FRI427 Hypocaloric Dietary Intervention Reduces Excessive Follicle Recruitment In Women With PCOS
Authors: Carter Faith , Lee Noah , Reich Alexandra , Jarrett Brittany Y , Brink Heidi Vanden , Oldfield Alexis , Lujan Marla Elaine 
Published: October 2023

Abstract
Disclosure: F. Carter: None. N. Lee: None. A. Reich: None. B.Y. Jarrett: None. H. Vanden Brink: None. A. Oldfield: None. M.E. Lujan: None.
Introduction: Disordered antral follicle development in polycystic ovary syndrome (PCOS) is characterized by excessive recruitment, early or absence of follicle selection and decreased incidence of dominance and ovulation. Whether lifestyle interventions aimed at weight loss improve defects in antral folliculogenesis to promote ovulation in women with PCOS and comorbid obesity is unknown. Objective: To test the hypothesis that a hypocaloric dietary intervention improves antral follicle development in a subset of women with PCOS and obesity as evidenced by decreased recruitment, and increased selection, dominance, and ovulation. Methods: Preliminary analysis of women with PCOS and obesity (7 out of 20) who participated in a hypocaloric dietary intervention was conducted. The study protocol consisted of every-other-day visits to a clinical research center for ovarian ultrasonography and venipuncture over a 4-week baseline period (pre-intervention), followed by a 12-week commercial hypocaloric dietary meal plan intervention aimed at achieving 1-2 lbs of weight loss per week. Anthropometry, DEXA, hirsutism scoring, and oral glucose tolerance testing were conducted at baseline and during the final month of the intervention in the follicular phase. The number and diameter of all follicles ≥ 2 mm at each visit were recorded offline, and individual follicles ≥ 7 mm were tracked using the Identity Method throughout the 16-weeks. Clinical, morphologic, and endocrine markers were compared using paired t-tests pre- vs. post-intervention, and linear mixed models assessed changes in recruitment, selection, dominance, and ovulation. Results: The hypocaloric dietary intervention resulted in mean weight loss of 8.8 ± 2.9% and significant reductions in waist (-13 ± 9 cm) and hips (-10 ± 3 cm) circumference, body mass index (-3.4 ± 1.4 kg/m2), and percent total body fat (-1.5 ± 1.3%; all p&lt;0.02). Glucoregulatory status, menstrual cycle lengths, reproductive hormone (LH, FSH, E2, P4, TT, AMH) concentrations, and hirsutism scores did not differ pre- vs. post-intervention. The number of follicle recruitment events decreased with percent weight loss during the intervention (p=0.01), as did the average number of follicles recruited per cohort (p=0.01). By contrast, the frequency of follicle selection, dominance, and ovulation did not change with weight loss (p&gt;0.05). Higher pre-intervention LH was associated with fewer follicles recruited per cohort during the intervention (p=0.03). No other metabolic or endocrine marker was correlated with changes in follicular events. Conclusion: Clinically meaningful weight loss induced by a hypocaloric dietary intervention resulted in improvements in early stages of antral follicle development in women with PCOS, albeit these changes did not affect ovulatory follicle dynamics or the frequency of ovulation
Presentation: Friday, June 16, 2023