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Box 1.  

  • Increased frequency of anovulatory cycles and infertility compared with normal-weight patients
  • Higher incidence of blunted responsiveness to pharmacological treatments to induce ovulation and reduced pregnancy rate [44-46].
  • Lower embryo quality and decreased rate of implantation by IVF treatment [47-50].
  • Greater risk of miscarriage [54-56].
  • Higher risk of gestational diabetes [66].

Impact of Obesity on Reproduction in Women With Polycystic Ovary Syndrome


Polycystic Ovary Syndrome, Obesity and Reproductive Implications

  • Authors: Angelica Lindén Hirschberg, MD, PhD
  • CME Released: 8/24/2009
  • Valid for credit through: 8/24/2010
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Target Audience and Goal Statement

This activity is intended for primary care clinicians, obstetricians and gynecologists, endocrinologists, and other specialists who care for women.

The goal of this activity is to review the clinical criteria for diagnosing polycystic ovary syndrome and its complications and management strategies.

Upon completion of this activity, participants will be able to:

  1. Describe the diagnostic criteria for polycystic ovary syndrome (PCOS)
  2. Identify clinical consequences of androgen excess in women with PCOS
  3. Describe long-term risks associated with PCOS
  4. Describe the effects of PCOS on pregnancy outcomes
  5. Describe the effect of metformin on PCOS


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  • Angelica Lindén Hirschberg, MD, PhD

    Department of Woman & Child Health, Division of Obstetrics & Gynecology, Karolinska Institutet, Stockholm, Sweden


    Disclosure: Angelica Lindén Hirschberg, MD, PhD, has disclosed no relevant financial relationships.


  • Elisa Manzotti

    Editorial Director, Future Science Group, London, United Kingdom


    Disclosure: Elisa Manzotti has disclosed no relevant financial relationships.

CME Author(s)

  • Désirée Lie, MD, MSEd

    Clinical Professor, Family Medicine, University of California, Orange; Director, Division of Faculty Development, UCI Medical Center, Orange, California


    Disclosure: Désirée Lie, MD, MSEd, has disclosed no relevant financial relationships.

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Polycystic Ovary Syndrome, Obesity and Reproductive Implications

Authors: Angelica Lindén Hirschberg, MD, PhDFaculty and Disclosures

CME Released: 8/24/2009

Valid for credit through: 8/24/2010


Abstract and Introduction


Polycystic ovary syndrome (PCOS) is one of the most common causes of female infertility, affecting 5-10% of women of reproductive age. The syndrome is characterized by anovulation, hyperandrogenism and polycystic ovaries. Furthermore, PCOS is associated with insulin resistance and obesity, which is present in approximately 50% of women with PCOS. Reproductive function in women with PCOS is strongly dependent on bodyweight and metabolic status. Obesity is associated with an increased risk of infertility and may also have a negative influence on pregnancy outcome. Considering the worldwide epidemic of obesity, clinical problems relating to PCOS may worsen and increase in frequency. Lifestyle interventions resulting in weight loss comprise the most successful strategy to improve symptoms of PCOS. However, many patients fail to lose weight or may quickly regain weight. It is an important challenge to develop effective lifestyle programs and adjuvant pharmacologic treatments in order to improve reproductive and metabolic health among women with PCOS.


Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders in women of fertile age, affecting 5-10% of the female population. The syndrome is characterized by chronic anovulation, hyperandrogenism, polycystic ovaries and decreased fertility.[1] PCOS is furthermore associated with insulin resistance, accumulation of abdominal fat and obesity (BMI >30 kg/m2), which is present in approximately 50% of women with PCOS.[2-3] It is well known that reproductive function in women with PCOS is strongly dependent on bodyweight and the metabolic status of the patient. In the long term, PCOS is associated with an increased risk of Type 2 diabetes, cardiovascular disease, dyslipidemia and endometrial cancer.[1] Therefore, the syndrome is recognized as having a major impact throughout life on the gynecological and metabolic health of women.

Polycystic ovary syndrome is a heterogeneous disorder that presents with a spectrum of symptoms and manifestations that vary over time. This leads to difficulties in diagnosing the syndrome. The diagnostic criteria for PCOS were revised at an International Expert Conference in Rotterdam in 2003.[4] According to the Rotterdam criteria, diagnosis of PCOS requires at least two of the three following features:[4]

  • Oligo-/anovulation;
  • Clinical and/or biochemical hyperandrogenism;
  • Polycystic ovaries on ultrasound.

However, this definition has been criticized owing to the fact that it broadens the population of women who will meet the criteria for PCOS, since it includes women with regular menses who also have polycystic ovaries. Furthermore, hyperandrogenism is not required for the diagnosis. Recently, the Androgen Excess Society recommended that PCOS should be considered a disorder of androgen excess and that the original NIH criteria of 1990 should be accepted with some modifications.[5] Thus, the criteria for a PCOS diagnosis are still under debate.

The etiology of PCOS is largely unknown, even though the syndrome was first described in 1935 by Stein and Leventhal.[6] Several etiological factors have been postulated, including genes involved in androgen and/or insulin actions, androgen programming in utero, as well as environmental factors.[7] There is strong evidence that PCOS has a genetic background, which is supported by increased familiar occurrence and by twin studies.[7-9] However, so far, no single gene defect has been identified and, therefore, PCOS is more likely to be a poly-genetic disorder. Experimental animal models have demonstrated that prenatal exposure to androgens is associated with many of the features typical of PCOS, such as abnormal luteinizing hormone secretion, hyperandrogenism, anovulation, abdominal adiposity and insulin resistance in adult life.[10] However, the clinical relevance of this hypothesis remains to be elucidated. Furthermore, it has been hypothesized that insulin resistance is a socioecological adaptation to behavioral changes in reproductive and lifestyle habits.[11] Overweight and obesity are of particular importance for the development of PCOS.[12]

A major concern for women with PCOS is decreased fertility, which is aggravated by obesity and metabolic aberrations. This review will focus on the association between PCOS and obesity and the mechanisms by which obesity influences reproductive function and pregnancy outcome in women with PCOS.

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