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Fertility and Obesity

  • Ulrik Schiøler Kesmodel
Chapter

Abstract

A number of hormonal and clinical changes related to fertility and fecundity are observed in overweight and obese women: Increased levels of leptin, which acts on the hypothalamus, the ovaries and the endometrium. Insulin resistance and compensatory hyperinsulinaemia is seen in obese women in general but also among women with polycystic ovary syndrome, and reduced levels of sex-hormone-binding globulin and increased levels of testosterone are observed. While it seems fairly consistent that obesity reduces fecundity in the spontaneous cycle, and while it appears that obesity does not much affect the chance of achieving a pregnancy once ovulation is induced in, for example, ovulation induction treatment and IUI treatment, results on the effect of obesity in IVF and ICSI treatment are much less clear. While many studies describe some significant association between obesity and one or more outcomes in IVF, the findings are not consistent. It may be that the inconsistencies are due to particular subgroups of overweight and/or obese women being at risk of adverse outcomes, for example young women and insulin-resistant women. Particular focus on identifying such subgroups seems to be warranted. Small reductions in weight of 5–10% of initial body weight may reduce the levels of insulin and androgens and increase the chance of achieving a pregnancy.

For men, overweight and obesity reduce both total testosterone and free testosterone levels but do not materially affect sperm concentration, sperm count, volume or sperm motility. Pregnancy rates may also be affected by male obesity, although the evidence is insufficient.

It appears evident that the cost of achieving a pregnancy or the cost of achieving a live birth is higher for overweight and obese, anovulatory women compared with normal-weight, anovulatory women. For overweight women, the costs may be approximately 50% higher and for obese women up to 100% higher. Even so, it seems clear that the costs of fertility treatment per se are low compared to the subsequent costs related to pregnancy and birth complications.

Given the fairly low cost associated with fertility treatment per se, the restrictions on fertility treatment imposed in some countries on the basis of BMI are debatable.

Keywords

Body Mass Index Obese Woman Live Birth Rate Body Mass Index Category Clomiphene Citrate 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Abbreviations

ART

Assisted reproduction techniques

BMI

Body mass index

FSH

Follicle-stimulating hormone

ICSI

Intracytoplasmatic sperm injection

IUI

Intrauterine insemination

IVF

In vitro fertilization

LH

Luteinizing hormone

PCOS

Polycystic ovary syndrome

SHBG

Sex-hormone-binding globulin

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Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  1. 1.Department of Obstetrics and GynaecologyAarhus University HospitalAarhus NDenmark

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