A Comprehensive Review of Infertility Outcomes Associated with Obesity and Polycystic Ovary Syndrome (PCOS)

Polycystic ovarian syndrome (PCOS) is one of the most prevalent endocrine conditions affecting women of reproductive age, and it is among the main causes of anovulatory infertility. The prevalence of PCOS is approximated to be between 6 and 15% worldwide based on the diagnostic criteria. The distinguishing characteristics of PCOS include polycystic ovarian morphology, chronic anovulation, and hyperandrogenism, characteristically linked with metabolic dysfunction and insulin resistance. Studies have shown that up to 80% of women with PCOS are overweight or obese, pointing to the greater prevalence of obesity, notably visceral fat accumulation. In cases where obesity and PCOS coexist, they considerably exacerbate both metabolic and reproductive phenotypes. Obesity negatively impacts infertility due to its interference in folliculogenesis, endometrial receptivity, and the hypothalamic-pituitary-ovarian (HPO) axis. When PCOS and obesity coexist, they aggravate hyperinsulinemia, insulin resistance, and hyperandrogenism, resulting in severe anovulatory cycles, reduced oocyte quality and implantation rates, along with greater susceptibility to miscarriage. Moreover, reduced pregnancy rates, increased demand for ART, and adverse pregnancy outcomes, such as gestational diabetes and pre-eclampsia, are correlated with obese women with PCOS. Current understanding of the relationship between obesity, PCOS, and infertility is summarized in this review. This review article evaluates the pathophysiological processes connecting these conditions, examines the clinical data supporting their association, and analyzes medical interventions. To conclude, it analyzes the adoption of precision medicine, newer biomarkers, and metabolic therapies as a future approach to facilitate fertility outcomes in obese women with PCOS.