Polycystic ovaries and obesity

• Obesity is one of the main characteristics of the polycystic ovary syndrome.
• Several substances secreted by the adipose tissue may participate in the pathophysiology of the syndrome.
• Obesity adversely affects the outcome of infertility treatment in anovulatory women with PCOS.
• Diet and lifestyle changes are recommended in obese women with PCOS.
• The use of anti-obesity drugs and bariatric surgery require further evaluation.

Almost 50% of the women with polycystic ovary syndrome (PCOS) are obese. Obesity in PCOS affects reproduction via various mechanisms. Hyperandrogenism, increased luteinizing hormone (LH) and insulin resistance play a pivotal role. Several substances produced by the adipose tissue including leptin, adiponectin, resistin and visfatin may play a role in the pathophysiology of PCOS. Infertility in PCOS is related to anovulation. For induction of ovulation, clomiphene citrate and human gonadotrophins are first- and second-line treatments, respectively. Other treatment modalities include the use of insulin sensitizers, such as metformin as well as aromatase inhibitors and laparoscopic ovarian drilling, while in vitro fertilization is the last resort. Obesity can adversely affect infertility treatment in PCOS. Diet and lifestyle changes are recommended for the obese women before they attempt conception. The use of anti-obesity drugs and bariatric surgery in PCOS require further evaluation.