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Wadden KP, Hollohan N, Furneaux T, Maher R, Barrett CM, Fuller D, Basset F, Murphy D, Murphy S, Healey S, McGowan E, Twells LK. PRO-FIT-CARE study: the feasibility assessment of a pilot online exercise intervention for persons living with obesity and female infertility. Front Sports Act Living 2024; 6:1332376. [PMID: 38774277 PMCID: PMC11107087 DOI: 10.3389/fspor.2024.1332376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 04/10/2024] [Indexed: 05/24/2024] Open
Abstract
Introduction Moderate-to-high physical activity participation is associated with a reduced risk of infertility. Yet, exercise interventions that target cardiorespiratory fitness, independent of weight loss, are lacking in obesity and female fertility research. Purpose The primary objective of the PRO-FIT-CARE (PROmoting FITness for CArdiometabolic & REproductive Health) study was to assess the feasibility of a moderate-to-high-intensity online exercise program for persons with obesity and female infertility. Methods Feasibility, safety, acceptability, and efficacy were assessed by examining: (1) recruitment and consent rate, (2) study retention, (3) adverse events, (4) participant satisfaction, (5) adherence, and (6) cardiorespiratory fitness. Results Eleven of thirty-two women contacted agreed to participate in the program (34.4% consent rate). Eight participants (72.7%) completed the study. One musculoskeletal injury was reported. There was a 30% adherence rate based on prescribed exercise intensity (60%-80% of heart rate maximum). One of eleven participants attended 80% of the exercise intervention. Based on a weekly satisfaction survey, the program had an overall high level of satisfaction. Compared to sex and age normative data, post-intervention, two of eight participants improved their cardiorespiratory fitness percentile rank. Conclusion The study highlights challenges with adherence to an online exercise program. While the program was safe and participants reported high levels of program satisfaction, approaches to improve adherence must be incorporated.
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Affiliation(s)
- K. P. Wadden
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John’s, NL, Canada
| | - N. Hollohan
- Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL, Canada
| | - T. Furneaux
- Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL, Canada
| | - R. Maher
- Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL, Canada
| | - C. M. Barrett
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John’s, NL, Canada
| | - D. Fuller
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - F. Basset
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John’s, NL, Canada
| | - D. Murphy
- Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL, Canada
- Discipline of Obstetrics and Gynecology, Memorial University of Newfoundland, St. John’s, NL, Canada
| | - S. Murphy
- Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL, Canada
- Discipline of Obstetrics and Gynecology, Memorial University of Newfoundland, St. John’s, NL, Canada
| | - S. Healey
- Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL, Canada
- Discipline of Obstetrics and Gynecology, Memorial University of Newfoundland, St. John’s, NL, Canada
| | - E. McGowan
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John’s, NL, Canada
| | - L. K. Twells
- Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL, Canada
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Sliwowska JH, Woods NE, Alzahrani AR, Paspali E, Tate RJ, Ferro VA. Kisspeptin a potential therapeutic target in treatment of both metabolic and reproductive dysfunction. J Diabetes 2024; 16:e13541. [PMID: 38599822 PMCID: PMC11006622 DOI: 10.1111/1753-0407.13541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 09/21/2023] [Accepted: 02/03/2024] [Indexed: 04/12/2024] Open
Abstract
Kisspeptins (KPs) are proteins that were first recognized to have antimetastatic action. Later, the critical role of this peptide in the regulation of reproduction was proved. In recent years, evidence has been accumulated supporting a role for KPs in regulating metabolic processes in a sexual dimorphic manner. It has been proposed that KPs regulate metabolism both indirectly via gonadal hormones and/or directly via the kisspeptin receptor in the brain, brown adipose tissue, and pancreas. The aim of the review is to provide both experimental and clinical evidence indicating that KPs are peptides linking metabolism and reproduction. We propose that KPs could be used as a potential target to treat both metabolic and reproductive abnormalities. Thus, we focus on the consequences of disruptions in KPs and their receptors in metabolic conditions such as diabetes, undernutrition, obesity, and reproductive disorders (hypogonadotropic hypogonadism and polycystic ovary syndrome). Data from both animal models and human subjects indicate that alterations in KPs in the case of metabolic imbalance lead also to disruptions in reproductive functions. Changes both in the hypothalamic and peripheral KP systems in animal models of the aforementioned disorders are discussed. Finally, an overview of current clinical studies involving KP in fertility and metabolism show fewer studies on metabolism (15%) and only one to date on both. Presented data indicate a dynamic and emerging field of KP studies as possible therapeutic targets in treatments of both reproductive and metabolic dysfunctions.
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Affiliation(s)
- Joanna Helena Sliwowska
- Department of Veterinary Medicine and Animal Sciences, Laboratory of Neurobiology, Poznan University of Life Sciences, Poznan, Poland
| | - Nicola Elizabeth Woods
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - Abdullah Rzgallah Alzahrani
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
- Department of Pharmacology and Toxicology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Elpiniki Paspali
- Department of Chemical Engineering, University of Strathclyde, Glasgow, UK
| | - Rothwelle Joseph Tate
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - Valerie Anne Ferro
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
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3
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Liu X, Shi J. Female obesity increases the risk of preterm birth of single frozen-thawed euploid embryos: a retrospective cohort study. Gynecol Endocrinol 2024; 40:2324995. [PMID: 38439198 DOI: 10.1080/09513590.2024.2324995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 10/05/2023] [Indexed: 03/06/2024] Open
Abstract
INTRODUCTION Obesity has been associated with an increased risk of reproductive failure, especially preterm birth. As preimplantation genetic testing for aneuploidies (PGT-A) is increasingly used worldwide, however, it is still unclear whether body mass index (BMI) has an effect on the preterm birth rate in patients undergoing in vitro fertilization (IVF) with PGT-A when transferring a single euploid blastocyst. MATERIALS AND METHODS This retrospective, single-center cohort study included 851 women who underwent the first cycle of frozen-thawed single euploid blastocyst transfer with PGT-A between 2015 and 2020. The primary outcome was the preterm birth rate. Secondary outcomes were clinical pregnancy, miscarriage, ectopic pregnancy, pregnancy complications, and live birth. RESULTS Patients were grouped by World Health Organization (WHO) BMI class: underweight (<18.5, n = 81), normal weight (18.5-24.9, n = 637), overweight (25-30, n = 108), and obese (≥30, n = 25). There was no difference in the clinical pregnancy, miscarriage, ectopic pregnancy, pregnancy complication, and live birth by BMI category. In multivariate logistic regression analysis, preterm birth rates were significantly higher in women with overweight (adjusted odds ratio [aOR] 3.18; 95% confidence interval [CI], 1.29-7.80, p = .012) and obese (aOR 1.49; 95% CI, 1.03-12.78, p = .027) compared with the normal weight reference group. CONCLUSION Women with obesity experience a higher rate of preterm birth after euploid embryo transfer than women with a normal weight, suggesting that the negative impact of obesity on IVF and clinical outcomes may be related to other mechanisms than aneuploidy.
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Affiliation(s)
- Xitong Liu
- The Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, China
| | - Juanzi Shi
- The Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, China
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Maitin-Shepard M, Werner EF, Feig LA, Chavarro JE, Mumford SL, Wylie B, Rando OJ, Gaskins AJ, Sakkas D, Arora M, Kudesia R, Lujan ME, Braun J, Mozaffarian D. Food, nutrition, and fertility: from soil to fork. Am J Clin Nutr 2024; 119:578-589. [PMID: 38101699 DOI: 10.1016/j.ajcnut.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 11/22/2023] [Accepted: 12/11/2023] [Indexed: 12/17/2023] Open
Abstract
Food and nutrition-related factors, including foods and nutrients consumed, dietary patterns, use of dietary supplements, adiposity, and exposure to food-related environmental contaminants, have the potential to impact semen quality and male and female fertility; obstetric, fetal, and birth outcomes; and the health of future generations, but gaps in evidence remain. On 9 November 2022, Tufts University's Friedman School of Nutrition Science and Policy and the school's Food and Nutrition Innovation Institute hosted a 1-d meeting to explore the evidence and evidence gaps regarding the relationships between food, nutrition, and fertility. Topics addressed included male fertility, female fertility and gestation, and intergenerational effects. This meeting report summarizes the presentations and deliberations from the meeting. Regarding male fertility, a positive association exists with a healthy dietary pattern, with high-quality evidence for semen quality and lower quality evidence for clinical outcomes. Folic acid and zinc supplementation have been found to not impact male fertility. In females, body weight status and other nutrition-related factors are linked to nearly half of all ovulation disorders, a leading cause of female infertility. Females with obesity have worse fertility treatment, pregnancy-related, and birth outcomes. Environmental contaminants found in food, water, or its packaging, including lead, perfluorinated alkyl substances, phthalates, and phenols, adversely impact female reproductive outcomes. Epigenetic research has found that maternal and paternal dietary-related factors can impact outcomes for future generations. Priority evidence gaps identified by meeting participants relate to the effects of nutrition and dietary patterns on fertility, gaps in communication regarding fertility optimization through changes in nutritional and environmental exposures, and interventions impacting germ cell mechanisms through dietary effects. Participants developed research proposals to address the priority evidence gaps. The workshop findings serve as a foundation for future prioritization of scientific research to address evidence gaps related to food, nutrition, and fertility.
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Affiliation(s)
| | - Erika F Werner
- Tufts University School of Medicine, Boston, MA, United States
| | - Larry A Feig
- Department of Developmental, Molecular, and Chemical Biology, Tufts University School of Medicine, Boston, MA, United States
| | - Jorge E Chavarro
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Sunni L Mumford
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, United States
| | - Blair Wylie
- Collaborative for Women's Environmental Health, Columbia University, New York, NY, United States
| | - Oliver J Rando
- Department of Biochemistry and Molecular Biotechnology, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Audrey J Gaskins
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, United States
| | | | - Manish Arora
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | | | - Marla E Lujan
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, United States
| | - Joseph Braun
- Department of Epidemiology, Brown University, Providence, RI, United States
| | - Dariush Mozaffarian
- Tufts University School of Medicine, Boston, MA, United States; Food is Medicine Institute, Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States.
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5
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Ancira-Moreno M, Burrola-Méndez S, Muñoz-Manrique C, Omaña-Guzmán I, Hoyos-Loya E, Trejo-Domínguez A, Hernández-Cordero S, Mazariegos M, Smith N, Tavano-Colaizzi L, Mier-Cabrera J, Avendaño-Álvarez F, Espino y Sosa S, Muciño-Sandoval K, Ibarra-González L, Medina-Avilés C. A scoping review and critical evaluation of the methodological quality of clinical practice guidelines on nutrition in the preconception. Front Nutr 2023; 10:1122289. [PMID: 37927499 PMCID: PMC10621738 DOI: 10.3389/fnut.2023.1122289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 10/03/2023] [Indexed: 11/07/2023] Open
Abstract
Introduction Clinical practice guidelines (CPGs) contain recommendations for specific clinical circumstances, including maternal malnutrition. This study aimed to identify the CPGs that provide recommendations for preventing, diagnosing, and treating women's malnutrition. Additionally, we sought to assess the methodological quality using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument. Methods An online search for CPGs was performed, looking for those that contained lifestyle and nutritional recommendations to prevent, diagnose and treat malnutrition in women during the preconception period using PubMed and different websites. The reviewers utilized the AGREE II instrument to appraise the quality of the CPGs. We defined high-quality guidelines with a final score of > 70%. Results The titles and abstracts from 30 guidelines were screened for inclusion, of which 20 guidelines were fully reviewed for quality assessment. The overall quality assessment of CPGs was 73%, and only 55% reached a high-quality classification. The domains in the guidelines classified as high-quality had the highest scores in "Scope and Purpose" and "Clarity of Presentation" with a median of 98.5 and 93%, respectively. Discussion Further assessment is needed to improve the quality of the guidelines, which is an opportunity to strengthen them, especially in the domains with the lowest scores.
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Affiliation(s)
- Mónica Ancira-Moreno
- Department of Health, Universidad Iberoamericana, Mexico City, Mexico
- Maternal and Child Health and Nutrition Network (MaCHiNNe), Observatorio Materno Infantil, Universidad Iberoamericana, Mexico City, Mexico
| | - Soraya Burrola-Méndez
- Department of Health, Universidad Iberoamericana, Mexico City, Mexico
- Maternal and Child Health and Nutrition Network (MaCHiNNe), Observatorio Materno Infantil, Universidad Iberoamericana, Mexico City, Mexico
| | - Cinthya Muñoz-Manrique
- Maternal and Child Health and Nutrition Network (MaCHiNNe), Observatorio Materno Infantil, Universidad Iberoamericana, Mexico City, Mexico
- Coordination of Nutrition and Bioprogramming, Instituto Nacional de Perinatología, Mexico City, Mexico
| | - Isabel Omaña-Guzmán
- Maternal and Child Health and Nutrition Network (MaCHiNNe), Observatorio Materno Infantil, Universidad Iberoamericana, Mexico City, Mexico
- Pediatric Obesity Clinic and Wellness Unit, Hospital General de México “Dr. Eduardo Liceaga”, Mexico City, Mexico
| | - Elizabeth Hoyos-Loya
- Maternal and Child Health and Nutrition Network (MaCHiNNe), Observatorio Materno Infantil, Universidad Iberoamericana, Mexico City, Mexico
| | - Alejandra Trejo-Domínguez
- Maternal and Child Health and Nutrition Network (MaCHiNNe), Observatorio Materno Infantil, Universidad Iberoamericana, Mexico City, Mexico
| | - Sonia Hernández-Cordero
- Maternal and Child Health and Nutrition Network (MaCHiNNe), Observatorio Materno Infantil, Universidad Iberoamericana, Mexico City, Mexico
- Research Center for Equitable Development EQUIDE, Universidad Iberoamericana, Mexico City, Mexico
| | - Mónica Mazariegos
- Maternal and Child Health and Nutrition Network (MaCHiNNe), Observatorio Materno Infantil, Universidad Iberoamericana, Mexico City, Mexico
- Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala
| | - Natalia Smith
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, United States
| | | | - Jennifer Mier-Cabrera
- Maternal and Child Health and Nutrition Network (MaCHiNNe), Observatorio Materno Infantil, Universidad Iberoamericana, Mexico City, Mexico
| | - Fermín Avendaño-Álvarez
- Maternal and Child Health and Nutrition Network (MaCHiNNe), Observatorio Materno Infantil, Universidad Iberoamericana, Mexico City, Mexico
| | - Salvador Espino y Sosa
- Maternal and Child Health and Nutrition Network (MaCHiNNe), Observatorio Materno Infantil, Universidad Iberoamericana, Mexico City, Mexico
- Clinical Research Branch, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Karla Muciño-Sandoval
- Maternal and Child Health and Nutrition Network (MaCHiNNe), Observatorio Materno Infantil, Universidad Iberoamericana, Mexico City, Mexico
| | - Lizeth Ibarra-González
- Maternal and Child Health and Nutrition Network (MaCHiNNe), Observatorio Materno Infantil, Universidad Iberoamericana, Mexico City, Mexico
- Nutrition and Dietetics Service, Instituto Nacional de Perinatología, Mexico City, Mexico
| | - Cristina Medina-Avilés
- Maternal and Child Health and Nutrition Network (MaCHiNNe), Observatorio Materno Infantil, Universidad Iberoamericana, Mexico City, Mexico
- Sub-Direction of Gynecology and Obstetrics Instituto Nacional de Perinatología, Mexico City, Mexico
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Luu TH, Kuhn K, Bradford AP, Wempe MF, Wittenburg L, Johnson RL, Carlson NE, Kumar TR, Polotsky AJ. Effects of pulsatile intravenous follicle-stimulating hormone treatment on ovarian function in women with obesity. Fertil Steril 2023; 120:890-898. [PMID: 37276947 PMCID: PMC10526695 DOI: 10.1016/j.fertnstert.2023.05.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 05/18/2023] [Accepted: 05/30/2023] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To establish conditions for effective hypothalamic suppression in women with normal and high body mass index (BMI) and test the hypothesis that intravenous (IV) administration of pulsatile recombinant follicle-stimulating hormone (rFSH) can overcome the clinically evident dysfunctional pituitary-ovarian axis in women with obesity. DESIGN Prospective interventional study. SETTING Academic medical center. PATIENT(S) Twenty-seven normal-weight women and 27 women with obesity, who were eumenorrheic and aged 21-39 years. INTERVENTION(S) Two-day frequent blood sampling study, in early follicular phase, before and after cetrorelix suppression of gonadotropins and exogenous pulsatile IV rFSH administration. MAIN OUTCOME MEASURE(S) Serum inhibin B and estradiol (E2) levels (basal and rFSH stimulated). RESULT(S) A modified gonadotropin-releasing hormone antagonism protocol effectively suppressed production of endogenous gonadotropins in women with normal and high BMIs, providing a model to address the functional role of FSH in the hypothalamic-pituitary-ovarian axis. The IV rFSH treatment resulted in equivalent serum levels and pharmacodynamics in normal-weight women and those with obesity. However, women with obesity exhibited reduced basal levels of inhibin B and E2 and a significantly decreased response to FSH stimulation. The BMI was inversely correlated with serum inhibin B and E2. In spite of this observed deficit in ovarian function, pulsatile IV rFSH treatment in women with obesity resulted in E2 and inhibin B levels comparable with those in normal-weight women, in the absence of exogenous FSH stimulation. CONCLUSION(S) Despite normalization of FSH levels and pulsatility by exogenous IV administration, women with obesity demonstrate ovarian dysfunction with respect to E2 and inhibin B secretion. Pulsatile FSH can partially correct the relative hypogonadotropic hypogonadism of obesity, thereby providing a potential treatment strategy to mitigate some of the adverse effects of high BMI on fertility, assisted reproduction, and pregnancy outcomes. CLINICAL TRIAL REGISTRATION NUMBER ClinicalTrials.gov #NCT02478775.
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Affiliation(s)
- Thanh Ha Luu
- Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Katherine Kuhn
- Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
| | - Andrew P Bradford
- Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Michael F Wempe
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Luke Wittenburg
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, California
| | - Rachel L Johnson
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Nichole E Carlson
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - T Rajendra Kumar
- Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Alex J Polotsky
- Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colorado; Shady Grove Fertility, Greenwood Village, Colorado
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Abstract
The prevalence of preobesity and obesity is rising globally, multiple epidemiologic studies have identified preobesity and obesity as predisposing factors to a number of noncommunicable diseases including type 2 diabetes (T2DM), cardiovascular disease (CVD), and cancer. In this review, we discuss the epidemiology of obesity in both children and adults in different regions of the world. We also explore the impact of obesity as a disease not only on physical and mental health but also its economic impact.
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Affiliation(s)
- Nasreen Alfaris
- King Fahad Medical City, 3895 Susah, Alwurud, Riyadh 12252-7111, Saudi Arabia.
| | | | - Naji Alamuddin
- RCSI Bahrain, King Hamad University Hospital, Alsayh, Sheikh Eisa Bin Salman Bridge, 7J62+X92, Bahrain
| | - Georgia Rigas
- St George Private Hospital, 1 South Street, Kogarah, New South Wales 2217, Australia
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Miñambres I, de Hollanda A, Vilarrasa N, Pellitero S, Rubio MA, Flores L, Caixàs A, Lobo S, Martinez Salamanca JI, Acevedo B, Moizé V, Andreu A, Escalada J. Obesity and fertility. Position statement. ENDOCRINOL DIAB NUTR 2023; 70 Suppl 1:110-115. [PMID: 36907798 DOI: 10.1016/j.endien.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 10/13/2022] [Indexed: 03/12/2023]
Affiliation(s)
- I Miñambres
- Servicio de Endocrinología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), CIBER de Diabetes y Enfermedades Metabólicas (CIBERDEM), Sociedad Española de Endocrinología y Nutrición (SEEN), Spain
| | - A de Hollanda
- Servicio de Endocrinología, Hospital Clínic, Barcelona, Centro de Investigación Biomédica en red Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Sociedad Española de Endocrinología y Nutrición (SEEN), Spain.
| | - N Vilarrasa
- Servicio de Endocrinología y Nutrición, Hospital Universitario de Bellvitge-IDIBELL, CIBER de Diabetes y Enfermedades Metabólicas (CIBERDEM), Sociedad Española de Endocrinología y Nutrición (SEEN), Spain
| | - S Pellitero
- Servicio de Endocrinología, Hospital Universitari Germans Trias i Pujol, Institut d'Investigació, Badalona, Sociedad Española de Endocrinología y Nutrición (SEEN), Spain
| | - M A Rubio
- Servicio de Endocrinología. Hospital Clínico San Carlos, Madrid, IDISSC, Facultad de Medicina, Universidad Complutense, Madrid, Sociedad Española de Endocrinología y Nutrición (SEEN), Spain
| | - L Flores
- Servicio de Endocrinología y Nutrición, Hospital Clínic, Barcelona, CIBER de Diabetes y Enfermedades Metabólicas (CIBERDEM), Sociedad Española para el Estudio de la Obesidad, SEEDO, Sociedad Española de Endocrinología y Nutrición (SEEN), Spain
| | - A Caixàs
- Servicio de Endocrinología y Nutrición, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí (I3PT), Departamento de Medicina Universitat Autònoma de Barcelona, Sabadell, Sociedad Española de Endocrinología y Nutrición (SEEN), Sociedad Española para el Estudio de la Obesidad, SEEDO, Spain
| | - S Lobo
- Servicio de Obstetricia y Ginecología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Grupo de Interés de Endocrinología Reproductiva, Sociedad Española de Fertilidad (SEF), Spain
| | - J I Martinez Salamanca
- Servicio de Urología, Hospital Universitario Puerta de Hierro, Majadahonda, Lyx Instituto de Urología, Universidad Francisco de Vitoria, Asociación Española de Urología, Spain
| | - B Acevedo
- Servicio de Ginecología y Obstetricia, Unidad de Reproducción Asistida, Hospital Fundación Jiménez Díaz, Madrid, Profesor asociado de Medicina de la Universidad Autónoma de Madrid (UAM), Sociedad Española de Ginecología y Obstetricia (SEGO), Spain
| | - V Moizé
- Servicio de Endocrinología y Nutrición, Hospital Clínic, Barcelona, Sociedad Española de Dietética y Nutrición (SEDYN), Spain
| | - A Andreu
- Servicio de Endocrinología y Nutrición, Hospital Clínic, Barcelona, Sociedad Española de Dietética y Nutrición (SEDYN), Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Spain
| | - J Escalada
- Departamento de Endocrinología y Nutrición, Clínica Universidad de Navarra, Pamplona, Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Sociedad Española de Endocrinología y Nutrición (SEEN), Spain
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9
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Gautam D, Purandare N, Maxwell CV, Rosser ML, O'Brien P, Mocanu E, McKeown C, Malhotra J, McAuliffe FM. The challenges of obesity for fertility: A FIGO literature review. Int J Gynaecol Obstet 2023; 160 Suppl 1:50-55. [PMID: 36635080 PMCID: PMC10107441 DOI: 10.1002/ijgo.14538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Obesity has been linked to infertility through several mechanisms, including at a molecular level. Those living with obesity face additional barriers to accessing fertility treatments and achieving a successful pregnancy, which can contribute to their economic and psychosocial stressors. There is scope to further improve care for people living with obesity and infertility with empathy, via a multidisciplinary approach.
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Affiliation(s)
- Divya Gautam
- Department of Obstetrics and Gynecology, University Hospital Galway, National University of Ireland, Galway, Ireland
| | - Nikhil Purandare
- Department of Obstetrics and Gynecology, University Hospital Galway, National University of Ireland, Galway, Ireland
| | - Cynthia V Maxwell
- Maternal Fetal Medicine, Sinai Health and Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Mary L Rosser
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York, USA
| | - Patrick O'Brien
- Institute for Women's Health, University College London, London, UK
| | - Edgar Mocanu
- RCSI Department of Reproductive Medicine, Rotunda Hospital, Dublin, Ireland
| | - Ciaran McKeown
- Department of Obstetrics and Gynecology, University Hospital Galway, National University of Ireland, Galway, Ireland
| | - Jaideep Malhotra
- Malhotra Nursing and Maternity Home, Agra, India.,Rainbow Hospital, Agra, India
| | - Fionnuala M McAuliffe
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
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10
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Exploring associations of anthropometric parameters and serum triglycerides with serum thyroid hormones in young women. Sci Rep 2022; 12:17374. [PMID: 36253522 PMCID: PMC9576678 DOI: 10.1038/s41598-022-22371-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 10/13/2022] [Indexed: 01/10/2023] Open
Abstract
Establishing links between serum thyroid hormone panel and triglyceride (TG) concentrations with non-invasively obtained measurements of anthropometric parameters of young women may provide preliminary knowledge about the homeostasis of metabolic processes and body composition and about the strategic role of the tested parameters as early screening tests for assessing the health status of apparently healthy women in the period preceding pregnancy. The study was conducted in 381 healthy female students (aged 18-26 years, mean ± SD = 22.1 ± 1.3). Anthropometric indices (BMI, waist-to-hip ratio, FAT%) were calculated and serum concentrations of thyroid hormones (TSH, fT3, fT4) were determined using electrochemiluminescence immunoassays and serum triglycerides (TG) with a commercially available test. No association was established between serum TSH and anthropometric indices in healthy young women. Increased serum concentrations of fT4, fT3 and TG were found in overweight subjects, i.e. BMI > 24.9 kg/m2 (p < 0.05). A significant negative association between fT3 and TG was found in underweight subjects (r = - 0.258, p = 0.049) and a significantly positive association in normal-weight subjects (r = 0.139, p = 0.019). In healthy young women differences in BMI are not related to thyroid function. The opposite directions between the associations fT3 vs TG in underweight compared to normal-weight young prepregnant females may suggest dependencies of fT3 and TG in the regulation of specific BMI-dependent metabolic processes.
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11
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Abstract
PURPOSE OF REVIEW The objective of this review is to highlight the recent literature on how obesity affects reproductive capacity in men and women. RECENT FINDINGS The relationship between fertility and obesity is complex and involves the hypothalamic-pituitary-ovarian axis, neuroendocrine systems and adipose tissue. The exact pathophysiology of how obesity lowers fertility rates is unknown, but is likely multifactorial involving anovulation, insulin resistance and alterations in gonadotropins. In addition, there is controversy on whether oocyte quality or endometrial receptivity plays a larger role in obese infertile women. Data on effects of bariatric surgery and weight loss on obese infertile men and women are mixed. SUMMARY Obesity alters the hormonal profile, gonadotropin secretion, embryo development and in-vitro fertilization outcomes in both men and women.
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Affiliation(s)
- Abigail Armstrong
- Department of Obstetrics & Gynecology, University of California Los Angeles, Los Angeles, California, USA
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12
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Fabian D, Kubandová-Babeľová J, Kšiňanová M, Waczulíková I, Fabianová K, Koppel J. Overweight and Fertility: What We Can Learn from an Intergenerational Mouse Obesity Model. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137918. [PMID: 35805577 PMCID: PMC9266121 DOI: 10.3390/ijerph19137918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/24/2022] [Accepted: 06/25/2022] [Indexed: 12/02/2022]
Abstract
The aim of this study was to evaluate the effects of being overweight on the ability to conceive, fertilization rate, and in vivo development of embryos in regularly cycling, spontaneously ovulating, and naturally mated female mice. The study was based on statistical analysis of data collected during 14 experiments with identical design, performed on 319 control and 327 obese mice, developed in an intergenerational model of obesity induction which eliminates the impact of aging and high-fat feeding. Six-week-old mice with a vaginal sperm plug were slaughtered on embryonic days 2, 3, or 4, and the flushed contents of the oviducts and uteri were assessed by stereomicroscopy. The results showed no association between being overweight and the proportion of ovulating or fertilized females. On the other hand, a strong association was found between being overweight and ovulation yield. On embryonic day 2, significantly higher numbers of eggs were recovered from the oviducts of fertilized obese mice. Maternal overweight status was also associated with higher developmental capacities of preimplantation embryos. In conclusion, contrary to studies based on the high-fat-diet model, in female mice fed regular chow, being overweight was associated with an increased ovulation quota and higher developmental rate of fertilized oocytes. Being overweight did not impact ability to conceive. On the other hand, as documented in our previous studies, the quality of oocytes and blastocysts recovered from overweight mice developed in an intergenerational model of obesity was low.
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Affiliation(s)
- Dušan Fabian
- Centre of Biosciences, Institute of Animal Physiology, Slovak Academy of Sciences, Šoltésovej 4/6, 040 01 Košice, Slovakia; (J.K.-B.); (J.K.)
- Correspondence:
| | - Janka Kubandová-Babeľová
- Centre of Biosciences, Institute of Animal Physiology, Slovak Academy of Sciences, Šoltésovej 4/6, 040 01 Košice, Slovakia; (J.K.-B.); (J.K.)
| | - Martina Kšiňanová
- Centre of Biosciences, Institute of Molecular Physiology and Genetics, Slovak Academy of Sciences, Dúbravská cesta 9, 840 05 Bratislava, Slovakia;
| | - Iveta Waczulíková
- Faculty of Mathematics, Physics and Informatics, Comenius University, Mlynská dolina F1, 842 48 Bratislava, Slovakia;
| | - Kamila Fabianová
- Biomedical Research Center, Institute of Neurobiology, Slovak Academy of Sciences, Šoltésovej 4/6, 040 01 Košice, Slovakia;
| | - Juraj Koppel
- Centre of Biosciences, Institute of Animal Physiology, Slovak Academy of Sciences, Šoltésovej 4/6, 040 01 Košice, Slovakia; (J.K.-B.); (J.K.)
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13
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Abstract
PURPOSE OF REVIEW To summarize recent findings related to the risk of miscarriage in women with elevated BMI undergoing IVF, and the mechanisms involved in said risk. RECENT FINDINGS Miscarriage rates are increased in overweight and obese women in both natural and assisted reproduction. Oocyte and embryo quality assessed according to classic morphological static parameters does not seem to be affected by excessive female body weight. Despite the initial lack of consensus between studies regarding embryo morphokinetics in obese women, blastocyst formation and quality have recently been shown to be similar across BMI groups, even in the case of euploid embryos. However, some metabolomic differences have been described in oocytes and embryos from obese women, thus pointing to a functional alteration. In women with elevated BMI, the percentage of aneuploid embryos is similar to that of normal weight women, and rates of miscarriage are higher, despite the transfer of euploid embryos. Therefore, the origin of the increased pregnancy loss rate after IVF in these women may be related to metabolomic, epigenetic or mitochondrial oocyte and embryo disturbances, or to the abnormal endocrine, metabolic and inflammatory uterine environment induced by obesity, which seems to be also responsible for other numerous complications during pregnancy and the in-utero fetal programming of postnatal diseases. A displacement of the window of implantation in obese women undergoing artificial endometrial preparation has recently been described and may be related to the poorer embryo implantation rates and increased risk of miscarriage observed following fresh and frozen embryo transfers with autologous oocytes, and with donated ova in recipients with extremely high BMI. SUMMARY Female obesity is related to poorer outcome in natural and assisted conception, including an increased risk of miscarriage. Embryo morphology, assessed by conventional methods or by morphokinetics, does not seem to be affected by excess weight, with similar blastocyst formation and quality than normal weight women reported in IVF cycles. Embryo aneuploidy is not increased, and higher miscarriages rates are seen after euploid embryo transfer in obese women. Disturbances of the uterus or its environment induced by female obesity seem to be the most likely cause of the increased risk of miscarriage, although metabolomic, epigenetic or mitochondrial oocyte and embryo dysfunction cannot be ruled out as cannot congenital anomalies. In the context of all the above, weight reduction before pregnancy should be advised in obese women trying to become pregnant.
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14
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Belan M, Gélinas M, Carranza-Mamane B, Langlois MF, Morisset AS, Ruchat SM, Lavoie K, Adamo K, Poder T, Gallagher F, Pesant MH, Jean-Denis F, Baillargeon JP. Protocol of the Fit-For-Fertility study: a multicentre randomised controlled trial assessing a lifestyle programme targeting women with obesity and infertility. BMJ Open 2022; 12:e061554. [PMID: 35440463 PMCID: PMC9020282 DOI: 10.1136/bmjopen-2022-061554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Women with obesity are at a higher risk of infertility as well as gestational and neonatal complications. Lifestyle changes are universally recommended for women with obesity seeking fertility treatments, but such intervention has only been assessed in very few robust studies. This study's objectives are therefore to assess the clinical outcomes and cost-effectiveness of an interdisciplinary lifestyle intervention (the Fit-For-Fertility Programme; FFFP) targeting women with obesity and subfertility in a diverse population. METHODS AND ANALYSIS This pragmatic multicentre randomised controlled trial (RCT) will include 616 women with obesity (body mass index ≥30 kg/m2 or ≥27 kg/m2 with polycystic ovary syndrome or at-risk ethnicities) who are evaluated at a Canadian fertility clinic for subfertility. Women will be randomised either to (1) the FFFP (experimental arm) alone for 6 months, and then in combination with usual care for infertility if not pregnant; or (2) directly to usual fertility care (control arm). Women in the intervention group benefit from the programme up to 18 months or, if pregnant, up to 24 months or the end of the pregnancy (whichever comes first). Women from both groups are evaluated every 6 months for a maximum of 18 months. The primary outcome is live birth rate at 24 months. Secondary outcomes include fertility, pregnancy and neonatal outcomes; lifestyle and anthropometric measures; and cost-effectiveness. Qualitative data collected from focus groups of participants and professionals will also be analysed. ETHICS AND DISSEMINATION This research study has been approved by the Research Ethics Board (REB) of Centre intégré universtaire de santé et des services sociaux de l'Estrie-CHUS (research coordinating centre) on 10 December 2018 and has been or will be approved successively by each participating centres' REB. This pragmatic RCT will inform decision-makers on improving care trajectories and policies regarding fertility treatments for women with obesity and subfertility. TRIAL REGISTRATION NUMBER NCT03908099. PROTOCOL VERSION 1.1, 13 April 2019.
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Affiliation(s)
- Matea Belan
- Department of Medicine, Division of Endocrinology, Université de Sherbrooke, Sherbrooke, Quebec, Canada
- Research Center of the Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Myriam Gélinas
- Department of Medicine, Division of Endocrinology, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Belina Carranza-Mamane
- Department of Medicine, Division of Endocrinology, Université de Sherbrooke, Sherbrooke, Quebec, Canada
- Department of Obstetrics and Gynecology, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Marie-France Langlois
- Department of Medicine, Division of Endocrinology, Université de Sherbrooke, Sherbrooke, Quebec, Canada
- Research Center of the Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Anne-Sophie Morisset
- School of Nutrition, Faculty of Agricultural and Food Science, Laval University, Quebec city, Quebec, Canada
| | - Stephanie-May Ruchat
- Department of Human Kinetics, Université du Quebec à Trois-Rivières, Trois-Rivières, Quebec, Canada
| | - Kim Lavoie
- Research Center CIUSSS-NIM, Montreal Behavioural Medicine Centre, Montreal, Quebec, Canada
- Department of Psychology, Université du Québec a Montréal, Montréal, Quebec, Canada
| | - Kristi Adamo
- Faculty of Health Sciences, School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
| | - Thomas Poder
- School of Public Health, University of Montreal, Montreal, Quebec, Canada
- CIUSSS de l'Est de l'Île de Montréal, Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montreal, Quebec, Canada
| | - Frances Gallagher
- School of Nursing, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Marie-Hélène Pesant
- Department of Medicine, Division of Endocrinology, Université de Sherbrooke, Sherbrooke, Quebec, Canada
- Research Center of the Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Farrah Jean-Denis
- Research Center of the Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Jean-Patrice Baillargeon
- Department of Medicine, Division of Endocrinology, Université de Sherbrooke, Sherbrooke, Quebec, Canada
- Research Center of the Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
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15
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LaMarre A, Rice C, Friedman M, Fowlie H. Carrying stories: digital storytelling and the complexities of intimacy, relationality, and home spaces. QUALITATIVE RESEARCH IN PSYCHOLOGY 2022. [DOI: 10.1080/14780887.2022.2047246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Andrea LaMarre
- Massey University, School of Psychology, Auckland, New Zealand
| | - Carla Rice
- University of Guelph, Re•Vision Centre for Art and Social Justice, Guelph, Ontario, Canada
| | - May Friedman
- Ryerson University, School of Social Work, Toronto, Ontario, Canada
| | - Hannah Fowlie
- University of Guelph, Re•Vision Centre for Art and Social Justice, Guelph, Ontario, Canada
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16
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Chen X, Xiao Z, Cai Y, Huang L, Chen C. Hypothalamic mechanisms of obesity-associated disturbance of hypothalamic-pituitary-ovarian axis. Trends Endocrinol Metab 2022; 33:206-217. [PMID: 35063326 DOI: 10.1016/j.tem.2021.12.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/20/2021] [Accepted: 12/20/2021] [Indexed: 12/20/2022]
Abstract
Ovulatory disorders are the most common clinical feature exhibited among obese women. Initiation of ovulation physiologically requires a surge of gonadotropin-releasing hormone (GnRH) released from GnRH neurons located in the hypothalamus. These GnRH neurons receive metabolic signals from circulation and vicinal neurons to regulate GnRH release. Leptin acts indirectly on GnRH via adjacent leptin receptor (LEPR)-expressing neurons such as proopiomelanocortin (POMC), neuropeptide Y (NPY)/agouti-related peptide (AgRP), and neuronal nitric oxide (NO) synthase (nNOS) neurons to affect GnRH neuronal activities. Additionally, hypothalamic inflammation also affects ovulation independent of obesity. Therefore, this review focuses on hypothalamic mechanisms that underlie the disturbance of hypothalamic-pituitary-ovarian (HPO) axis during obesity with an attempt to promote future studies and/or novel therapeutic strategies for ovulatory disorders in obesity.
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Affiliation(s)
- Xiaolin Chen
- Department of Endocrinology, Renmin Hospital of Wuhan University, Wuchang District, Wuhan, Hubei, China
| | - Zhuoni Xiao
- Reproductive Medical Center, Renmin Hospital of Wuhan University, Wuchang District, Wuhan, Hubei, China
| | - Yuli Cai
- Department of Endocrinology, Renmin Hospital of Wuhan University, Wuchang District, Wuhan, Hubei, China
| | - Lili Huang
- School of Biomedical Science, University of Queensland, St. Lucia, Brisbane, Queensland 4072, Australia
| | - Chen Chen
- School of Biomedical Science, University of Queensland, St. Lucia, Brisbane, Queensland 4072, Australia.
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17
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Alibhai K, Churchill I, Vause T, Lochnan HA. The impact of bariatric surgery on assisted reproductive technology outcomes: a systematic review protocol. Syst Rev 2022; 11:1. [PMID: 34980263 PMCID: PMC8722006 DOI: 10.1186/s13643-021-01870-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 12/09/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Individuals with obesity are at higher risk of experiencing complications during their pregnancy and may also experience infertility, requiring assisted reproductive technologies (ART) to conceive. The current body of literature demonstrates that bariatric surgery decreases an individual's risk of developing a variety of obesity-related obstetrical conditions during and after pregnancy. However, the effects of bariatric surgery on ART outcomes are not well understood. Therefore, the paucity in the literature warrants a need to determine these effects. METHODS We will search electronic databases, including MEDLINE, Embase, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL), as well as the gray literature and the reference lists of included articles. We will screen all studies published between January 1978 and the present day that explore the impact of bariatric surgery on ART outcomes for women and men. We will include observational studies. Two independent reviewers will assess the studies for inclusion and extract data for each article. The main outcome that will be analyzed is live birth rate. Secondary outcomes such as time to conception, number of rounds of ART, type of bariatric surgery, and length of time between bariatric surgery and initiation of ART will also be recorded. Risk of bias will be conducted using the National Institutes of Health Study Quality Assessment Tools. A random effects model will be used to account for statistical analysis and results will be pooled with forest plots. In the event of statistical and reporting heterogeneity, we will provide a qualitative synthesis and narrative review of the results. DISCUSSION This review will provide information on the outcomes of ART following bariatric surgery and may help healthcare professionals make informed decisions about the length of time between bariatric surgery and initiation of ART. The study findings may be of interest to various stakeholders including patients, bariatric surgeons, obstetricians, and gynecologists, and those who specialize in obesity medicine and reproductive endocrinology and infertility. We plan to disseminate our findings through presentations, publications, and social media releases to individuals who are navigating infertility and are interested in undergoing or have undergone bariatric surgery, healthcare professionals, policymakers, and researchers. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42021252561.
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Affiliation(s)
- Kameela Alibhai
- Faculty of Medicine, University of Ottawa, 501 Smyth Rd, Ottawa, Ontario K1H 8L6 Canada
| | - Isabella Churchill
- Faculty of Medicine, University of Ottawa, 501 Smyth Rd, Ottawa, Ontario K1H 8L6 Canada
| | - Tannys Vause
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Heather Anne Lochnan
- Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Canada
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18
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del Carmen Nogales M, Cruz M, de Frutos S, Martínez EM, Gaytán M, Ariza M, Bronet F, Garcia-Velasco JA. Association between clinical and IVF laboratory parameters and miscarriage after single euploid embryo transfers. Reprod Biol Endocrinol 2021; 19:186. [PMID: 34906128 PMCID: PMC8670289 DOI: 10.1186/s12958-021-00870-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 11/24/2021] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND The goal of this study was to investigate which factors, excluding embryo aneuploidies, are associated with miscarriage in patients who have undergone a single euploid blastocyst transfer. METHODS Retrospective, observational and multicenter study with 2832 patients undergoing preimplantational genetic testing for aneuploidies (PGT-A) due to repeated implantation failure, recurrent pregnancy loss, advanced maternal age or severe male factor were transferred one single euploid embryo. RESULTS One of the main findings was a significant relationship between body mass index (BMI) and miscarriage rates (13.4% in underweight women, 12.1% in normal weight, 14.5% in overweight, and 19.2% in obese women, odds ratio [OD] 1.04; 95% confidence interval [CI], 1.01-1.07 p = 0.006). Endometrial thickness (OD 0.65; 95%, 0.52-0.77 p = 0.04) and type of endometrial preparation (natural cycle or hormone replacement cycle) (OD 0.77; 95%, 0.52-0.77, p = 0.04) were also associated with miscarriage rates. CONCLUSIONS BMI was strongly associated to miscarriage rates. We also observed a weaker association with endometrial thickness and with the type of endometrial preparation (natural cycle or hormone replacement cycle). None of the other studied variables (biopsy day, maternal and male age, duration of infertility, cycle length, previous miscarriages, previous live births, previous In Vitro Fertilization (IVF) cycles, endometrial pattern and/or diagnosis) were associated with miscarriage rates.
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Affiliation(s)
| | - María Cruz
- IVI Madrid, Av. del Talgo, 68, 28023 Madrid, Spain
| | | | | | - María Gaytán
- IVI Madrid, Av. del Talgo, 68, 28023 Madrid, Spain
| | - Marta Ariza
- IVI Madrid, Av. del Talgo, 68, 28023 Madrid, Spain
| | | | - Juan A. Garcia-Velasco
- IVI Madrid, Av. del Talgo, 68, 28023 Madrid, Spain
- Rey Juan Carlos University, Madrid, Spain
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19
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Abstract
The purpose of this American Society for Reproductive Medicine Practice Committee report is to provide clinicians with principles and strategies for the evaluation and treatment of couples with infertility associated with obesity. This revised document replaces the Practice Committee document titled "Obesity and reproduction: an educational bulletin" last published in 2015 (Fertil Steril 2015;104:1116-26).
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Affiliation(s)
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- American Society for Reproductive Medicine, Birmingham, Alabama
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20
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Influence of social determinants on fertility: a critical review. Curr Opin Obstet Gynecol 2021; 33:164-169. [PMID: 33186187 DOI: 10.1097/gco.0000000000000673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Intrinsic factors, such as age, weight and lifestyle habits, together with extrinsic factors, such as socioeconomic level, must be considered when it comes to reproductive healthcare. Over the last few years, studies that attempt to respond to the participation and interaction of these factors in subfertility have been published; however, some questions remain unanswered. RECENT FINDINGS Although there are little modifiable factors for women, it is possible to influence other factors, such as behavioural or cultural factors in order to minimize fertility problems; however, they are often highly influenced by each other. SUMMARY Advanced age, obesity, sedentary lifestyle, alcohol, tobacco and other compounds, have a clearly negative effect and may extend time-to-pregnancy, although the responsible mechanisms and the magnitude of the detriment that they produce in the reproductive health are yet to be studied. Economic context and new environmental factors are a current challenge for reproductive health too.
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21
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Bellver J, Marín C, Lathi RB, Murugappan G, Labarta E, Vidal C, Giles J, Cabanillas S, Marzal A, Galliano D, Ruiz-Alonso M, Simón C, Valbuena D. Obesity Affects Endometrial Receptivity by Displacing the Window of Implantation. Reprod Sci 2021; 28:3171-3180. [PMID: 34033112 DOI: 10.1007/s43032-021-00631-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 05/19/2021] [Indexed: 11/26/2022]
Abstract
Our aim was to determine prospectively whether increased body mass index (BMI) affects endometrial receptivity through displacement of the window of implantation (dWOI) using the endometrial receptivity analysis (ERA), and whether this effect is BMI-dependent. We recruited a population of 170 infertile women with a normal uterus and no clinical history of recurrent miscarriage or implantation failure. These women were divided into four groups according to BMI: normal weight (18.5-24.9 kg/m2; n = 44), overweight (25-29.9 kg/m2; n = 29), class I obese (30.0-34.9 kg/m2; n = 54), and class II and III obese (> 35 kg/m2; n = 43). We also assigned the patients to one of two larger BMI cohorts: non-obese (normal weight and overweight; n = 73) and obese (class I, II, and III obese; n = 97). We compared analytical and clinical data and dWOI in these categories, finding significant metabolic differences in glycemia, TSH, insulin, HDL cholesterol, LDL cholesterol, triglycerides, and systolic and diastolic blood pressure among the different BMI groups. One-day dWOI increased significantly with BMI, and significant differences were observed in the non-obese versus obese categories (9.7% vs 25.3 %, respectively (p = 0.02)). dWOI was most pronounced in patients with class II-III obesity. In addition, displacement was longer as BMI increased since ERA revealed a higher proportion of displacements of 1 day than of 12 h and showed they were predominantly pre-receptive. In conclusion, obesity has a negative effect on endometrial receptivity through delaying of the WOI, which increases in function of BMI as well as the metabolic disturbances of the patient.
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Affiliation(s)
- José Bellver
- IVI-RMA Valencia, Plaza de la Policía Local, 3, 46015, Valencia, Spain.
- Department of Pediatrics, Obstetrics & Gynecology, University of Valencia, Valencia, Spain.
- IVI Foundation, Health Research Institute La Fe, Valencia, Spain.
| | - Carlos Marín
- Igenomix Foundation-INCLIVA, Parque Tecnológico de Paterna, Ronda Narciso Monturiol Estarriol 11B, 46980, Paterna, Valencia, Spain
| | - Ruth B Lathi
- Department of Obstetrics & Gynecology, REI Division, Stanford University, Stanford, CA, USA
| | - G Murugappan
- Department of Obstetrics & Gynecology, REI Division, Stanford University, Stanford, CA, USA
| | - Elena Labarta
- IVI-RMA Valencia, Plaza de la Policía Local, 3, 46015, Valencia, Spain
- IVI Foundation, Health Research Institute La Fe, Valencia, Spain
| | - Carmina Vidal
- IVI-RMA Valencia, Plaza de la Policía Local, 3, 46015, Valencia, Spain
| | - Juan Giles
- IVI-RMA Valencia, Plaza de la Policía Local, 3, 46015, Valencia, Spain
| | - Sergio Cabanillas
- IVI-RMA Valencia, Plaza de la Policía Local, 3, 46015, Valencia, Spain
| | - Alicia Marzal
- IVI-RMA Valencia, Plaza de la Policía Local, 3, 46015, Valencia, Spain
| | - Daniela Galliano
- IVI-RMA Valencia, Plaza de la Policía Local, 3, 46015, Valencia, Spain
| | - Maria Ruiz-Alonso
- Igenomix Foundation-INCLIVA, Parque Tecnológico de Paterna, Ronda Narciso Monturiol Estarriol 11B, 46980, Paterna, Valencia, Spain
| | - Carlos Simón
- Department of Pediatrics, Obstetrics & Gynecology, University of Valencia, Valencia, Spain
- Igenomix Foundation-INCLIVA, Parque Tecnológico de Paterna, Ronda Narciso Monturiol Estarriol 11B, 46980, Paterna, Valencia, Spain
- Department of Obstetrics & Gynecology, REI Division, Stanford University, Stanford, CA, USA
| | - Diana Valbuena
- Igenomix Foundation-INCLIVA, Parque Tecnológico de Paterna, Ronda Narciso Monturiol Estarriol 11B, 46980, Paterna, Valencia, Spain
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22
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Dedov II, Shestakova MV, Melnichenko GA, Mazurina NV, Andreeva EN, Bondarenko IZ, Gusova ZR, Dzgoeva FK, Eliseev MS, Ershova EV, Zhuravleva MV, Zakharchuk TA, Isakov VA, Klepikova MV, Komshilova KA, Krysanova VS, Nedogoda SV, Novikova AM, Ostroumova OD, Pereverzev AP, Rozhivanov RV, Romantsova TI, Ruyatkina LA, Salasyuk AS, Sasunova AN, Smetanina SA, Starodubova AV, Suplotova LA, Tkacheva ON, Troshina EA, Khamoshina MV, Chechelnitskaya SM, Shestakova EA, Sheremet’eva EV. INTERDISCIPLINARY CLINICAL PRACTICE GUIDELINES "MANAGEMENT OF OBESITY AND ITS COMORBIDITIES". OBESITY AND METABOLISM 2021; 18:5-99. [DOI: 10.14341/omet12714] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Affiliation(s)
| | | | | | | | | | | | | | | | - M. S. Eliseev
- Research Institute of Rheumatogy named after V.A. Nasonova
| | | | | | | | - V. A. Isakov
- Federal Research Center of Nutrition, Biotechnology and Food Safety
| | - M. V. Klepikova
- Russian Medical Academy of Continuous Professional Education
| | | | | | | | - A. M. Novikova
- Research Institute of Rheumatogy named after V.A. Nasonova
| | - O. D. Ostroumova
- A.I. Yevdokimov Moscow State University of Medicine and Dentistry
| | - A. P. Pereverzev
- Russian National Research Medical University named after N.I. Pirogov
| | | | | | | | | | - A. N. Sasunova
- Federal Research Center of Nutrition, Biotechnology and Food Safety
| | | | | | | | - O. N. Tkacheva
- Russian National Research Medical University named after N.I. Pirogov
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Liang T, Ruetz K, Haakman O, Vilos A, Vilos G, Abu-Rafea B. Impact of class III obesity on outcomes and complications of transvaginal ultrasound-guided oocyte pickup. F S Rep 2020; 1:270-276. [PMID: 34223255 PMCID: PMC8244278 DOI: 10.1016/j.xfre.2020.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/13/2020] [Accepted: 08/21/2020] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To assess the impact of class III obesity on outcomes and complications of transvaginal ultrasound-guided oocyte pickup (OPU). DESIGN Retrospective cohort study. SETTING Hospital-based fertility clinic. PATIENTS All women undergoing OPU procedures during autologous in vitro fertilization (IVF) and oocyte banking cycles, grouped by patient body mass index (BMI: <25, 25-29.9, 30-34.9, 35-39.9, ≥40 kg/m2). INTERVENTIONS Transvaginal OPU under conscious sedation. MAIN OUTCOME MEASURES Sedation and procedure-related parameters and complications. RESULTS A total of 2,141 OPU procedures in 1,579 patients were analyzed, including 121 OPU procedures in 94 patients with BMI ≥40 kg/m2. There was a statistically significant increase in total fentanyl and midazolam doses and procedure duration as BMI increased. Compared with patients with BMI <25 kg/m2, those with BMI ≥40 kg/m2 were more likely to require additional sedation during the procedure (adjusted odds ratio [aOR] 1.99; 95% confidence interval [CI], 1.14-3.49). The rate of difficult access was 28.9% for procedures with BMI ≥40 kg/m2 compared with 5.2% with BMI <25 kg/m2 (aOR 7.57; 95% CI, 4.66-12.29). The OPU was incomplete due to inaccessible follicles through a transvaginal approach in 18.2% of procedures with BMI ≥40 kg/m2 compared with 1.3% with BMI <25 kg/m2 (aOR 16.94; 95% CI, 8.24-34.84). The rates of sedation and procedure-related complications were low, and none occurred in patients with BMI ≥40 kg/m2. CONCLUSIONS There was no increased risk of complications for women with class III obesity undergoing OPU with conscious sedation. However, the operator was more likely to encounter difficult access and to incompletely aspirate follicles through a transvaginal approach.
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Affiliation(s)
- Tina Liang
- Fertility Clinic, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - Kelsey Ruetz
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Olga Haakman
- Fertility Clinic, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - Angelos Vilos
- Fertility Clinic, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - George Vilos
- Fertility Clinic, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - Basim Abu-Rafea
- Fertility Clinic, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, London, Ontario, Canada
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Cozzolino M, García-Velasco JA, Meseguer M, Pellicer A, Bellver J. Female obesity increases the risk of miscarriage of euploid embryos. Fertil Steril 2020; 115:1495-1502. [PMID: 33267960 DOI: 10.1016/j.fertnstert.2020.09.139] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/07/2020] [Accepted: 09/15/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To determine whether female body mass index (BMI) is associated with an increased risk of miscarriage after euploid embryo transfer. DESIGN A retrospective, observational, multicenter cohort study. SETTING University-affiliated in vitro fertilization center. PATIENT(S) In this study, 3,480 cycles of in vitro fertilization with preimplantation genetic testing for aneuploidy (PGT-A) in the blastocyst stage and euploid embryo transfer were divided into four groups according to patient BMI. INTERVENTION(S) In vitro fertilization with PGT-A. MAIN OUTCOME MEASURE(S) The primary outcome was the miscarriage rate, which included both biochemical and clinical miscarriages. Secondary outcomes were implantation, pregnancy, clinical pregnancy, and live birth rates. RESULT(S) Cycles were divided into four groups according to BMI (kg/m2): underweight (<18.5; n = 155), normal weight (18.5-24.9; n = 2,549), overweight (25-29.9; n = 591), and obese (≥30; n = 185). The number of PGT-A cycles per patient was similar in the four groups. Fertilization rate, day of embryo biopsy, technique of chromosomal analysis, number of euploid embryos, number of transferred embryos, and method of endometrial preparation for embryo transfer were similar in the four BMI groups. Miscarriage rates were significantly higher in women with obesity compared to women with normal weight, mainly due to a significant increase in the clinical miscarriage rates. Live birth rates also were lower in women with obesity. Obesity in women and day 6 trophectoderm biopsy were found to influence the reduced live birth rate. CONCLUSION(S) Women with obesity experience a higher rate of miscarriage after euploid embryo transfer than women with a normal weight, suggesting that other mechanisms than aneuploidy are responsible for this outcome.
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Affiliation(s)
- Mauro Cozzolino
- IVI-RMA, IVI Foundation, Valencia, Spain; Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut; Rey Juan Carlos University, Madrid, Spain.
| | | | - Marcos Meseguer
- IVI-RMA, IVI Foundation, Valencia, Spain; IVI-RMA Valencia, Valencia, Spain
| | - Antonio Pellicer
- IVI-RMA, IVI Foundation, Valencia, Spain; IVI-RMA Roma, Rome, Italy; Department of Pediatrics, Obstetrics and Gynecology, Faculty of Medicine, University of Valencia, Valencia, Spain
| | - Jose Bellver
- IVI-RMA, IVI Foundation, Valencia, Spain; IVI-RMA Valencia, Valencia, Spain; Department of Pediatrics, Obstetrics and Gynecology, Faculty of Medicine, University of Valencia, Valencia, Spain
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Kim SY, Park ES, Kim HW. Effectiveness of Non-Pharmacological Interventions for Overweight or Obese Infertile Women: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207438. [PMID: 33066039 PMCID: PMC7650570 DOI: 10.3390/ijerph17207438] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/27/2020] [Accepted: 10/05/2020] [Indexed: 12/23/2022]
Abstract
Obesity is a well-known risk factor for infertility, and nonpharmacological treatments are recommended as effective and safe, but evidence is still lacking on whether nonpharmacological interventions improve fertility in overweight or obese women. The aim of this study was to systematically assess the current evidence in the literature and to evaluate the impact of nonpharmacological interventions on improving pregnancy-related outcomes in overweight or obese infertile women. Seven databases were searched for randomized controlled trials (RCTs) of nonpharmacological interventions for infertile women with overweight or obesity through August 16, 2019 with no language restriction. A meta-analysis was conducted of the primary outcomes. A total of 21 RCTs were selected and systematically reviewed. Compared to the control group, nonpharmacological interventions significantly increased the pregnancy rate (relative risk (RR), 1.37; 95% CI, 1.04–1.81; p = 0.03; I2 = 58%; nine RCTs) and the natural conception rate (RR, 2.17, 95% CI, 1.41–3.34; p = 0.0004; I2 = 19%, five RCTs). However, they had no significant effect on the live birth rate (RR, 1.36, 95% CI, 0.94–1.95; p=0.10, I2 = 65%, eight RCTs) and increased the risk of miscarriage (RR: 1.57, 95% CI, 1.05–2.36; p = 0.03; I2 = 0%). Therefore, nonpharmacological interventions could have a positive effect on the pregnancy and natural conception rates, whereas it is unclear whether they improve the live birth rate. Further research is needed to demonstrate the integrated effects of nonpharmacological interventions involving psychological outcomes, as well as pregnancy-related outcomes.
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Affiliation(s)
- Seo Yun Kim
- College of Nursing, Seoul National University, Seoul 03080, Korea;
| | - Eun-Sun Park
- Medical Library, Seoul National University, Seoul 03080, Korea;
| | - Hae Won Kim
- Research Institute of Nursing Science, College of Nursing, Seoul National University, Seoul 03080, Korea
- Correspondence: ; Tel.: +82-2-740-8820
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Orthmann Bless D, Hofmann V. Abortion in women with Down syndrome. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2020; 64:690-699. [PMID: 32643815 DOI: 10.1111/jir.12761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 06/11/2020] [Accepted: 06/17/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Nearly two-thirds of pregnancies in women with Down syndrome (DS) end in abortion. The aim of the present study was to determine if these high abortion rates might relate to specific characteristics of women with DS, their life situation and the course of pregnancy. METHODS In a sample of 351 pregnancies in Switzerland (1998 to 2009), women with DS were compared with women with other forms of intellectual disability (ID) and women without ID, regarding the type of abortion, personal characteristics and pregnancy complications that might increase the probability of abortion. RESULTS All abortions among women with DS were medically induced. In women with DS and ID, abortions were more likely to occur due to unwanted pregnancy than in women without ID. In addition, women with DS and ID were more often diagnosed with fetal complications and maternal health problems. However, no correlation between fetal complications or maternal health problems and pregnancy outcome was found. CONCLUSIONS The group differences found do not directly explain the high abortion rates among women with DS. Maternal diagnosis of DS appears to be the most important predictor of abortion. Possible explanations for this finding are discussed.
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Affiliation(s)
- D Orthmann Bless
- Department of Special Education, University of Fribourg, Fribourg, Switzerland
| | - V Hofmann
- Department of Special Education, University of Fribourg, Fribourg, Switzerland
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Effects of short-term exposure to high-fat diet on histology of male and female gonads in rats. Acta Histochem 2020; 122:151558. [PMID: 32622421 DOI: 10.1016/j.acthis.2020.151558] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 04/22/2020] [Accepted: 05/04/2020] [Indexed: 12/18/2022]
Abstract
Obesity, which reaches an epidemic, is characterized by alterations in metabolic and hormonal profiles. Moreover, uncontrolled obesity may lead to development of diabetes type 2, which accounts for about 90% of all diabetic cases. In obesity, besides changes in metabolism, numerous co-morbidities are reported, e.g. disruptions of reproductive functions. Additionally, sex differences in development of this disease occur. We hypothesized that short-term exposure to high-fat diet (HFD; containing 50% of total energy from fat) would alter histology of testes and ovaries, and thus contribute to reproductive disruptions in male and female rats. Adult rats were fed ad libitum with HFD for 6-7 weeks and its effects on histology of testes and ovaries (n = 4/sex and treatment group) were studied using hematoxylin-eosin staining followed by microscopic analysis and compared to control (laboratory chow fed) group. We have found that in male rats fed with HFD there were: 1) decrease in diameter of seminiferous tubules due to smaller luminar diameter, and no change in epithelium height; 2) decrease in number of Sertoli cells; 3) no changes in number of spermatogonia and in percentage of semen in seminiferous tubules. In female rats exposed to HFD we have seen: 1) decrease in diameters of corpora lutea; 2) decrease in diameter of ovarian follicles types 7 and 8, but no changes in their number; 3) no changes in number of early primary follicles, primary follicles, and secondary follicles. We concluded that relatively short-term exposure to HFD in rats leads to changes in histology of both testes and ovaries, thus affecting reproductive functions.
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Simon A, Pratt M, Hutton B, Skidmore B, Fakhraei R, Rybak N, Corsi DJ, Walker M, Velez MP, Smith GN, Gaudet LM. Guidelines for the management of pregnant women with obesity: A systematic review. Obes Rev 2020; 21:e12972. [PMID: 31943650 PMCID: PMC7064940 DOI: 10.1111/obr.12972] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 09/27/2019] [Accepted: 10/02/2019] [Indexed: 02/06/2023]
Abstract
Multiple clinical practice guidelines (CPGs) have been established for pregnant women with obesity. The quality and consistency of recommendations remain unknown. The objective of this study is to conduct a systematic review to synthesize and appraise evidence from CPGs, available worldwide, for pregnant women affected by obesity. An experienced information specialist performed a rigorous search of the literature, searching MEDLINE, Embase, grey literature, and guideline registries to locate CPGs that reported on pregnancy care relating to obesity. CPGs related to antenatal care of pregnant women with obesity (pre-pregnancy body mass index [BMI] ≥ 30 kg/m2 ) in low-risk (eg, care provider = family physician or midwife) or high-risk settings (eg, obstetrician or maternal fetal medicine) were included. CPGs were appraised for quality with independent data collection by two raters. Information was categorized into five domains: preconception care. care during pregnancy, diet and exercise during pregnancy, care immediately before, during, and after delivery, and postpartum care. The literature search yielded 2614 unique citations. Following screening of abstracts and full texts, 32 CPGs were included, with quality ranging between 0 and 100 on the AGREE II tool. The strongest evidence related to nutritional advice, exercise, and pregnancy risk counselling. Guidance was limited for timing of screening tests, antenatal visits and delivery, ideal postpartum care, and management of adverse pregnancy outcomes. Most guidelines in this population are not evidence based. Research is needed to bridge knowledge gaps pertaining to fetal antenatal surveillance, management of adverse outcomes and postpartum care, and enhance consistency across CPGs.
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Affiliation(s)
- Alexandre Simon
- OMNI Research Group, Clinical Epidemiology ProgramOttawa Hospital Research InstituteOttawaOntarioCanada
| | - Misty Pratt
- Knowledge Synthesis Group, Clinical Epidemiology ProgramOttawa Hospital Research InstituteOttawaOntarioCanada
| | - Brian Hutton
- Knowledge Synthesis Group, Clinical Epidemiology ProgramOttawa Hospital Research InstituteOttawaOntarioCanada
- Public Health and Preventive MedicineUniversity of Ottawa School of EpidemiologyOttawaOntarioCanada
| | - Becky Skidmore
- Knowledge Synthesis Group, Clinical Epidemiology ProgramOttawa Hospital Research InstituteOttawaOntarioCanada
| | - Romina Fakhraei
- OMNI Research Group, Clinical Epidemiology ProgramOttawa Hospital Research InstituteOttawaOntarioCanada
- Public Health and Preventive MedicineUniversity of Ottawa School of EpidemiologyOttawaOntarioCanada
| | - Natalie Rybak
- OMNI Research Group, Clinical Epidemiology ProgramOttawa Hospital Research InstituteOttawaOntarioCanada
| | - Daniel J. Corsi
- OMNI Research Group, Clinical Epidemiology ProgramOttawa Hospital Research InstituteOttawaOntarioCanada
- Public Health and Preventive MedicineUniversity of Ottawa School of EpidemiologyOttawaOntarioCanada
| | - Mark Walker
- OMNI Research Group, Clinical Epidemiology ProgramOttawa Hospital Research InstituteOttawaOntarioCanada
- Public Health and Preventive MedicineUniversity of Ottawa School of EpidemiologyOttawaOntarioCanada
- Department of Obstetrics, Gynecology& Newborn CareUniversity of OttawaOttawaOntarioCanada
| | - Maria P. Velez
- Department of Obstetrics and GynecologyQueen's UniversityKingstonOntarioCanada
- Department of Public Health SciencesQueen's UniversityKingstonOntarioCanada
| | - Graeme N. Smith
- Department of Obstetrics and GynecologyQueen's UniversityKingstonOntarioCanada
| | - Laura M. Gaudet
- OMNI Research Group, Clinical Epidemiology ProgramOttawa Hospital Research InstituteOttawaOntarioCanada
- Public Health and Preventive MedicineUniversity of Ottawa School of EpidemiologyOttawaOntarioCanada
- Department of Obstetrics, Gynecology& Newborn CareUniversity of OttawaOttawaOntarioCanada
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30
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Maxwell C, Sharma A. Un langage respectueux des patientes : Préjugés, stigmatisation et discrimination liés au poids en santé reproductive des femmes. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:1535-1537. [DOI: 10.1016/j.jogc.2019.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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31
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Maxwell C, Sharma A. Thinking About People-First Language: Weight Bias, Stigma, and Discrimination, and Women's Reproductive Health. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:1533-1534. [DOI: 10.1016/j.jogc.2019.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Kelley AS, Smith YR, Padmanabhan V. A Narrative Review of Placental Contribution to Adverse Pregnancy Outcomes in Women With Polycystic Ovary Syndrome. J Clin Endocrinol Metab 2019; 104:5299-5315. [PMID: 31393571 PMCID: PMC6767873 DOI: 10.1210/jc.2019-00383] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 08/01/2019] [Indexed: 12/29/2022]
Abstract
CONTEXT Polycystic ovary syndrome (PCOS) is the most common endocrinopathy of reproductive-aged women. In pregnancy, women with PCOS experience increased risk of miscarriage, gestational diabetes, preeclampsia, and extremes of fetal birth weight, and their offspring are predisposed to reproductive and cardiometabolic dysfunction in adulthood. Pregnancy complications, adverse fetal outcomes, and developmental programming of long-term health risks are known to have placental origins. These findings highlight the plausibility of placental compromise in pregnancies of women with PCOS. EVIDENCE SYNTHESIS A comprehensive PubMed search was performed using terms "polycystic ovary syndrome," "placenta," "developmental programming," "hyperandrogenism," "androgen excess," "insulin resistance," "hyperinsulinemia," "pregnancy," and "pregnancy complications" in both human and animal experimental models. CONCLUSIONS There is limited human placental research specific to pregnancy of women with PCOS. Gestational androgen excess and insulin resistance are two clinical hallmarks of PCOS that may contribute to placental dysfunction and underlie the higher rates of maternal-fetal complications observed in pregnancies of women with PCOS. Additional research is needed to prevent adverse maternal and developmental outcomes in women with PCOS and their offspring.
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Affiliation(s)
- Angela S Kelley
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
| | - Yolanda R Smith
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
| | - Vasantha Padmanabhan
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
- Correspondence and Reprint Requests: Vasantha Padmanabhan, PhD, Department of Pediatrics, University of Michigan, 7510 MSRB 1, 1500 West Medical Center Drive, Ann Arbor, Michigan 48109. E-mail:
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Dudek M, Ziarniak K, Cateau ML, Dufourny L, Sliwowska JH. Diabetes Type 2 and Kisspeptin: Central and Peripheral Sex-Specific Actions. Trends Endocrinol Metab 2019; 30:833-843. [PMID: 31699240 DOI: 10.1016/j.tem.2019.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 07/04/2019] [Accepted: 07/08/2019] [Indexed: 01/23/2023]
Abstract
Kisspeptin (KP) plays a major role in the regulation of reproduction governed by the hypothalamic-pituitary-gonadal (HPG) axis. However, recent findings suggest that the KP system is present not only centrally (at the level of the hypothalamus), but also in the peripheral organs crucial for the control of metabolism. The KP system is sexually differentiated in the hypothalamus, and it is of particular interest to study whether sex-specific responses to type 2 diabetes (DM2) exist centrally and peripherally. As collection of data is limited in humans, animal models of DM2 are useful to understand crosstalk between metabolism and reproduction. Sex-specific variations in the KP system reported in animals suggest a need for the development of gender specific therapeutic strategies to treat DM2.
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Affiliation(s)
- Monika Dudek
- Laboratory of Neurobiology, Institute of Zoology, Poznan University of Life Sciences, Wojska Polskiego 71C, 60-625 Poznan, Poland
| | - Kamil Ziarniak
- Laboratory of Neurobiology, Institute of Zoology, Poznan University of Life Sciences, Wojska Polskiego 71C, 60-625 Poznan, Poland
| | - Marie-Line Cateau
- UMR Physiologie de la Reproduction et des Comportements, INRA-CNRS-Université de Tours-IFCE, Centre INRA Val de Loire, F-37380 Nouzilly, France
| | - Laurence Dufourny
- UMR Physiologie de la Reproduction et des Comportements, INRA-CNRS-Université de Tours-IFCE, Centre INRA Val de Loire, F-37380 Nouzilly, France
| | - Joanna Helena Sliwowska
- Laboratory of Neurobiology, Institute of Zoology, Poznan University of Life Sciences, Wojska Polskiego 71C, 60-625 Poznan, Poland.
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El-Wakf AM, El-Habibi ESM, Ali DA, Abd El-Ghany E, Elmougy R. Marjoram and sage oils protect against testicular apoptosis, suppressed Ki-67 expression and cell cycle arrest as a therapy for male infertility in the obese rats. J Food Biochem 2019; 44:e13080. [PMID: 31612531 DOI: 10.1111/jfbc.13080] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 09/22/2019] [Accepted: 09/22/2019] [Indexed: 01/26/2023]
Abstract
Alterations in testicular apoptosis, cell cycle progression and proliferation rate in dietary-induced obese male rats and role of oral administration of marjoram (0.16 ml/kg BW) and sage (0.05 ml/kg BW) oils were evaluated. Results showed increased body weight, serum leptin, testicular lipid peroxidation, protein oxidation and nitric oxide, with reduction in serum testosterone, sperm count and endogenous enzymatic and non-enzymatic antioxidants in testis of the obese rats. Flow cytometry results revealed increased number of annexin-V (+ve) cells with activation of apoptotic proteins (Bax, caspase-3) and reduction of anti-apoptotic Bcl-2. Cell cycle arrest at phases S and G2/M with decline in expression of Bcl-2 and germ cell proliferation marker ki-67 was also validated, indicating lowered spermatogenesis in the obese rats. Supplementation of marjoram or sage oils displayed normalized body weight, sperm count, germ cells apoptosis and proliferation, suggesting the two oils as a new therapeutic approach against obesity promoted male infertility. PRACTICAL APPLICATIONS: Obese men have a greater chance of fertility problems compared to those with normal weight. Obesity-associated oxidative stress and free radicals production have shown to adversely affect sperm quality with activation of pro-apoptotic pathways, allowing germ cell death. Marjoram and sage essential oils are now being widely studied due to their antioxidant and radical scavenging properties. Our findings indicated effectiveness of the two oils for combating body weight gain, testicular oxidative stress, and apoptosis, which seemed to aid in increasing sperm count. The outcomes of this study may help scientists to formulate novel medications for improving fertility problems in men.
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Affiliation(s)
- Azza M El-Wakf
- Zoology Department, Faculty of Science, Mansoura University, Mansoura, Egypt
| | | | - Doaa A Ali
- Zoology Department, Faculty of Science, Mansoura University, Mansoura, Egypt
| | - Eman Abd El-Ghany
- Zoology Department, Faculty of Science, Mansoura University, Mansoura, Egypt
| | - Rehab Elmougy
- Chemistry Department, Faculty of Science, Mansoura University, Mansoura, Egypt
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Vitamin D and Obesity: Two Interacting Players in the Field of Infertility. Nutrients 2019; 11:nu11071455. [PMID: 31252555 PMCID: PMC6683323 DOI: 10.3390/nu11071455] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 06/24/2019] [Accepted: 06/26/2019] [Indexed: 12/31/2022] Open
Abstract
Obesity plays an important role in human fertility in both genders. The same is true for vitamin D, for which accumulating evidence from observational human studies suggests a key role for both male and female fertility. In the latter case, however, robust data from relevant interventional studies are currently lacking. It is also not clear whether obesity and vitamin D deficiency, besides their independent effect on human infertility, act in synergy. Several pathogenetic mechanisms may be proposed as a linkage between vitamin D deficiency and obesity, with respect to infertility. In any case, the independent contribution of vitamin D deficiency in obese infertile states needs to be proven in interventional studies focusing on either vitamin D supplementation in obese or weight loss strategies in vitamin D-deficient infertile patients.
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Kelley AS, Badon SE, Lanham MSM, Fisseha S, Moravek MB. Body mass index restrictions in fertility treatment: a national survey of OB/GYN subspecialists. J Assist Reprod Genet 2019; 36:1117-1125. [PMID: 30963351 DOI: 10.1007/s10815-019-01448-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 03/29/2019] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To explore the attitudes of reproductive endocrinology and infertility (REI) and maternal-fetal medicine (MFM) subspecialists regarding the necessity and appropriateness of body mass index (BMI) cutoffs for women seeking fertility treatment. METHODS Members of the Society for Reproductive Endocrinology and Infertility (SREI) and the Society for Maternal Fetal Medicine (SMFM) were invited to participate in a survey querying their knowledge of existing institutional or clinic BMI policies and personal opinions regarding upper and lower BMI cutoffs for a range of fertility treatments, including oral ovulation agents, gonadotropins, and in vitro fertilization. RESULTS Respondents included 398 MFMs and 201 REIs. The majority of REI and MFM providers agreed with upper limit BMI cutoffs (72.5% vs 68.2%, p = 0.29), but REIs were twice as likely to support lower limit BMI restrictions compared to MFMs (56.2% vs 28.4%, p < 0.0001). Those who supported upper BMI restrictions were more likely to be female and report existing institutional BMI cutoffs. The majority of respondents (99.3%) believed that an official statement to guide clinicians should be issued by a national professional organization. CONCLUSIONS Although practice patterns widely vary, the majority of REIs and MFMs believe that there should be a BMI cutoff above which women should not be offered immediate fertility treatment. Furthermore, there is a reported need for a written statement by a national professional organization to guide clinical practice and to ensure that OB/GYN subspecialists are providing consistent, fair, and safe recommendations to infertile women at the extremes of BMI.
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Affiliation(s)
- Angela S Kelley
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, 48108, USA.
| | - Sylvia E Badon
- Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
| | - Michael S M Lanham
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, 48108, USA
| | - Senait Fisseha
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, 48108, USA
| | - Molly B Moravek
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, 48108, USA
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