The Overlooked Role of Obesity in Infertility

  • Safaa Al-Hasani Mail Department of Obstetrics and Gynecology, University of Schleswig-Holstein, Lübeck, Germany
  • Khaled Zohni Medical Sciences Division, Reproduction unit, National Research Center, Egypt
Keywords:
Obesity, Overweight, Male and female infertility

Abstract

Being either underweight or overweight can affect a woman's fertility. Irregular menstrual cycles, reduced spontaneous and assisted fertility and an increased risk of miscarriage are risks associated with obesity that are often overlooked. Excessive weight and central distribution of body fat are both related to an increased risk of normogonadotrophic anovulation. Weight loss can re-establish ovulation in obese anovulatory patients or improve their response to ovulation induction. However, even a small amount of weight loss (5%) may improve fertility. Men who are overweight or obese have significantly lower sperm counts than men of normal weight.

References

World Health Organization. Obesity: preventing and managing the global epidemic. WHO Technical report series 894. Geneva 2000.

Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a standard definition for child overweight and obesity worldwide: International survey. British Medical Journal 2000; 320: 1240-3.

Health Survey for England 2003, Latest Trends. Department of Health, December 2004.

Jotangia D, Moody A, Stamatakis E, Wardle H. Obesity among children under 11. National Centre for Social Research. April 2005.

Zaadstra BM, Seidell JC, Van Noord PA, te Velde ER, Habbema JD, Vrieswijk B, et al. Fat and female fecundity: prospective study of effect of body fat distribution on conception rates. JBMJ 1993; 306: 1065.

Yusuf S, Hawken S, Ounpuu S, Bautista L, Franzosi MG, Commerford P, et al. Obesity and the risk of myocardial infarction in 27,000 participants from 52 countries: a case-control study. Lancet 2005; 366: 1640-9.

Grodstein F, Goldman MB, Cramer DW. Body mass index and ovulatory infertility. Epidemiology 1994; 5: 247-50.

Reid RL, Van Vugt DA. Weight-related changes in reproduction function. Fertil Steril 1987; 48: 905-13.

Hassan MA, Killick SR. Negative lifestyle is associated with a significant reduction in fecundity. Fertil Steril 2004; 81: 384-92.

Clark AM, Ledger W, Galletly C, Tomlinson L, Blaney F, Wang X, et al. Weight loss results in significant improvement in pregnancy and ovulation rates in anovulatory obese women. Hum Reprod 1995; 10: 2705-12.

Friedman CI, Kim MH. Obesity and its effect on reproductive function. Clin Obstet Gynecol 1985; 28: 645–63.

Norman RJ, Clark AM. Obesity and reproductive disorders. Reprod Fertil Dev 1998; 10 : 55 – 63

Reid RL, Van Vugt DA. Weight-related changes in reproductive function. Fertility and Sterility 1987; 48: 905–13.

Shepard MK, Balmaceda JP, Lelia CG. Relationship of weight to successful induction of ovulation with clomiphene citrate. Fertility and Sterility 1979; 32: 641–5.

Crosignani PG, Ragni G, Parazzini F, Wyssling H, Lombroso G, Perotti L.Anthropometric indicators and response to gonadotrophin for ovulation induction. Hum Reprod 1994; 9: 420-3.

Hamilton-Fairley D, Kiddy D, Watson H, Paterson C, Franks S. Association of moderate obesity with a poor pregnancy outcome in women with polycystic ovary syndrome treated with low dose gonadotrophin. Br J Obstet Gynaecol. 1992 ; 99 : 128 - 31.

Lanzone A, Fulghesu A, Andreani C, Caruso A, Mancuso S. Correlation between body weight and pure FSH dosage in the induction of ovulation in patients with polycystic ovary disease (PCOD). Infertility 1988; 11: 103–6.

Kiddy DS, Sharp PS, White DM, Scanlon MF, Mason HD, Bray CS, et al. Differences in clinical and endocrine features between obese and non-obese subjects with polycystic ovary syndrome: an analysis of 263 consecutive cases. Clin Endocrinol 1990; 32: 213-20.

Barbieri RL, Smith S, Ryan KJ. The role of hyperinsulinemia in the pathogenesis of ovarian hyperandrogenism. Fertil Steril 1988; 50: 197-212.

Balen AH, Conway GS, Kaltsas G, Techatrasak K, Manning PJ, West C,et al. Polycystic ovary syndrome: the spectrum of the disorder in 1741 patients. Hum Reprod 1995 ; 10 : 2107 - 11.

Dunaif A. Polycystic ovary syndrome. Curr Ther Endocrinol Metab 1994; 5: 222–9.

Norman RJ, Clark AM. Obesity and reproductive disorders. Reprod Fertil Dev 1998 ; 10 : 55 – 63.

Legro RS, Finegood D, Dunaif A. A fasting glucose to insulin ratio is a useful measure of insulin sensitivity in women with polycystic ovary syndrome. J Clin Endocrinol Metab 1998; 83: 2694–8.

Hollmann M, Runnebaum B, Gerhard I. Effects of weight loss on the hormonal profile in obese, infertile women. Hum Reprod 1996; 11 : 1884 - 91.

Guzick DS, Wing R, Smith D, Berga SL, Winters SJ. Endocrine consequences of weight loss in obese, hyperandrogenic, anovulatory women. Fertil Steril 1994; 61: 598-604.

Andersen P, Seljeflot I, Abdelnoor M, Arnesen H, Dale PO, Løvik A,et al. Increased insulin sensitivity and fibrinolytic capacity after dietary intervention in obese women with polycystic ovary syndrome. Metabolism 1995; 44: 611-6.

Holte J, Bergh T, Berne C, Wide L, Lithell H. Restored insulin sensitivity but persistently increased early insulin secretion after weight loss in obese women with polycystic ovary syndrome. J Clin Endocrinol Metab 1995; 80: 2586-93.

Huber-Buchholz MM, Carey DG, Norman RJ. Restoration of reproductive potential by lifestyle modification in obese polycystic ovary syndrome: role of insulin sensitivity and luteinizing hormone. J Clin Endocrinol Metab 1999; 84: 1470-4.

Pasquali R, Casimirri F, Vicennati V. Weight control and its beneficial effect on fertility in women with obesity and polycystic ovary syndrome. Hum Reprod 1997 ;12 ( Suppl 1 ): 82-7.

Bates GW, Whitworth NS. Effect of body weight reduction on plasma androgens in obese, infertile women. Fertil Steril 1982; 38: 406-9.

Crosignani PG, Piloni S, Gessati A, Colombo M, Vegetti W, Comi D, Ragni G. (1999) Resuption of fertility with diet in PCOS patients. Fertil Steril (ASRM/CFAS) Conjoint Annual Meeting, September 25–30 ; Toronto, Ontario, Canada, Abstract Book, S233.

Crosignani PG, Vegetti W, Colombo M, Ragni G. Resumption of fertility with diet in overweight women. Reprod Biomed Online 2002; 5: 60-4.

Fedorcsák P, Dale PO, Storeng R, Tanbo T, Abyholm T. The impact of obesity and insulin resistance on the outcome of IVF or ICSI in women with polycystic ovarian syndrome. Hum Reprod 2001; 16: 1086-91.

Kyei-Mensah AA, LinTan S, Zaidi J, Jacobs HS. Relationship of ovarian stromal volume to serum androgen concentrations in patients with polycystic ovary syndrome. Hum Reprod 1998; 13 : 1437 - 41 .

Falsetti L, Gambera A, Tisi G. Efficacy of the combination ethinyl oestradiol and cyproterone acetate on endocrine, clinical and ultrasonographic profile in polycystic ovarian syndrome. Hum Reprod 2001; 16: 36-42.

Crosignani PG, Colombo M, Vegetti W, Somigliana E,Gessati A, Ragni G. Overweight and obese anovulatory patients with polycystic ovaries: parallel improvements in anthropometric indices, ovarian physiology and fertility rate induced by diet. Hum Reprod 2003; 18: 1928-32.

Clark AM, Thornley B, Tomlinson L, Galletley C, Norman RJ. Weight loss in obese infertile women results in improvement in reproductive outcome for all forms of fertility treatment. Hum Reprod 1998; 13: 1502-5.

Galletly C, Clark A, Tomlinson L, Blaney F. Improved pregnancy rates for obese, infertile women following a group treatment program. An open pilot study. Gen Hosp Psychiatry 1996; 18: 192-5.

Pasquali R, Antenucci D, Casimirri F, Venturoli S, Paradisi R, Fabbri R, et al. Clinical and hormonal characteristics of obese amenorrheic hyperandrogenic women before and after weight loss. J Clin Endocrinol Metab 1989; 68: 173-9.

Ryley D, Bayer S, Eaton J, Zimon A, Klipstein S, Reindollar R. Influence of body mass index (BMI) on the outcome of 6,827 IVF cycles. Fertility and Sterility 2004 ; 82 ( Supplement 2 ): S38 - S39.

Fejes I, Koloszár S, Szöllosi J, Závaczki Z, Pál A. Is semen quality affected by male body fat distribution? Andrologia 2005; 37: 155-9.

Koloszár S, Daru J, Kereszturi A, Závaczki Z, Szöllosi J, Pál A. Effect of female body weight on efficiency of donor AI. Arch Androl 2002; 48: 323-7.

Mery CM, Rubio V, Duarte-Rojo A, Suazo-Barahona J, Peláez-Luna M, Milke P,et al. Android fat distribution as predictor of severity in acute pancreatitis. Pancreatology 2002; 2: 543-9.

Raman JD, Schlegel PN. Aromatase inhibitors for male infertility. J Urol 2002; 167: 624-9.

Rami B, Schober E, Kirchengast S, Waldhör T, Sefranek R. Prevalence of overweight and obesity in male adolescents in Austria between 1985 and 2000. A population based study. J Pediatr Endocrinol Metab 2004; 17: 67 - 72.

Vermeulen A, Kaufman JM, Goemaere S, van Pottelberg I. Estradiol in elderly men. Aging Male 2002; 5: 98-102.

World Health Organization. Laboratory Manual for the Examination of Human Semen and Sperm–Cervical Mucus Interaction. Cambridge University Press, 1999. UK.

Current practices and controversies in assisted reproduction. Report of a meeting on “medical, ethical and social aspects of assisted reproduction “WHO headquartes, Geneva,Switzerland,17-21 September 2001.

How to Cite
1.
Al-Hasani S, Zohni K. The Overlooked Role of Obesity in Infertility. J Fam Reprod Health. 2(3):115-122.
Section
Review Articles