Randomized Controlled Trial of Preconception Interventions in Infertile Women With Polycystic Ovary Syndrome
Context: Lifestyle modification is recommended in women with polycystic ovary syndrome (PCOS) prior to conception but there are few randomized trials to support its implementation or benefit. Objective: This study aimed to determine the relative efficacy of preconception intervention on reproductive...
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| Veröffentlicht in: | The journal of clinical endocrinology and metabolism 2015-11, Vol.100 (11), p.4048-4058 |
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| creator | Legro, Richard S Dodson, William C Kris-Etherton, Penny M Kunselman, Allen R Stetter, Christy M Williams, Nancy I Gnatuk, Carol L Estes, Stephanie J Fleming, Jennifer Allison, Kelly C Sarwer, David B Coutifaris, Christos Dokras, Anuja |
| description | Context:
Lifestyle modification is recommended in women with polycystic ovary syndrome (PCOS) prior to conception but there are few randomized trials to support its implementation or benefit.
Objective:
This study aimed to determine the relative efficacy of preconception intervention on reproductive and metabolic abnormalities in overweight/obese women with PCOS.
Design, Setting, and Participants:
This was a randomized controlled trial of preconception and infertility treatment at Academic Health Centers in women with infertility due to PCOS, age 18–40 y and body mass index 27–42 kg/m2.
Intervention:
Women were randomly assigned to receive either 16 weeks of 1) continuous oral contraceptive pills (OCPs) (ethinyl estradiol 20 mcg/1 mg norethindrone acetate) (“OCP”); 2) lifestyle modification consisting of caloric restriction with meal replacements, weight loss medication (either sibutramine, or orlistat), and increased physical activity to promote a 7% weight loss (“Lifestyle”); or 3) combined treatment with both OCP and lifestyle modification (“Combined”). After preconception intervention, women underwent standardized ovulation induction with clomiphene citrate and timed intercourse for four cycles. Pregnancies were followed with trimester visits until delivery.
Main Outcome Measures:
Weight, ovulation, and live birth were measured.
Results:
We consented 216 and randomly assigned 149 women (Lifestyle: n = 50; OCP: n = 49; Combined: n = 50). We achieved significant weight loss with both Lifestyle (mean weight loss, −6.2%; 95% confidence interval (CI), −7.4–−5.0; and Combined (mean weight loss, −6.4%; 95% CI, −7.6–−5.2) compared with baseline and OCP (both P < .001). There was a significant increase in the prevalence of metabolic syndrome at the end of preconception treatment compared with baseline within OCP (odds ratio [OR, 2.47; 95% CI, 1.42–4.27) whereas no change in metabolic syndrome was detected in the Lifestyle (OR, 1.18; 95% CI, 0.63–2.19) or Combined (OR, 0.72; 95% CI, 0.44–1.17) groups. Cumulative ovulation rates were superior after weight loss: OCP, 46%; Lifestyle, 60%; and Combined, 67% (P < .05). Live birth rates were OCP, 12%; Lifestyle, 26%; and Combined, 24% (P = .13).
Conclusions:
A preconception weight loss intervention eliminates the adverse metabolic oral contraceptive effects and, compared with oral contraceptive pretreatment, leads to higher ovulation rates. |
| doi_str_mv | 10.1210/jc.2015-2778 |
| format | Article |
| fullrecord | <record><control><sourceid>pubmed_cross</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_4702450</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>26401593</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4739-922a7d854ad1aef29aea48d63a12b19c2a311aa659c6dcbbf5d5260446c89fc03</originalsourceid><addsrcrecordid>eNptUdFOHCEUJcZGt-qbzw0f4FhgmGF4MTEbbU1MNK2NvhEW7nRZWdjA7Jrt15fJtkYTeYF77znnnhwQOqXknDJKvi7MOSO0qZgQ3R6aUMmbSlAp9tGEEEYrKdjTIfqc84IQynlTH6BD1vJCkfUE-R862Lh0f8DiaQxDit6X50Ny2uPY4_sEJgYDq8HFgG_CAGkDYSwydmOjhzQ4D_gxLiHgRzfM8X30W7PNgzP4bqPTFv_cBpvK_Bh96rXPcPLvPkK_rq8ept-r27tvN9PL28pwUctKMqaF7RquLdXQM6lB8862taZsRqVhuqZU67aRprVmNusb27CWcN6aTvaG1EfoYqe7Ws-WYE0xnLRXq-SWxY6K2qn3k-Dm6nfcKC4I480ocLYTMCnmnKB_5VKixtTVwqgxdTWmXuBf3u57Bf-PuQD4DvASfUkwP_v1CyQ1B-2HuSLl8FZ01ahIaamqsSULrd7RoPyRSS7AKkHOahHXKZQAP3bzF2gUogo</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype></control><display><type>article</type><title>Randomized Controlled Trial of Preconception Interventions in Infertile Women With Polycystic Ovary Syndrome</title><source>MEDLINE</source><source>Journals@Ovid Complete</source><source>EZB-FREE-00999 freely available EZB journals</source><source>Alma/SFX Local Collection</source><source>Oxford Journals</source><creator>Legro, Richard S ; Dodson, William C ; Kris-Etherton, Penny M ; Kunselman, Allen R ; Stetter, Christy M ; Williams, Nancy I ; Gnatuk, Carol L ; Estes, Stephanie J ; Fleming, Jennifer ; Allison, Kelly C ; Sarwer, David B ; Coutifaris, Christos ; Dokras, Anuja</creator><creatorcontrib>Legro, Richard S ; Dodson, William C ; Kris-Etherton, Penny M ; Kunselman, Allen R ; Stetter, Christy M ; Williams, Nancy I ; Gnatuk, Carol L ; Estes, Stephanie J ; Fleming, Jennifer ; Allison, Kelly C ; Sarwer, David B ; Coutifaris, Christos ; Dokras, Anuja</creatorcontrib><description>Context:
Lifestyle modification is recommended in women with polycystic ovary syndrome (PCOS) prior to conception but there are few randomized trials to support its implementation or benefit.
Objective:
This study aimed to determine the relative efficacy of preconception intervention on reproductive and metabolic abnormalities in overweight/obese women with PCOS.
Design, Setting, and Participants:
This was a randomized controlled trial of preconception and infertility treatment at Academic Health Centers in women with infertility due to PCOS, age 18–40 y and body mass index 27–42 kg/m2.
Intervention:
Women were randomly assigned to receive either 16 weeks of 1) continuous oral contraceptive pills (OCPs) (ethinyl estradiol 20 mcg/1 mg norethindrone acetate) (“OCP”); 2) lifestyle modification consisting of caloric restriction with meal replacements, weight loss medication (either sibutramine, or orlistat), and increased physical activity to promote a 7% weight loss (“Lifestyle”); or 3) combined treatment with both OCP and lifestyle modification (“Combined”). After preconception intervention, women underwent standardized ovulation induction with clomiphene citrate and timed intercourse for four cycles. Pregnancies were followed with trimester visits until delivery.
Main Outcome Measures:
Weight, ovulation, and live birth were measured.
Results:
We consented 216 and randomly assigned 149 women (Lifestyle: n = 50; OCP: n = 49; Combined: n = 50). We achieved significant weight loss with both Lifestyle (mean weight loss, −6.2%; 95% confidence interval (CI), −7.4–−5.0; and Combined (mean weight loss, −6.4%; 95% CI, −7.6–−5.2) compared with baseline and OCP (both P < .001). There was a significant increase in the prevalence of metabolic syndrome at the end of preconception treatment compared with baseline within OCP (odds ratio [OR, 2.47; 95% CI, 1.42–4.27) whereas no change in metabolic syndrome was detected in the Lifestyle (OR, 1.18; 95% CI, 0.63–2.19) or Combined (OR, 0.72; 95% CI, 0.44–1.17) groups. Cumulative ovulation rates were superior after weight loss: OCP, 46%; Lifestyle, 60%; and Combined, 67% (P < .05). Live birth rates were OCP, 12%; Lifestyle, 26%; and Combined, 24% (P = .13).
Conclusions:
A preconception weight loss intervention eliminates the adverse metabolic oral contraceptive effects and, compared with oral contraceptive pretreatment, leads to higher ovulation rates.</description><identifier>ISSN: 0021-972X</identifier><identifier>EISSN: 1945-7197</identifier><identifier>DOI: 10.1210/jc.2015-2778</identifier><identifier>PMID: 26401593</identifier><language>eng</language><publisher>United States: Endocrine Society</publisher><subject>Adult ; Anti-Obesity Agents - therapeutic use ; Behavior Therapy ; Birth Rate ; Body Mass Index ; Clomiphene - pharmacology ; Combined Modality Therapy ; Diet, Reducing ; Drug Resistance ; Female ; Fertility Agents, Female - pharmacology ; Humans ; Infertility, Female - etiology ; Infertility, Female - prevention & control ; Infertility, Female - therapy ; Life Style ; Metabolic Syndrome - complications ; Metabolic Syndrome - epidemiology ; Motor Activity ; Obesity - complications ; Obesity - diet therapy ; Obesity - drug therapy ; Obesity - therapy ; Original ; Overweight - complications ; Overweight - diet therapy ; Overweight - drug therapy ; Overweight - therapy ; Ovulation Induction ; Pennsylvania - epidemiology ; Polycystic Ovary Syndrome - complications ; Polycystic Ovary Syndrome - physiopathology ; Preconception Care ; Pregnancy ; Pregnancy Rate ; Prevalence</subject><ispartof>The journal of clinical endocrinology and metabolism, 2015-11, Vol.100 (11), p.4048-4058</ispartof><rights>Copyright © 2015 by the Endocrine Society</rights><rights>Copyright © 2015 by The Endocrine Society</rights><rights>Copyright © 2015 by the Endocrine Society 2015</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4739-922a7d854ad1aef29aea48d63a12b19c2a311aa659c6dcbbf5d5260446c89fc03</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,315,781,785,886,27929,27930</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26401593$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Legro, Richard S</creatorcontrib><creatorcontrib>Dodson, William C</creatorcontrib><creatorcontrib>Kris-Etherton, Penny M</creatorcontrib><creatorcontrib>Kunselman, Allen R</creatorcontrib><creatorcontrib>Stetter, Christy M</creatorcontrib><creatorcontrib>Williams, Nancy I</creatorcontrib><creatorcontrib>Gnatuk, Carol L</creatorcontrib><creatorcontrib>Estes, Stephanie J</creatorcontrib><creatorcontrib>Fleming, Jennifer</creatorcontrib><creatorcontrib>Allison, Kelly C</creatorcontrib><creatorcontrib>Sarwer, David B</creatorcontrib><creatorcontrib>Coutifaris, Christos</creatorcontrib><creatorcontrib>Dokras, Anuja</creatorcontrib><title>Randomized Controlled Trial of Preconception Interventions in Infertile Women With Polycystic Ovary Syndrome</title><title>The journal of clinical endocrinology and metabolism</title><addtitle>J Clin Endocrinol Metab</addtitle><description>Context:
Lifestyle modification is recommended in women with polycystic ovary syndrome (PCOS) prior to conception but there are few randomized trials to support its implementation or benefit.
Objective:
This study aimed to determine the relative efficacy of preconception intervention on reproductive and metabolic abnormalities in overweight/obese women with PCOS.
Design, Setting, and Participants:
This was a randomized controlled trial of preconception and infertility treatment at Academic Health Centers in women with infertility due to PCOS, age 18–40 y and body mass index 27–42 kg/m2.
Intervention:
Women were randomly assigned to receive either 16 weeks of 1) continuous oral contraceptive pills (OCPs) (ethinyl estradiol 20 mcg/1 mg norethindrone acetate) (“OCP”); 2) lifestyle modification consisting of caloric restriction with meal replacements, weight loss medication (either sibutramine, or orlistat), and increased physical activity to promote a 7% weight loss (“Lifestyle”); or 3) combined treatment with both OCP and lifestyle modification (“Combined”). After preconception intervention, women underwent standardized ovulation induction with clomiphene citrate and timed intercourse for four cycles. Pregnancies were followed with trimester visits until delivery.
Main Outcome Measures:
Weight, ovulation, and live birth were measured.
Results:
We consented 216 and randomly assigned 149 women (Lifestyle: n = 50; OCP: n = 49; Combined: n = 50). We achieved significant weight loss with both Lifestyle (mean weight loss, −6.2%; 95% confidence interval (CI), −7.4–−5.0; and Combined (mean weight loss, −6.4%; 95% CI, −7.6–−5.2) compared with baseline and OCP (both P < .001). There was a significant increase in the prevalence of metabolic syndrome at the end of preconception treatment compared with baseline within OCP (odds ratio [OR, 2.47; 95% CI, 1.42–4.27) whereas no change in metabolic syndrome was detected in the Lifestyle (OR, 1.18; 95% CI, 0.63–2.19) or Combined (OR, 0.72; 95% CI, 0.44–1.17) groups. Cumulative ovulation rates were superior after weight loss: OCP, 46%; Lifestyle, 60%; and Combined, 67% (P < .05). Live birth rates were OCP, 12%; Lifestyle, 26%; and Combined, 24% (P = .13).
Conclusions:
A preconception weight loss intervention eliminates the adverse metabolic oral contraceptive effects and, compared with oral contraceptive pretreatment, leads to higher ovulation rates.</description><subject>Adult</subject><subject>Anti-Obesity Agents - therapeutic use</subject><subject>Behavior Therapy</subject><subject>Birth Rate</subject><subject>Body Mass Index</subject><subject>Clomiphene - pharmacology</subject><subject>Combined Modality Therapy</subject><subject>Diet, Reducing</subject><subject>Drug Resistance</subject><subject>Female</subject><subject>Fertility Agents, Female - pharmacology</subject><subject>Humans</subject><subject>Infertility, Female - etiology</subject><subject>Infertility, Female - prevention & control</subject><subject>Infertility, Female - therapy</subject><subject>Life Style</subject><subject>Metabolic Syndrome - complications</subject><subject>Metabolic Syndrome - epidemiology</subject><subject>Motor Activity</subject><subject>Obesity - complications</subject><subject>Obesity - diet therapy</subject><subject>Obesity - drug therapy</subject><subject>Obesity - therapy</subject><subject>Original</subject><subject>Overweight - complications</subject><subject>Overweight - diet therapy</subject><subject>Overweight - drug therapy</subject><subject>Overweight - therapy</subject><subject>Ovulation Induction</subject><subject>Pennsylvania - epidemiology</subject><subject>Polycystic Ovary Syndrome - complications</subject><subject>Polycystic Ovary Syndrome - physiopathology</subject><subject>Preconception Care</subject><subject>Pregnancy</subject><subject>Pregnancy Rate</subject><subject>Prevalence</subject><issn>0021-972X</issn><issn>1945-7197</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNptUdFOHCEUJcZGt-qbzw0f4FhgmGF4MTEbbU1MNK2NvhEW7nRZWdjA7Jrt15fJtkYTeYF77znnnhwQOqXknDJKvi7MOSO0qZgQ3R6aUMmbSlAp9tGEEEYrKdjTIfqc84IQynlTH6BD1vJCkfUE-R862Lh0f8DiaQxDit6X50Ny2uPY4_sEJgYDq8HFgG_CAGkDYSwydmOjhzQ4D_gxLiHgRzfM8X30W7PNgzP4bqPTFv_cBpvK_Bh96rXPcPLvPkK_rq8ept-r27tvN9PL28pwUctKMqaF7RquLdXQM6lB8862taZsRqVhuqZU67aRprVmNusb27CWcN6aTvaG1EfoYqe7Ws-WYE0xnLRXq-SWxY6K2qn3k-Dm6nfcKC4I480ocLYTMCnmnKB_5VKixtTVwqgxdTWmXuBf3u57Bf-PuQD4DvASfUkwP_v1CyQ1B-2HuSLl8FZ01ahIaamqsSULrd7RoPyRSS7AKkHOahHXKZQAP3bzF2gUogo</recordid><startdate>201511</startdate><enddate>201511</enddate><creator>Legro, Richard S</creator><creator>Dodson, William C</creator><creator>Kris-Etherton, Penny M</creator><creator>Kunselman, Allen R</creator><creator>Stetter, Christy M</creator><creator>Williams, Nancy I</creator><creator>Gnatuk, Carol L</creator><creator>Estes, Stephanie J</creator><creator>Fleming, Jennifer</creator><creator>Allison, Kelly C</creator><creator>Sarwer, David B</creator><creator>Coutifaris, Christos</creator><creator>Dokras, Anuja</creator><general>Endocrine Society</general><general>Copyright by The Endocrine Society</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>5PM</scope></search><sort><creationdate>201511</creationdate><title>Randomized Controlled Trial of Preconception Interventions in Infertile Women With Polycystic Ovary Syndrome</title><author>Legro, Richard S ; Dodson, William C ; Kris-Etherton, Penny M ; Kunselman, Allen R ; Stetter, Christy M ; Williams, Nancy I ; Gnatuk, Carol L ; Estes, Stephanie J ; Fleming, Jennifer ; Allison, Kelly C ; Sarwer, David B ; Coutifaris, Christos ; Dokras, Anuja</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4739-922a7d854ad1aef29aea48d63a12b19c2a311aa659c6dcbbf5d5260446c89fc03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Adult</topic><topic>Anti-Obesity Agents - therapeutic use</topic><topic>Behavior Therapy</topic><topic>Birth Rate</topic><topic>Body Mass Index</topic><topic>Clomiphene - pharmacology</topic><topic>Combined Modality Therapy</topic><topic>Diet, Reducing</topic><topic>Drug Resistance</topic><topic>Female</topic><topic>Fertility Agents, Female - pharmacology</topic><topic>Humans</topic><topic>Infertility, Female - etiology</topic><topic>Infertility, Female - prevention & control</topic><topic>Infertility, Female - therapy</topic><topic>Life Style</topic><topic>Metabolic Syndrome - complications</topic><topic>Metabolic Syndrome - epidemiology</topic><topic>Motor Activity</topic><topic>Obesity - complications</topic><topic>Obesity - diet therapy</topic><topic>Obesity - drug therapy</topic><topic>Obesity - therapy</topic><topic>Original</topic><topic>Overweight - complications</topic><topic>Overweight - diet therapy</topic><topic>Overweight - drug therapy</topic><topic>Overweight - therapy</topic><topic>Ovulation Induction</topic><topic>Pennsylvania - epidemiology</topic><topic>Polycystic Ovary Syndrome - complications</topic><topic>Polycystic Ovary Syndrome - physiopathology</topic><topic>Preconception Care</topic><topic>Pregnancy</topic><topic>Pregnancy Rate</topic><topic>Prevalence</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Legro, Richard S</creatorcontrib><creatorcontrib>Dodson, William C</creatorcontrib><creatorcontrib>Kris-Etherton, Penny M</creatorcontrib><creatorcontrib>Kunselman, Allen R</creatorcontrib><creatorcontrib>Stetter, Christy M</creatorcontrib><creatorcontrib>Williams, Nancy I</creatorcontrib><creatorcontrib>Gnatuk, Carol L</creatorcontrib><creatorcontrib>Estes, Stephanie J</creatorcontrib><creatorcontrib>Fleming, Jennifer</creatorcontrib><creatorcontrib>Allison, Kelly C</creatorcontrib><creatorcontrib>Sarwer, David B</creatorcontrib><creatorcontrib>Coutifaris, Christos</creatorcontrib><creatorcontrib>Dokras, Anuja</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>The journal of clinical endocrinology and metabolism</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Legro, Richard S</au><au>Dodson, William C</au><au>Kris-Etherton, Penny M</au><au>Kunselman, Allen R</au><au>Stetter, Christy M</au><au>Williams, Nancy I</au><au>Gnatuk, Carol L</au><au>Estes, Stephanie J</au><au>Fleming, Jennifer</au><au>Allison, Kelly C</au><au>Sarwer, David B</au><au>Coutifaris, Christos</au><au>Dokras, Anuja</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Randomized Controlled Trial of Preconception Interventions in Infertile Women With Polycystic Ovary Syndrome</atitle><jtitle>The journal of clinical endocrinology and metabolism</jtitle><addtitle>J Clin Endocrinol Metab</addtitle><date>2015-11</date><risdate>2015</risdate><volume>100</volume><issue>11</issue><spage>4048</spage><epage>4058</epage><pages>4048-4058</pages><issn>0021-972X</issn><eissn>1945-7197</eissn><abstract>Context:
Lifestyle modification is recommended in women with polycystic ovary syndrome (PCOS) prior to conception but there are few randomized trials to support its implementation or benefit.
Objective:
This study aimed to determine the relative efficacy of preconception intervention on reproductive and metabolic abnormalities in overweight/obese women with PCOS.
Design, Setting, and Participants:
This was a randomized controlled trial of preconception and infertility treatment at Academic Health Centers in women with infertility due to PCOS, age 18–40 y and body mass index 27–42 kg/m2.
Intervention:
Women were randomly assigned to receive either 16 weeks of 1) continuous oral contraceptive pills (OCPs) (ethinyl estradiol 20 mcg/1 mg norethindrone acetate) (“OCP”); 2) lifestyle modification consisting of caloric restriction with meal replacements, weight loss medication (either sibutramine, or orlistat), and increased physical activity to promote a 7% weight loss (“Lifestyle”); or 3) combined treatment with both OCP and lifestyle modification (“Combined”). After preconception intervention, women underwent standardized ovulation induction with clomiphene citrate and timed intercourse for four cycles. Pregnancies were followed with trimester visits until delivery.
Main Outcome Measures:
Weight, ovulation, and live birth were measured.
Results:
We consented 216 and randomly assigned 149 women (Lifestyle: n = 50; OCP: n = 49; Combined: n = 50). We achieved significant weight loss with both Lifestyle (mean weight loss, −6.2%; 95% confidence interval (CI), −7.4–−5.0; and Combined (mean weight loss, −6.4%; 95% CI, −7.6–−5.2) compared with baseline and OCP (both P < .001). There was a significant increase in the prevalence of metabolic syndrome at the end of preconception treatment compared with baseline within OCP (odds ratio [OR, 2.47; 95% CI, 1.42–4.27) whereas no change in metabolic syndrome was detected in the Lifestyle (OR, 1.18; 95% CI, 0.63–2.19) or Combined (OR, 0.72; 95% CI, 0.44–1.17) groups. Cumulative ovulation rates were superior after weight loss: OCP, 46%; Lifestyle, 60%; and Combined, 67% (P < .05). Live birth rates were OCP, 12%; Lifestyle, 26%; and Combined, 24% (P = .13).
Conclusions:
A preconception weight loss intervention eliminates the adverse metabolic oral contraceptive effects and, compared with oral contraceptive pretreatment, leads to higher ovulation rates.</abstract><cop>United States</cop><pub>Endocrine Society</pub><pmid>26401593</pmid><doi>10.1210/jc.2015-2778</doi><tpages>11</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0021-972X |
| ispartof | The journal of clinical endocrinology and metabolism, 2015-11, Vol.100 (11), p.4048-4058 |
| issn | 0021-972X 1945-7197 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_4702450 |
| source | MEDLINE; Journals@Ovid Complete; EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection; Oxford Journals |
| subjects | Adult Anti-Obesity Agents - therapeutic use Behavior Therapy Birth Rate Body Mass Index Clomiphene - pharmacology Combined Modality Therapy Diet, Reducing Drug Resistance Female Fertility Agents, Female - pharmacology Humans Infertility, Female - etiology Infertility, Female - prevention & control Infertility, Female - therapy Life Style Metabolic Syndrome - complications Metabolic Syndrome - epidemiology Motor Activity Obesity - complications Obesity - diet therapy Obesity - drug therapy Obesity - therapy Original Overweight - complications Overweight - diet therapy Overweight - drug therapy Overweight - therapy Ovulation Induction Pennsylvania - epidemiology Polycystic Ovary Syndrome - complications Polycystic Ovary Syndrome - physiopathology Preconception Care Pregnancy Pregnancy Rate Prevalence |
| title | Randomized Controlled Trial of Preconception Interventions in Infertile Women With Polycystic Ovary Syndrome |
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