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Polycystic Ovary Syndrome
decrease in visceral adiposity over the 12-month period. Comparable improving the likelihood of becoming pregnant. Compliance with
improvement in menstrual function was noted in both groups in the first weight-loss regimens is, however, a widely recognized problem and was
six months. Interestingly, this study also included a group of subjects noted in many of the studies. Fortunately, there is evidence that small to
randomized to metformin and flutamide (n=20); these women had moderate amounts of weight loss improve reproductive, endocrine, and
significant improvement in menstrual cyclicity up to 12 months. metabolic profiles in women with PCOS. However, we urgently need
studies in women with PCOS that answer the following questions: does
From these three randomized trials, it appears that lifestyle modifications weight loss improve pregnancy and live birth rates, and would lifestyle
along with metformin therapy for at least six months improves body fat interventions with or without metformin be more effective in a particular
distribution, insulin sensitivity, and menstrual function. There may be BMI range? Given the difficulties with achieving and maintaining weight
beneficial effects of metformin beyond those explained by weight loss loss, studies using pharmacotherapy as an adjunct to hypocaloric diets
alone. In fact, prolonged dietary changes may be associated with a are also urgently needed in this population. The combination of lifestyle
decrease in visceral adiposity rather than a decrease in BMI, with an modification and pharmacotherapy results in greater weight loss than
overall positive effect on metabolic and reproductive end-points. either alone. In counseling these patients, one must emphasize the
positive impact of weight loss beyond the reproductive system, including
Conclusion lower obstetric risks and a reduction in the long-term risk of diabetes,
This article suggests that weight loss is a simple, cost-effective way of hypertension, hyperlipidemia, and coronary artery disease. ■
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12 FERTILITY TREATMENT REVIEW
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