User:MAUCSF/sandbox

Women
Management for obese women with PCOS follows a relatively step-wise approach, but can be individualized based on the person and their unique needs.

Weight loss is normally the first option for overweight women with PCOS. Multiple studies have illustrated the marked improvement in endocrine profile, menstrual cycle, rate of ovulation, and likelihood of healthy pregnancy amongst women who have lost weight.9 It should be noted that the amount weight lost does not need to be drastic in order for women to reap the aforementioned benefits; indeed, with even only a 5% decrease in total body weight can lead to increased insulin-sensitivity and ovulation restoration. Thus, for overweight women with anovulation and PCOS, lifestyle modifications are important, and are very often an integral part of the treatment plan to relieve PCOS symptoms. These lifestyle modifications may include increased exercise and a diverse diet composed of fruits, vegetables, low-fat products, and lean meats.

Following weight loss are insulin-sensitizing drugs. This class of drugs is the main therapy for women who experience irregular cycles, and want to improve their fertility. One example of an insulin-sensitizing drug is Metformin, which works by inhibiting the liver’s production of glucose. The decrease in available glucose leads to less insulin secretion, and thereby increases insulin-sensitivity in cells. A systematic review of Metformin illustrated that it benefits women with PCOS in a myriad of ways: decreasing body insulin concentrations, lowering androgen levels, aiding in ovulation, and increasing positive reproductive outcomes.

Even for women looking to utilize medications, weight loss should be encouraged to increase the likelihood of ovulation and ovarian response. In the United Kingdom, weight loss is advised for overweight women with PCOS, preferably to a body mass index of less than 30, before initiating drugs for ovarian stimulation.10 Another study on Metformin is more lenient, and suggests that women with obesity and PCOS should defer treatment with Metformin until achieving a body mass index of 35 or less. Treatment mointoring is more difficult in obese women because the ovaries become more difficult to see on ultrasound scans, potentially leading to oversight of multiple ovulations and pregnancies. Additionally, drugs like Metformin may be less effective in women with anovulation and extreme obesity, although this situation may simply justify a higher dose to be efficacious.12

Bariatric surgery - procedures that target the stomach and intestines for weight loss - is another option for obese women with PCOS. A small study of 17 women with PCOS revealed that a vast majority improved upon undergoing either biliopancreatic diversion or laparoscopic bypass. Additionally, other metabolic parameters - including insulin sensitivity and blood pressure - also improved in these women.

Men
Obesity in males leads to negative repercussions in fertility, sperm function, and overall health of the offspring. Fortunately, the effects of obesity on male fertility can be reversed.

Losing weight has been shown to yield numerous beneficial results; doing so can alter misaligned BMI statuses, and can correct metabolic disturbances associated with increased weight, ultimately decreasing the amount of oxidative stress and DNA damage. It should be noted that there is currently limited evidence for the effect of weight loss on semen-associated factors. Weight loss can be achieved through lifestyle modifications, which include options like a reduced caloric diet, regular exercise, and quitting smoking. In a randomized control trial of obese men, it was observed that increased physical activity and reduced caloric intake led to improvement in erectile dysfunction. Bariatric surgery is another option to improve sexual function in overweight men. In a randomized trial, bariatric surgery reduced BMI significantly more than lifestyle modifications, and ultimately led to a reversal in both erectile dysfunction and hypogonadism.

Trained healthcare professionals and weight loss groups may also be beneficial. People struggling to keep to these lifestyle changes may seek the help of medications like Orlistat or weight loss surgery.

Testosterone therapy may improve hormone imbalances and treat erectile dysfunction. While nearly two-thirds of urologists indicated that they used empirical testosterone therapy for idiopathic male infertility, the efficacy of these agents remains controversial, with particular concerns about the cardiovascular safety profile. Aromatase inhibitors - such as Letrozole - can be used in place of testosterone to overcome reduced testosterone levels commonly found in obese men. However, aromatase inhibitors are not without their own risks as well; there are concerns surrounding long-term aromatase inhibitor therapy due to its effect on bone health.