Obstetrics and Gynaecology, Department of Obstetrics and Gynaecology, University of Thessaly, School of Health Sciences, Faculty of Medicine, 41110 Larissa, Greece.
Embryology, Department of Obstetrics and Gynaecology, University of Thessaly, School of Health Sciences, Faculty of Medicine, 41110 Larissa, Greece.
Best Pract Res Clin Obstet Gynaecol. 2015 May;29(4):479-88. doi: 10.1016/j.bpobgyn.2014.11.001. Epub 2014 Nov 12.
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.
大约 50% 的多囊卵巢综合征 (PCOS) 患者肥胖。PCOS 中的肥胖通过多种机制影响生殖。高雄激素血症、黄体生成素 (LH) 增加和胰岛素抵抗起着关键作用。脂肪组织产生的几种物质，包括瘦素、脂联素、抵抗素和内脂素，可能在 PCOS 的病理生理学中发挥作用。PCOS 中的不孕与无排卵有关。为了诱导排卵，枸橼酸氯米芬和人绒毛膜促性腺激素分别是一线和二线治疗药物。其他治疗方法包括使用胰岛素增敏剂，如二甲双胍，以及芳香化酶抑制剂和腹腔镜卵巢打孔术，而体外受精是最后的手段。肥胖会对 PCOS 的不孕治疗产生不利影响。建议肥胖妇女在尝试怀孕前改变饮食和生活方式。抗肥胖药物和减肥手术在 PCOS 中的应用需要进一步评估。
