabetes mellitus meaning that early intervention and management are of crucial importance [2].…”

Investigating the therapeutic options for diabetes‐associated male infertility as illustrated in animal experimental models

“…Recent literature also suggests that there is an emerging relationship between diabetes and infertility in both sexes. In diabetic women with polycystic ovary syndrome and infertility the optimization of diabetic control increases pregnancy rates (Liu et al, 2021; Pirotta et al, 2021). Furthermore, diabetic men will present with infertility more frequently than non‐diabetic men (Fantus et al, 2021; Mulholland et al, 2011).…”