The impact of diabetes and obesity on fertility and the potential role of gut hormones as treatment

Abstract

Obesity poses an enormous threat to life expectancy and quality of life in people with associated metabolic comorbidities. Alongside its metabolic implications, obesity and associated diabetes impair female reproductive function, causing infertility and polycystic ovarian syndrome (PCOS). Recently, gut hormones and their receptors have been identified in various reproductive organs indicating their potential regulatory effects on reproductive function. This review focuses on modifications during obesity, diabetes and related infertility with an emphasis on gut hormones and their therapeutic potential. Evidence suggests that bariatric surgery has positive effects on fertility and PCOS where major alterations in metabolism occurs through restoration of gut hormone levels. This is thought to be due to the indirect effect weight loss and regulation of blood glucose has on the hypothalamic‐pituitary‐ovarian and hypothalamic‐pituitary‐adrenal axis influencing reproduction. Further research is required to elucidate the cellular mechanisms involved in the direct effects of gut hormone receptor activation on reproductive tissues. Current observations suggest a therapeutic role for gut hormones in infertility/PCOS associated with metabolic pathophysiology.

Basic science lays the foundation to success

“…In developing future outstanding UK researchers in diabetes, Diabetes UK supports both basic and clinical professionals through the award of several career‐enhancing funding programmes, namely the 5‐year RD Lawrence and Harry Keen Fellowships. This year, we are fortunate to have excellent articles from both current (Mcilroy, 2 Moffett, 3 Leete 4 ) and former (Hodson, 5 Yaghootkar 6 ) RD Lawrence and Harry Keen (Salem 7 ) fellows. The breadth of expertise on offer covers an array of topics including the use of therapeutic strategies in restoring adipose tissue function in rare disorders of lipodystrophy 2 and in diabetes‐induced fertility problems, 3 and an accessible overview of histological advances made in characterisation of type 1 diabetes development and the endotype concept 4 .…”

“…This year, we are fortunate to have excellent articles from both current (Mcilroy, 2 Moffett, 3 Leete 4 ) and former (Hodson, 5 Yaghootkar 6 ) RD Lawrence and Harry Keen (Salem 7 ) fellows. The breadth of expertise on offer covers an array of topics including the use of therapeutic strategies in restoring adipose tissue function in rare disorders of lipodystrophy 2 and in diabetes‐induced fertility problems, 3 and an accessible overview of histological advances made in characterisation of type 1 diabetes development and the endotype concept 4 . Pia Leete's review 4 is based on her presentation at the conference “Pancreas and Diabetes” symposium, and David Hodson, who also presented at that symposium, has written an article on the synthesis and functional activity at beta cells of modified light‐activated sulfonylureas 5 .…”