reproduction
Post on 04-Jan-2016
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REPRODUCTIONOBesity Project
Pathophysiology of Obesity Regarding Fertility
• Obesity affects the endocrine system
• Endocrine changes with central obesity
• Insulin resistance results in suppression of hepatic SHBG
• Increased ovarian androgen synthesis and increased circulating free androgen
• Increased aromatization of androgens to estrogen in adipose tissue
• Leptin, a peptide secreted by adipocytes, inhibits ovarian follicular activity and steroidogenesis
Effect of Obesity on the Menstrual Cycle
• One third to half of overweight and obese women have irregular menstrual cycles
• Direct correlation between increasing BMI and cycle irregularity
• PCOS most common endocrinopathy in women
• Obesity frequently seen in PCOS patients
Effect of Obesity on Fertility
• Natural Reproduction
• Negatively affects natural reproduction through the interference of ovulation
• With weight reduction, ovulatory function and pregnancy rates frequently improve
• May reduce natural fecundity in ovulatory women- may involve potential adverse effects of insulin resistance
Effect of Obesity on Treatment of Subfertility
• Assisted Reproduction
• Higher doses and longer duration of fertility medications (gonadotropins)
• Increased frequency of cancelled IVF cycles
• Lower oocyte yields and reduced pregnancy rates
• Reduced ovulatory response to Clomiphene Citrate and higher doses required to induce ovulation
Effect of Obesity on the Male Reproductive System
• Obesity is associated with adverse effect
• Conversion of androgens to estrogens by peripheral adipose aromatization
• Relatively high estrogenic/androgenic state in obese males
• Total serum testosterone levels are reduced and gonadotropin levels are suppressed
Effect of Obesity on the Male Reproductive System
• Incidence of oligozoospermia and asthenozoospermia increase with BMI
• Scrotum remains in closer contact with surrounding tissue predisposing to higher temperatures that may adversely affect semen parameters
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