Polycystic ovary syndrome (PCOS) is a syndrome characterized by ovulation disorders, hyperandrogenicity, and polycystic ovary changes. It is a common gynecological endocrine disease with main clinical manifestations of follicular development disorders, hyperinsulinemia, and excessive androgen. It belongs to the categories of menstrual abnormalities, oligomenorrhea, amenorrhea, infertility, etc. About 50% of patients are related to obesity. Obese PCOS disease is currently one of the refractory diseases. The main causes are hyperinsulinemia and insulin resistance. The incidence rate is high among women of childbearing age, which is an important reason for menstrual disorders and infertility. Polycystic ovary syndrome accounts for 50% to 70% of anovulatory infertility and is one of the common infertility factors. For obese polycystic ovary patients with fertility needs, the most important concern is how to easily conceive. Can you make a test tube if necessary?

Obesity is one of the important external manifestations of PCOS. Data shows that 54% of PCOS patients have an obese constitution (body mass index≥ 30 kg/m2), with the majority being abdominal obesity. Some scholars believe that the metabolic disorder and endocrine disorder of obese PCOS patients are more serious than those of non obese patients, and are more likely to induce cardiovascular disease, type 2 diabetes and breast cancer.

Obesity can lead to an increase in androgen production in PCOS patients, while the accumulation of abdominal and visceral fat can further lead to hyperandrogenism. The mechanism of insulin resistance in PCOS patients includes a decrease in adiponectin levels, which is an insulin sensitizer secreted by adipose tissue and is directly related to androgen levels. Insulin resistance leads to an increase in compensatory insulin levels, known as hyperinsulinemia. Hyperinsulinemia reduces the secretion of liver sex hormone binding globulin and insulin-like growth factor binding protein, increases the availability of testosterone and insulin-like growth factor to target tissues, and stimulates the secretion of androgens by the ovaries and adrenal glands. Visceral adipose tissue also secretes other regulatory factors, such as adiponectin and cytokines, which directly affect adrenal and ovarian function. Therefore, obesity leads to a more pronounced pathological increase in androgens, insulin resistance, and hyperinsulinemia in PCOS.

PCOS patients often experience menstrual cycle changes, long-term or intermittent anovulation, and obesity exacerbates anovulation, leading to infertility. Obesity, especially abdominal obesity, exacerbates clinical and biochemical levels, as well as hyperandrogenism, which has a negative impact on the reproduction and metabolism of PCOS. Compared to normal weight PCOS women, 60% of obese PCOS patients are more likely to experience menstrual disorders and infertility.

How can obese patients with polycystic ovary syndrome easily conceive?

1. Adjustment and intervention of lifestyle.

Patients with polycystic ovary syndrome often experience hyperandrogenism and hyperinsulinemia, which lead to obesity in the majority of patients with polycystic ovary syndrome. But not all patients have insulin resistance or hyperinsulinemia. Therefore, fat and thin cysts often appear in clinical practice. For patients with insulin resistance in Kaohsiung, lifestyle intervention is the first choice for treatment.

In many polycystic patients, insulin resistance leads to potential diabetes. Although their fasting blood sugar is not high, their postprandial blood sugar levels are unstable. The main purpose of controlling the amount and type of diet is to ensure the stability of postprandial blood sugar in polycystic ovary patients. Therefore, improving insulin resistance and daily life intervention are first-line treatments.

We should strengthen the monitoring of patients' blood sugar and blood lipids, exercise appropriately to lose weight, promptly correct hyperandrogenism, improve insulin resistance, cultivate a good life, and implement effective dietary control.

2. The method of assisted pregnancy with polycystic ovary.

After adopting lifestyle interventions to lose weight and reduce male fertility, most patients can naturally ovulate and conceive. However, some patients have poor implementation of lifestyle interventions and are unable to resume ovulation on their own. So for this group of patients, active ovulation promotion and pregnancy assistance measures can be taken.

In the selection of ovulation promotion and pregnancy assistance plans, oral ovulation promoting drugs such as clomiphene citrate and letrozole are preferred. If the ovaries have no response or resistance, further intramuscular injection of gonadotropin can be chosen to promote ovulation. The complications of gonadotropin ovulation are multiple pregnancies and ovarian hyperstimulation.

After undergoing treatment, ovulation still fails, or after pregnancy, in vitro fertilization is also the ultimate choice for women with polycystic ovary syndrome. Among numerous ovulation disorders, the pregnancy rate of in vitro fertilization (IVF) in polycystic ovary (PCO) patients is relatively high, as the retrieval rate of PCO patients is not an issue. Frozen embryo transfer can not only avoid further development of ovarian hyperstimulation, but also improve the pregnancy rate.