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What is impact of obesity on infertility? – Part 3

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.

Female Obesity and Fertility

Fertility issues arising from obesity in women include:
• Irregular menstrual cycles.
• Problems with ovulation.
• Increased androgen levels.
• Polycystic ovarian syndrome (PCOS).
• Increased risk of miscarriage.
• Decreased success rates with assisted reproductive technologies (ART).
• These associations between obesity and reduced fertility are particularly significant when excess fat is deposited around the abdominal area.
• Changes in circulating sex hormones are thought to be largely responsible for decreasing fertility.
• The overall effect of these changes is usually an increased production of androgens.
• This leads to a condition called hyperandrogenism which is excessive androgen production.
• This condition is evident in obese women who experience amenorrhoea.
• Obesity is also often associated with increased insulin production and insulin resistance.
• These two factors are believed to contribute to hyperandrogenism in obesity.
• This is because insulin is important for the regulation of sex hormone production.
• This can be seen in obese women with PCOS.
• In such a case excess weight gain leads to excessive insulin production.
• This promotes increased androgen secretion and abnormal follicles in the ovary.
• This results in an overall disruption in ovarian and menstrual activity, causing fertility problems.
• Obese women who turn to assisted reproductive technologies (ART) also face additional obstacles compared to non-obese patients.
• Obesity is linked to decreased success of fertility treatments such as in vitro fertilisation(IVF).

Leptin – a link between obesity and fertility

• Leptin is a protein produced by fatty tissue that plays an important role in controlling food intake and energy expenditure.
• This is also necessary for the regulation of reproductive function.
• The former two functions are important in the development of obesity.
• Since body weight increases when food intake exceeds energy expenditure.
• When we consume more energy from food than we work off from physical activity.
• It is the role of leptin to detect energy store levels in the body and to relay this information to the central nervous system (CNS).
• When fat stores and leptin levels are high, the brain acts to decrease food intake and to increase energy expenditure.
• Administration of leptin later on leads to the restoration of normal body weight and fertility.
• Leptin therefore plays an important role in the relationship between obesity and fertility.
• Leptin is present in large amounts in obesity and excessive fatty tissue is maintained along with a decrease in fertility.
• It is believed that obese individuals have some sort of resistance to leptin that cannot be overcome by high leptin levels.
• This makes it difficult for obese individuals to lose weight.

Psychological Factors

• The decrease in fertility associated with obesity can come about as a result of interactions between physiological and psychological factors.
• Psychological factors include a decreased sex drive and increased sexual dysfunction.
• This can lead to obese individuals not having sexual intercourse as frequently as non-obese people.
• Obesity can therefore affect a person’s sexuality, which impacts on their overall fertility.

How does treating obesity affect fertility?

• Weight loss can dramatically improve fertility in obese people.
• It is often the first step in fertility treatment when an obese patient seeks help from assisted reproductive technology (ART).
• Even a loss of 5-10% can significantly improve ovulation and pregnancy rates.
• Weight loss improves fertility in obese people both physiologically and psychologically.
• Psychological state and mood has been found to increase significantly after weight loss.
• A reduction in insulin and androgen levels has been found in women after weight loss.
• This may lead to an 80% improvement in menstrual function and pregnancy rates of 29%.

Clinical Gynecologic Endocrinology and Infertility The Obesity Reality Obstetrics/Gynecology

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