The effect of home exercise on ovulation induction using clomiphene citrate in overweight underserved women with polycystic ovarian syndrome

Abstract

BackgroundAge-adjusted rates of obesity are reported to be 35.8 % among US adult women and 49 % in some race/ethnicity, underserved populations. (1). Underserved populations often have less access to weight-loss intervention options and are at high risk for obesity related problems including anovulation, infertility, pregnancy-related complications and adverse long-term health outcomes. (2). The purpose of this study was to evaluate a home exercise plan using a pedometer on weight loss, ovulation induction and pregnancy rates in our overweight and obese underserved clinic population.MethodsTwenty one overweight (BMI ≥ 25–29.9) and obese I-II (BMI ≥ 30–39.9) 18–42 years old were recruited. Participants received an exercise/nutrition questionnaire at the initiation and completion and called weekly for 4 weeks. Ten participants were randomly assigned to the home exercise program (PedGp). PedGp received a pedometer, daily step-count goal, and were called to increase goal by 50 % weekly. All participants then underwent clomiphene stair-step ovulation induction. All study participants were referred to the University Wellness Clinic for diet and exercise counseling.ResultsThere were high percentages of women with co-morbidities in both groups including fatty liver, low vitamin D, hyperlipidemia, hypothyroidism, prediabetes and diabetes.1. Those completing the 4-week home program increased baseline steps by 21.2 % weekly. Only 3/10 women reached at least one weekly goal of 50 % increase. Although the goal was rarely met, participants who completed study had increased number of daily steps.2. Greater number in PedGp lost weight or stayed the same (5/10 vs. 2/11).3. Greater number in PedGp spontaneously ovulated (4/10 vs. 1/11) or became pregnant (4/10 vs. 3/11). (not statistically significant due to small sample size).ConclusionThere are high percentages of comorbidities in this population. Although the goal was rarely met, participants who completed study had increased number of daily steps. A greater number in PedGp lost weight or stayed the same. A greater number in PedGp spontaneously ovulated or became pregnant (not statistically significant due to small sample size). Importantly, 40 % of women who lost weight became pregnant. This is highly encouraging and suggests that the development of pedometer interventions may prove a cost effective option. Weight loss programs for this population hold promise and efficient hospital or community-based programs may prove beneficial.

The effectiveness of weight‐loss lifestyle interventions for improving fertility in women and men with overweight or obesity and infertility: A systematic review update of evidence from randomized controlled trials

“…The updated search identified eight new studies 44,45,48–53 . These eight RCTs, combined with the seven identified in our previous review 41,54–59 resulted in a total of 15 studies eligible for inclusion in the update.…”

“…Of the 15 studies, five were carried out in the USA 49,51–53,56 and two in Australia, 57,59 while the others were conducted in Canada, 55 Brazil, 54 The Netherlands, 41 Spain, 44 Italy, 58 Iran, 45 Norway, 50 and Sweden, Denmark, and Iceland 48 . Four out of the 15 were multi‐center trials 41,48,50,56 .…”

“…The lengths of the interventions ranged from 4 to 48 weeks. Ten studies evaluated diet and exercise combined, 41,44,49,52,53,55–59 two studies examined the effects of diet alone, 48,54 two focused on exercise alone 45,50 and another examined the use of a pedometer added to dietary and exercise counseling 51 . Characteristics of the studies are displayed in Data S1.…”

“…No significant differences in duration of infertility between the intervention and control groups was reported. Studies included women referred to receive fertility treatment, 44,50,51,54,59 women receiving fertility treatment 57 or both 48 . Women with PCOS and infertility were the focus of some studies 45,49,51,56,58 and were included in others 48,52,54,59 .…”

Application of a Pedometer for the Management of Impaired Glucose Tolerance in Pregnant Women

“…Walker et al showed that a 10,000 steps per day for 6 months resulted in a 3.0 cm loss in waist circumference, whereas there were no differences in body mass index among 142 subjects, including both genders [24]. The application of pedometer was examined for ovulation induction along with administration of clomiphene citrate in overweight women with polycystic ovary syndrome with greater number of spontaneous ovulation and pregnancy [25]. With respect to the effect of exercise monitored with a pedometer on carbohydrate metabolism, Huus et al showed that physical activity assessed with a pedometer in healthy schoolchildren at the age of 8 and 12 longitudinally improved insulin sensitivity and decreased fasting C-peptide irrespective of the BMI [26].…”