Pretherapy fitness effort may up pregnancies in women with PCOS

By David Douglas

NEW YORK (Reuters Health) - Overweight and obese women with polycystic ovary syndrome (PCOS) who concentrate on fitness and weight loss before embarking on infertility treatment are more likely to become pregnant, according to a post-hoc analysis of two randomized trials.

As Dr. Richard S. Legro told Reuters Health by email, "compared to going right into infertility treatment . . . taking some time off to lose weight and improve fitness has ultimately twice the chance of a baby."

"Focusing on overall health," he added, "improves reproductive health."

In a paper online May 12 in the Journal of Clinical Endocrinology & Metabolism, Dr. Legro of Penn State University College of Medicine, Hershey, and colleagues note that they recently demonstrated a significant benefit of lifestyle modification on ovulation in overweight and obese women.

To gain specific information on fertility, the team compared outcome of two of their earlier trials involving infertile overweight and obese women aged 18 to 40 years with PCOS.

One trial (PPCOS II) enrolled 187 women who had immediate treatment with clomiphene. The other (OWL PCOS) in 142 women, was conducted concurrently, and delayed treatment with clomiphene until completion of continuous oral contraceptive or lifestyle modifications or both.

In PPCOS II, after four cycles of clomiphene the cumulative per cycle ovulation rate was 44.7% and the cumulative live birth rate was 10.2%. This was almost identical to the 45.0% and 8.5% seen in the oral contraceptive pretreatment arm of the OWL PCOS trial.

Thus, say the researchers, "Pretreatment with oral contraceptives likely has little effect on the ovulation and live birth rate compared with immediate treatment."

In OWL PCOS, deferred clomiphene treatment preceded by lifestyle modification offered a better cumulative ovulation rate (62.0%; risk ratio compared with PPCOS II, 1.4; p=0.003). This was also the case for combined treatment (64.3%; RR, 1.4; p

The live birth rate was also significantly improved in the lifestyle group and the combination group (25.0% and 25.5%, respectively). This amounted to a risk ratio of 2.5 for both of these interventions (p=0.01).

The outcome of lifestyle modification, the researchers conclude, "provides momentum to test this concept more completely and prospectively in properly designed and adequately powered multicenter studies to generate Level I evidence for the practice."

Commenting on the findings by email, Dr. Alex J. Polotsky, of the University of Colorado Denver, told Reuters Health "concerns about age-related fertility decline are always present when women are advised to delay fertility treatment for any reason. This needs to be counterbalanced against the benefits of weight loss and lifestyle modifications in women with high body mass, including women with PCOS. Weight loss prior to fertility treatment in obese women will only become a standard of care if the evidence of benefits is clear."

Dr. Polotsky, who directs the Reproductive Endocrinology and Infertility Fellowship, added that the researchers "present one the very first pieces of evidence that fertility outcomes appear to be improved following weight loss and lifestyle modifications. These findings are encouraging and should be followed up by a dedicated, specifically designed study with a head-to-head comparison of the impact of weight loss and lifestyle modifications versus expectant management on fertility and chances of livebirth."

"This," he said, "is a step in the right direction!"

SOURCE: https://bit.ly/1TObCop

J Clin Endocrinol Metab 2016.