Obesity and Infertility

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.

Infertility is defined as a condition of the female partner who can not get pregnant after 12 months of unprotected sexual intercourse.
How do calculate your BMI indexBMI= weight (kg)/ height (m²)

How obesity associates with Infertility
1. Hormonal effects
In a study of " Body mass index in relation to semen quality, sperm DNA integrity, and serum reproductive hormone levels among men attending an infertility clinic." by Chavarro JE, Toth TL, Wright DL, Meeker JD, Hauser R. (Source from Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA. jchavarr@hsph.harvard.edu, Copyright 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.), posted in PubMed, using the Standard semen analysis, sperm DNA fragmentation, and serum levels of reproductive hormones, researchers found that despite major differences in reproductive hormone levels with increasing body weight, only extreme levels of obesity may negatively influence male reproductive potential.

2. Sperm concentration and total sperm count
According to the study of " Is overweight a risk factor for reduced semen quality and altered serum sex hormone profile?" by Aggerholm AS, Thulstrup AM, Toft G, Ramlau-Hansen CH, Bonde JP. (Source from Department of Occupational Medicine, Aarhus University Hospital, Aarhus, Denmark. ansag@as.aaa.dk), posted in PubMed, researchers found that The T and inhibin B serum concentrations were 25%-32% lower in obese men in comparison with normal-weight men, whereas the E(2) concentration was 6% higher in obese men. Overweight men (BMI, 25.1-30.0 kg/m(2)) had a slightly lower adjusted sperm concentration and total sperm count than did men with a normal BMI (20.0-25.0 kg/m(2)), but no reduction in sperm count was observed among the obese men and suggested that that overweight and obese men have a markedly changed sex hormone profile in serum, whereas reduction of semen quality, if any, was marginal and below the detection limit of this large study.

3. Egg quality
In a stidu of " The impact of obesity on egg quality" by Purcell SH, Moley KH. (Source from Department of Obstetrics and Gynecology, Washington University in St. Louis, 660 South Euclid Ave., St. Louis, MO, 63110, USA), posted in PubMed, researchers found that Both oocyte maturation and metabolism are impaired due to obesity, negatively impacting further development. In addition to reproductive hormones, obesity induced elevations in insulin, glucose, or free fatty acids, and changes in adipokines appear to impact the developmental competence of the oocyte. The data indicate that any one of these hormones or metabolites can impair oocyte developmental competence in vivo, and the combination of all of these factors and their interactions are the subject of ongoing investigations

4. Ovarian structure and function
In a study of " The New Zealand obese mouse model of obesity insulin resistance and poor breeding performance: evaluation of ovarian structure and function" by Radavelli-Bagatini S, Blair AR, Proietto J, Spritzer PM, Andrikopoulos S. (Source from Department of Medicine (Austin Health/Northern Health), Heidelberg Repatriation Hospital, The University of Melbourne, Heidelberg Heights, Melbourne, Victoria 3081, Australia), researchers concluded that NZO mice (New Zealand obese 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.

5. Ovarian dysfunction
According to the study of "Inflammatory pathways linking obesity and ovarian dysfunction" by
Robker RL, Wu LL, Yang X. (Source from School of Paediatrics and Reproductive Health, Robinson Institute, University of Adelaide, Adelaide, South Australia 5005, Australia. rebecca.robker@adelaide.edu.au, Copyright © 2011 Elsevier Ireland Ltd. All rights reserved), posted in PubMed, researchers found that Studies in mice support this and allow further dissection of the pathways by which diet-induced obesity contributes to changes in mitochondria and the endoplasmic reticulum. These studies are in their infancy but cumulatively provide basic information about the cellular mechanisms that may lead to the impaired ovulation and reduced oocyte developmental potential that is observed in obese females.

6. Pregnancy-related complications
According to the study "Effect of body mass index on in vitro fertilization outcomes in women" by Sathya A, Balasubramanyam S, Gupta S, Verma T. (Source from Consultant Endocrinologist, Institute of Reproductive Medicine and Women's Health, Madras Medical Mission Hospital, Chennai, Tamil Nadu, India), posted in PobMed, researchers concluded in abstract that Increase in body mass index in women does not appear to have an adverse effect on IVF outcome. However, preconceptual counselling for obese women is a must as weight reduction helps in reducing pregnancy-related complications.

7. Etc.

Effect of Female obesity and Newborn
In a study of "[Obesity and female reproduction].[Article in French], by Sarfati J, Young J, Christin-Maitre S. (Source from Service d'Endocrinologie et des Maladies de la Reproduction, Centre Hospitalier Universitaire de Bicêtre - APHP, 78 rue du Général-Leclerc 94275 Le Kremlin-Bicêtre, France. sarfati_julie@yahoo.fr, Copyright © 2010 Elsevier Masson SAS. All rights reserved), posted in PobMed, researchers found that In this model, all weaned pups have been fed with a regular diet. At 13 weeks, pups delivered from obese mice were significantly larger, and these pups demonstrated early development of a metabolic-type syndrome. These findings suggest that maternal obesity has adverse effects as early as the oocyte and preimplantation embryo stages and that these effects may contribute to lasting morbidity in offspring, underscoring the importance of optimal maternal weight and nutrition before conception.

The importance of Obesity and Infertility treatment
1. According to the study of "Impact of obesity on female fertility and fertility treatment" by Zain MM, Norman RJ. (Source from University of Adelaide, Research Centre for Reproductive Health, School of Paediatrics & Reproductive Health, South Australia, Australia. murizah.mohdzain@adelaide.edu.au), posted in PubMed, researchers filed in abstract that 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. In a study of "Improving reproductive performance in overweight/obese women with effective weight management" by Norman RJ, Noakes M, Wu R, Davies MJ, Moran L, Wang JX. (Source from Reproductive Medicine Unit, University of Adelaide, The Queen Elizabeth Hospital, Woodville Rd, Woodville, SA5011, Australia_, posted in PubMed, researchers found that weight loss can improve the fertility of obese women through the recovery of spontaneous ovulation, whereas others will have improved response to ovarian stimulation in infertility treatment. Therefore, it is proposed that following the initial assessment of infertility and body mass index or other measurement of obesity, various weight management interventions, including diet, exercise or pharmacotherapeutic approaches, should be considered for overweight and obese infertile women.

3. Reported from the study of "The obese patient with infertility: a practical approach to diagnosis and treatment" by Moran LJ, Norman RJ. (Source from Reproductive Medicine Unit, Department of Obstetrics and Gynaecology, University of Adelaide, The Queen Elizabeth Hospital, South Australia, Australia), posted in Pubmed, researchers found that weight loss should be promoted as an initial treatment option for obese women with infertility. However, the most effective method for achieving and maintaining weight loss is unclear. Gradual weight loss is best achieved through a sensible eating plan that can be maintained over long periods of time. The likelihood of maintaining weight loss is increased when diet is combined with regular exercise, cognitive behavior therapy, and a supportive group environment. Adoption of these principles in a primary healthcare setting can therefore aid in treatment of infertility related to obesity.

4. Etc.
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