Infertility in women with obesity

Authors

  • Celeste Muntaner National University of Comahue, Neuquén, Argentina

DOI:

https://doi.org/10.47196/diab.v57i3Sup.676

Keywords:

infertility, women with obesity

Abstract

The negative impact of obesity on reproductive function is not only linked to infertility but also to adverse perinatal outcomes and increased maternal and fetal morbidity and mortality1.

The obese patient is three times more likely to suffer infertility than the patient with normal BMI both in natural cycles and in assisted reproductive therapy. Obese patients with PCOS have a more complex metabolic and reproductive phenotype. The most characteristic alteration of obesity, increased insulin secretion, impacts on the functioning of the hypothalamic-pituitary-ovarian axis.

Adipose tissue is an endocrine organ that generates proinflammatory adipokines and obesity is considered a chronic inflammatory state. The main hormone it secretes is leptin, which is increased in obese patients and may have a negative effect on fertility by inhibiting folliculogenesis through direct and indirect control of LH and FSH secretion, but also by affecting perifollicular blood flow and endometrial receptivity2. Adipose tissue produces steroid hormones by conversion of inactive forms resulting in decreased SHBG, increased peripheral aromatisation of androgens to oestrogens and relative hyperandrogenemia. The ovary has receptors for insulin and IGF-1 receptors in the granulosa, theca and stroma. Modulation of sex steroid bioavailability by insulin inhibiting hepatic synthesis of SHBG results in obese patients having a lower response to ovarian stimulation with gonadotrophins, lower oocyte quality and lower pregnancy rate than those with normal BMI3.

At the endometrial level, the hyperestrogenism present in obesity can negatively affect endometrial receptivity. Reduced glycodelin, secreted by endometrial glands and decidua, a paracrine regulator of pregnancy in the endometrium, and reduced IGF-1 involved in embryo adhesion, are associated with high levels of circulating insulin and increased recurrent pregnancy loss. Obese women have elevated levels of acute phase proteins and pro-inflammatory cytokines (including IL6, PAI1 and TNF) and these inflammatory markers are thought to have a negative effect on implantation and early embryo development4.

Author Biography

Celeste Muntaner, National University of Comahue, Neuquén, Argentina

Obstetrician-gynecologist, specialist in prenatal diagnosis and high-risk pregnancy, Regular Adjunct Professor

References

I. Simon A, Pratt M, Hutton B, Skidmore B, Fakhraei R, Rybak N, Corsi DJ, Walker M, Vélez MP, Smith GN, Gaudet LM. Guidelines for the management of pregnant women with obesity: a systematic review. Obes Rev 2020 Mar;21(3):e12972.

II. Brewer CJ, Balen AH, The adverse effects of obesity on conception an implantation. Reproduction2010;140(3):347-364.

III. Snider AP, Wood JR. Obesity induces ovarian inflammation and reduces oocyte quality, Reproduction 2019;158(3):R79-R90.

IV. Broughton DE, Moley KH. Obesity and female infertility: potential mediators of obesity's impact. Fertil Steril 2017 Apr;107(4):840-847.

Published

2023-08-30

How to Cite

Muntaner, C. (2023). Infertility in women with obesity. Journal of the Argentine Society of Diabetes, 57(3Sup), 18–19. https://doi.org/10.47196/diab.v57i3Sup.676

Issue

Section

5 VOICES IN 10 MINUTES: What should Martina know?