Abstract

Background: Infertility appeared to be influenced by several PCOS comorbidities. Obesity and insulin resistance in particular were independently linked to lower pregnancy and live birth rates, as well as a higher risk of abortion. Aim: investigate the effect of physical activity habit modifications on gynecological features among studied infertile overweight and polycystic ovary syndrome. Subjects and Methods: A quasi-experimental design at Beni-Suef University Hospital's gynecological and infertility clinics; a purposive sample of 116 women with polycystic ovary syndrome, overweight, and obesity, was selected. Tools: I: The Arabic-structured interview questionnaire contains personal data; II: Block Adult Physical Activity (PA) Screener was the predictor for physical activity. This tool assessed the frequency and duration of job-related, daily life, and leisure activities. Results: reveals that 87.5% of Mild Physical Activity of the study group women has duration of menstrual cycle of less than 3 days (hypomenorrhea before intervention. Compared to 68% of moderate physical activity had a normal duration of the menstrual cycle of 3-5 days after the intervention. About 93.6%, of Mild Physical Activity (sedentary lifestyle) of the study group women have an irregular cycle before intervention. Compared to 80% of moderate physical activity had a regular cycle after the intervention. Conclusion: Physical activity habit modifications affect gynecological features among studied infertile overweight and polycystic ovary syndrome Recommendations: A study can be conducted to assess the PCOS on pregnancy outcomes and childbirth.

1. Introduction

According to the earliest description, one of the primary symptoms originally associated with PCOS was infertility. Epidemiological data later showed that oligo anovulation is associated with a higher risk of infertility, and PCOS is the most prevalent cause of ovulatory disorders. A large population of 1,741 women with PCOS reported primary infertility in 50% of cases and subsequent infertility in 25% of cases ^{1, 2, 3, 4}.

Infertility appeared to be influenced by several PCOS comorbidities. Obesity and insulin resistance (IR) in particular were independently linked to lower pregnancy and live birth rates, as well as a higher risk of abortion. In PCOS women, endometrial abnormalities were also reported, which may have an impact on implantation. Finally, descriptions of ovarian changes at several levels, including ovarian/follicular/corpus luteum vascularity, follicular fluid environment, and subsequent oocyte competence and quality, were provided ^{5, 6, 7, 8 9, 10, 11}.

Additionally, it has been discovered that the endometrium of women with PCOS has an immunological pattern indicative of chronic low-grade inflammation, as well as intrinsic abnormalities in glucose metabolism, the expression of hormone receptors, and proteins related to cell stress protection ^{9, 10, 11, 12, 13 14, 15, 16, 17, 18}.

Even at an early age, endometrial cancer is four times more likely to occur in women with PCOS than in those without the condition. The persistent progesterone deficit brought on by anovulation, which keeps the endometrium perpetually in a proliferative state, is assumed to be the cause of this. Furthermore, endometrial hyperplasia and carcinoma are independent risk factors for obesity and insulin resistance, both of which are prevalent in women with PCOS ^{19, 20, 21, 22 23, 24, 25, 26 27, 28, 29}.

Programs for lifestyle modification (LSM) combine dietary advice with the goal of small-to-moderate weight loss or maintenance. Several studies have demonstrated that LSM programs may prevent or delay the onset of type 2 diabetes in persons with poor glucose tolerance and women with PCOS using physical activity patterns, and behavioral, and cognitive methods ^{30, 31, 32, 33 34, 35, 36, 37 38, 39, 40 41, 42}.

2. Aim of the Study

This study aims to investigate the effect of physical activity habit modifications on gynecological features among studied infertile overweight and polycystic ovary syndrome

3. Subjects and Methods

The study was conducted at gynecological and infertility outpatient and inpatient clinics at Beni-Suef University Hospital. A purposive sample of 116 women with infertility, overweight, and obese with polycystic ovary syndrome who attended the previously mentioned sitting will be selected.

Instruments of data collection

Instrument one: Arabic Structured interviewing questionnaire contains basic data: Telephone number, Age, Residence, marital status, employment, Length in centimeters, Weight in kilograms, Waist circumference, and Thigh circumference

Instrument two: the Block Adult Physical Activity (PA) Screener was the predictor for physical activity. This tool assessed the frequency and duration of job-related, daily life, and leisure activities. It was developed using data from a large United States representative sample of men and women ⁴³. Permission was obtained to use this questionnaire. The responses of the women towards the nine items were measured on five points, ranging from 1 to 5, and the total score was adopted from and assessed by summation of sub-scores as follows:

• Mild physical activity (sedentary life) if score is < 25% of total score that mean (9-15).

• Moderate physical activity if score is 25%-50% of the total score, that means (16-30).

• Vigorous physical activity if score is 50%-75% of the total score, that means (30-45).

Statistical Analysis:

Data were collected, tabulated, and statistically analyzed using an IBM personal computer with Statistical Package of Social Science (SPSS) version 25 (SPSS, Inc, Chicago, Illinois, USA)

4. Results

Figure 2 reveals that about 67.2%, 67.2% in the study and control groups are 21-25yrs.

Figure 3 reveals that, 65.5%, 69% in the study and control groups 4-6 years duration of marriage.

Figure 4 reveals that 56.9%, 51.7% in the study and control groups had 1-2 years period of infertility.

Figure 5 reveals that 25.9%, 31%in the study and control groups had no previous pregnancy (primary infertility).

Figure 6 reveals that 62%, 51.7% in the study and control groups had no abortion

Figure 7 reveals that 43.1%, 37.9% in the study and control groups are nulliparous.

Figure 8 showed Relationship between duration of menstruation and physical activity level among the study group of infertile overweight and obese women with polycystic ovary syndrome. About 87.5% of Mild Physical Activity (sedentary lifestyle) of the study group women has duration of menstrual cycle of less than 3 days (hypomenorrhea before intervention. Compared to 68% of moderate physical activity had a normal duration of the menstrual cycle of 3-5 days after the intervention.

Figure 9 showed relationship between regularity of menstruation and physical activity level among the study group of infertile overweight and obese women with polycystic ovary syndrome. About 93.6%, of Mild Physical Activity (sedentary lifestyle) of the study group women have an irregular cycle before intervention. Compared to 80% of moderate physical activity had a regular cycle after the intervention.

Figure 10 showed relationship between frequency of menstruation and physical activity level among the study group of infertile overweight and obese women with polycystic ovary syndrome. About 77.7% of Mild Physical Activity (sedentary lifestyle) of the study group women has a long average menstrual cycle of more than 90 days (oligo amenorrhea) before intervention. Compared to 83.3% of moderate physical activity had the long average of the menstrual cycle is 21-34 days after the intervention.

5. Discussion

Maternity nurses play а crucial role in the quality of care improvement, which provides woman education and Maternity nurses play а crucial role in the quality of care improvement, which provides woman education and support. At the same time, the nurse can provide health promotion & psychosocial services include assessment, health education, counseling & appropriate referral ^{44, 45, 46, 47 48, 49, 50 51, 52}.

Regarding the duration of the menstrual cycle, the findings of the current study showed that the present study revealed that, there were highly statistically significant improvements in menstrual cycle irregularities in the study, more than half of the study and control groups had a 3–5-day duration of the menstrual cycle before the intervention compared to the majority of the study group had had a 3-5 day duration of the menstrual cycle after the intervention.

These findings are similar to the study done by Öberg, (2022). They studied "Effects of Lifestyle Intervention in Overweight Women with Polycystic Ovary Syndrome. From the researcher's point of view, lifestyle interventions have been shown to have positive effects in terms of improved menstrual cycle irregularities ⁵³.

On the contrary, these findings were incongruous with those of Abd Elmenim, et al., (2016), who studied "Effect of lifestyle changes on symptoms of polycystic ovarian syndrome in obese girls”. They showed that the mean duration of menstruation was 5-7 days ⁵⁴. From the researcher's point of view, this incongruence between the current and previous studies may be related to the different ages between participants.

In addition, the current study findings showed that the number of menstrual cycles increased from pre-intervention to post-intervention. it revealed that more than half of the study had a duration of menstrual rhythm was 35–90 days, and two-thirds of the control group had more than 90 days before the intervention, compared to nearly half of the study group having a duration of menstrual rhythm 21–34 days. These findings are similar to the study done by Turan, et al., (2015), who revealed that there are positive results of decreasing menstruation period from 46.1 days to 27.3 days from females in the experimental group were reported by the structured exercise that lasted for 8 weeks and applied to females of normal body weight suffering PCOS ⁵⁵. From the researcher's point of view, lifestyle modification improves menstrual regularity, ovulation phase, and fertility with PCOS.

Regarding the duration of the marriage, the current study findings reveal that the mean age at marriage in the study and control groups was 23.21±2.11 and 22.69±2.24 and the mean duration of marriage in the study and control groups was 5.52±2.69 and 5.81±3.17, these findings came in agreement with Alwahab, et al., (2018). They studied “A ketogenic diet may restore fertility in women with polycystic ovary syndrome” ⁵⁶.

On the contrary, these findings were incongruous with those of Tabassum, et al., (2021), who studied " Impact of polycystic ovary syndrome on quality of life of women in correlation to age, basal metabolic index, education, and marriage.. ” and showed that the mean was 19.31±3.97 ⁵⁷. From the researcher's point of view, this incongruence between the current and previous studies may be related to differences in culture Also, people in some areas of India reject the idea of women’s education and have many children who leave school at an early age to start a profession or to travel abroad to earn their living, which may raise their living standards and forced for early marriage.

Moreover, the current study findings reveal that the mean period of infertility in the study and control groups was 3.15±1.15, 3.51±2.21 years. These findings came in agreement with Pembe, et al., (2009), who study " Polycystic ovaries and associated clinical and biochemical features among women with infertility in a tertiary hospital in Tanzania” showed that the mean period of infertility in the study and control groups was 4±2.2 and 4.6 ±2.7 ⁵⁸.

The current study findings reveal that the mean number of births in the study and control groups was 0.70±0.59 and 1.16±0.37. On the contrary, these findings were incongruous with those of Haakova, et al., (2003) who studied Pregnancy outcomes in women with PCOS and controls matched by age and weight” they showed that 2.08±1.55 ⁵⁹. According to the researcher’s point of view, the study differed from the current study may be due to different age groups.

Moreover, the mean number of pregnancies in the study and control groups was 1.21±1.02 and 1.79±0.85, respectively. In addition, the mean number of abortions in the study and control groups was 0.48±0.73 and 1.31±0.47, respectively. Additionally, the mean number of births in the study and control groups was 0.71±0.59 and 1.16±0.37, respectively. These findings came in agreement with Tabassum, et al., (2021), who study "Impact of polycystic ovary syndrome on quality of life of women in correlation to age, basal metabolic index, education, and marriage” showed that the mean number of pregnancies 1.77±1.02 ⁵⁷. Furthermore, these findings were supported by Rai et al. (2000), who concluded that the prevalence of women with recurrent miscarriage is significantly higher amongst PCOS ⁶⁰.

The current study findings revealed that there was a significant association between ovulatory function improvement and physical activity level in the study group of infertile overweight and obese women with polycystic ovary syndrome. The majority of the sedentary lifestyle of the study group women had menstrual irregularities problems such as (hypo-menorrhea), irregular cycles, and a long average menstrual cycle is more than 90 days (oligo-amenorrhea) before intervention. Compared to most moderate physical activity had improvement in the menstrual cycle as a normal duration of the menstrual cycle3-5 days, regular cycle, and long average of the menstrual cycle is 21-34 days after intervention.

These results came in agreement with Abdolahian et al., (2020) and Amiri, et al., (2016), who studied the “Effect of interventions based on lifestyle modification on clinical, hormonal and metabolic findings in the patients with polycystic ovary syndrome "and found out weight reduction, through increasing physical exercise alone, can be effective in regulating menstrual cycles ^{61, 62}. But was not similar to the meta-analysis of 14 studies involving 617 adult women achieved by Benham, et al., (20180, who studied “Role of exercise training in polycystic ovary syndrome", and found out the impact of exercise interventions on reproductive function remained unclear ⁶³. According to the researcher’s point of view, this disagreement could be due to differences in the type and duration of interventions and populations studied.

In brief, the results of the current study declare the women’s physical activity habit modifications affect improved their gynecological features after the implementation of the program; the results indicated that there is a significant improvement in women’s gynecological features and weekly exercise. This improvement could be attributed to the attending of the sessions and the lecture and positive reinforcement or the long-term retention of knowledge, as well as a wide variety of educational methods used ^{64, 65, 66, 67, 68, 69}. Additionally, the distributed Arabic booklets also played a crucial role in attaining and retaining knowledge. Booklets are best used when they are brief, written in plain language, and full of good pictures and when they are used to back up other forms of education. This is in accordance with Edgar Dale’s or the NTL’s Pyramid of Learning as cited by Masters, as the pyramid illustrated that individuals can retain 10.0% of what they read and 20.0% of what they see and hear (audiovisual). The same author added that one can retain 50.0% of what he learned by a discussion ^{68, 69, 70, 71 72, 73, 74, 75}.

6. Conclusion

Physical activity habit modifications affect gynecological features among studied infertile overweight and polycystic ovary syndrome

Recommendations

A study can be conducted to assess the PCOS on pregnancy outcomes and childbirth.

References