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Obesity and Reproduction

Obesity and Reproduction . Obesity Awareness Symposium: 2102 October 26, 2012. Jane Nani, M.D. Fertility Centers of Illinois. Scope of the Problem. Percent of Obese (BMI > 30) in US Adults . Percent of Obese (BMI > 30) in US Adults . Percent of Obese (BMI > 30) in US Adults .

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Obesity and Reproduction

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  1. Obesity and Reproduction Obesity Awareness Symposium: 2102 October 26, 2012 Jane Nani, M.D. Fertility Centers of Illinois

  2. Scope of the Problem Percent of Obese (BMI > 30) in US Adults

  3. Percent of Obese (BMI > 30) in US Adults

  4. Percent of Obese (BMI > 30) in US Adults

  5. Percent of Obese (BMI > 30) in US Adults

  6. Percent of Obese (BMI > 30) in US Adults

  7. Percent of Obese (BMI > 30) in US Adults

  8. Percent of Obese (BMI > 30) in US Adults

  9. Percent of Obese (BMI > 30) in US Adults

  10. Percent of Obese (BMI > 30) in US Adults

  11. Percent of Obese (BMI > 30) in US Adults

  12. Percent of Obese (BMI > 30) in US Adults

  13. Percent of Obese (BMI > 30) in US Adults

  14. Percent of Obese (BMI > 30) in US Adults

  15. Percent of Obese (BMI > 30) in US Adults

  16. Percent of Obese (BMI > 30) in US Adults

  17. Percent of Obese (BMI > 30) in US Adults

  18. Percent of Obese (BMI > 30) in US Adults

  19. Percent of Obese (BMI > 30) in US Adults

  20. Percent of Obese (BMI > 30) in US Adults

  21. Percent of Obese (BMI > 30) in US Adults

  22. INTRODUCTION Prevalence of Obesity Nationally Globally Impact of Obesity Natural fecundity ART Childhood obesity Allocation of reproductive resources

  23. Centers FOR Disease control • 2005-2006: 34% of US adults older than 20 years had BMI higher than 30mg/kg. • Most common chronic condition in US • 31% non-Hispanic white • 38% Hispanics • 49% non-Hispanic blacks

  24. Centers for disease control : 2010 • No state had less that 20% • 36 states: prevalence of 25% or greater • 12 of these: prevalence of 30% or greater

  25. Body mass index: 1998 NIH

  26. THE MOST COMMON DISEASE IN THE U.S.

  27. Global Obesity

  28. World Health organization • PREVALENCE OF OBESITY IN 2010 • HIGHEST: PACIFIC ISLANDS ~ 80% • LOWEST: INDIA ~ 1%

  29. Impact on health care • 300,000 deaths in the US each year • Diabetes • Hypertension • Obstructive Sleep Apnea • Cancer: breast, endometrial, ovarian, colon • Dyslipidemia • Cardiovascular Disease

  30. The New Yorker, July 20, 2009 Why are we so fat? “Human appetite is elastic: give us more and we’ll eat more”.

  31. Impact on Reproductive Health • Gynecology • Early puberty • DUB • Urinary incontinence • Breast cancer • Endometrial cancer • Fertility • ART • Increased Miscarriages • Adverse Obstetrical Outcome

  32. Douchi t et al, Acta Obstet Gynecol Scand 2002 Menstrual cycle disturbances • 30-50% of overweight & obese have cycle irregularity • Correlation with increasing BMI and increased truncal obesity

  33. Shah DK, et al. Curr Opin ObstetGynecol, 2010 INFERTILITY • ANOVULATION: COMMON CAUSE • INCREASE BMI: INCREASE RISK of ANOVULATION • WEIGHT LOSS IMPROVES OVULATION

  34. Polycystic ovarian syndrome (PCOS) • MOST COMMON ENDOCRINOPATHY • Not all obese women have PCOS • Not all women with PCOS are obese

  35. Conway G. et al. JCEM, 1996 Fasting Insulin and Cycle frequency

  36. Catalano PM, et al. Reproduction 2010 Obesity and PCOS • Insulin Resistance • Hyperinsulinemia • Decreased SHBG • Increased free testosterone • Increased peripheral aromatization • Relative increased estrogen • Altered negative pituitary feedback

  37. Conway G, et al. JCEM 1996 Insulin in lean & classic PCOS Majority of women with PCOS regardless of weight have insulin resistance

  38. Carmina E, et al. Obstet Gynecol, 2012 20-year follow-up: PCOS • Longitudinal Study • 193 PCOS women • Aged 20-25 • Followed at 5 year intervals over 20 years • Focus: metabolic changes with aging

  39. Carmina E, et al. Obstet Gynecol 2012 20-year follow-up: PCOS ** **

  40. van der Steeg JR, et al. Hum Reprod, 2008 OVULATORY OBESE WOMEN • LONGER TIME TO CONCEIVE • 4% per kg/m2 decrease in natural conception in women with BMI > 29 kg/m2 • H-P-O AXIS DYSREGULATION • LONGER FOLLICULAR PHASAE • SHORTENED LUTEAL PHASE

  41. Paasch U, et al. Fertil Steril, 2010 Impact of obesity on Male fertility • Case-Cohort • 2,157 men • Ages: 17-67 • All SA parameters decreased in age • 20-30 yr: Count negatively correlated in BMI

  42. Hammoud AO, et al. Feril Steril, 2008. Effect of obesity on Male fertility • Incidence of oligospermia and asthenospermia increase with BMI: • 5.3% and 4.5 % in normal men • 9.5% and 8.9% in overweight men • 15.6% and 13.3 % in obese men

  43. Etiology: BMI assoc. Infertility in men • Abnormal reproductive hormones • Increased adipose-derived E2 • Reduced total testosterone levels • Gonadotropin suppression (negative E2 feedback) • Increased Scrotal Temperature • Erectile Dysfunction

  44. Impact of obesity on Natural fecundity

  45. Sneed ML, et al. Hum Reprod, 2008 RETROSPECTIVE DATA: FCI • Effect of BMI on IVF outcome • 2167 cases: first cycle of IVF • January, 2005 – March, 2006 • Clinical pregnancy rate: main outcome • BMI alone: no impact on IVF outcome

  46. Clinical Pregnancy Rate

  47. Conclusion • At younger ages, high BMI has a profound negative influence on IVF pregnancy rates but this effect diminished with increasing age.

  48. IVF outcomes in obese patients

  49. IVF outcomes in Obese patients • Higher cycle cancellation rate • More days of gonadotropins • Higher doses of gonadotropins • Lower peak estradiol levels • Lower oocyte yield • Lower fertilization rate

  50. EFFECTS OF OBESITY IN REPRODUCTIVE DEVELOPMENT

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