Cardio‐metabolic risk factors among young infertile women: a systematic review and meta‐analysis

Abstract

Background There is currently no concise systematic review or meta‐analysis addressing cardio‐metabolic risk factors in women experiencing infertility. Objectives To determine whether infertile women have higher levels of cardiovascular risk factors compared with fertile women. Search strategy We performed a systematic literature search using PubMed, Embase and CINAHL, Scopus and additional manual and bibliographic searches for relevant articles (end search date 6 November 2019). Selection criteria We selected studies that compared cardio‐metabolic risk factors in fertile and infertile women of reproductive age. Data collection and analysis At least two authors independently screened potentially eligible studies. Main results There was an increased presence of several cardio‐metabolic risk factors in infertile women compared with fertile women. Infertile women had statistically significant higher body mass index (BMI), increased total cholesterol (TC), low‐density lipoprotein cholesterol (LDL‐C) and triglycerides (TG) compared with fertile women. Fasting glucose, fasting insulin, homeostatic model assessment of insulin resistance (HOMA‐IR) and mean arterial pressure were not found to be different between fertile and infertile women. A subgroup analysis revealed that TC, fasting glucose and fasting insulin were increased, and high‐density lipoprotein was decreased only in women with polycystic ovarian syndrome compared with fertile women, whereas BMI, TG and LDL‐C were statistically significantly increased in women with any indication of infertility compared with fertile women. Conclusions Infertile women have a higher level of cardio‐metabolic risk factors compared with fertile women. This finding has clinical implications for infertile women in general, and those attempting to conceive through medically assisted reproduction. Tweetable abstract Infertile women appear to have a higher level of cardio‐metabolic risk factors compared with fertile women.

Obesity, Polycystic Ovary Syndrome, and Infertility: A New Avenue for GLP-1 Receptor Agonists

“…In addition to insulin resistance and hyperglycemia, also dyslipidemia, typical component of metabolic syndrome, has been suggested to have negative effects on fertility and pregnancy ( 32 ). A recent meta-analysis documented that infertile women had statistically significant higher BMI, increased total cholesterol, low-density lipoprotein (LDL)-cholesterol, and triglycerides compared to fertile women ( 33 ). A subgroup analysis revealed that total cholesterol, high-density lipoprotein (HDL)-cholesterol, fasting glucose, and fasting insulin were increased only in women with PCOS compared with fertile women, while BMI, triglycerides, and LDL-cholesterol were significantly increased in women with any cause of infertility relative to fertile women.…”

Effects of Metabolic Syndrome on Semen Quality and Circulating Sex Hormones: A Systematic Review and Meta-Analysis

“…Besides, individuals with obesity, dyslipidemia or hypertension were also reported with a decrease in semen quality and changes in sex hormones. These might contribute to concomitant oxidative stress and inflammation, and impaired seminal antioxidant capacity (34,35). In this meta-analysis, we found a decrease of sperm total count, sperm concentration, sperm normal morphology, sperm progressive motility, and sperm vitality and an increase of sperm DNA fragmentation and MMP, while no significant difference was found in semen volume and sperm total motility.…”

“…Small sample size could increase the risk of sampling error, and thus lead to within-study and between-study heterogeneity and the expansion of synthetic effect size. Besides, the meta-analysis of continuous data usually showed a higher heterogeneity than categorical data, just like the recent study of "Cardio-metabolic risk factors among young infertile women: a systematic review and meta-analysis" (35).…”

“…Besides, individuals with obesity, dyslipidemia or hypertension were also reported with a decrease in semen quality and changes in sex hormones. These might contribute to concomitant oxidative stress and inflammation, and impaired seminal antioxidant capacity ( 34 , 35 ).…”

In‐Hospital Complications in Pregnancies Conceived by Assisted Reproductive Technology

“… 31 Furthermore, women with infertility are more likely to have cardiometabolic risk factors, such as atherogenic lipid profile and obesity, compared with fertile women. 32 Nevertheless, it remains challenging to determine whether the increased prevalence of adverse outcomes is attributable to the ART procedure itself 33 , 34 , 35 , 36 or maternal factors associated with infertility 37 or is multifactorial. 38 , 39 , 40 , 41 , 42 , 43 , 44 …”