Bachmann Annette, Weidlinger Susanna, von Wolff Michael, Bitterlich Norman, Karn Thomas, Estermann Julia, Sourouni Marina, Stute Petra
Division of Gynaecological Endocrinology and Reproductive Medicine, Department of Gynaecology and Obstetrics, University Hospital Frankfurt, Frankfurt, Germany.
Division of Gynaecological Endocrinology and Reproductive Medicine, University Hospital Inselspital, Bern, Switzerland.
Arch Gynecol Obstet. 2025 Mar;311(3):851-859. doi: 10.1007/s00404-024-07916-1. Epub 2025 Jan 25.
Polycystic ovary syndrome (PCOS) is a common endocrine disorder in women of reproductive age, often leading to anovulatory infertility. Obesity exacerbates the reproductive, metabolic and psychological features of PCOS, making fertility treatment and patient satisfaction difficult. Despite guidelines from the European Society of Human Reproduction and Embryology (ESHRE) emphasizing lifestyle modifications and specific treatments, there remains a significant gap in adherence to these guidelines by both healthcare providers and patients.
A cross-sectional online survey was conducted from 1 January to 14 March 2021 among PCOS patients in Germany, Austria and Switzerland. A non-standardized, non-validated questionnaire covering several aspects of reproductive health was distributed via online channels. Data were analyzed using descriptive statistics, chi-squared tests, Student's t-tests and Jonckheere-Terpstra tests, with significance set at p < 0.05.
Out of 2029 participants, 1902 completed the fertility questionnaire. Of these, 73.9% perceived their fertility to be impaired, with this perception being higher in obese women (80.8% vs. 67.4%, p < 0.001). The analysis focused on 564 childless women with a current desire to have children, 67.0% of whom met WHO criteria for infertility. Obese women (BMI ≥ 30 kg/m) reported lower satisfaction with fertility treatment (40.9 vs. 47.8, p = 0.009) and were less likely to receive fertility treatment (56.7% vs. 75.8%, p < 0.001). Despite recommendations, only 34.1% reported lifestyle changes as part of their treatment. Letrozole, the recommended first-line treatment, was underused (14.6%) and clomiphene citrate was more commonly prescribed (35.4%). Obese women reported fewer current pregnancies (4% vs. 13.9%, p < 0.001) and were more likely to be infertile for more than one year (77.0% vs. 53.0%, p < 0.001). They also expressed a greater desire for possibilities to ask more questions about PCOS and fertility and to undergo more infertility tests. (56.1% vs. 45.3%, p = 0.013; 69.4% vs. 59.8%, p = 0.020).
Fertility management in PCOS patients, especially in obese patients, shows significant gaps in adherence to recommended guidelines, highlighting the need for improved patient education, professional training and individualized treatment strategies. Improved health care is essential to address reproductive concerns and improve outcomes in this population.
多囊卵巢综合征（PCOS）是育龄期女性常见的内分泌紊乱疾病，常导致无排卵性不孕。肥胖会加重PCOS的生殖、代谢和心理特征，给生育治疗和患者满意度带来困难。尽管欧洲人类生殖与胚胎学会（ESHRE）的指南强调生活方式的改变和特定治疗方法，但医疗服务提供者和患者在遵循这些指南方面仍存在显著差距。
2021年1月1日至3月14日，对德国、奥地利和瑞士的PCOS患者进行了一项横断面在线调查。通过在线渠道分发了一份涵盖生殖健康多个方面的非标准化、未经验证的问卷。使用描述性统计、卡方检验、学生t检验和琼克尔-特普斯特拉检验对数据进行分析，显著性设定为p < 0.05。
在2029名参与者中，1902人完成了生育问卷。其中，73.9%的人认为自己的生育能力受损，肥胖女性的这种认知更高（80.8%对67.4%，p < 0.001）。分析集中在564名目前想要孩子的未育女性身上，其中67.0%符合世界卫生组织的不孕症标准。肥胖女性（BMI≥30 kg/m²）对生育治疗的满意度较低（40.9对47.8，p = 0.009），接受生育治疗的可能性也较小（56.7%对75.8%，p < 0.001）。尽管有相关建议，但只有34.1%的人报告将生活方式改变作为治疗的一部分。推荐的一线治疗药物来曲唑使用不足（14.6%），而枸橼酸氯米芬的处方更为常见（35.4%）。肥胖女性目前的怀孕次数较少（4%对13.9%，p < 0.001），不孕超过一年的可能性更大（77.0%对53.0%，p < 0.001）。她们还表达了更强烈的愿望，希望有更多机会询问有关PCOS和生育的问题，并接受更多的不孕症检查（56.1%对45.3%，p = 0.013；69.4%对59.8%，p = 0.020）。
PCOS患者，尤其是肥胖患者的生育管理在遵循推荐指南方面存在显著差距，这凸显了改善患者教育、专业培训和个体化治疗策略的必要性。改善医疗保健对于解决该人群的生殖问题和改善治疗结果至关重要。
