Obesity, Polycystic Ovary Syndrome, andWeight Loss. A Potential Treatment forinfertility using GLP-1 Receptor Agonists(Semiglutide and Wegovy)Obesity in western society has tripled over the last 40 years, and we know that more than 1.9billion adults were estimated as overweight in 2016, of whom over 650 million were obese.l Obesity is now one of the leading causes of premature death.l 41 million children under the age of 5 and over 340 million children and adolescents were estimatedto be overweight or obese in 2016.l Obesity will shorten the life and health expectancy of the current generation of children incomparison with earlier generations.l It also will result in PCOS and infertility.l Perhaps using GLP-1 Receptor Agonists (semiglutide) provide a new treatment to improvereproductive health, and long term health.The scientific literature has demonstrated that obesityis responsible for not only difficulty in becoming pregnant, but also long-term infertility. Many scientificpublications have confirmed that obese women havepoorer reproductive outcomes regardless of the modeof conception. They also are at higher risk of poorpregnancy outcome.A higher body mass index (BMI) (being overweight)is directly associated with poor fertility outcomes. Polycystic ovary syndrome (PCOS) is one of the leadingcauses of infertility, and many women with PCOS arecharacteristically overweight or obese.There is now a potential role for the glucagon-likepeptide-1 (GLP-1) receptor agonists (GLP-1 Rassemiglutide, liraglutide), as potential treatments forobese women with PCOS, who want to conceive.I currently prescribe metformin as a treatment forPCOS, and it can result in a 5kg weight loss. This improves the fertility rate, and pregnancy outcome. Itimproves ovulation, and lowers testosterone.Clinical researchers have now begun to assess theadministration of GLP-1 RA (mainly liraglutide) aloneor in combination with metformin in women withobesity and PCOS. Several studies demonstrated significant weight loss and testosterone reduction, butwith mixed results relative to improvements in insulinresistance parameters and menstrual patterns.However, it is clear now that the weight loss effects ofGLP-1 RA offer a unique opportunity to expand thetreatment options available to PCOS patients.Weight reduction treatment in women with PCOS orinfertilityWeight reduction has demonstrated that there is aclear benefit for women who want to conceive .Theexisting literature on the effect of weight loss in obesewomen desiring conception has shown that ovulationwas restored in 90% of women and 78% went on toconceive. Weight loss is a vital part of infertility treatment. Weight loss also improved IVF cycle outcomes.Liraglutide in PCOS.There have now been a series of scientific studieswhich have shown that short-term treatment with liraglutide either as sole treatment or with metformin,will produce significant weight loss, and improvemetabolic function in women who are either overweight or are obese with PCOS.Summary.l The weight loss effects of liraglutide offers Gynaecologists wider treatment options available for womenwith PCOS.l Weight loss will not only improve fertility outcomesbut also reduces the risk of pregnancy complications.Author - Mr Nicholas Morriswww.rapidaccessgynaecology.co.uk
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