Obesity in western society has tripled over the last 40 years, and we know that more than 1.9 billion adults were estimated as overweight in 2016, of whom over 650 million were obese.

• Obesity is now one of the leading causes of premature death.
• 41 million children under the age of 5 and over 340 million children and adolescents were estimated to be overweight or obese in 2016.
• Obesity will shorten the life and health expectancy of the current generation of children in comparison with earlier generations.
• It also will result in PCOS and infertility.
• Perhaps using GLP-1 Receptor Agonists (semiglutide) provide a newtreatment to improve reproductive health, and long term health.

The scientific literature has demonstrated that obesity is responsible for not only difficulty in becoming pregnant, but also long-term infertility. Many scientific publications have confirmed that obese women have poorer reproductive outcomes regardless of the mode of conception. They also are at higher risk of poor pregnancy outcome.

A higher body mass index (BMI) (being overweight) is directly associated with poor fertility outcomes. Polycystic ovary syndrome (PCOS) is one of the leading causes of infertility, and many women with PCOS are characteristically overweight or obese.

There is now a potential role for the glucagon-like peptide-1 (GLP-1) receptor agonists (GLP-1 Ras semiglutide, liraglutide), as potential treatments for obese women with PCOS, who want to conceive.

I currently prescribe metformin as a treatment for PCOS, and it can result in a a 5kg weight loss. This improves the fertility rate, and pregnancy outcome. It improves ovulation, and lowers testosterone.

Clinical researchers have now begun to assess the administration of GLP-1 RA (mainly liraglutide) alone or in combination with metformin in women with obesity and PCOS. Several studies demonstrated significant weight loss and testosterone reduction, but with mixed results relative to improvements in insulin resistance parameters and menstrual patterns.

However, it is clear now that he weight loss effects of GLP-1 RA offer a unique opportunity to expand the treatment options available to PCOS patients.

Weight reduction treatment in women with PCOS or infertility

Weight reduction has demonstrated that there is a clear benefit for women who want to conceive .The existing literature on the effect of weight loss in obese women desiring conception has shown that ovulation was restored in 90% of women and 78% went on to conceive. 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 studies which have shown that short-term treatment with liraglutide either as sole treatment or with metformin, will produce significant weight loss, and improve metabolic function in women who are either overweight or are obese with PCOS.

Summary.

• The weight loss effects of liraglutide offers Gynaecologists wider treatment options available for women with PCOS.
• Weight loss will not only improve fertility outcomes but also reduces the risk of pregnancy complications.