Impact of Obesity on Ovulatory Functions in Polycystic Ovarian Syndrome
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- Category: Vol. 81, December 2013
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Impact of Obesity on Ovulatory Functions in Polycystic Ovarian Syndrome, AHMED AL-SAWAF and EMAN A. HUSSEIN
Abstract
Background: Indeed the impact of obesity on female infertility is a topic of increasing importance in modern gynecological practice and extensive research is needed to reach well defined guidelines. In this current work the effect of obesity on ovulatory functions in pco was evaluated in 80 PCO patients attending the infertility outpatient clinic of Kasr Al-Aini Hospital.
Patients and Methods: 80 PCO patients were selected according a restricted inclusion and exclusion criteria from Kasr Al-Aini infertility clinic in the period from July 2011 to March 2012, then divided into three groups according to BMI; Group (A) 38 patients with BMI <30Kg/m2, Group (B) 24 patients with BMI 30-35kg/m2, Group (C) 18 patients with BMI 35-40kg/m2. Ovulatory function in the three groups was evaluated by folliculometry and day 21 progesterone. Basal hormonal profile on day 2 of the cycle (FSH, LH, E2, PRL and TSH) was also evaluated and statistically analyzed.
Results: The results showed significant difference in the level of basal LH and prolactin (p-value <0.05) between the three groups; there was an inverse correlation between obesity and basal LH. PRL level was also significantly higher in the non obese groups. There was no significant difference in the level of basal FSH, E2 nor TSH. As regards to ovulatory functions; non obese group showed better ovulatory perfor-mance especially when monitored by day 21 progesterone (18.4% compared to 5.5% in the morbidly obese group).
Conclusion: Obesity in PCO seems to increases the risk for anovulation most probably through the disruption of HPO axis by hyperandrogenism, and/or insulin resistance. Leptin may play a role through its direct effect on folliculogenesis. Weight reduction in PCO may improve ovulatory performance. Monitoring ovulation by folliculometry alone may not reflect accurate ovarian response and addition of day 21 progesterone should be considered to improve evaluation. Further studies and RCTs are needed to justify this conclusion.