scholarly journals Obesity, Polycystic Ovary Syndrome, and Infertility: A New Avenue for GLP-1 Receptor Agonists

2020 ◽  
Vol 105 (8) ◽  
pp. e2695-e2709 ◽  
Author(s):  
Hellas Cena ◽  
Luca Chiovato ◽  
Rossella E Nappi
Keyword(s):  
Weight Loss ◽  
Polycystic Ovary Syndrome ◽  
Polycystic Ovary ◽  
Therapeutic Option ◽  
Evidence Synthesis ◽  
Treatment Options ◽  
Obese Women ◽  
Ovary Syndrome ◽  
Receptor Agonists ◽  
Increased Risk

Abstract Context Obesity is responsible for an increased risk of sub-fecundity and infertility. Obese women show poorer reproductive outcomes regardless of the mode of conception, and higher body mass index (BMI) is associated with poorer fertility prognosis. Polycystic ovary syndrome (PCOS) is one of the leading causes of infertility, and many women with PCOS are also overweight or obese. Evidence Acquisition The aim of the present narrative review is to describe the mechanisms responsible for the development of infertility and PCOS in women with obesity/overweight, with a focus on the emerging role of glucagon-like peptide-1 (GLP-1) receptor agonists (GLP-1 RAs) as a therapeutic option for obese women with PCOS. Evidence synthesis Weight reduction represents the most significant factor affecting fertility and pregnancy outcomes. Current experimental and clinical evidence suggests the presence of an underlying pathophysiological link between obesity, GLP-1 kinetic alterations, and PCOS pathogenesis. Based on the positive results in patients affected by obesity, with or without diabetes, the administration of GLP-1 RA (mainly liraglutide) alone or in combination with metformin has been investigated in women with obesity and PCOS. Several studies demonstrated significant weight loss and testosterone reduction, with mixed results relative to improvements in insulin resistance parameters and menstrual patterns. Conclusions The weight loss effects of GLP-1 RA offer a unique opportunity to expand the treatment options available to PCOS patients.

scholarly journals A review of therapeutic options for managing the metabolic aspects of polycystic ovary syndrome

2020 ◽  
Vol 11 ◽  
pp. 204201882093830 ◽  
Author(s):  
Mohammed Altigani Abdalla ◽  
Harshal Deshmukh ◽  
Stephen Atkin ◽  
Thozhukat Sathyapalan
Keyword(s):  
Insulin Resistance ◽  
Weight Loss ◽  
Polycystic Ovary Syndrome ◽  
Polycystic Ovary ◽  
Therapeutic Options ◽  
Reproductive Age ◽  
Obese Women ◽  
Cardiovascular Risk Reduction ◽  
Ovary Syndrome ◽  
Incretin Mimetics

Polycystic ovary syndrome (PCOS) is a common endocrine disorder in women of reproductive age. Metabolic sequelae associated with PCOS range from insulin resistance to type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). Insulin resistance plays a significant role in the pathophysiology of PCOS and it is a reliable marker for cardiometabolic risk. Although insulin sensitising agents such as metformin have been traditionally used for managing metabolic aspects of PCOS, their efficacy is low in terms of weight reduction and cardiovascular risk reduction compared with newer agents such as incretin mimetics and SGLT2 inhibitors. With current pharmaceutical advances, potential therapeutic options have increased, giving patients and clinicians more choices. Incretin mimetics are a promising therapy with a unique metabolic target that could be used widely in the management of PCOS. Likewise, bariatric procedures have become less invasive and result in effective weight loss and the reversal of metabolic morbidities in some patients. Therefore, surgical treatment targeting weight loss becomes increasingly common in the management of obese women with PCOS. Newer emerging therapies, including twincretins, triple GLP-1 agonists, glucagon receptor antagonists and imeglemin, are promising therapeutic options for treating T2DM. Given the similarity of metabolic and pathological features between PCOS and T2DM and the variety of therapeutic options, there is the potential to widen our strategy for treating metabolic disorders in PCOS in parallel with current therapeutic advances. The review was conducted in line with the recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome 2018.

scholarly journals Dietary Options in Polycystic Ovary Syndrome (PCOS)

2017 ◽  
Vol 23 (2) ◽  
Author(s):  
Hafsa Kamran ◽  
Maria Aslam ◽  
Shaista Jabeen
Keyword(s):  
Polycystic Ovary Syndrome ◽  
Intervention Program ◽  
Polycystic Ovary ◽  
Glycemic Load ◽  
Energy Restriction ◽  
Moderate Physical Activity ◽  
Obese Women ◽  
Ovary Syndrome ◽  
Female Population ◽  
Increased Risk

Abstract Poly Cystic Ovary Syndrome is the hormonal imbalance that is by and large considered to affect more or less 10% of the female population. PCOs is more common in obese and overweight women, which further increases androgen secretion causing impaired metabolism and reproductive functions. Women with PC-OS are at increased risk of developing cardiovascular diseases, dyslipidemias, hypertension and type II diabetes Mellitus. Weight reduction is difficult to achieve in obese women with PCOS than normal individuals. So a comprehensive lifestyle intervention program including individualized diet with moderate energy restriction based on basic healthy eating principles, at least 30 minutes moderate physical activity 3-5 days a week and behavior modification approach is required. Hypocaloric diets along with modification of carbohydrates have found to be effective. Selection of foods among low glycemic load (GL) and high fiber foods and replacing fats with polyunsaturated fats may be a helpful strategy in PCOS patients. Keywords:  Polycystic Ovary Syndrome (PCOS), Obesity, Insulin Resistance, Diet.

scholarly journals A Narrative Review of Placental Contribution to Adverse Pregnancy Outcomes in Women With Polycystic Ovary Syndrome

2019 ◽  
Vol 104 (11) ◽  
pp. 5299-5315 ◽  
Author(s):  
Angela S Kelley ◽  
Yolanda R Smith ◽  
Vasantha Padmanabhan
Keyword(s):  
Insulin Resistance ◽  
Polycystic Ovary Syndrome ◽  
Pregnancy Complications ◽  
Polycystic Ovary ◽  
Evidence Synthesis ◽  
Developmental Programming ◽  
Androgen Excess ◽  
Ovary Syndrome ◽  
Increased Risk ◽  
Adverse Pregnancy

Abstract Context Polycystic ovary syndrome (PCOS) is the most common endocrinopathy of reproductive-aged women. In pregnancy, women with PCOS experience increased risk of miscarriage, gestational diabetes, preeclampsia, and extremes of fetal birth weight, and their offspring are predisposed to reproductive and cardiometabolic dysfunction in adulthood. Pregnancy complications, adverse fetal outcomes, and developmental programming of long-term health risks are known to have placental origins. These findings highlight the plausibility of placental compromise in pregnancies of women with PCOS. Evidence Synthesis A comprehensive PubMed search was performed using terms “polycystic ovary syndrome,” “placenta,” “developmental programming,” “hyperandrogenism,” “androgen excess,” “insulin resistance,” “hyperinsulinemia,” “pregnancy,” and “pregnancy complications” in both human and animal experimental models. Conclusions There is limited human placental research specific to pregnancy of women with PCOS. Gestational androgen excess and insulin resistance are two clinical hallmarks of PCOS that may contribute to placental dysfunction and underlie the higher rates of maternal–fetal complications observed in pregnancies of women with PCOS. Additional research is needed to prevent adverse maternal and developmental outcomes in women with PCOS and their offspring.

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