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

Abstract

Female infertility constitutes a growing health problem in developing countries and could be associated with several possible causes including reproductive disorders, congenital malformations, infections and hormonal dysfunction. Nonetheless, a series of additional factors can also negatively impact female fertility and are represented by chronic exposure to environmental pollutants, stress, unhealthy lifestyle choices such as cigarette smoking and, among others, obesity. Excess weight is associated with several chronic diseases, and growing evidence demonstrates that it can compromise reproductive physiology due to its influence on endometrial gene expression and receptivity. Thus, the current review of the literature mainly focused on how obesity can impair uterine receptivity, mostly from a molecular point of view throughout the window of implantation (WOI) period at an endometrial level. It was also highlighted that an obesity-related increase in adipose tissue may lead to a modulation in the expression of multiple pathways, which could cause a hostile endometrial environment with a consequent negative impact on the uterine receptivity and the establishment of pregnancy. Thanks to the use of the endometrial receptivity assay (ERA), a specific microarray that studies the expression of a series of genes, it is now possible to evaluate the endometrial status of patients with infertility problems in a more detailed manner. Moreover, female fertility and endometrial receptivity could be affected by endometriosis, a chronic benign gynecological disease, whose cause-and-effect relationship to obesity is still uncertain. Therefore, further investigations would be required to better elucidate these mechanisms that govern embryo implantation and could be potentially useful for the generation of new strategies to overcome implantation failure and improve the pregnancy rates in obese women.

Associations Between Total and Regional Fat-to-Muscle Mass Ratio with the Prevalence of Infertility: A Cross-Sectional Study

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Associations Between Total and Regional Fat-to-Muscle Mass Ratio with the Prevalence of Infertility: A Cross-Sectional Study

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Body mass index as a key determinant of oxidative stress in women undergoing infertility treatment

“…Our findings are consistent with previous reports demonstrating elevated oxidative stress markers in women with endometriosis ( 50 ), Rambulangi & Ardianta Widyanugraha ( 51 ),. However, some studies suggest an inverse association between BMI and endometriosis, indicating a lower prevalence of the disease among women with higher BMI ( 52 ), Dai et al ( 49 ). Consequently, the etiological contribution of BMI to endometriosis remains uncertain, which may explain the relatively weak associations observed in our dataset between the endometriosis factor and other analyzed clinical or biochemical variables ( 53 ).…”

Impact of GnRH Agonist Pretreatment on Frozen-Thawed Embryo Transfer Outcomes of Overweight/Obese Women Undergoing Hormone Replacement Therapy

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Associations Between Total and Regional Fat-to-Muscle Mass Ratio with the Prevalence of Infertility: A Cross-Sectional Study

“……”

Body mass index as a key determinant of oxidative stress in women undergoing infertility treatment

“…Our findings are consistent with previous reports demonstrating elevated oxidative stress markers in women with endometriosis ( 50 ), Rambulangi & Ardianta Widyanugraha ( 51 ),. However, some studies suggest an inverse association between BMI and endometriosis, indicating a lower prevalence of the disease among women with higher BMI ( 52 ), Dai et al ( 49 ). Consequently, the etiological contribution of BMI to endometriosis remains uncertain, which may explain the relatively weak associations observed in our dataset between the endometriosis factor and other analyzed clinical or biochemical variables ( 53 ).…”

Impact of GnRH Agonist Pretreatment on Frozen-Thawed Embryo Transfer Outcomes of Overweight/Obese Women Undergoing Hormone Replacement Therapy

“……”

Associations Between Total and Regional Fat-to-Muscle Mass Ratio with the Prevalence of Infertility: A Cross-Sectional Study

“……”

Body mass index as a key determinant of oxidative stress in women undergoing infertility treatment

“…Our findings are consistent with previous reports demonstrating elevated oxidative stress markers in women with endometriosis ( 50 ), Rambulangi & Ardianta Widyanugraha ( 51 ),. However, some studies suggest an inverse association between BMI and endometriosis, indicating a lower prevalence of the disease among women with higher BMI ( 52 ), Dai et al ( 49 ). Consequently, the etiological contribution of BMI to endometriosis remains uncertain, which may explain the relatively weak associations observed in our dataset between the endometriosis factor and other analyzed clinical or biochemical variables ( 53 ).…”

Impact of GnRH Agonist Pretreatment on Frozen-Thawed Embryo Transfer Outcomes of Overweight/Obese Women Undergoing Hormone Replacement Therapy

“……”