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Wednesday, 18 December 2013

Women's Health: Obesity and Infertility

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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