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Reproduction

OBesity Project. Reproduction. Pathophysiology of Obesity Regarding Fertility. Obesity affects the endocrine system Endocrine changes with central obesity Insulin resistance results in suppression of hepatic SHBG Increased ovarian androgen synthesis and increased circulating free androgen

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Reproduction

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  1. OBesity Project Reproduction

  2. Pathophysiology of Obesity Regarding Fertility • Obesity affects the endocrine system • Endocrine changes with central obesity • Insulin resistance results in suppression of hepatic SHBG • Increased ovarian androgen synthesis and increased circulating free androgen • Increased aromatization of androgens to estrogen in adipose tissue • Leptin, a peptide secreted by adipocytes, inhibits ovarian follicular activity and steroidogenesis

  3. Effect of Obesity on the Menstrual Cycle • One third to half of overweight and obese women have irregular menstrual cycles • Direct correlation between increasing BMI and cycle irregularity • PCOS most common endocrinopathy in women • Obesity frequently seen in PCOS patients

  4. Effect of Obesity on Fertility • Natural Reproduction • Negatively affects natural reproduction through the interference of ovulation • With weight reduction, ovulatory function and pregnancy rates frequently improve • May reduce natural fecundity in ovulatory women- may involve potential adverse effects of insulin resistance

  5. Effect of Obesity on Treatment of Subfertility • Assisted Reproduction • Higher doses and longer duration of fertility medications (gonadotropins) • Increased frequency of cancelled IVF cycles • Lower oocyte yields and reduced pregnancy rates • Reduced ovulatory response to Clomiphene Citrate and higher doses required to induce ovulation

  6. Effect of Obesity on the Male Reproductive System • Obesity is associated with adverse effect • Conversion of androgens to estrogens by peripheral adipose aromatization • Relatively high estrogenic/androgenic state in obese males • Total serum testosterone levels are reduced and gonadotropin levels are suppressed

  7. Effect of Obesity on the Male Reproductive System • Incidence of oligozoospermia and asthenozoospermia increase with BMI • Scrotum remains in closer contact with surrounding tissue predisposing to higher temperatures that may adversely affect semen parameters

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