From January 2021 to January 2022, obese PCOS patients who met the study criteria were screened from the gynecological outpatients of the Affiliated Foshan Maternity and Child Healthcare Hospital, Southern Medical University (Foshan, Guangdong, China). Using the random number table method, a qualified cohort comprising 100 patients was divided into a control and an experimental group in a 1:1 ratio. All the enrolled patients provided signed informed consent, and the study was approved by the Ethics Committee of the Affiliated Foshan Maternity and Child Healthcare Hospital, Southern Medical University. The age of the patients in the control group ranged from 22 to 32 years, with an average age of 26.91 $\pm$ 3.08 years and a mean body mass index (BMI) of 28.57 $\pm$ 1.34. Comparatively, the age of patients from the experimental group ranged from 22 to 33 years, with an average age of 27.54 $\pm$ 3.06 years and a mean BMI of 28.69 $\pm$ 1.43. We found no significant difference in the baseline information between the two groups, making experimental results obtained in the present study comparable.

The study inclusion criteria were: (1) women aged 20 to 40 years; (2) meeting the relevant standard of the 2018 International Evidence-based Guidelines for PCOS [5]; (3) BMI $\ge$24 kg/m${}^2$; (4) could use mobile network phone and willing to accept a follow-up visit; (5) without any contraceptive use for more than one year and no successful conception with normal sexual life. The exclusion criteria were: (1) had taken medicines related to ovulation induction, androgen reduction, lipid-lowering or weight loss in the past 3 months that may have an impact on the study; (2) PCOS patients associated with other organic lesions such as hysteromyoma, endometrial polyps, uterine malformations, and intrauterine adhesion; (3) hysteroscopy showed $\ge$5 CD138 positive plasma cells; (4) genital tract infections such as mycoplasma, chlamydia or gonorrhea; (5) had cancer-related or acute diabetic complications with unstable conditions; (6) disabilities in daily living and activities; and (7) patient’s spouse diagnosed with chromosomal abnormalities, asthenozoospermia, oligospermia or azoospermia diagnosed.

Based on the patients’ complaints and needs, the control group was given traditional treatment and routine nursing, such as prescribing examinations and drugs, simple education on disease-related knowledge by medical workers, instructions for diet and exercise, and notifications of medication precautions.

Comparatively, patients in the experimental group were treated using the “Internet +” multidisciplinary management model oriented by nurse specialists while also receiving drug treatment. The specific management contents included: (1) establishment of a gynecological endocrine integrated management team, such as implementing a gynecological endocrinology consultation service consisting of 5 gynecological endocrinologists, 3 gynecological specialist nurses, 2 nutrition specialist nurses, and 1 psychological specialist nurse; (2) establishment of a multidisciplinary collaborative joint management model oriented by nurse specialists: (i) the gynecological endocrinologist diagnosed the condition according to the patient’s medical history, provided clear treatment objectives, and opened menstrual health management archives; (ii) the gynaecological specialist nurses established a personal and exclusive health records for the PCOS patients; (iii) one-to-one disease education and sport-related guidance for gynecological specialized nurses: awareness of the pathogenesis, etiologies, recent symptoms and long-term complications of PCOS, and explaining the treatment plan according to various inspection reports and individual needs; one-to-one exercise guidance: make exercise plans according to the age and occupation of the patient; one-to-one medication guidance: explaining the precautions and cycle of medication, emphasize that medication should not be missed, and the remedial measures for missed medication to relieve patients’ concerns about hormone drugs; one-to-one response to the patient’s questions during the consultation process; (iv) the specialist nurse system in the nutrition department conducted one-to-one diet intervention according to the patient’s BMI and body fat analysis report, and formulated a diet according to the dietary guidelines for diabetic patients and their living habits; The blood glucose production index table of commonly used foods was distributed to patients to guide the selection and collocation of foods with low blood glucose production index; (v) the psychological specialist nurse assessed the patient’s psychological state according to the patient’s anxiety scale, depression scale and Anderson symptom inventory, listened to the patient’s thoughts on the disease, established mental health files, and offered timely guidance and persuasion based on their psychological problems. (3) Follow-up interventions and visits were performed with the help of an internet platform: (i) For patients with weight loss needs, nurses guided them to download the “Knott Weight Management APP” (Zhejiang Knott health science Co., LTD., Hangzhou, Zhejiang, China) and monitored the daily conditions of the patient’s weight, diet, exercise and metabolic consumption. If the indicators on the day were not up to standard, the dietitian conducted telephonic guidance and detailed inquiry to supervise the patients to establish a good lifestyle. (ii) The nurse informed the patients to log onto the hospital’s internet during the treatment process and provided a 24-hour consultation system to answer the patient’s questions at any time. (iii) Scientific knowledge about gynecological endocrine was regularly published on the WeChat official account of the Foshan Maternal and Child Health Gynecology. The patients were guided to subscribe to the WeChat official account and read the educational health information published. (iv) Follow-up visits were performed 1 month, 3 months and 6 months after archiving. The purpose of the follow-up was to assess patients’ compliance with the current long-term management plan, educate the importance of long-term management, remind them to perform subsequent regular visits, and record the patient’s long-term follow-up and management.

Follow-up visits and information collection were conducted before and six months after the intervention. The following indicators were assessed: BMI, waistline, rates of ovulation and pregnancy, serum testosterone (T), follicle-stimulating hormone (FSH), luteinizing hormone (LH), indicators related to glucose metabolisms such as fasting blood glucose (FBG) and homeostasis model assessment of insulin resistance (HOMA-IR), and psychological status of patients.

The SPSS v25.0 (IBM Corp., Armonk, NY, USA) statistical software was used for statistical analysis. Quantitative data that met or almost met the Gaussian distribution are represented as mean $\pm$ standard deviation (mean $\pm$ SD). The student t-test was applied to compare two independent samples meeting the Gaussian distribution. Pre- and post-treatment comparisons within the same group were performed using the paired t-test. Enumeration data are reported as proportions, and differences between two or more occurrence rates or structural ratios were compared using the Chi-square test. A p value 0.05 was considered statistically significant.

After the six-month intervention, 34 patients were found to have ovulated, showing an ovulation rate of 68.00% in the control group, while that of the experimental group was 44 and 88.00%, respectively. As for pregnancy rate, 11 and 24 patients successfully conceived, accounting for 22.00% and 48% of patients in the control and experimental groups, respectively. Further, patients from the experimental group had higher ovulation and pregnancy rates than the control group after intervention ($\chi {}^2$ value = 5.828 and 7.429; p value = 0.016 and 0.006).

The baseline characteristics of the two groups were comparable, as indicated by the absence of significant differences in BMI and waist circumference before intervention. Subsequently, after six months of intervention, both groups showed a significant decrease in BMI (t-control and test group values = 7.608 and 20.702, respectively, p 0.05) and waist circumference (t-control and test group values = 2.939 and 5.052, respectively, p 0.05) within the same group compared to before the intervention. Notably, the test group exhibited significantly lower BMI and waist circumference than the control group after six months of intervention (p 0.05) (Table 1).

After six months of intervention, both control and test groups showed significant decreases in serum levels of T (t-control and test group values = 3.087 and 11.345, p 0.05), while the FSH levels did not significantly change (t-control and test group values = 0.411 and 0.436, p $\mathrm{>}$ 0.05). The LH levels were significantly decreased in both groups (t-control and test group values = 3.121 and 6.923, p 0.05). After six months of intervention, there was no significant difference in FSH levels between the control group and the experimental group. Furthermore, the test group exhibited significantly lower levels of both T and LH levels than the control group (p 0.05) (Table 1).

The FBG and HOMA-IR of the patients were similar between the control group and the test group before the intervention. The intra-group comparison showed that the FBG levels were significantly lower in both groups after six months of intervention (t-control and test group values = 5.469 and 3.093, respectively, p 0.05). The HOMA-IR levels were also significantly lower (t-control and test group values = 2.137 and 7.284, respectively, p 0.05), while the FBG levels were not significantly different between the groups after six months of intervention. In addition, the HOMA-IR in the test group was significantly lower than the control group (p 0.05) (Table 1).

We found no significant difference in self-rating anxiety scale (SAS) and self-rating depression scale (SDS) scores between the control and experimental groups before the intervention. However, after the six-month intervention, both the control and experimental groups exhibited significant decreases in SAS (t-control and test group SAS values = 4.187 and 9.720) and SDS (t-control and test group SDS values = 4.529 and 8.570, p 0.05). Additionally, the experimental group had significantly decreased SAS (44.34 $\pm$ 6.56) and SDS (43.69 $\pm$ 5.61) scores than the control group (SAS, 52.10 $\pm$ 6.84; SDS, 49.45 $\pm$ 5.65) after the six-month intervention (p 0.05) (Table 1).