Good News for Those with Polycystic Ovarian Syndrome

Women suffering from infertility related to polycystic ovarian syndrome (PCOS) will be heartened to hear the results of a recently published, well-designed study from Pennsylvania State University that weight loss and regular exercise can help them improve their chances of having children.

PCOS, a common cause of female infertility, is a hormonal disorder in which cysts form on the ovaries (unfertilized eggs). The condition can cause women’s bodies to produce excess male hormones and not provide a woman’s body with enough female hormones for the eggs in her ovaries to mature, thus interfering with ovulation. Symptoms of this hormonal disorder may manifest as excessive growth of body hair, acne, weight gain, and irregular periods.

In this study, 149 infertile overweight or obese PCOS patients between the ages of 18-40 were randomly assigned to one of three treatment groups for 16 weeks consisting of:

1. Continuous birth control pills

2. Lifestyle modification consisting of caloric restriction with meal replacements, behavior modification, weight loss medication (for those with a BMI of at least 30 kg/m2), and increased physical activity to promote a 7% weight loss, OR

3. Combined treatment with both birth control pills and lifestyle modification.

Caloric restriction consisted of prescribed diets centered on meal replacement items which included prepared entrees for breakfast, lunch, and dinner and two servings of fruit, three servings of vegetables and two servings of skim milk each day for a total caloric intake of 12,000 calories per day for participants between 120-170 lbs., 1500 calories per day for those weighing 175-215 lbs., 1800 calories per day for those weighing 220-245 lbs., and 2000 calories per day for those weighing 250-300 lbs.

Increased physical activity consisted of brisk walking or similar aerobic activity five days per week, beginning with 10 minutes per day and gradually building over the four month period to 30-35 minutes per day.

After the preconception intervention, women underwent standard ovulation induction with Clomid and timed intercourse for four cycles. Meal replacements were discontinued and participants were advised to maintain their weight and level of activity from the preconception period.

Pregnancies were followed with trimester visits until delivery.

Birth rates were as follows: 10% of the birth control group, 26% of the lifestyle modification group, and 24% of the combination group gave birth to a baby.

It has often been recommended that women take birth control pills for several months before trying to get pregnant as a way to boost their female hormones and regulate their ovulation. The thinking was that this would improve their odds of success once they stopped taking the oral contraceptives and started trying to conceive. However, in this study, in addition to the lower pregnancy rates, the researchers found that women taking oral contraceptives alone also demonstrated worsened metabolic profiles. Metabolic syndrome is a cluster of symptoms including high blood sugar that has been linked to fertility challenges as well as heightened risk for problems such as heart disease and diabetes.

The present study was too small to demonstrate a statistically significant difference in the outcomes between the two groups who dieted and exercised. If future research confirms the findings of the present study that physical activity and a healthy diet improves fertility for women with PCOS, giving serious consideration to making lifestyle changes may be beneficial for women diagnosed with PCOS. Unfortunately, however, weight loss and lifestyle modification is difficult for many, especially for those not having the option of meal replacements. Counseling and support may help make this goal more attainable to patients with PCOS, perhaps saving them the heartbreak and expense of infertility and its treatment.

Reference:

Legro, RS, Dodson, WC, Kris-Etherton, PM, Kunselman, AR, Stetter, CM et al. Randomized controlled trial of preconception interventions in infertile women with polycystic ovary syndrome. J Clin Endocrinol Metab, 2015. Sep 24:jc20152778. [Epu