Association of moderate obesity with a poor pregnancy outcome in women with polycystic ovary syndrome treated with low dose gonadotrophin

Abstract

Objective To assess the effect of moderate obesity on the outcome of induction of ovulation with low dose gonadotrophin in women with polycystic ovary syndrome (PCOS). Design Retrospective analysis of women with PCOS treated consecutively. An analysis of the impact of obesity on outcome of pregnancy using data from the North West Thames Regional (NWTR) obstetric database was included for comparison. Setting Induction of ovulation clinic at the Samaritan Hospital for Women (St. Mary's Hospital Group). Subjects 100 women with clomiphene‐resistant anovulation associated with PCOS. 75 were of normal weight (BMI 19–24. 9 kg/m2, lean group) and 25 were moderately overweight (BMI 25–27.9 kg/m2, obese group). Interventions Induction of ovulation using low doses of gonadotrophins with small, stepwise increments in dosage as required. Main outcome measures Rates of ovulation, pregnancy and miscarriage; daily and total doses of gonadotrophin required for induction of ovulation. Results The proportion of ovulatory cycles was significantly greater in the lean group (77%) compared with the obese group (57%) (χ2 9.8, P<0.001). Obese women required larger doses of gonadotrophin to achieve ovulation (P <0.001). The proportion of women who achieved at least one pregnancy was similar in the two groups (39%vs 48%) but miscarriage was more frequent in the obese group (60%vs 27%; P<0.05). This difference was independent of the baseline and/or mid‐follicular luteinizing hormone (LH) concentration either before or during treatment. Analysis of data from the North West Thames Health Region obstetric database confirmed an increased risk of miscarriage in moderately obese women which was independent of maternal age. Conclusions Moderate obesity in women with PCOS, treated with low dose gonadotrophin, is associated with an increased risk of miscarriage. This is reflected in the results of analysis of the effect of obesity on outcome of pregnancy in the general population. It is therefore important to encourage weight reduction in obese women with PCOS before considering therapy to induce ovulation.

Cosmetic Surgery as Intrasexual Competition: The Mediating Role of Social Comparison

“…The popularity of these elective procedures is not surprising given that symmetrical and attractive facial features and a healthy BMI and waist-to-hip ratio have been linked to health and reproductive viability (e.g., Hamilton-Fairley et al, 1992;Rhodes et al, 2005;Rhodes et al, 2001;Singh, 1993), and are also signs of physical attractiveness (Shackelford & Larsen, 1999;Tovée & Cornelissen, 2001). Researchers have observed that individuals often compete with members of the same sex on mating-relevant dimensions that are valued by the opposite sex (Buss, 1988), suggesting that cosmetic surgery may be, in part, a function of intrasexual competition.…”

“…For instance, men's facial attractiveness correlates with both sperm morphology and motility (Soler et al, 2003), and both men and women with attractive faces may be healthier than their less attractive counterparts (Shackelford & Larsen, 1999). Similarly, body size and shape are important cues to women's fertility status (Hamilton-Fairley, Kiddy, Watson, & Franks, 1992;Singh, 1993) and likelihood of miscarriage (Metwally, Ong, Ledger, & Li, 2008). Various dimensions of physical attractiveness have therefore been linked to mating success indices.…”

Resistin levels of serum and follicular fluid in non-obese patients with polycystic ovary syndrome during IVF cycles

“…Ovulation induction with gonadotrophins in obese PCOS women required higher doses than in lean PCOS women, the rate of ovulatory cycles was lower and incidence of miscarriage was higher in obese women (Hamilton-Fairley et al, 1992;Fridstrom et al, 1997). However, insulin resistance was thought neither to be related to hormone levels nor to the IVF outcome.…”

Manipulation of Human Ovarian Function: Physiological Concepts and Clinical Consequences*

“…Obesity frequently coincides with PCOS, and differences in pharmacokinetic characteristics of gonadotropin preparations (283), as well as clinical outcome (284,285) related to body weight, have been reported. Moreover, other concomitant endocrine disorders such as hyperprolactemia or adrenal hyperandrogenemia may also affect treatment outcome.…”