The influence of obesity on femile infertility

Neplodnost jest nemogućnost ostvarivanja kliničke trudnoće nakon 12 ili više mjeseci redovitih nezaštićenih spolnih odnosa para reproduktivne dobi. Debljina ili pretilost je kronična metabolička bolest karakterizirana prekomjernim nakupljanjem masnog tkiva u organizmu. Brojna istraživanja su dosad pokazala da debljina potencijalno negativno utječe na plodnost žena. Rizik neplodnosti veći je 2.7 puta u žena koje boluju od debljine, a rizik pobačaja veći je za 25 – 37 % u odnosu na žene normalne tjelesne mase. Debljina žena se povezuje s disfunkcijom ovulacije, smanjenim odgovorom jajnika na indukciju ovulacije i niže stope živorođene djece nakon medicinski potpomognute oplodnje. Predloženi mehanizmi kojima debljina utječe na plodnost žena su hormonalni disbalans s učinkom na hipotalamičkohipofizno-ovarijsku os pomoću inzulinske rezistencije povezane s hiperinzulinemijom i hiperandrogenemijom. Čini se da stanje kronične upale niske aktivnosti koje je povezano s oksidativnim i endoplazmatskim stresom, poremećajem lučenja adipokina i imunološkim stanicama masnog tkiva igra važnu ulogu. Izolirani utjecaji nabrojanih mehanizama na endometrij, jajnu stanicu i zametke pogoršavaju reproduktivne ishode. U kontekstu utjecaja debljine na neplodnost vrlo je važna uloga sindroma policističnih jajnika koji se često isprepliće i javlja zajedno s debljinom, a zajedno imaju sinergistički negativan utjecaj na plodnost. Intervencije koje se mogu primijeniti za poboljšanje plodnosti u pretilih žena su raznolike, a naglasak je dosad bio na potrebi za smanjenjem tjelesne mase promjenom životnog stila u vidu prehrambenih navika i fizičke aktivnosti. Novija istraživanja ukazala su na upitan učinak smanjenja tjelesne mase u razdoblju prije začeća na stopu živorođene djece. Budući da je stopa živorođenčadi presudan, ali ne jedini pokazatelj plodnosti, ipak treba nastojati postići smanjenje tjelesne mase u pretilih pacijentica. Smanjenje tjelesne mase vjerojatno povećava stopu spontanog začeća pretilih žena i potencijalno utječe na komplikacije hipertenzije u trudnoći i prijevremeni porod. Promjena životnog stila prva je terapijska intervencija, a slijedi farmakološka terapija lijekovima za smanjenje tjelesne mase. Barijatrijskom kirurgijom postiže se najveće smanjenje tjelesne mase, ali se preporuča čekati godinu dana postoperativno do ostvarivanja trudnoće.Infertility is the inability to achieve a clinical pregnancy after 12 or more months of regular unprotected intercourse by a couple of reproductive age. Obesity is a chronic metabolic disease characterized by excessive accumulation of fat tissue in the body. Numerous studies have shown so far that obesity has a potentially negative effect on female fertility. The risk of infertility is 2.7 times higher in women suffering from obesity, and the risk of miscarriage is higher by 25-37% compared to women of normal body weight. Obesity in women is associated with ovulatory dysfunction, decreased ovarian response to ovulation induction, and lower live birth rates after medically assisted reproduction. The proposed mechanisms by which obesity affects female fertility are hormonal imbalance with an effect on the hypothalamic-pituitaryovarian axis through insulin resistance associated with hyperinsulinemia and hyperandrogenemia. A state of chronic low activity inflammation associated with oxidative and endoplasmic stress, adipokine secretion disorder, and adipose tissue immune cells appears to play an important role. The isolated effects of the listed mechanisms on the endometrium, ovum and embryos worsen reproductive outcomes. In the context of the influence of obesity on infertility, the role of polycystic ovary syndrome is very important, as it is often intertwined and appears together with obesity, and together they have a synergistic negative impact on fertility. Interventions that can be applied to improve fertility in obese women are diverse, and so far the emphasis has been on the need to reduce body weight by changing lifestyle in the form of diet and physical activity. More recent studies have pointed to the questionable effect of reducing body weight in the period before conception on the rate of live births. Since the rate of live births is a decisive, but not the only, indicator of fertility, we should still strive to achieve a reduction in body weight in obese patients. Weight loss likely increases spontaneous conception rates in obese women and potentially affects complications of hypertension in pregnancy and preterm birth. Changing the lifestyle is the first therapeutic intervention, followed by pharmacological therapy with drugs to reduce body weight. Bariatric surgery achieves the greatest reduction in body weight, but it is recommended to wait a year postoperatively before becoming pregnant