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Polycystic ovary syndrome, obesity and its consequences on fertility

Mr Anil Gudi, Mr Amit Shah and Prof Roy homburg

Polycystic ovary syndrome (PCOS) is the commonest female hormonal syndrome, affecting 5-10% of the female population of fertile age. It involves an over-production of male hormones by the ovaries leading to a range of symptoms including excess body and facial hair (hirsutism), acne, loss of ovulation and infertility. According to the severity of the syndrome, all or any one of these symptoms may be present. What is clear is that maternal weight has a substantial effect on the severity of the symptoms; the greater the body weight, the worse the symptoms. About 60% of women who have PCOS are obese and because of being overweight, levels of insulin are often higher than normal. This is often a key feature, genetically linked to PCOS and having a substantial effect on the chances of conceiving. Obese women are less fertile in both natural and treatment cycles and have higher rates of miscarriage than their counterparts of normal weight. Induction of ovulation in obese women requires higher doses of ovulation inducing injections.

Although obesity on its own seems to be an independent factor in the cause of subfertility and the poor outcome of treatment in general, its predominance in women with associated PCOS further complicates the issue as 80% of these women have high insulin levels. They almost inevitably have all the symptoms of PCOS. Insulin stimulates more male hormone (testosterone) production.

The successful treatment of obesity, with or without high insulin levels, is capable of reversing its deleterious effects on fertility potential. Obesity exaggerates the signs and symptoms in women with PCOS. Loss of weight can reverse this process, improve the function of the ovaries and the hormone abnormalities. Curiously, in obese women with PCOS, a loss of just 5-10% of body weight is enough to restore reproductive function in 55-100% within 6 months of weight reduction. Weight loss is thus a cheap and effective way to restore ovulation and fertility in obese women. If medication is needed to restore ovulation, it is definitely facilitated by loss of weight and when pregnancy ensues, miscarriage rates are also greatly improved by weight loss. This should be the first line of treatment in obese women with infertility due to lack of ovulation.

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