Behavioral Modification Improves Fertility in Polycystic Ovary Syndrome

Behavioral modification intervention has demonstrated efficacy in improving fertility among women with obesity with polycystic ovary syndrome (PCOS), according to study results recently published in Clinical Endocrinology; however, substantial weight loss remained difficult to achieve through behavioral modification intervention

This randomized controlled trial included 68 adult women between 18 and 40 years old with PCOS and a body mass index >27 kg/m². Participants were randomly assigned 1:1 to either a behavioral modification intervention program or a control for 4 months. Follow-up was completed at one year.

Despite a number of participants expressing a wish to conceive, all used nonhormonal contraception throughout the 4-month study period. The primary outcome was an improvement in menstrual regularity, defined as a shift from either amenorrhea or oligomenorrhea to regular cycles or from amenorrhea to oligomenorrhea. The χ² test was used to analyze changes within and between the 2 groups for categorical variables.

The intervention group had a 2.1% decrease in weight over the 4-month study period (P =.002) whereas the control group had a nonsignificant 1.0% decrease. Menstrual regularity showed greater improvement in the intervention group (59%) than the control group (24%; mean difference, 35% [95% CI, 16%-60%]; P =.003). Ovulation rates did not differ significantly between groups, although improvement in menstrual function was predicted solely by intervention (odds ratio 3.9; 95% CI, 1.3-11.9).

At the 1-year follow-up, after both groups had received 4 months of intervention, 54% of all participants showed improvements in menstrual function compared with baseline and 43% had both a regular menstrual cycle and were ovulating compared with baseline rates of 0% (P =.000 for both). Pregnancy was achieved by 38% of women who wished to conceive.

Although the study was possibly limited by a 16% 4-month dropout rate and a 31% 1-year dropout rate, 5 of 21 who left did so because of pregnancy, which was likely a positive outcome of the intervention.

The study researchers conclude that “extensive weight loss can be difficult to achieve in obese women with [polycystic ovary syndrome] through behavioral modification intervention; however, this type of intervention can help to reduce weight, improve menstrual function, and potentially improve the chances of conceiving. We propose behavioral modification intervention as one of the first line treatments in [women with obesity] with PCOS where improved fertility rather than substantial weight loss is the main concern. For improvements in metabolic outcomes, lifestyle intervention needs to be maintained long term.”

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Reference

Oberg E, Gidlöf S, Jakson I, et al. Improved menstrual function in obese women with polycystic ovary syndrome after behavioral modification intervention – a randomized controlled trial [published online December 19, 2018]. Clin Endocrinol (Oxf). doi:10.1111/cen.13919