Review article: The impact of obesity on reproduction in women with polycystic ovary syndrome
Abstract
The polycystic ovary syndrome (PCOS) is one of the most common causes of infertility due to anovulation in women. The clinical features of PCOS are heterogeneous and may change throughout the lifespan, starting from adolescence to postmenopausal age. This is largely dependent on the influence of obesity and metabolic alterations, including an insulin-resistant state and the metabolic syndrome, which consistently affect most women with PCOS. Obesity does in fact have profound effects on both the pathophysiology and the clinical manifestation of PCOS, by different mechanisms leading to androgen excess and increased free androgen availability and to alterations of granulosa cell function and follicle development. Notably, simple obesity per se represents a functional hyperandrogenic state. These mechanisms involve early hormonal and metabolic factors during intrauterine life, leptin, insulin and the insulin growth factor system and, potentially, the endocannabinoid system. Compared with normal weight women with PCOS, those with obesity are characterised by a worsened hyperandrogenic and metabolic state, poorer menses and ovulatory performance and, ultimately, poorer pregnancy rates. The importance of obesity in the pathogenesis of PCOS is emphasised by the efficacy of lifestyle intervention and weight loss, not only on metabolic alterations but also on hyperandrogenism, ovulation and fertility. The increasing prevalence of obesity among adolescent and young women with PCOS may partly depend on the increasing worldwide epidemic of obesity, although this hypothesis should be supported by long-term prospective epidemiological trials. This may have great relevance in preventive medicine and offer the opportunity to expand our still limited knowledge of the genetic and environmental background favouring the development of the PCOS.
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Obesity is the major risk factor for polycystic ovary syndrome.
“obesity is the major risk factor for polycystic ovary syndrome (PCOS).”
From Overweight, obesity and excessive weight gain in pregnancy as risk factors for adverse pregnancy outcomes: A narrative review (2022) · cites this paper as [27]
The cause of fertility problems in PCOS is elevated androgen concentrations, secondary to insulin resistance.
“The cause of fertility problems in PCOS is elevated androgen concentrations, although this is secondary to insulin resistance. 27”
From Overweight, obesity and excessive weight gain in pregnancy as risk factors for adverse pregnancy outcomes: A narrative review (2022) · cites this paper as [27]
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- Authors
- Pasquali, R., Gambineri, A., & Pagotto, U.
- Affiliations
- IRCCS Azienda Ospedliero-Universitaria di Bologna Policlinico di Sant'Orsola (IT)
- Corresponding author
- Pasquali, R
- Venue
- BJOG: An International Journal of Obstetrics & Gynaecology
- Publisher
- Wiley
- Published
- 2006-08-10
- Volume
- 113
- Issue
- 10
- Pages
- 1148-1159
- ISSN
- 0306-5456 (ISSN-L)
- 1470-0328
- 1471-0528
- OpenAlex
- W2089391845
- Cited by
- 359
- References
- 11
- Citations by year
- 2026: 6 · 2025: 23 · 2024: 13 · 2023: 11 · 2022: 14 · 2021: 22 · 2020: 15 · 2019: 12 · 2018: 20 · 2017: 15 · 2016: 17 · 2015: 23 · 2014: 26 · 2013: 11 · 2012: 34
- FWCI
- 3.71
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- BJOG An International Journal of Obstetrics & Gynaecology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Ovarian function and disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Biology and Fertility
- Keywords
- polycystic ovary syndrome, obesity, female infertility, anovulation, insulin resistance, metabolic syndrome, hyperandrogenism, free androgen index, folliculogenesis, leptin, insulin-like growth factor, endocannabinoid system, pregnancy rate, weight loss, lifestyle intervention, adolescent obesity, PCOS pathogenesis
- MeSH terms
- Adipose Tissue, Adult, Female, Humans, Infertility, Female, Insulin Resistance, Male, Menstruation Disturbances, Obesity, Phenotype, Polycystic Ovary Syndrome, Pregnancy, Prenatal Exposure Delayed Effects, Hyperandrogenism, Leptin, Cannabinoid Receptor Modulators
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