Spontaneous pregnancy rates after the weight loss program in infertile PCOS women with obesity

Abstract Study question What is the spontaneous pregnancy rate in infertile polycystic ovary syndrome (PCOS) women with obesity after the weight loss program in womoen who achieve ≥ 5% BMI reduction? Summary answer Spontaneous pregnancy rate in infertile PCOS women is 29.4 % after the end of the weight loss program and reduction of BMI for ≥ 5%. What is known already PCOS affects 6 to 15% of reproductive age women and is the most common cause of anovulatory infertility. Twenty-five to 75 % of women with PCOS are overweight (BMI >25 kg/m2) or obese (BMI >30 kg/m2). Obesity aggravates symptoms of PCOS. Women with obesity and women with PCOS have lower spontaneous and IVF pregnancy rates. Pregnant women with PCOS and obesity have higher incidence of pregnancy-associated complications. Weight reduction of even 5% improves metabolic and hormonal profile as well as reproductive functions and weight reduction through lifestyle modification is the treatment of choice for overweight and obese women with PCOS. Study design, size, duration Twenty-seven infertile PCOS women with BMI >30 kg/m2 were prospectively included to the study. They attended a weight loss program prior to inclusion to IVF procedures. The program lasted for 8-12 consecutive weeks. Participants/materials, setting, methods Twenty-seven infertile women, aged less than 38 years, with PCOS and obesity were prospectively included to the weight loss program. The program consisted of lifestyle modifications (diet with daily caloric deficit) and physical exercise. Group trainings were held twice a week and were designed as circuit interval trainings. Individual aerobic activity (walking, brisk walking, cycling, walking up the hill) were also performed twice a week. Main results and the role of chance All women completed the prescribed weight loss program. Mean body weight before the program (106.43 kg ± 15.09 kg) was significantly (p < 0.001) higher than after the program (100.63 kg ± 14.67 kg). Mean BMI prior to the start was 37.65 ± 5.1 kg/m2 and after the end of the program 35.68 ± 4.9 kg/m2. The difference was statistically significant (p < 0.001). Of 27 included women, 17 (62.9 %) achieved the desirable BMI reduction of ≥ 5%. Of women who reduced their BMI by ≥ 5%, 5 (29.4 %) conceived spontaneously in three months after the end of the weight loss program. All other were included to IVF procedures. Besides weight loss, significantly more women reported on having healthier eating habits, started to exercise regularly, and improved their sleep after the end of the weight loss program. Limitations, reasons for caution The limitation of the present study is a relatively small sample size. Wider implications of the findings Weight loss represents an important approach towards treatment of obese infertile PCOS women prior to inclusion to IVF procedures. Almost 30 % of women who achieved the desirable BMI reduction conceived spontaneously. They were therefore spared of IVF procedures which has a beneficial health, psychological as well as financial impact. Trial registration number NCT04989244