***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Obesity worsens and modest weight loss improves female fertility . Overweight women were r and omised to lifestyle or st and ard treatment pre‐in vitro fertilisation with treatment cessation at embryo transfer . There was a greater reduction in weight ( P < 0.001 ) for lifestyle treatment ( −3.8 ± 3.0 kg , P < 0.001 ) compared with no changes for st and ard treatment ( −0.5 ± 1.2 kg , P = 0.092 ) . Both the intervention ( −5.3 ± 4.6 cm ) and control ( −3.5 ± 3.5 cm ) group had reductions in waist circumference ( P < 0.001 ) with no differences between the two groups ( P = 0.215 ) . The overall pregnancy rate was 53 % ( 20/38 ) for the intervention and control group combined INTRODUCTION The aims of this prospect i ve cohort study were to examine 16-year trajectories of weight and BMI in young adult women who had a healthy BMI in 1996 and determinants of remaining in the healthy BMI category . METHODS A total of 4,881 women with healthy BMI at baseline and either healthy , overweight , or obese BMI at 16-year follow-up reported their weight , height , health , and health behaviors in six surveys of the Australian Longitudinal Study on Women 's Health between 1996 ( aged 18 - 23 years ) and 2012 ( aged 34 - 39 years ) . Determinants of BMI maintenance were estimated using binary logistic regression and generalized estimating equations in 2015 . RESULTS Almost 60 % remained in the healthy BMI category from 1996 to 2012 , ( mean weight gain , 0.19 kg/year ) , 29 % transitioned to overweight BMI ( 0.83 kg/year ) , and 11.6 % transitioned to obese ( 1.73 kg/year ) . The mean rates of annual weight gain in each group were consistent over time . Only three factors ( low alcohol , moderate/high physical activity , having a university degree ) were positively associated with maintaining a healthy BMI . Additional behavioral factors ( smoking , high sitting time , energy intake , dieting , takeaway food , and use of oral contraceptives ) , as well as blue collar occupation , separation/divorce/widowhood , and major illness were negatively associated with BMI maintenance . CONCLUSIONS To prevent the transition from healthy to overweight/obese BMI , weight gain must be limited to < 0.5 kg/year . Women with healthy BMI , but with higher rates of weight gain in their early 20s , could be identified by health professionals for assistance with prevention of becoming overweight/obese Introduction : Several established tools are available to assess study quality and reporting of r and omized controlled trials ; however , these tools were design ed with clinical intervention trials in mind . In exercise training intervention trials some of the traditional study quality criteria , such as participant or research er blinding , are extremely difficult to implement . Methods : We developed the Tool for the assEssment of Study qualiTy and reporting in EXercise ( TESTEX ) – a study quality and reporting assessment tool , design ed specifically for use in exercise training studies . Our tool is a 15-point scale ( 5 points for study quality and 10 points for reporting ) and addresses previously unmentioned quality assessment criteria specific to exercise training studies . Results : There were no systematic differences between the summated TESTEX scores of each observer [ H(2 ) = 0.392 , P = 0.822 ] . There was a significant association between the summated TESTEX scores of the three observers , with almost perfect agreement between observers 1 and 2 [ intra-class correlation coefficient ( ICC ) = 0.93 , 95 % confidence interval ( CI ) 0.82–0.97 , P < 0.001 ] , observers 1 and 3 ( ICC = 0.96 , 95 % CI 0.89–0.98 , P < 0.001 ) and observers 2 and 3 ( ICC = 0.91 , 95 % CI 0.75–0.96 , P < 0.001 ) . Conclusions : The TESTEX scale is a new , reliable tool , specific to exercise scientists , that facilitates a comprehensive review of exercise training trials OBJECTIVE To investigate whether r and omized diet and /or physical exercise influence serum levels of antimüllerian hormone ( AMH ) in obese women with polycystic ovary syndrome ( PCOS ) . DESIGN R and omized , 4-month trial with three interventions . SETTING Women 's health clinical research unit at a university hospital . PATIENT(S ) Fifty-seven overweight/obese women with PCOS . INTERVENTION(S ) Diet , physical exercise , or both , using programs individually adapted and supervised by a dietician and /or a physiotherapist . MAIN OUTCOME MEASURE(S ) Serum AMH levels before and after the interventions and correlations to reproductive function , body composition , and endocrine and metabolic variables . RESULT ( S ) After intervention , serum levels of AMH were significantly decreased only in the diet group , and the levels were significantly lower than in the exercise group . The strongest predictor of decreased AMH was a decrease in free T , whereas weight loss had no significant influence . Normalized levels of AMH were associated with improvements in menstrual cyclicity and hyper and rogenism but not in metabolic variables . CONCLUSION ( S ) This r and omized study supports that diet reduces serum AMH in association with decreased and rogen levels in obese women with PCOS . Increased serum AMH may be used as a marker of ovulatory dysfunction and hyper and rogenism but not as a marker of insulin resistance . CLINICAL TRIAL REGISTRY NUMBER IS RCT N48342048 This pilot study assessed the effects of exercise and nutritional counseling on hormonal , menstrual , and reproductive function in women with polycystic ovary syndrome ( PCOS ) . Twelve females with a clinical , biochemical , and ultrasonographic diagnosis of PCOS were r and omly assigned to endurance and resistance exercise plus nutritional counseling ( EN ) or nutritional counseling only ( N ) for a period of 12 weeks . Anthropometry , resting metabolic rate ( RMR ) , selected hormones , and ovarian follicle population were measured pre and post-intervention . Following the 12 week intervention , greater decreases in sum of 2 skinfolds ( p = 0.002 ) and a greater increase in estimated VO2 max ( p = 0.017 ) occurred in the exercise group . Significant decreases in waist girth ( p = 0.001 ) and insulin levels ( p = 0.03 ) occurred in both groups . Hormonal changes were not statistically significant ; however , a trend towards an improved hormonal profile , specifically sex-hormone binding globulin ( EN , 39 % increase ; N , 8 % increase ) and lutenizing hormone : follicle-stimulating hormone ( LH : FSH ) ( EN , 9 % decrease ; N , 27 % decrease ) occurred in the absence of weight loss . These findings suggest exercise and nutritional counseling may benefit the metabolic and reproductive abnormalities associated with PCOS Aim of this study was to compare the effects of metformin and a body weight reduction regimen using sibutramine on insulinemia , insulin sensitivity , and ovarian function in women with anovulatory cycles or infertility . 30 women with anovulatory cycles and hyperinsulinemia were treated with metformin  and 15 anovulating women with obesity were treated with sibutramine in combination with a caloric restriction diet and physical exercise . In the metformin group there was a mild decrease of the body mass index ( BMI ) , a decrease of fasting and stimulated insulinemia ( I0 , p < 0.05 , I120 , p < 0.01 ) , a significant reduction of insulin resistance calculated as index FIRI ( p < 0.05 ) , serum LH ( p < 0.05 ) and testosterone levels ( p < 0.05 ) . There was an improvement of menstrual cycles in 21 ( 70 % ) of women , and 6 of them became pregnant . In the sibutramine group we found a significant decrease of BMI ( p < 0.01 ) , waist circumference ( p < 0.01 ) , fasting and stimulated insulinemia ( p < 0.05 , p < 0.01 ) and a significant improvement of insulin sensitivity ( FIRI , p < 0.01 ) . However , the levels of FSH , LH , and testosterone were not significantly changed . There was a significantly greater reduction of insulin levels and FIRI after sibutramine treatment compared with metformin treatment , while the changes of LH were not signifcantly different . Testosterone was changed more after metformin therapy . We conclude that although the body weight reduction using sibutramine has a more pronounced effect on insulinemia and insulin sensitivity , metformin may be more effective in the prompt restoration of ovarian function . ( Tab . 3 , Ref . 24 . ) CONTEXT Polycystic ovary syndrome ( PCOS ) is an insulin-resistant ( IR ) state . Visceral fat ( VF ) is independently associated with IR . OBJECTIVES The objectives of the study were to explore mechanisms underpinning IR by assessing the effect of exercise training on IR and body composition in overweight PCOS and non-PCOS women . DESIGN This was a prospect i ve exercise intervention study . SETTING AND PARTICIPANTS The study was conducted at an academic medical center . Participants included 20 overweight PCOS and 14 overweight non-PCOS women . INTERVENTION The intervention included 12 wk of intensified aerobic exercise ( 3 h/wk ) . MAIN OUTCOME MEASURES IR on euglycemic hyperinsulinemic clamp , body composition including abdominal visceral and sc fat distribution by computer tomography and lipids was measured . RESULTS PCOS subjects were more IR ( P = 0.02 ) and had more VF ( P = 0.04 age adjusted ) than non-PCOS women . In PCOS women , IR correlated with VF ( r = -0.78 , P < 0.01 ) . With exercise training , both groups maintained weight but within PCOS , VF ( -12.0 cm(2 ) , P = 0.03 ) and within non-PCOS abdominal sc fat ( -40.2 cm(2 ) , P = 0.02 ) decreased . Despite exercise-induced improvement in IR within PCOS ( + 27.9 mg · m(-2 ) · min(-1 ) , P = 0.03 ) , no relationship with decreased VF ( r = -0.08 , P = 0.84 ) and no differential changes in IR and VF between groups were noted . Triglycerides decreased within PCOS ( -0.27 mmol/liter , P = 0.02 ) and decreased differentially between groups ( P < 0.01 ) . CONCLUSIONS Higher IR was related to increased VF in PCOS , suggesting an etiological role for VF in intrinsic IR in PCOS ; however , changes with exercise intervention did not support a causal relationship . Triglycerides were modulated more by exercise training in PCOS than non-PCOS women . Within-group exercise-induced reductions in cardiometabolic risk factors including IR , triglycerides , and VF in PCOS were observed without significant weight loss and if confirmed in future controlled trials , suggest weight loss should not be the sole focus of exercise programs CONTEXT Lifestyle modification is recommended in women with polycystic ovary syndrome ( PCOS ) prior to conception but there are few r and omized trials to support its implementation or benefit . OBJECTIVE This study aim ed to determine the relative efficacy of preconception intervention on reproductive and metabolic abnormalities in overweight/obese women with PCOS . DESIGN , SETTING , AND PARTICIPANTS This was a r and omized controlled trial of preconception and infertility treatment at Academic Health Centers in women with infertility due to PCOS , age 18 - 40 y and body mass index 27 - 42 kg/m(2 ) . INTERVENTION Women were r and omly assigned to receive either 16 weeks of 1 ) continuous oral contraceptive pills ( OCPs ) ( ethinyl estradiol 20 mcg/1 mg norethindrone acetate ) ( " OCP " ) ; 2 ) lifestyle modification consisting of caloric restriction with meal replacements , weight loss medication ( either sibutramine , or orlistat ) , and increased physical activity to promote a 7 % weight loss ( " Lifestyle " ) ; or 3 ) combined treatment with both OCP and lifestyle modification ( " Combined " ) . After preconception intervention , women underwent st and ardized ovulation induction with clomiphene citrate and timed intercourse for four cycles . Pregnancies were followed with trimester visits until delivery . MAIN OUTCOME MEASURES Weight , ovulation , and live birth were measured . RESULTS We consented 216 and r and omly assigned 149 women ( Lifestyle : n = 50 ; OCP : n = 49 ; Combined : n = 50 ) . We achieved significant weight loss with both Lifestyle ( mean weight loss , -6.2 % ; 95 % confidence interval ( CI ) , -7.4 - -5.0 ; and Combined ( mean weight loss , -6.4 % ; 95 % CI , -7.6 - -5.2 ) compared with baseline and OCP ( both P < .001 ) . There 
    Output:
    
WIDER IMPLICATION S There is emerging evidence from RCT that PA may improve pregnancy rates in women with reproductive health problems .
Comparative studies indicate that PA intervention may be as effective as other commonly used clinical intervention strategies for improving reproductive health outcomes .
While the type , intensity , frequency , and duration of optimal PA intervention , and the role of PA independent of weight loss , remain unclear , these preliminary findings suggest that PA may be an affordable and feasible alternative or complementary therapy to fertility treatments