Unmet clinical needs in women with polycystic ovary syndrome regarding fertility and obesity: a cross-sectional study from the patient's perspective.

Purpose: Polycystic ovary syndrome (PCOS) is a common endocrine disorder in women of reproductive age, often leading to anovulatory infertility. Obesity exacerbates the reproductive, metabolic and psychological features of PCOS, making fertility treatment and patient satisfaction difficult. Despite guidelines from the European Society of Human Reproduction and Embryology (ESHRE) emphasizing lifestyle modifications and specific treatments, there remains a significant gap in adherence to these guidelines by both healthcare providers and patients.

Methods: A cross-sectional online survey was conducted from 1 January to 14 March 2021 among PCOS patients in Germany, Austria and Switzerland. A non-standardized, non-validated questionnaire covering several aspects of reproductive health was distributed via online channels. Data were analyzed using descriptive statistics, chi-squared tests, Student's t-tests and Jonckheere-Terpstra tests, with significance set at p < 0.05.

Results: Out of 2029 participants, 1902 completed the fertility questionnaire. Of these, 73.9% perceived their fertility to be impaired, with this perception being higher in obese women (80.8% vs. 67.4%, p < 0.001). The analysis focused on 564 childless women with a current desire to have children, 67.0% of whom met WHO criteria for infertility. Obese women (BMI ≥ 30 kg/m) reported lower satisfaction with fertility treatment (40.9 vs. 47.8, p = 0.009) and were less likely to receive fertility treatment (56.7% vs. 75.8%, p < 0.001). Despite recommendations, only 34.1% reported lifestyle changes as part of their treatment. Letrozole, the recommended first-line treatment, was underused (14.6%) and clomiphene citrate was more commonly prescribed (35.4%). Obese women reported fewer current pregnancies (4% vs. 13.9%, p < 0.001) and were more likely to be infertile for more than one year (77.0% vs. 53.0%, p < 0.001). They also expressed a greater desire for possibilities to ask more questions about PCOS and fertility and to undergo more infertility tests. (56.1% vs. 45.3%, p = 0.013; 69.4% vs. 59.8%, p = 0.020).

Conclusions: Fertility management in PCOS patients, especially in obese patients, shows significant gaps in adherence to recommended guidelines, highlighting the need for improved patient education, professional training and individualized treatment strategies. Improved health care is essential to address reproductive concerns and improve outcomes in this population.