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Prise en charge de l’infertilité chez la femme obèse

Management of infertility in obese women

  • Dossier Thématique / Thematic File
  • Published:
Obésité

Résumé

Avec l’âge maternel et le tabac, l’IMC est un facteur pronostic important de la fertilité d’une femme. Chez une femme obèse, une prise en charge hygiéno-diététique préconceptionnelle doit être mise en place précocement en amont du désir de grossesse, à la fois pour améliorer la fertilité, mais aussi pour diminuer les futures complications obstétricales. En cas d’infertilité, la prise en charge d’une patiente obèse devra tenir compte de son âge et de l’association ou non à un syndrome des ovaires polykystiques (SOPK). Une perte de poids est recommandée chez une femme obèse et jeune pour rétablir des ovulations spontanées et diminuer la morbidité obstétricale. En revanche, après 35 ans, l’obtention d’une perte de poids ne doit pas retarder la prise en charge en AMP d’une infertilité. En effet, l’âge de la patiente et sa réserve ovarienne sont des éléments pronostics plus importants que l’IMC. Chez les femmes obèses de plus de 35 ans, une exigence de perte de poids serait plus dommageable que les effets délétères propres de l’obésité sur la fertilité. Par ailleurs, les données concernant l’intérêt de la chirurgie bariatrique avant AMP sont très discutées. Si l’obésité est associée à un SOPK, les mesures hygiéno-diététiques seront au coeur de la prise en charge et pourront être associées à la prescription de myo-inositol.

Abstract

With maternal age and tobacco, IMC is a significant prognostic factor for female fertility. In an obese woman, a life-style intervention program with weight loss must be set up early before the desire for pregnancy, both to improve fertility and to reduce future obstetric complications. In case of infertility, the management of an obese women depends on her age and the association or not with a Polycystic Ovary Syndrome (PCOS). Weight loss is recommended in a young obese woman to restore spontaneous ovulation and decrease obstetrical morbidity. On the other hand, after 35 years, a weight loss should not delay the management of an infertility by ART (Assisted Reproductive Treatment). Indeed, the age of the women and her ovarian reserve are much more important prognosis factors than the BMI. After 35 years, weight loss requirement to achieve could be more damaging than the BMI himself. Data on the value of bariatric surgery prior ART are still debated. If obesity is associated with PCOS, weight loss associated with a prescription of Myoinositol should be strongly encouraged.

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Authors and Affiliations

  1. Service d’endocrinologie, maladies métaboliques et nutrition, Pôle Endo, AP-HM La Conception, 147 bld Baille, 13005, Marseille, France

    C. Vincentelli, B. Gaborit & A. Dutour Meyer

  2. NORT, Aix Marseille Univ, INSERM, INRA, NORT, Marseille, France

    C. Vincentelli, B. Gaborit & A. Dutour Meyer

  3. Pôle Femmes-Parents-Enfants – Centre Clinico-Biologique d’AMP - CECOS, AP-HM La Conception, 147 bld Baille, 13005, Marseille, France

    V. Castera & B. Courbiere

  4. Aix Marseille Université, CNRS, IRD, Avignon Université, IMBE UMR 7263, 13397, Marseille, France

    B. Courbiere

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  1. C. Vincentelli
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  2. B. Gaborit
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Correspondence to C. Vincentelli.

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Vincentelli, C., Gaborit, B., Castera, V. et al. Prise en charge de l’infertilité chez la femme obèse. Obes 12, 186–192 (2017). https://doi.org/10.1007/s11690-017-0559-8

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  • DOI: https://doi.org/10.1007/s11690-017-0559-8

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