In the Journals

Lifestyle intervention before fertility treatment may improve outcome in PCOS

Delaying fertility treatment in women with polycystic ovary syndrome to allow for lifestyle modification for weight loss may improve ovulation and live birth rate, according to study findings published in The Journal of Clinical Endocrinology & Metabolism.

In a secondary analysis of two randomized trials, Richard S. Legro, MD, of the department of obstetrics and gynecology at Penn State College of Medicine, M.S. Hershey Medical Center in Hershey, Pennsylvania, and colleagues evaluated data on women with PCOS and obesity from the PPCOS II trial (n = 187) and the OWL PCOS trial ( n = 142) to compare immediate treatment with clomiphene to delayed treatment with clomiphene after preconception treatment with oral contraceptives, lifestyle modification or their combination.

Richard Legro

Richard S. Legro

Participants of the PPCOS II trial received immediate treatment with clomiphene and participants from the OWL PCOS trial received preconception after treatment with lifestyle modification or a combination of oral contraceptives and lifestyle modification.

Participants from the OWL PCOS trial in the lifestyle and combined groups had a 2.5-fold increase in the number of live births compared with women who received immediate treatment with clomiphene in the PPCOS II trial (P = .01). Compared with the immediate treatment in PPCOS II, the lifestyle (P = .003) and combined groups (P < .001) from OWL PCOS had a 1.4-fold increase in cumulative ovulation rate. No significant differences in live birth or ovulation rates were observed in participants from OWL PCOS who received preconception treatment with oral contraceptives and participants with immediate clomiphene treatment from PPCOS II. Similarly, no difference existed for pregnancy loss between any of the groups.

Compared with the first ovulation induction cycle in PPCOS II, the lifestyle group in OWL PCOS had an improved chance of pregnancy and live birth in the first ovulation induction cycle. Compared with immediate treatment in PPCOS II, the ovulation rate was significantly improved in the first, second and fourth ovulation induction cycles in the combined group in OWL PCOS; similarly, the lifestyle group in OWL PCOS had improved chances of ovulation in the first and fourth ovulation induction cycles compared with immediate treatment in PPCOS II.

“Our research holds significant implications for current practice and supports the concept of delaying fertility treatment to pursue lifestyle modification in overweight/obese women with PCOS,” the researchers wrote. “It provides momentum to test this concept more completely and prospectively in properly designed and adequately powered multicenter studies to generate level I evidence for practice. Future studies may also want to utilize other ovulation induction agents in the infertility treatment phase, such as low-dose gonadotropin or letrozole, which tend to have greater success rates combined with comparable rates of multiple pregnancy and congenital anomalies as clomiphene.” – by Amber Cox

Disclosure: Legro reports various financial ties with Astra Zeneca, Clarus Therapeutics, Euro screen, Ferring, Kindex and Takeda. Please see the full study for a list of all other authors’ relevant financial disclosures.

Delaying fertility treatment in women with polycystic ovary syndrome to allow for lifestyle modification for weight loss may improve ovulation and live birth rate, according to study findings published in The Journal of Clinical Endocrinology & Metabolism.

In a secondary analysis of two randomized trials, Richard S. Legro, MD, of the department of obstetrics and gynecology at Penn State College of Medicine, M.S. Hershey Medical Center in Hershey, Pennsylvania, and colleagues evaluated data on women with PCOS and obesity from the PPCOS II trial (n = 187) and the OWL PCOS trial ( n = 142) to compare immediate treatment with clomiphene to delayed treatment with clomiphene after preconception treatment with oral contraceptives, lifestyle modification or their combination.

Richard Legro

Richard S. Legro

Participants of the PPCOS II trial received immediate treatment with clomiphene and participants from the OWL PCOS trial received preconception after treatment with lifestyle modification or a combination of oral contraceptives and lifestyle modification.

Participants from the OWL PCOS trial in the lifestyle and combined groups had a 2.5-fold increase in the number of live births compared with women who received immediate treatment with clomiphene in the PPCOS II trial (P = .01). Compared with the immediate treatment in PPCOS II, the lifestyle (P = .003) and combined groups (P < .001) from OWL PCOS had a 1.4-fold increase in cumulative ovulation rate. No significant differences in live birth or ovulation rates were observed in participants from OWL PCOS who received preconception treatment with oral contraceptives and participants with immediate clomiphene treatment from PPCOS II. Similarly, no difference existed for pregnancy loss between any of the groups.

Compared with the first ovulation induction cycle in PPCOS II, the lifestyle group in OWL PCOS had an improved chance of pregnancy and live birth in the first ovulation induction cycle. Compared with immediate treatment in PPCOS II, the ovulation rate was significantly improved in the first, second and fourth ovulation induction cycles in the combined group in OWL PCOS; similarly, the lifestyle group in OWL PCOS had improved chances of ovulation in the first and fourth ovulation induction cycles compared with immediate treatment in PPCOS II.

“Our research holds significant implications for current practice and supports the concept of delaying fertility treatment to pursue lifestyle modification in overweight/obese women with PCOS,” the researchers wrote. “It provides momentum to test this concept more completely and prospectively in properly designed and adequately powered multicenter studies to generate level I evidence for practice. Future studies may also want to utilize other ovulation induction agents in the infertility treatment phase, such as low-dose gonadotropin or letrozole, which tend to have greater success rates combined with comparable rates of multiple pregnancy and congenital anomalies as clomiphene.” – by Amber Cox

Disclosure: Legro reports various financial ties with Astra Zeneca, Clarus Therapeutics, Euro screen, Ferring, Kindex and Takeda. Please see the full study for a list of all other authors’ relevant financial disclosures.