JBRA Assisted Reproduction 2025;29(Suppl.2 SBRA 2025):229
Poster Presentation
29^th Annual Congress of the SBRA. São Paulo/SP - Brazil, 2025
doi: 10.5935/1518-0557.20263852

P-217. Sustainable and Accessible Approaches to Obesity-Related Infertility: A Narrative Review

Victória Bidart Salomone¹, Julia Roverso Correa Silveira¹

¹ Universidade Santo Amaro - São Paulo – SP -Brasil

Objective: This review aims to evaluate whether sustainable and accessible lifestyle interventions, including balanced diet and regular physical activity, can improve fertility outcomes in women with obesity. It focuses on the effects of modest weight loss, dietary patterns, and exercise on ovulation, menstrual regularity, pregnancy rates, and metabolic profiles, considering subgroups with conditions such as PCOS, type 2 diabetes, hypothyroidism, and eating disorders.
Methods: A narrative review of the literature was carried out using systematic searches in international and regional scientific databases, including PubMed, SciELO, LILACS, and Google Scholar. Search strategies combined the terms "obesity", "infertility", "lifestyle intervention", "diet", "exercise" and "reproductive outcomes" and associated conditions such as PCOS and type 2 diabetes. Eligible studies included observational research, randomized controlled trials, systematic reviews, and meta-analyses published in English or Portuguese between 2000 and 2024. Inclusion criteria required studies to focus on reproductive-age women (18–45 years) with obesity (BMI ≥30 kg/m²) experiencing infertility and undergoing lifestyle-based interventions such as structured diet plans, exercise regimens, or combined programs. Studies had to report measurable outcomes such as weight change, ovulation and menstrual parameters, pregnancy rates, hormonal profiles (including insulin, SHBG, testosterone), or assisted reproduction results. Exclusion criteria eliminated studies centered on pharmacological or surgical weight-loss treatments, non-reproductive-age populations, case reports, and articles with insufficient data. Article selection involved initial screening of titles and abstracts, followed by full-text assessment for eligibility and relevance. Data extraction systematically recorded study design, sample characteristics, intervention details, duration, outcomes, and relevant subgroup analyses. The findings were synthesized narratively to identify consistent evidence, gaps in knowledge, and implications for clinical practice and public health.
Results: Lifestyle interventions combining diet and exercise led to meaningful improvements in reproductive outcomes for women with obesity. According to a systematic review and meta-analysis of 40 studies including 14 RCTs, these approaches showed increased rates of ovulation, menstrual regularity, and spontaneous pregnancies, especially in women with PCOS. Moderate weight loss (5–10%) over several months increased SHBG levels (by ~50%) and reduced free testosterone and insulin levels, restoring ovulation in over 80% of women with PCOS and reducing hirsutism in ~40%, as supported by a British low-calorie diet study in women with PCOS. Mediterranean-style diets, rich in plant-based proteins, healthy fats, and antioxidants, were associated with ~40% higher pregnancy rates in IVF cycles, according to a Dutch prospective IVF study with 161 couples. Physical activity without significant weight loss improved implantation rates and live births (24.4% vs. 7.4% in sedentary women), as demonstrated by Palomba et al. (2014). Meta-analyses also found that lifestyle interventions significantly increased the likelihood of spontaneous pregnancy, with women in intervention groups about 60% more likely to conceive than controls (RR 1.59) and tended to improve live birth rates. Additionally, a prospective donor insemination study with 500 women found that waist-to-hip ratio independently predicted fecundity, with a 0.1 increase lowering conception chances by ~30%.
Conclusion: Sustainable and accessible lifestyle interventions represent effective first-line strategies for managing obesity-related infertility. By focusing on moderate calorie restriction, improved diet quality, regular exercise, and personalized support, these approaches can improve ovulatory function, pregnancy rates, and overall metabolic health, while minimizing costs and adverse effects. Integration of these strategies into public health policies and clinical practice can promote equitable access and long-term reproductive health improvements, especially in resource-limited settings.