Tham is 1.7 m tall and weighs 93 kg, with a body mass index (BMI) of 32, classifying her as obese. Dr. Tran Ngoc Van Anh, from the Fertility Center at Tam Anh General Hospital - District 8, diagnosed her with polycystic ovary syndrome (PCOS) through an ultrasound.

Dr. Anh explained that these two conditions create a vicious cycle, where obesity both causes and exacerbates PCOS. In obese individuals, increased fatty tissue secretes estrogen, creating an imbalance with other hormones (FSH, LH) produced by the brain. This hormonal imbalance disrupts follicle development, leading to irregular menstrual cycles (Tham's periods lasted 60-90 days) and anovulation (lack of ovulation). This is a significant factor contributing to her difficulty conceiving.

Obesity and PCOS also contribute to insulin resistance and disruptions in sugar and fat metabolism. Furthermore, high blood insulin levels stimulate the ovaries and adrenal glands to produce more male hormones (androgens), resulting in ovulation disorders and androgenic symptoms like acne and hair loss.

Dr. Anh advised Tham to lose weight first to improve her menstrual cycle and increase the chances of natural conception. However, she opted for intrauterine insemination (IUI) combined with dietary adjustments and light exercise.

During the first IUI cycle, oral medication to stimulate her ovaries was ineffective, requiring a switch to low-dose injections. She developed too many follicles after the injections, so the cycle was stopped to avoid multiple pregnancies and ovarian hyperstimulation syndrome. "Obesity combined with PCOS creates unpredictable ovarian responses, resistant to mild stimulation yet overly sensitive to strong stimulation," Dr. Anh explained.

In the second IUI cycle, the doctor doubled the oral medication dosage and combined it with low-dose injections for 7 days to gradually nurture follicle growth. This resulted in one mature follicle. The doctor successfully retrieved fresh sperm from her husband and performed the IUI. Tham is now more than 12 weeks pregnant.

The doctor warned that Tham has a higher risk of gestational diabetes, hypertension, and preeclampsia. She needs to avoid excessive weight gain during the first trimester, limiting total pregnancy weight gain to 5-9 kg, carefully monitoring her diet, and attending regular prenatal checkups.

Dr. Van Anh performs an ultrasound on a patient. *Illustrative photo: Tam Anh General Hospital*

Polycystic ovary syndrome is a common hormonal disorder affecting about 10-15% of women of reproductive age. It causes irregular menstrual cycles, increased male hormone levels, and the formation of multiple small cysts within the ovaries. PCOS not only reduces fertility but also increases the risk of other serious conditions, most commonly obesity. Some studies show that 80% of women with PCOS are overweight or obese.

Being overweight causes hormonal imbalances, directly impacting menstrual cycles and ovulation, leading to difficulty conceiving. Obese women have lower success rates with assisted reproductive technologies and require higher doses of fertility drugs. If not managed well, PCOS increases the risk of developing other diseases such as type 2 diabetes, hypertension, dyslipidemia, atherosclerosis, endometrial cancer, sleep apnea, depression, and anxiety.

Dr. Anh advises women with PCOS to adopt lifestyle changes and lose weight if necessary to improve insulin resistance, regulate hormones, and restore regular menstrual cycles. This includes a healthy diet, limiting processed carbohydrates and sugar, increasing fiber intake, consuming more vegetables, and getting regular exercise.

Dinh Lam

*The patient's name has been changed.