A. Obesity is defined as a medical condition of excess
body fat has accumulated overtime, while overweight is a condition of
excess body weight relatively to the height. According to the Body Mass
Index(BMI), a BMI between 25 to 29.9 is considered over weight, while a
BMI of over 30 is an indication of obesity. According to the statistic,
68% of American population are either overweight or obese.
B. How do calculate your BMI index
BMI= weight (kg)/ height (m2)
C. Infertility
is defined as a condition of a female partner who can not get pregant
or give birth to a baby after 12 months of unprotected sexual
intercourse. According to Brannian JD. in the study of Obesity and
fertility,posted in PubMed, Brannian indicated that obesity has an
overall negative impact on fertility, affecting both women and men. Not
only are obese individuals more likely to experience infertility, they
are less likely to benefit from fertility treatment. Moreover, achieving
pregnancy may place obese women at high risk for serious complications.
It is important that obese individuals understand the effects that
their obesity can have on reproductive function.
D. How Obesity associates with infertility
1. Egg quality
Egg
quality is important for a normal conception and the growth of the
fetus, unfortunately, women women who are obese in general have poor egg
quality as result of elevations in insulin, glucose, or free fatty
acids, and changes in adipokines. According to the study of "The impact of obesity on egg quality" by Purcell SH, Moley KH., posted in PubMed,
researchers indicated that Bidirectional communication and metabolic
support from the surrounding cumulus cells are critical for oocyte
development, and the impact of obesity on these cells is also addressed.
Both oocyte maturation and metabolism are impaired due to obesity.
2. Fibroids
Women who are obese at higher risk of development of fibroid that can affect the chance of fertility. In a study of "Management of fibroids should be tailored to the patient" by King R, Overton C., posted in PubMed,
researcher wrote that if they enlarge, they can cause abnormal
bleeding, pressure on the bladderand/or bowel and the patient may have
difficulty getting pregnant. Fibroids are often discovered as an
incidental finding on ultrasound but may also present in the following
ways: abnormal uterine bleeding and menorrhagia; infertility; pelvic
mass; increasing girth; pressure symptoms (urinary frequency and/or
constipation); urinary retention; acute pelvic pain....
3. Insulin resistant
In
a study of investigating the complication of New Zealand obese (NZO)
mice display similar metabolic characteristics such as obesity, leptin
insensitivity, glucose intolerance, and IR. Importantly, NZO mice are
poor breeders, conducted by Heidelberg Repatriation Hospital, The
University of Melbourne, posted in PubMed,
researchers found that NZO mice show a poor breeding performance due to
decreased ovulation, increased number of primordial and atretic
follicles, and ovarian size. Given that NZO mice are obese,
hyperinsulinemic and insulin resistant, they are suitable for
investigating pathophysiological mechanisms linking metabolic
alterations with reproductive defects.
4. Polycystic Ovarian Syndrome(PCOs)
Polycystic
Ovarian Syndrome is defined as endocrinologic diseases caused by
undeveloped follicles clumping on the ovaries that interferes with the
function of the normal ovaries as resulting of enlarged ovaries, leading
to hormone imbalance( excessive androgen), resulting in male pattern
hair development, acne,irregular period or absence of period, weight
gain and effecting fertility. It effects over 5% of women population or 1
in 20 women. In a sudy of follow-up study represents ICSI outcomes in
obese women with PCOS (BMI ≥ 30 kg/m(2)) compared with non-obese women
with PCOS (BMI < 30 kg/m(2)). Obese (n = 18) and non-obese (n = 26)
women with PCOS underwent long protocol pituitary suppression, ovarian
stimulation and ICSI with fresh embryo transfer, conducted by Erciyes
University, Gevher Nesibe Hospital, posted in PubMed, researchers
concluded that Obese patients with PCOS required higher doses of
gonadotropin (2994 IU vs 1719 IU; p < 0.001). Miscarriage rate was
significantly higher in obese women compared with the non-obese women
with PCOS (60% vs 6.7%, p = 0.002). Our results are valuable for
counselling couples before initiation of assisted reproduction
techniques (ART).
5. Menstrual Irregularities
As we mentioned
in previous article that obesity promotes the risk of menstrual
irregularities of that can reduce the chance of getting amd maintaining
the normal pregnancy. According to the study of "Impact of obesity on gynecology" by Pandey S, Bhattacharya S., posted in PubMed,
researchers wrote that Rising obesity rates around the world have had a
profound impact on female reproductive health. Childhood obesity is
associated with early onset of puberty, menstrual irregularities during
adolescence and polycystic ovary syndrome. Women of reproductive age
with high BMIs have a higher risk of ovulatory problems and tend to
respond poorly to fertility treatment.
6. Late pregnancy complications
According to the study of "Late pregnancy complications in polycystic ovarian syndrome" by I Katsikis, M Kita, A Karkanaki, N Prapas, and D Panidis, posted in Hippokratia quatrely medical Journal,
researchers concluded that Multiple studies have demonstrated
associations between markers of insulin resistance on one hand and
gestational diabetes mellitus and hypertensive pregnancy on the other.
Findings consistent with the insulin resistance syndrome have been
observed before, during, and after these pregnancy complications.
7. Etc.
E. Treaments of Obesity and Infertility
1.
Diet, exercise and weight are important for obese women to get
pregnant. Some ovulation-induction drugs may also be considered in case
of necessary. According to the study of "Impact of obesity on female
fertility and fertility treatment"by Zain MM, Norman RJ., posted in
PubMed, researchers indicated in abstract that Obesity contributes to
anovulation and menstrual irregularities, 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; hence, treatment of obesity itself should be
the initial aim in obese infertile women before embarking on
ovulation-induction drugs or assisted reproductive techniques. While
various strategies for weight reduction, including diet, exercise,
pharmacological and surgical intervention exist, lifestyle modification
continues to be of paramount importance.
2. Weight and infertility management
In
a study of 270 women with polycystic ovarian syndrome attending the
infertility clinic were evaluated clinically, biochemically, and
laparoscopically. They were stratified according to their body mass
index (BMI) as follows: normal weight: 18-24; overweight: 25-29,
obese:30-34, and grossly obese: > or = 35, conducted by Faculty of
Medicine, Kuwait University, posted in PubMed, researchers filed the
result that Obesity has a negative impact on the outcome of treatment of
infertility. Weight reduction programme should be an essential
component of infertility management.
3. PCOs and fertility
Most obese women are associated with PCOs that can affect the chance of conceive. According to the study of Guzick DS.
in the study of "Ovulation induction management of PCOS", researchers
found that For women in whom weight loss is not possible, or for lean
women with PCOS, clomiphene citrate is an effective first-line method of
ovulation induction. In clomiphene-resistant women, alternative
treatments include adjunctive metformin or dexamethasone, aromatase
inhibitors, or ovarian drilling. If there is no pregnancy despite
several cycles of successful ovulation induction, gonadotropin treatment
should be considered, in which case in vitro fertilization is
recommended as the safest and most effective strategy.
4. Etc.
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