Lifestyle intervention before and during fertility treatment in women with obesity or overweight with PCOS - a RCT.

Abstract

Lifestyle interventions are recommended for women with obesity and infertility, but trial evidence is scarce, and none investigated interventions that continues during fertility treatment. Evaluate the effectiveness of a lifestyle intervention compared with usual care on fertility outcomes in women with obesity and infertility. The Obesity-Fertility Randomized controlled trial, stratified for PCOS status. Academic fertility clinic. 127 women aged 18-40 years with infertility and obesity (body mass index ≥30 kg/m2, or ≥27 kg/m2 with polycystic ovary syndrome (PCOS)), excluding those unlikely to conceive naturally. The intervention group (IG) received a 6-month lifestyle intervention alone (individual follow-up with a dietician and kinesiologist, and group sessions) before adding fertility treatments. The control group (CG) received usual fertility care directly. Live birth conceived within 18 months of randomization. Compared to CG, the IG lost more weight (-3.21±4.73% vs. -0.40±3.66%, p=0.003) and waist circumference (-2.62±4.46cm vs. -0.23±3.81cm, p=0.01) at 6 months. The live-birth rate was 44.4% in the IG (n=63) vs. 35.9% in the CG (n=64) (risk ratio (RR) (95%CI)=1.24 (0.81-1.90)). In the IG vs. CG, clinical pregnancy rates were 52.4% vs. 37.5% (RR=1.40 (0.94-2.07)) and natural pregnancy rates were 27.0% vs. 12.5% (RR=2.16 (1.01-4.64)). Compared with usual care, a lifestyle intervention alone for 6 months and then combined with fertility treatments did not increase the 18-month rate of pregnancies leading to a live birth, but significantly increased natural pregnancy rates, potentially reducing the need for costly assisted reproduction in this population.