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Reproduction in obese women has been a subject of contempt for some time now. Studies show that obesity among women of reproductive age is on the rise in fact it’s almost doubling. Obesity mostly begins in childhood and becomes more common in the teenage years (Kanagalingam, Forouhi, Greer & Satter, 2005). This article looks at what obesity is and how it affects reproduction in women together with possible medical intervention.
Definition of Obesity
Obesity in the simplest terms refers to the condition whereby one has extra fat in the body. The term has over time been confused with the term ‘overweight’ which is related to but not the same, overweight often refers to the situation where one weighs more than the optimum weight relative to the height. Weight however may be obtained from muscle structure, water content, fat as well as bones (Nelson & Fleming, 2009). The number of calories that one consumes should balance with the amount of the same used in day-to-day activities, failure to balance the two leads to obesity. This kind of disorder can be caused by lack of proper physical exercise which is meant to help the body utilize the excess fat consumed, bad eating habits where one component of food, for instance, fat is consumed in large portions as compared to other components, therefore, presenting a balance crisis. some of the fat is not converted into energy; it ends up accumulating in the body. The situation may also be genetically motivated.
Problems related to obesity in reproduction
Obesity as a condition leads to several health-related complications for instance quite often it is associated with diabetes mellitus a disease that is becoming very common among both young and old people across the globe. In fact, recently a nine old child was diagnosed with the disease which initially passed as an old age complication. Other common therapeutic conditions include cardiovascular ailments, cancer of the breast and that of the uterus, problems relating to pregnancy, and shortcomings in the reproductive health of an individual. The named problems are predominant in women than men however that does not suggest that no man experiences obesity-related difficulties but the proposition here is that, the prevalence in women is high (Nelson & Fleming, 2009).
Empirical data shows that a good number of women in pursuit of medical solutions at reproductive health centers present problems associated with infertility apparently most of them have an above-average body mass index (BMI).
Obesity is said to have a negative impact on the ability of a woman to ovulate regularly, this in the long run leads to a condition known as subfertility as well as a high prevalence to miscarry whenever a conception occurs (Smith, 2004).
Obesity causes serious maternal problems because there is a great correlation between obesity and hypersensitive disorders that come with pregnancy. The disorders include fetal distress which may lead to giving birth to an abnormal child, the situation also comes with altered moods among pregnant mothers, thromboembolism, diabetes and other infections that may come with it (Smith GC et al.1998). First The condition leads to early and recurrent miscarriages among women in recent meta-analysis obesity was found to have caused 17%of the recorded miscarriages.
Obesity and Fertility
Low conception rates among obese women are primarily caused by ovulation dysfunction this however does not pass as the sole cause of the condition is although it accounts for a good number of the present cases. The ovulation interval among obese women is a big and polycystic ovarian syndrome (PCOS) a common of ovulation failure which affects about 4-7% of women is closely paired with BMI values of more than 25kg per square meter. This ovulation dysfunction is initiated by insulin resistance and concomitant hyperinsulinemia which opposites any accumulation of fat in the body. Insulin has a reversed effect on the synthesis of sex- hormones. The other proposition is that truncal obesity causes insulin resistance independent of PCOS (Shen W et al., 2006).
Obesity poses the risk of maternal congenital anomalies diagnoses at the antenatal level of pregnancy, research shows that 10% of obese women develop four-chamber views at 22-24weeks, the anomalies pose a risk of fetal death which has high chances of occurring if the mother increases her BMI before conceiving (Willis LH et al, 2007). Women with more than 40kg/m square are more likely to experience stillbirths as opposed to their counterparts with a smaller figure with regard to BMI. For an optimal pregnancy to occur women are advised to lose weight before they can conceive whether naturally or by other induced conception means. A 5%-10% loss of body weight can lead to a series of corrections in the body’s reproduction. It will greatly mend the insulin sensitivity, as well as reduce the visceral adiposity and all this will rejuvenate normal ovulation.
Obesity that is associated with menstrual dysfunction drastically decreases the fertility rate and causes miscarriages at later Stages. Statistics from cross-sectional research conducted indicates that 30%-47% of women diagnosed as overweight and obese have an irregular menstrual cycle this condition further complicates fertility viability amongst the sufferers. In men, obesity brings about serious reproductive anomalies for instance the condition affects men’s fertility by thermal, genetic and endocrinal dimensions (Willis LH et al, 2007).
In obese men a large portion of androgen is transformed to estrogen through aromatization in extra fat. Subsequently the serum and total testosterone level get compacted. The series of reactions cause a reversed feedback of estrogen and in the long run infertility is evident. The situation is seemingly common among most if not all obese men. Testicular dysfunction is another primary cause of infertility among obese men; in this, the scrotum is kept in close contact with neighboring tissues which maximally raises the scrotal temperature resulting in overall affected semen parameters.
Obesity in pregnancy
Obesity poses a risk to pregnant obese women. These women have a high chance of getting early or recurrent miscarriages. For any successful pregnancy to survive in obese cases one has to undergo weight loss, it is advisable to avoid conception until the weight loss is optimally attained. Before any treatment induction to improve ovarian response the obstetric risks have to be thoroughly assessed. An abnormal hormonal profile on the mother can contribute to miscarriages but PCOS is not responsible for miscarriages after in vitro fertilization. Obesity and hypertension together with other disorders have a close association with obesity (Shen W et al. 2006). These disorders lead to fetal distress thus making it to grow slowly or not mature at all due to fetal anomalies. It also makes the chances of a caesarian birth common. The correct model of weight loss involves a six months exercise intensive period and a possible calorie restriction. This model has been recommended to a number of obese cases and it has been proved to have elicited fertility and prenatal benefits.
Treatment-Medical and weight loss
The first intervention towards treating obese women is through ovulation induction to counter the reduced ovulation rates. This procedure is done by induction of antiestrogen clomifene citrate this increases the chances of restoring a normal ovulation cycle which can be monitored for three to four months before conception van lace. Treatment with metformin alone can also cause a significant impact on ovulation because it triggers weight loss and successful reduction of visceral adiposity however the effect will be superb if paired with lifestyle modification. Another administered hormone is gonadotrophins which relatively decreases the anovulation. Obese women seeking to avoid reproductive complications are advised to reduce weight to boost the endocrine profile and menstrual viability (Haslam, Sattar & Lean, 2006).
Some obese patients can undergo Bariatric Surgery especially those with morbid obesity. This surgery involves creating a small gastric pouch that can fill rapidly. Food eaten bypasses a large section of the small bowel leading to reduced surface area for food absorption. This surgery enables weight loss, an improved menstrual pattern and a remarkable reduction in medical complications related to obesity (Sattan, 2006). The patient also experiences improved conditions in diseases such as diabetes, dyslipidemia, sleep apnea and hypertension. This intervention is only helpful to obese patients who still have an active reproductive life. Then it is likely to optimize the maternal metabolic profile before one can settle for treatment of fertility or pregnancy. Gastric bypass is the most common type of bariatric surgery since they achieve a greater weight loss compared to gastric banding procedures through their postoperative nutritional and electrolyte anomalies are greater.
Pregnancy is not recommended after the first year of surgery because this is the time period within which weight loss occurs. As opposed to obese women, those who have undergone bariatric surgery are at a lower risk of complications during pregnancy (Galtier-Dereure, 1997). However, this surgery may lead to anemic conditions which may lead to the death of both the mother and the baby due to a lack of iron and vitamin B12. Gastric bypass may also result in death due to herniation of a part of the bowel through a mesenteric defect which leads to necrosis and acidosis.
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Lifestyle modification to trigger weight loss especially in women with the polycyclic ovarian syndrome has been found to improve their endocrine profile and their cyclicity as well as the health of their pregnancy. A slight loss of about 5-10% of the total body weight can create a relatively big impact of up to 30% lowering the visceral adiposity thus leading to normal ovulation and better sensitivity of the body to insulin (Jensen, 1998). Lifestyle modification should be encouraged before ovulation induction treatment because this modification helps in increasing ovulation rates. This is to improve the chances of the ovary responding by ovulating and to limit obstetric complications. Weight loss can be achieved through regular exercise and watchful intake of food in a period as short as 6 months along with benefits in the endocrine system and improved fertility and perinatal levels. Weight loss can also be achieved through pharmacological therapies such as sibutramine which brings about lifestyle-induced weight loss by causing metabolic disturbances in polycyclic ovarian syndrome patients. Metformin when used together with lifestyle modification induces weight loss together with lowering visceral adiposity (Alberti, 2005).
Another way of treatment is the use of anti-absorptive drugs. Drugs such as orlistat which is got from concentrated lipostatin are used to alter the hydrolysis of fat from absorbable to absorbable free fatty acids so as to decrease the amount of fat absorbed to upto30%. Orlistat reduces the absorption of fat-soluble vitamins such as vitamin D which can be taken from supplements such as multivitamin tablets which should be taken 2hours prior to or after orlistat (Zhou, 2002).
Appetite suppressants can be used to treat obesity. Phentermine is used to increase the presence of norepinephrine in the periventricular and perifornical region of the hypothalamus so as to cause satiety. Herbal supplements have been used by obese women to treat themselves though it has not been documented (Pasquali & Gambineri, 2002).
In addition, cannabinoid receptor antagonists which are responsible for controlling food intake and energy homeostasis in the body through the endocannabinoid system are over-activated in obese people. Drugs such as rimonabant improve and metabolic risk factors such as body weight and waist circumference.
In conclusion, obesity has been found to affect reproduction in women by affecting their fertility rates. However, this can be countered if the person in question is willing to undergo treatment. These fertility problems include ovulation frequency which can be overcome through standard treatment strategy which includes weight loss and fertility treatment (Rexrode et al, 2002). This includes lifestyle modification through exercise and combination with pharmacotherapy so as to result in reduced visceral adipose tissue. Bariatric surgery is also used by obese women especially through the gastric bypass to reduce their weight leading to a direct reduction in no ovulation in women and other obstetric dangers in reproduction. Other ways of treatment such as appetite suppressants and anti-absorption drugs also help in the reduction of total body weight.
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