Comparing QOL Among Women With Infertility, PCOS, Obesity


Results of a secondary analysis indicate anxiety, depression, physical quality of life (QOL), and sexual function in obese infertile woman with polycystic ovary syndrome (PCOS) seem to be more related to obesity rather than PCOS status.

Polycystic ovary syndrome (PCOS) is associated with impaired mental quality of life (QOL) among women with obesity and a history of infertility, according to a cross-sectional analysis of a follow-up of a randomized controlled trial.

However, findings published in Human Reproduction Open also revealed anxiety, depression, physical QOL, and sexual function in obese infertile woman with PCOS seem to be more related to obesity rather than PCOS status, researchers said.

PCOS is estimated to affect between 5% and 20% of all reproductive-age women worldwide, and studies have suggested the syndrome and its associated symptoms can have a negative effect on mental health.

As some previous research on women with PCOS has been confounded by the presence of obesity and infertility, the investigators sought to determine whether mental health and sexual function differ between women with or without PCOS who have a comparable body mass index (BMI) and fertility characteristics.

Using data from a study conducted in The Netherlands, initially carried out between 2009 and 2012, the researchers assessed information from over 100 women aged 18 to 39 years. All participants had infertility and a BMI ≥29 kg/m2, and they were randomized to either a lifestyle intervention plus infertility treatment or immediate infertility treatment.

The main goal of the lifestyle intervention—which consisted of an energy-restricted diet, increased exercise, and other factors—was “a weight reduction of at least 5% of their initial bodyweight, or a reduction in BMI below 29 kg/m2 within the intervention period of 6 months,” the authors wrote.

Five years following randomization, participants completed a follow-up evaluation on physical, mental, dietary, and physical activity health measures.

Of the initially enrolled 577 women, 173 returned completed questionnaires after a mean 5.5 years of follow-up. However, “of these, 30 women did not have intercourse in the past 4 weeks and were therefore excluded from the analyses as we could not compute an McCoy Female Sexuality Questionnaire total score,” the authors wrote. Seventy-three women with PCOS and 100 ovulatory and anovulatory women without PCOS were included in the final analysis.

The researchers found the following:

  • Symptoms of anxiety and depression, physical QOL, and sexual function did not differ significantly between obese women with and without PCOS
  • Women with PCOS had a worse mental QOL summary component score (−3.60; 95% CI, −6.72 to −0.56), mainly due to a lower score on the subscale "role limitations due to emotional problems" (−12.41; 95% CI, −22.78 to −2.28) compared with women without PCOS
  • Compared with an age-matched Dutch reference population, the obese infertile women with and without PCOS both scored lower on most physical and mental QOL subscales

The average participant age was 34.7 while the average BMI was measured at 34.5 kg/m2.

“Role limitations due to emotional problems hamper women to optimally function in terms of work, social interactions, self-care, and mobility and may thus importantly affect their wellbeing even while physical functioning itself was not impaired,” the authors explained.

Findings indicate that a high BMI and infertility serve as important factors impairing physical and mental QOL with and without PCOS and “that PCOS is an additional factor in lowering mental QOL,” they added.

The additional hormonal imbalance leading to anovulation seen in women with PCOS may also lead to a higher experienced burden on daily activities.

The cross-sectional nature of the original study precludes conclusions relating to causality, marking a limitation, while no power analysis was performed for outcomes in the current review of data. The study was also conducted in a relatively small sample size.

“We cannot rule out that PCOS as a diagnosis and main factor of infertility in a couple gives an additional burden to the mental QOL in these women. Clinicians therefore may want to pay attention to the psychosocial dimension of PCOS,” the researchers concluded. “Future studies should validate our findings in a group of women with and without PCOS with matched BMIs and infertility histories.”


Karsten MDA, Wekker V, Groen H, et al. The role of PCOS in mental health and sexual function in women with obesity and a history of infertility. Hum Reprod Open. Published online October 22, 2021. doi:10.1093/hropen/hoab038

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