Introduction:
Obesity is one of the serious problems faced by many people that affect their lives. Obesity can cause health problems along with endocrine and other metabolic disorders. Female obesity is a multifactorial condition that can affect the functioning of various systems, including the reproductive system.
What Is Obesity?
Obesity is defined as excessive fat accommodation that can affect normal metabolism and health. According to the World Health Organisation (WHO), the calculation of body mass index (BMI) helps to classify overweight and obesity. In adults, a BMI more than or equal to 25 is considered overweight, and a BMI greater than or equal to 30 is considered obese. Considering the global population, women have the highest rate of obesity than men. Obesity can affect their metabolic functions and is a major risk factor for several diseases like cardiovascular disease, diabetes, hypertension, and cancer. The studies have revealed a direct relation between obesity in females and poor reproductive health. It can lead to poor fertilization and embryo development. It can account for negative pregnancy outcomes.
How Can Obesity Affect Reproductive Health in Women?
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Infertility:
Obesity is considered a dependent risk factor for fertility. In females, excess fat accumulation, especially in the visceral adipose tissues, causes stimulation of the reproductive organs. Ovaries and adrenal glands are stimulated, causing excess androgen production. This, in the term, leads to menstrual irregularities and finally to infertility. Obesity in childhood or adolescent periods is closely related to menstrual irregularities and difficulty in natural conception.
Obesity increases the circulating level of insulin and ovarian androgens. This sends a negative feedback signal to the hypothalamic-pituitary axis and stops the production of gonadotropins. Gonadotropins are hormones that produce the reproductive organs and help in follicle development, maturation, and release of egg and formation of corpus luteum. The absence of hormones and inhibition of ovarian functions lead to infertility.
For the successful implantation of the embryo, there should be optimal endometrial receptivity. In an obese woman, the stromal endometrial cells have a reduced ability to undergo functional and morphological changes. This causes failure of implantation and pregnancy. Obesity causes increased androgen levels and leads to a condition called polycystic ovarian syndrome (PCOS). The abnormal levels of ovarian androgens impair follicular growth and development, also leading to fertility problems.
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Embryonic Developmental Abnormalities:
Obesity can increases the risk of
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Preterm birth.
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Congenital anomalies.
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Perinatal death.
Maternal obesity is a strong factor leading to macrosomia. The growth of the fetus is determined by the functions of the placenta and the transportation of nutrients and genetic factors. Obesity can lead to impairment of placental functions and restricts the availability of nutrients to the developing fetus, and failure of growth of the baby.
Compared to pregnant women of normal weight, 30 % increased risk for congenital anomalies in obese pregnant women. It may cause neural tube defects, heart and limb developmental defects. Maternal obesity directly increases the chance of gestational diabetes.
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Miscarriage:
Obesity can increase the risk of miscarriages and also in assisted reproductive techniques. The increase in BMI increased the miscarriage by 38.1 %. The changes in endometrium, making it unfavorable for implantation, are a major cause of miscarriage in the first trimester. In obese women, endocrine disorders like hypothyroidism and insulin resistance are common and might be a factor for miscarriage.
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Health of the Newborn:
Obesity and metabolic changes in the mother can increase the prevalence of future metabolic dysfunction in that child. Genetic factors can increase the chance of developing obesity, type 2 diabetes, hypertension, cardiovascular disease, and kidney disease in offspring. There is a general association between maternal obesity and congenital heart disease in kids. The increased fat deposition can alter the insulin level lipotoxicity and causes inflammation. There is an additional risk of developing hypertrophy and enlargement of heart ventricles.
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Failure in Fertility Treatments:
The pandemic has made the population have a sedentary lifestyle and resulted in increased obesity in the population. Obesity and weight gain resulted in poor reproductive outcomes and tried assisted reproductive techniques (ART). The success rate has reduced significantly in obese women due to the poor quality of embryos and altered hormonal levels.
During the time of in vitro fertilization, obese women face many difficulties, like a delayed ovarian response.
How to Prevent Obesity-Related Reproductive Problems?
Losing weight is the prime step to reduce obesity-related reproductive issues. Women planning to conceive should prepare themselves by maintaining body weight and overall health. Reduced calorie diet and physical activities are the effective steps to prevent obesity. If needed, seek help from a dietician and doctor to follow a healthy diet and maintain body weight.
Conclusion:
Being overweight and obese negatively affects reproductive health and chances of pregnancy. This is important to maintain the body weight before trying for a pregnancy or assisted reproductive techniques. Women should be made aware of the importance of maintaining a healthy weight in reproductive age. Obesity is not the only factor leading to infertility, obesity can alter the various metabolic factors, which, when combined, can lead to infertility.
