Objectives: To evaluate the impact of weight reduction and changes in lifestyle compared to
insulin sensitizers used alone or in combination with lifestyle changes on the ovulatory function
of polycystic ovary syndrome (PCOS) women
Patients & Methods: Ninety clomiphene citrate (CC) resistant PCOS women were randomly
allocated into three equal groups: Group A received oral CC 50 mg twice daily on Days 2–6 of a
menstrual period and metformin oral 0.5 gm tablets trice daily, Group B assigned to undergo
dieting regimen and changing lifestyle towards increased energy expenditure and received no
medications and Group C assigned to undergo dieting regimen in conjunction with
metformin/CC combination treatment. All patients underwent transvaginal ultrasonographic
examination and body height and weight measurements and calculation of body mass index
(BMI). Fasting blood glucose (FBG), fasting plasma insulin (FPI) levels were estimated and
hormone profile was obtained. Insulin resistance (IR) was measured using Matthews
homeostasis model assessment (HOMA) with the HOMA-IR score >2 was considered as insulin
resistant. At end of 3 months, BMI and HOMA-IR scores were re-evaluated and ovulation was
considered the primary outcome and reduction of BMI and HOMA-IR scores as secondary
outcome.
Results: Sixty-three women got ovulation with ovulatory success rate of 86.7% in group C,
76.7% in group A and 46.7% in group B with significantly higher ovulatory success rate in
groups A and C compared to group B and non-significantly higher rate in group C compared to
group A. All applied therapeutic strategies effectively reduced body weight and BMI with
significant reduction of BMI grades in association with significant reduction of FBG and FPI
levels and significant reduction of HOMA-IR score and number of women with IR score>2.
These effects were marvelous in group C with superior outcome followed by group B and lastly
group A
Conclusion: Obesity and insulin resistance have inhibitory effect on ovarian function and
reproductive life of PCOS women and combined pharmacotherapy and weight reduction
regimens associated with changes in lifestyle towards increased energy expenditure induces
weight loss and improves insulin sensitivity with subsequent induction of ovulation