{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T22:52:29Z","timestamp":1788648749347,"version":"build-2803163510"},"reference-count":109,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2024,4,16]],"date-time":"2024-04-16T00:00:00Z","timestamp":1713225600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Ministerio de Econom\u00eda y Competitividad (MINECO), Plan Nacional de I\u2009+\u2009D+i call RETOS 2018","award":["RTI2018-093302-A-I00"],"award-info":[{"award-number":["RTI2018-093302-A-I00"]}]},{"name":"Ministry of Science, Innovation and Universities of the government of Spain"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,7,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>BACKGROUND<\/jats:title><jats:p>The increasing prevalence of obesity worldwide poses a significant threat to reproductive function owing, in part, to hormonal disturbances caused by negative feedback between excess adiposity and the hypothalamic\u2013pituitary\u2013ovarian axis. Consequently, finding the most appropriate strategies to lose weight and improve ovulation in women with overweight or obesity is a clinically relevant matter that needs to be investigated. A comprehensive comparison of the independent and combined efficacy of lifestyle and\/or pharmacological interventions on BMI, ovulation, and hormonal profile in women with overweight or obesity at risk of anovulatory infertility would facilitate improving fertility strategies in this population.<\/jats:p><\/jats:sec><jats:sec><jats:title>OBJECTIVE AND RATIONALE<\/jats:title><jats:p>This study aimed to evaluate the comparative efficacy of exercise, diet, and pharmacological interventions on BMI, ovulation, and hormonal profile in reproductive-aged women with overweight or obesity.<\/jats:p><\/jats:sec><jats:sec><jats:title>SEARCH METHODS<\/jats:title><jats:p>A systematic review was performed by searching PubMed, Scopus, Web of Science, PsycINFO, and Cochrane Library up to 14 December 2023, for randomized controlled trials assessing the effects of exercise, diet and\/or pharmacological interventions (i.e. weight-lowering drugs or ovulation inducers) on BMI, ovulation, and\/or hormonal profile in reproductive-aged women with overweight or obesity. We performed frequentist random-effect network meta-analyses and rated the certainty of the evidence. The primary outcomes were BMI and ovulation rate, and the secondary outcomes were serum reproductive hormone levels (gonadotrophins, androgens, or oestrogens). We performed sensitivity analyses, including the studies that only involved women with PCOS.<\/jats:p><\/jats:sec><jats:sec><jats:title>OUTCOMES<\/jats:title><jats:p>Among 1190 records screened, 148 full texts were assessed for eligibility resulting in 95 trials (9910 women), of which 53% presented a high or unclear risk of bias. The network meta-analyses revealed that, compared to control: diet combined with weight-lowering drugs (mean difference (MD) \u22122.61\u2009kg\/m2; 95% CI \u22123.04 to \u22122.19; \u03c42\u2009=\u20090.22) and adding exercise (MD \u22122.35\u2009kg\/m2; 95% CI \u22122.81 to \u22121.89; \u03c42\u2009=\u20090.22) led to the greatest decrease in BMI; exercise combined with diet and ovulation inducers (risk ratio (RR) 7.15; 95% CI 1.94\u201326.40; \u03c42\u2009=\u20090.07) and exercise combined with diet and weight-lowering drugs (RR 4.80; 95% CI 1.67\u201313.84; \u03c42\u2009=\u20090.07) produced the highest increase in ovulation rate; and exercise combined with diet and weight-lowering drugs was the most effective strategy in reducing testosterone levels (standardized mean difference (SMD) \u22122.91; 95% CI \u22124.07 to \u22121.74; \u03c42\u2009=\u20092.25), the third most effective strategy in increasing sex hormone-binding globulin levels (SMD 2.37; 95% CI 0.99\u20133.76; \u03c42\u2009=\u20092.48), and it was coupled with being ranked first in terms of free androgen index reduction (SMD \u22121.59; 95% CI \u22123.18 to 0.01; \u03c42\u2009=\u20091.91). The surface under the cumulative ranking curve scores suggested that: diet combined with weight-lowering drugs is the strategy most likely (94%) to produce the highest BMI reduction; and exercise combined with diet and ovulation inducers is the strategy most likely (89%) to produce the highest ovulation rate improvement. The sensitivity analyses, which exclusively included studies involving women diagnosed with PCOS, were consistent with the results presented above.<\/jats:p><\/jats:sec><jats:sec><jats:title>WIDER IMPLICATIONS<\/jats:title><jats:p>Overall, the findings of this network meta-analysis indicate that the combination of exercise, diet, and pharmacological interventions is effective for weight loss, improving ovulation, and normalizing the androgen levels of women with overweight or obesity. Although higher quality studies are needed, these results support that the optimal treatment strategy for women with overweight or obesity wishing to conceive must consider exercise, diet, and pharmacological interventions during the shared decision-making process.<\/jats:p><\/jats:sec>","DOI":"10.1093\/humupd\/dmae008","type":"journal-article","created":{"date-parts":[[2024,4,17]],"date-time":"2024-04-17T02:50:09Z","timestamp":1713322209000},"page":"472-487","source":"Crossref","is-referenced-by-count":52,"title":["Comparative efficacy of exercise, diet and\/or pharmacological interventions on BMI, ovulation, and hormonal profile in reproductive-aged women with overweight or obesity: a systematic review and network meta-analysis"],"prefix":"10.1093","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9297-1028","authenticated-orcid":false,"given":"David","family":"Ruiz-Gonz\u00e1lez","sequence":"first","affiliation":[{"name":"Department of Education, Faculty of Education Sciences, and SPORT Research Group (CTS-1024), CIBIS (Centro de Investigaci\u00f3n para el Bienestar y la Inclusi\u00f3n Social) Research Center, University of Almer\u00eda , Almer\u00eda, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iv\u00e1n","family":"Cavero-Redondo","sequence":"additional","affiliation":[{"name":"Health and Social Research Center, Universidad de Castilla-La Mancha , Cuenca, Spain"},{"name":"Facultad de Ciencias de la Salud, Universidad Aut\u00f3noma de Chile , Talca, Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alba","family":"Hern\u00e1ndez-Mart\u00ednez","sequence":"additional","affiliation":[{"name":"Department of Education, Faculty of Education Sciences, and SPORT Research Group (CTS-1024), CIBIS (Centro de Investigaci\u00f3n para el Bienestar y la Inclusi\u00f3n Social) Research Center, University of Almer\u00eda , Almer\u00eda, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andr\u00e9s","family":"Baena-Raya","sequence":"additional","affiliation":[{"name":"Department of Education, Faculty of Education Sciences, and SPORT Research Group (CTS-1024), CIBIS (Centro de Investigaci\u00f3n para el Bienestar y la Inclusi\u00f3n Social) Research Center, University of Almer\u00eda , Almer\u00eda, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonia","family":"Mart\u00ednez-Forte","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynaecology Unit, Torrec\u00e1rdenas University Hospital , Almer\u00eda, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0708-1865","authenticated-orcid":false,"given":"Signe","family":"Altm\u00e4e","sequence":"additional","affiliation":[{"name":"Department of Biochemistry and Molecular Biology, Faculty of Sciences, University of Granada , Granada, Spain"},{"name":"Instituto de Investigaci\u00f3n Biosanitaria ibs.Granada , Granada, Spain"},{"name":"Division of Obstetrics and Gynaecology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital , Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana M","family":"Fern\u00e1ndez-Alonso","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynaecology Unit, Torrec\u00e1rdenas University Hospital , Almer\u00eda, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4626-420X","authenticated-orcid":false,"given":"Alberto","family":"Soriano-Maldonado","sequence":"additional","affiliation":[{"name":"Department of Education, Faculty of Education Sciences, and SPORT Research Group (CTS-1024), CIBIS (Centro de Investigaci\u00f3n para el Bienestar y la Inclusi\u00f3n Social) Research Center, University of Almer\u00eda , Almer\u00eda, 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