Objectives: To evaluate the ability of preconception weight reduction and aerobic exercise intervention to improve early pregnancy loss (EPL) rate among women with polycystic ovary syndrome and affect pre-interventional (Pre-I) serum levels of kisspeptin1 (KP1) and tumor necrosis factor-α (TNF-α).
Patients & Methods: 531 PCOS women had previous EPL underwent 12-wk intervention composed of high-fiber/low calories dieting regimen plus supervised regularly increasing intensity aerobic exercise. Treatment protocol included clomiphine citrate (50 mg) twice daily since day-2 till day-6 of menstrual period and metformin oral tablets (0.5 gm three times daily). Pre-I data included determination of body mass index (BMI), estimation of fasting blood glucose (FBG), serum insulin and calculation of homeostasis model assessment for insulin resistance (HOMA-IR) and gave blood samples for later ELISA estimation of serum TNF-α and KP1 and all parameters are re-evaluated at end of intervention (Post-I). Women who got positive chemical pregnancy and negative TUV were collected as group A, women who had positive TUV signs continued their pregnancy till >12 GW were included as Group B, while women who developed EPL were grouped as Group C.
Results: Study group A-C included 56, 66 and 41 women, respectively. Post-I body weight, BMI, FBG, FSI and HOMA-IR score, and serum TNF-α and KP1 were significantly lower compared to Pre-I data with significant variance among studied groups, but in favor of women of group B. The percentage of decrease of BMI was positively correlated with the percentage of decrease of HOMA-IR and serum TNF-α and KP1 levels. Regression analysis defined high percentage of decrease in serum TNF-α as the most significant predictor for upcoming clinical pregnancy manifestations among women had positive chemical pregnancy followed by percentage of decrease in serum KP1 and BMI, while high percentages of decrease in serum KP1 and HOMA-IR were the significant predictors for continued pregnancy till 12th GW.
Conclusion: Dieting regimen and aerobic exercise allows breaking of the vicious circle of obesity, IR and high serum levels of KP1 and TNF-α mostly through reducing levels of TNF-α and KP1 in accordance with reduction of BMI and IR. |
