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What is impact of obesity on infertility? – Part 1

Introduction to Obesity

• Obesity and overweight are common conditions.
• Obesity may be defined as a body mass index (BMI) of 30 or higher.
• It is a medical condition in which excess body fat builds up to the extent that the health of the individual becomes affected.
• It is becoming increasingly common in both men and women especially in Western developed nations, including Australia and US.
• This exerts significant financial pressure on health care systems.
• Obesity is usually not caused by a single factor.
• The genetic make-up of a person can influence the probability of developing the condition.
• The most significant contribution to the rise in obesity is thought to be the changes in behavior and environment seen in modern society which is due to the technological advances.
• The reduction in physical activity levels has been put forward as a major contributing factor in the development of the disease.
• Many health conditions are associated with obesity.Well-known conditions include:
– Type 2 diabetes
– Coronary heart disease
– Sleep apnea

• However, obesity can also affect the fertility of both men and women by contributing to problems with ovulation and general sexual dysfunction.
• These conditions have consequences not only on general health but also to a great extent on reproductive health.
• There is a high prevalence of obese women in the infertile population.
• Numerous studies have highlighted the link between obesity and infertility.
• Obesity contributes to an ovulation and menstrual irregularities.
• It also results in reduced conception rate and a reduced response to fertility treatment.
• It also increases miscarriage and contributes to maternal and perinatal complication.
• Reduction of obesity, particularly abdominal obesity, is associated with improvements in reproductive functions.
• Treatment of obesity itself should be the initial aim in obese infertile women before embarking on ovulation-induction drugs or any assisted reproductive techniques.

Various strategies for weight reduction

• Diet
• Exercise
• Pharmacological and surgical intervention.
• Lifestyle modification.
• Lifestyle changes continue to be of great importance of all.
• Obesity during pregnancy is associated with numerous maternal and perinatal risks.
• It is not clear whether obesity is a direct cause of adverse pregnancy outcome.
• It is also not clear whether the association between obesity and adverse pregnancy outcome is due to factors that are shared characteristics of both entities.
• Adverse outcomes are often attributed to the association between obesity and diabetes.
• There is some evidence that glucose tolerant obese women are also at greater risk of these outcomes.
• Indirect data suggest a causal association between maternal obesity and several pregnancy complications.
• The risks appear to increase with increasing obesity.
• The mechanism appears to be related to the endocrine milieu associated with obesity which is due to increased levels of insulin, androgens, and leptin.
• In addition, adipose tissue is an active endocrine organ and a source of proinflammatory cytokines (adipokines).
• This may lead to vascular endothelial dysfunction in the mother and placenta and result in adverse pregnancy outcome.
• This suggests that obese women should be encouraged to undertake a weight reduction program.

Clinical Gynecologic Endocrinology and Infertility The Obesity Reality Obstetrics/Gynecology

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