Obesity and its impact on female reproductive health: unraveling the connections

Abstract

In the modern era, the escalating global prevalence of obesity has profound implications on female reproductive health. Obesity, transcending mere lifestyle choices, has evolved into a complex disorder affecting physiological and metabolic functions. Concurrently, female infertility is rising as a significant global health issue. Obesity, with its extensive systemic effects, is pinpointed as a major disruptor. The convergence of these health challenges reveals a multifaceted scenario: on one hand, obesity directly impacts female reproductive health, particularly in the context of conditions like polycystic ovary syndrome (PCOS) and menstrual disturbances; on the other, the psychosocial consequences of infertility might intensify weight-gain patterns, forming a challenging cycle. Additionally, the economic implications of treating obesity-related infertility are considerable. This review delves into the myriad ways obesity affects female reproductive health, drawing insights from epidemiological, clinical, and molecular studies. It explores the epidemiological relationship between obesity and PCOS, the influence of obesity on menstrual disturbances, and the broader impact of obesity on female infertility. Weight loss, through pharmacological interventions, surgical methods, or lifestyle adjustments, emerges as a promising strategy. Lastly, the efficacy of assisted reproductive technologies, such as IVF, is influenced by obesity, underscoring the importance of an optimal body mass index. The review also highlights the molecular and physiological mechanisms underlying the impact of obesity on female reproductive health, including the disruption of the hypothalamic-pituitary-ovary axis, altered adipokine secretion, and the role of chronic inflammation and oxidative stress.

Examining the causal relationship between sex hormone-binding globulin (SHBG) and infertility: A Mendelian randomization study

“…Leave-one-out analysis evaluates the effect of an observation on sample data by excluding the overall result [22].…”

“…phenoscanner.medschl.cam.ac.uk/) to explore whether the infertility-associated SNPs were concurrently associated with several common risk factors that could potentially bias the MR estimate. For women, these factors included body mass index (BMI) [22] and polycystic ovary syndrome (PCOS) [23], whereas for men, BMI was considered [24]. Subsequently, if the SNPs were found to be associated with these potential confounders at a threshold of P < 5 × 10 −8 , IVW was replicated after removing these SNPs to validate the robustness of the results.…”

Mechanism of elevated LH/FSH ratio in lean PCOS revisited: a path analysis

“…PCOS etiology is not well understood, but it is speculated to occur as a result of a complex interaction between genetic and environmental factors 10 , 11 . Intrauterine hyperandrogen exposure has been proposed as a key factor causing the reprogramming of multiple genes contributing to the development of PCOS, which affects the hypothalamus-pituitary axis and metabolic disturbance, increasing LH secretion and abdominal fat accumulation and elevating insulin resistance risks at puberty and adolescence 12 .…”

The Molecular Link between Obesity and the Endometrial Environment: A Starting Point for Female Infertility

“…Overall, the existing literature sustains that obese women may exhibit differential gene expression in the endometrium in association with endometrial cancer [12] and angiogenesis [13], as well as an inflammatory response and decidualization [14], highlighting the importance of this kind of investigation to better comprehend the receptivity and, potentially, embryo implantation. To date, not all contributing factors able to interfere with endometrial receptivity are well known, but, apart from inflammatory events, they are often associated with endocrine causes, thin endometria, polyps, septa, fibroids, immunologically mediated disturbances, pre-eclampsia [15], cardiovascular risk factors such as dyslipidemia and hypertension, and diabetes [16] contributing to a series of reproductive problems [17]. The diagnosis of one of the most frequent gynecological conditions, such as endometriosis, has also been evaluated in subjects with higher BMIs.…”