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Deshpande S, Patel KD, Parulkar T, Mahabalesh K, Madhusudhan P, Madhusudhan DK, Thimmapuram J. Effect of Heartfulness meditation based integrative therapy on infertility outcomes: A retrospective case series evaluation. J Ayurveda Integr Med 2023; 14:100793. [PMID: 37797350 PMCID: PMC10562913 DOI: 10.1016/j.jaim.2023.100793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 07/12/2023] [Accepted: 08/02/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND In Indian context, infertility is often a silent struggle. Despite the high prevalence of infertility in the country, the majority of couples do not share their struggles with family or friends due to social stigma, thus increasing their psychological vulnerability. Heartfulness meditation has shown to decrease stress, anxiety, loneliness and improve sleep along with quality of life. OBJECTIVES The current retrospective series evaluated the effectiveness of Heartfulness-based integrative therapy on infertility outcomes. METHODS The program consisted of a 5- day onsite lifestyle modification workshop and online follow up meditation sessions. RESULTS 54 couples with infertility participated in the program with a mean age of 30.74 years (SD 5.04) for females and 34.03 years (SD 4.54) for males. 15 couples presented with male infertility, 16 couples presented with female infertility and in 5 couples both partners had infertility problems. Further, 18 couples had unexplained infertility. 24 couples conceived with 18 natural conceptions, five via assisted reproductive technology and one spontaneous abortion. CONCLUSION The program was beneficial in the cohort who utilized it as prescribed resulting in conception of 24 out of 54 couples. Future research investigating the causal relationship of Heartfulness meditation on fertility outcomes in a randomized control study could solidify this treatment method to be used independently or as an adjuvant therapy with assisted reproductive technologies.
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Affiliation(s)
| | | | | | | | | | - Divya K Madhusudhan
- GCSRT, Department of Postgraduate Medical Education, Harvard Medical School, USA
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Cordova-Gomez A, Wong AP, Sims LB, Doncel GF, Dorflinger LJ. Potential biomarkers to predict return to fertility after discontinuation of female contraceptives-looking to the future. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 5:1210083. [PMID: 37674657 PMCID: PMC10477712 DOI: 10.3389/frph.2023.1210083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 07/18/2023] [Indexed: 09/08/2023] Open
Abstract
Nowadays there are multiple types of contraceptive methods, from reversible to permanent, for those choosing to delay pregnancy. Misconceptions about contraception and infertility are a key factor for discontinuation or the uptake of family planning methods. Regaining fertility (the ability to conceive) after contraceptive discontinuation is therefore pivotal. Technical studies to date have evaluated return to fertility by assessing pregnancy as an outcome, with variable results, or return to ovulation as a surrogate measure by assessing hormone levels (such as progesterone, LH, FSH) with or without transvaginal ultrasound. In general, relying on time to pregnancy as an indicator of return to fertility following contraceptive method discontinuation can be problematic due to variable factors independent of contraceptive effects on fertility, hormone clearance, and fertility recovery. Since the ability to conceive after contraceptive method discontinuation is a critical factor influencing product uptake, it is important to have robust biomarkers that easily and accurately predict the timing of fertility return following contraception and isolate that recovery from extrinsic and circumstantial factors. The main aim of this review is to summarize the current approaches, existing knowledge, and gaps in methods of evaluating return-to-fertility as well as to provide insights into the potential of new biomarkers to more accurately predict fertility restoration after contraceptive discontinuation. Biomarker candidates proposed in this document include those associated with folliculogenesis, cumulus cell expansion, follicular rupture and ovulation, and endometrial transport and receptivity which have been selected and scored on predefined criteria meant to evaluate their probable viability for advancement. The review also describes limitations, regulatory requirements, and a potential path to clinically testing these selected biomarkers. It is important to understand fertility restoration after contraceptive method discontinuation to provide users and health providers with accurate evidence-based information. Predictive biomarkers, if easy and low-cost, have the potential to enable robust evaluation of RTF, and provide potential users the information they desire when selecting a contraceptive method. This could lead to expanded uptake and continuation of modern contraception and inform the development of new contraceptive methods to widen user's family planning choices.
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Affiliation(s)
- Amanda Cordova-Gomez
- Office of Population and Reproductive Health, USAID/Public Health Institute, Washington, DC, United States
| | - Andrew P. Wong
- CONRAD, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA, United States
| | - Lee B. Sims
- Office of Population and Reproductive Health, USAID/Public Health Institute, Washington, DC, United States
| | - Gustavo F. Doncel
- CONRAD, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA, United States
| | - Laneta J. Dorflinger
- Department of Product Development and Introduction, FHI 360, Durham, NC, United States
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3
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Oldfield AL, Vanden Brink H, Carter FE, Jarrett BY, Lujan ME. Obesity is associated with alterations in antral follicle dynamics in eumenorrheic women. Hum Reprod 2023; 38:459-470. [PMID: 36708012 PMCID: PMC9977134 DOI: 10.1093/humrep/dead007] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 12/23/2022] [Indexed: 01/29/2023] Open
Abstract
STUDY QUESTION Are ovarian antral follicle dynamics altered in women with obesity and regular ovulatory cycles? SUMMARY ANSWER Eumenorrheic women with obesity display evidence of suppressed antral follicle dynamics as judged by fewer recruitment events, selectable follicles, and anovulatory dominant follicles, as well as lower anti-Müllerian hormone (AMH) concentrations and an increased prevalence of luteal phase defects. WHAT IS KNOWN ALREADY Ovarian antral follicle development is a dynamic process involving distinct follicular and endocrine events that are critical for the occurrence of regular monthly ovulations. Follicle dynamics have not been prospectively evaluated in eumenorrheic women with obesity despite the known impact of obesity on gonadotropin production, ovarian steroid hormone concentrations, and fecundity. STUDY DESIGN, SIZE, DURATION This was a prospective, longitudinal study of 42 women conducted over one inter-ovulatory interval (IOI). PARTICIPANTS/MATERIALS, SETTING, METHODS A group of 21 women with obesity (total percent body fat ≥35%) and a group of 21 women without obesity (total percent body fat <35%) underwent transvaginal ultrasonography and venipuncture every-other-day for one IOI at an academic clinical research unit. Participants were aged 19-38 years and had a history of self-reported regular menstrual cycles (21-35 days). Follicle number and diameter (≥2 mm) were quantified at each visit. Individual growth profiles for all follicles that grew to ≥7 mm were assessed. Blood samples were assayed for gonadotropins, AMH, estradiol, and progesterone. MAIN RESULTS AND THE ROLE OF CHANCE Women with obesity exhibited fewer recruitment events (mean ± SD, 1 ± 1 vs 2 ± 1 events; P = 0.010) and fewer selectable follicles (4 ± 3 vs 8 ± 6 follicles per participant; P = 0.022) during an IOI compared to women without obesity. AMH levels were lower in women with obesity (4.40 ± 3.01 vs 5.94 ± 2.49 ng/ml; P = 0.023), while gonadotropin profiles were similar between groups, across the IOI. Of the individual follicles tracked, fewer follicles progressed to >10 mm in the cohort with obesity (30 vs 40 follicles; P = 0.04) and fewer anovulatory follicles achieved dominance (9 vs 18 follicles; P = 0.041). Ovulatory follicles were selected at smaller diameters in women with compared to those without obesity (7.5 ± 1.6 vs 9.5 ± 1.9 mm; P = 0.001). Luteal phase defects were also more common in women with compared to those without obesity, as defined by either integrated (76 vs 29%, P = 0.002) or maximum (71 vs 24%, P = 0.002) luteal progesterone. LIMITATIONS, REASONS FOR CAUTION This study was limited to an assessment of antral follicle dynamics and cannot inform on earlier stages of folliculogenesis. This study was observational and cannot address causation between obesity and altered antral follicle dynamics. Lastly, the data cannot be extrapolated to account for reduced fecundity and fertility in obesity. WIDER IMPLICATIONS OF THE FINDINGS The increasing global prevalence of obesity necessitates an understanding of the mechanisms that underlie obesity-related adverse reproductive health outcomes. Eumenorrheic women with obesity demonstrate altered ovarian antral follicle and endocrine dynamics compared to their counterparts without obesity. The degree to which abnormal granulosa cell assembly and/or activity underlie the suboptimal luteinization and subfertility requires further investigation. STUDY FUNDING/COMPETING INTEREST(S) Funding was provided by Cornell University, President's Council of Cornell Women, United States Department of Agriculture (grant no. 8106), and National Institutes of Health (R01-HD0937848). B.Y.J. and H.V.B. were supported by doctoral training awards from the National Institutes of Health (T32-DK007158) and Canadian Institutes of Health Research (grant no. 146182), respectively. TRIAL REGISTRATION NUMBER NCT01927432, NCT01785719.
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Affiliation(s)
- Alexis L Oldfield
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | | | - Faith E Carter
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | | | - Marla E Lujan
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
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4
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Liu Y, Tilleman K, Vlaeminck B, Gervais R, Chouinard PY, De Sutter P, Fievez V. The fatty acid composition in follicles is related to the developmental potential of oocytes up to the blastocyst stage: a single-centre cohort study. Reprod Biol Endocrinol 2022; 20:107. [PMID: 35879714 PMCID: PMC9310456 DOI: 10.1186/s12958-022-00974-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 06/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Advanced maternal age and obesity are associated with impaired female fertility. Moreover, fatty acids (FA) in follicular fluid (FF) play important roles in oocyte maturation and embryo development. However, the effects of body mass index (BMI), age, and FF FA composition on embryo development between days 3 and 5 and blastocyst stage on day 5 are still unclear. METHODS This study included 138 patients undergoing assisted reproductive technology (ART), which were divided into three BMI groups (18.5-24.9 kg/m2 vs. 25.0-29.9 kg/m2 vs. ≥ 30.0 kg/m2) and three age-related groups (20-30 years vs. 31-34 years vs. ≥ 35 years) which were compared for ART outcomes. Further, observations were divided into quartiles based on either of three parameters related to embryo outcome, i.e. (i) embryos developing between days 3 and 5 (ED3-5) and (ii) expanded blastocysts on day 5 (EB5), both expressed proportionally to the number of oocytes with two pronuclei (2PN), as well as (iii) the embryo utilization rate (EUR). Proportions of FF FA were then compared between Q1 and Q4, representing the quartile with the worst vs. the best embryo outcome, respectively. Finally, regression models were created to assess the relationships between BMI, age, FF total FA (TFA) concentration, relative proportions of specific FA and embryo outcome. RESULTS Patients of Q1 had higher proportions of FF C20:5n-3, C22:6n-3 and total n-3 PUFA than Q4 patients. Furthermore, Q4 patients tended to be younger than Q1 patients. Within the whole cohort, the proportion of C20:5n-3 negatively correlated with ED3-5/2PN and EUR, while EB5/2PN tended to be negatively correlated with age. Regression models within the overweight and obese group confirmed the negative relation between C20:5n-3 and ED3-5/2PN, but also indicated additional associations: C18:1n-9 and C20:4n-6 were positively associated with ED3-5/2PN and EUR, respectively while the proportion of C18:0 was negatively associated with EUR. CONCLUSION The proportions of n-3 PUFA, particularly C20:5n-3 and C22:6n-3 were reduced in the patients' quartile with the best embryo outcome. This group of patients was also younger. However, the embryo quality parameters of overweight/obese patients were not associated with age but were positively associated with FF C18:1n-9 and negatively with the proportions of C18:0 or C20:5n-3. TRIAL REGISTRATION This study' registration number was B670201627735.
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Affiliation(s)
- Yujie Liu
- Department of Animal Sciences and Aquatic Ecology, Ghent University, Coupure Links 653, 9000, Ghent, Belgium
| | - Kelly Tilleman
- Department for Reproductive Medicine, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Bruno Vlaeminck
- Department of Biology, Ghent University, Krijgslaan 281, S8, 9000, Ghent, Belgium
| | - Rachel Gervais
- Department of Animal Sciences, Laval University, 2425, rue de l'Agriculture, Québec, Québec, G1V 0A6, Canada
| | - P Yvan Chouinard
- Department of Animal Sciences, Laval University, 2425, rue de l'Agriculture, Québec, Québec, G1V 0A6, Canada
| | - Petra De Sutter
- Department for Reproductive Medicine, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Veerle Fievez
- Department of Animal Sciences and Aquatic Ecology, Ghent University, Coupure Links 653, 9000, Ghent, Belgium.
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Asendorpf JB, Penke L, Back MD. From Dating to Mating and Relating: Predictors of Initial and Long–Term Outcomes of Speed–Dating in a Community Sample. EUROPEAN JOURNAL OF PERSONALITY 2020. [DOI: 10.1002/per.768] [Citation(s) in RCA: 139] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
We studied initial and long–term outcomes of speed–dating over a period of 1 year in a community sample involving 382 participants aged 18–54 years. They were followed from their initial choices of dating partners up to later mating (sexual intercourse) and relating (romantic relationship). Using Social Relations Model analyses, we examined evolutionarily informed hypotheses on both individual and dyadic effects of participants’ physical characteristics, personality, education and income on their dating, mating and relating. Both men and women based their choices mainly on the dating partners’ physical attractiveness, and women additionally on men's sociosexuality, openness to experience, shyness, education and income. Choosiness increased with age in men, decreased with age in women and was positively related to popularity among the other sex, but mainly for men. Partner similarity had only weak effects on dating success. The chance for mating with a speed–dating partner was 6%, and was increased by men's short–term mating interest; the chance for relating was 4%, and was increased by women's long–term mating interest. Copyright © 2010 John Wiley & Sons, Ltd.
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Affiliation(s)
| | - Lars Penke
- Department of Psychology and Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, UK
| | - Mitja D. Back
- Department of Psychology, Johannes Gutenberg-University Mainz, Germany
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Kim J, Juneau C, Patounakis G, Morin S, Neal S, Seli E, Scott R. The appraisal of body content (ABC) trial: obesity does not significantly impact gamete production in infertile men and women. J Assist Reprod Genet 2020; 37:2733-2742. [PMID: 32827101 PMCID: PMC7642175 DOI: 10.1007/s10815-020-01930-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 08/17/2020] [Indexed: 02/08/2023] Open
Abstract
PURPOSE As obesity becomes increasingly prevalent, its impact on fertility has been a subject of great debate. Nearly all prior research is retrospective and evaluates obesity utilizing body mass index (BMI), which may overestimate adiposity in individuals with a greater amount of lean muscle and underestimate adiposity in those with less muscle mass. METHODS We prospectively evaluated 2013 couples undergoing infertility treatment with in vitro fertilization (IVF). Percent body fat (%BF) was measured by use of a bioelectric impedance analysis (BIA) scale at baseline. BMI was also determined. Ovarian reserve parameters, ovarian response to controlled ovarian hyperstimulation, and semen analyses were measured in correlation with their %BF and BMI. RESULTS Females classified as obese based on %BF or BMI had lower serum FSH. However, when the analysis was limited to women without PCOS (n = 1706), obesity based on %BF or BMI was associated with lower serum AMH. Female obesity-regardless of a PCOS diagnosis-did not affect number of mature oocytes retrieved. Males who were in obese %BF category were found to have lower TMSC compared with normal weight counterparts (p < 0.05); however, the observed decrease was not significant enough to limit the success of assisted reproductive technologies. CONCLUSIONS These findings suggest that while obesity may affect ovarian reserve in women variably depending on presence of PCOS, it does not affect number of mature oocytes available after COH. Similarly, while a high %BF in males is associated with lower TMSC, the observed difference is unlikely to affect IVF outcomes.
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Affiliation(s)
- Julia Kim
- IVI RMA New Jersey, Basking Ridge, NJ, USA.
- Sidney Kimmel Medical School of Jefferson University, Philadelphia, PA, USA.
| | | | | | - Scott Morin
- IVI RMA New Jersey, Basking Ridge, NJ, USA
- Sidney Kimmel Medical School of Jefferson University, Philadelphia, PA, USA
- IVI RMA of Northern California, San Francisco, CA, USA
| | - Shelby Neal
- IVI RMA New Jersey, Basking Ridge, NJ, USA
- Sidney Kimmel Medical School of Jefferson University, Philadelphia, PA, USA
- Wake Forest School of Medicine, Wake Forest, NC, USA
| | - Emre Seli
- IVI RMA New Jersey, Basking Ridge, NJ, USA
- Yale School of Medicine, New Haven, CT, USA
| | - Richard Scott
- IVI RMA New Jersey, Basking Ridge, NJ, USA
- Sidney Kimmel Medical School of Jefferson University, Philadelphia, PA, USA
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7
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Effect of body mass index on intrauterine insemination cycle success. Fertil Steril 2020; 115:221-228. [PMID: 33070966 DOI: 10.1016/j.fertnstert.2020.07.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/17/2020] [Accepted: 07/01/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To determine whether body mass index (BMI) affects intrauterine insemination treatment success. DESIGN Retrospective cohort study. SETTING Academic medical center. PATIENT(S) A total of 3,217 intrauterine insemination treatment cycles in 1,306 patients. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Primary outcome was live birth rate stratified by BMI. Secondary outcomes included rates of clinical pregnancy (defined as an intrauterine pregnancy with a heartbeat present on ultrasound), multiple gestation, biochemical pregnancy, missed abortion, ectopic, and spontaneous abortion. RESULT(S) Women with BMI 25 to 29.99 kg/m2 or ≥30 kg/m2 were equally likely to have a live birth as women of normal BMI. Women with BMI ≥30 kg/m2 did have a higher likelihood of biochemical pregnancy than women with normal BMI. CONCLUSION(S) A BMI between 25 and 29.99 kg/m2 or ≥30 kg/m2 does not appear to have a negative effect on live birth after intrauterine insemination. Obesity may be associated with a higher risk of biochemical pregnancy after intrauterine insemination.
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8
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Sasaki RSA, Approbato MS, Maia MCS, Ferreira EABFE, Zanluchi N. Ovulatory status of overweight women without Polycystic Ovary Syndrome. JBRA Assist Reprod 2019; 23:2-6. [PMID: 30614235 PMCID: PMC6364286 DOI: 10.5935/1518-0557.20180071] [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] [Indexed: 11/28/2022] Open
Abstract
Objective: Obesity is one of the extra hypothalamic-pituitary-ovarian axis factors that
can influence ovulation. The isolated impact of obesity on ovulation without
other comorbidities needs to be further studied. Our goal is to evaluate the
association between the anovulation in the ultrasonographic monitoring of
the ovulation cycle and the body mass increase of infertile patients without
polycystic ovaries of a university service. Methods: Case-control study performed at the Human Reproduction Laboratory of the
University Hospital. We evaluated 1,356 ultrasound monitoring reports of
ovulation between January 2011 and December 2015. We named case those
patients who ovulated on the monitored cycle. After applying the exclusion
criteria, we consolidated a total of 110 cases and 118 controls. The
exposure variables were normal BMI or patients classified with a BMI above
normal. Data analysis was performed using SPSS 22.0. Differences in
proportions were assessed by X2 test Pearson, Fisher and Wilcoxon
test. The value of p<0.05 was considered statistically
significant. Results: The groups were comparable in age, age at menarche, number of pregnancies,
deliveries, cesarean sections and abortions, number of antral follicles,
FSH, prolactin and TSH values. Among the anovulatory patients, 57 (51.82%)
were overweight, while among ovulatory patients, 44 (37.29%) were in this
same BMI category. The odds ratio was 1.8655, with a significant p value
(p<0.05). Conclusion: There was an association between anovulation and increase in the Body Mass
Index, with an increased risk of anovulation in patients with BMI above
normal.
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Affiliation(s)
- Reinaldo S A Sasaki
- Assisted Reproduction Laboratory - Hospital das Clínicas - Federal University of Goiás
| | - Mário S Approbato
- Assisted Reproduction Laboratory - Hospital das Clínicas - Federal University of Goiás
| | - Mônica C S Maia
- Assisted Reproduction Laboratory - Hospital das Clínicas - Federal University of Goiás
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van Elten TM, Karsten MDA, Geelen A, van Oers AM, van Poppel MNM, Groen H, Gemke RJBJ, Mol BW, Mutsaerts MAQ, Roseboom TJ, Hoek A. Effects of a preconception lifestyle intervention in obese infertile women on diet and physical activity; A secondary analysis of a randomized controlled trial. PLoS One 2018; 13:e0206888. [PMID: 30403756 PMCID: PMC6221548 DOI: 10.1371/journal.pone.0206888] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 10/18/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Lifestyle changes are notoriously difficult. Since women who intend to become pregnant are more susceptible to lifestyle advice, interventions during this time window might be more effective than interventions during any other period in life. We here report the effects of the first large preconception lifestyle intervention RCT on diet and physical activity in obese infertile women. METHODS In total, 577 women were randomized between a six-month lifestyle intervention program (intervention group; N = 290) or prompt infertility treatment (control group; N = 287). Self-reported dietary behaviors and physical activity were assessed at baseline, three, six and twelve months after randomization. Mixed models were used to analyze differences between groups. RESULTS Compared to the control group, the intervention group reduced their intake of sugary drinks at three months (-0.5 glasses/day [95% C.I. = -0.9;-0.2]), of savory snacks at three (-2.4 handful/week [-3.4;-1.4]) and at six months (-1.4 handful/week [-2.6;-0.2]), and of sweet snacks at three (-2.2 portion/week [-3.3;-1.0]) and twelve months after randomization (-1.9 portion/week [-3.5;-0.4]). Also, the intervention group was more moderate to vigorous physically active at three months after randomization compared to the control group (169.0 minutes/week [6.0; 332.1]). CONCLUSION Our study showed that obese infertile women who followed a six-month preconception lifestyle intervention program decreased their intake of high caloric snacks and beverages, and increased their physical activity. These changes in lifestyle may not only improve women's health but their offspring's health too.
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Affiliation(s)
- Tessa M. van Elten
- Amsterdam UMC, Vrije Universiteit Amsterdam, VU University medical center, Department of Public and Occupational Health, de Boelelaan, Amsterdam, The Netherlands
- Amsterdam UMC, University of Amsterdam, Academic Medical Center, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Meibergdreef, Amsterdam, The Netherlands
- Amsterdam UMC, University of Amsterdam, Academic Medical Center, Department of Obstetrics and Gynecology, Meibergdreef, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
- * E-mail:
| | - Matty D. A. Karsten
- Amsterdam UMC, University of Amsterdam, Academic Medical Center, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Meibergdreef, Amsterdam, The Netherlands
- Amsterdam UMC, University of Amsterdam, Academic Medical Center, Department of Obstetrics and Gynecology, Meibergdreef, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
- University of Groningen, University Medical Center Groningen, Department of Obstetrics and Gynecology, Groningen, the Netherlands
| | - Anouk Geelen
- Wageningen University & Research, Division of Human Nutrition, Wageningen, The Netherlands
| | - Anne M. van Oers
- University of Groningen, University Medical Center Groningen, Department of Obstetrics and Gynecology, Groningen, the Netherlands
| | - Mireille N. M. van Poppel
- Amsterdam UMC, Vrije Universiteit Amsterdam, VU University medical center, Department of Public and Occupational Health, de Boelelaan, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- University of Graz, Institute of Sport Science, Graz, Austria
| | - Henk Groen
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands
| | - Reinoud J. B. J. Gemke
- Amsterdam UMC, Vrije Universiteit Amsterdam, VU University medical center, Department of Public and Occupational Health, de Boelelaan, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
- Amsterdam UMC, Vrije Universiteit Amsterdam, Emma Childrens Hospital, Department of Pediatrics, Amsterdam, The Netherlands
| | - Ben Willem Mol
- Monash University, Department of Obstetrics and Gynecology, Melbourne, Australia
| | - Meike A. Q. Mutsaerts
- University of Groningen, University Medical Center Groningen, Department of Obstetrics and Gynecology, Groningen, the Netherlands
| | - Tessa J. Roseboom
- Amsterdam UMC, University of Amsterdam, Academic Medical Center, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Meibergdreef, Amsterdam, The Netherlands
- Amsterdam UMC, University of Amsterdam, Academic Medical Center, Department of Obstetrics and Gynecology, Meibergdreef, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
| | - Annemieke Hoek
- University of Groningen, University Medical Center Groningen, Department of Obstetrics and Gynecology, Groningen, the Netherlands
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Evans MC, Anderson GM. Integration of Circadian and Metabolic Control of Reproductive Function. Endocrinology 2018; 159:3661-3673. [PMID: 30304391 DOI: 10.1210/en.2018-00691] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 10/03/2018] [Indexed: 12/11/2022]
Abstract
Optimal fertility in humans and animals relies on the availability of sufficient metabolic fuels, information about which is communicated to the brain via levels of the hormones leptin and insulin. The circadian clock system is also critical; this input is especially evident in the precise timing of the female-specific surge of GnRH and LH secretion that triggers ovulation the next day. Chronodisruption and metabolic imbalance can both impair reproductive activity, and these two disruptions exacerbate each other, such that they often occur simultaneously. Kisspeptin neurons located in the anteroventral periventricular nucleus of the hypothalamus are able to integrate both circadian and metabolic afferent inputs and use this information to modulate the timing and magnitude of the preovulatory GnRH/LH surge. In an environment in which exposure to high caloric diets and chronodisruptors such as artificial night lighting, shift work, and transmeridian travel have become the norm, the implications of these factors for couples struggling to conceive deserve closer attention and more public education.
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Affiliation(s)
- Maggie C Evans
- Centre for Neuroendocrinology and Department of Anatomy, University of Otago School of Biomedical Sciences, Dunedin, New Zealand
| | - Greg M Anderson
- Centre for Neuroendocrinology and Department of Anatomy, University of Otago School of Biomedical Sciences, Dunedin, New Zealand
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Ko KM, Han K, Chung YJ, Yoon KH, Park YG, Lee SH. Association between Body Weight Changes and Menstrual Irregularity: The Korea National Health and Nutrition Examination Survey 2010 to 2012. Endocrinol Metab (Seoul) 2017; 32:248-256. [PMID: 28685514 PMCID: PMC5503870 DOI: 10.3803/enm.2017.32.2.248] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Revised: 03/16/2017] [Accepted: 03/28/2017] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Menstrual irregularity is an indicator of endocrine disorders and reproductive health status. It is associated with various diseases and medical conditions, including obesity and underweight. We aimed to assess the association between body weight changes and menstrual irregularity in Korean women. METHODS A total of 4,621 women 19 to 54 years of age who participated in the 2010 to 2012 Korea National Health and Nutrition Examination Survey were included in this study. Self-reported questionnaires were used to collect medical information assessing menstrual health status and body weight changes. Odds ratios (ORs) and 95% confidence interval (CI) were calculated to evaluate the association between body weight changes and menstrual irregularity. RESULTS Significantly higher ORs (95% CI) were observed in the association between menstrual irregularity and both weight loss (OR, 1.74; 95% CI, 1.22 to 2.48) and weight gain (OR, 1.45; 95% CI, 1.13 to 1.86) after adjusting for age, body mass index, current smoking, heavy alcohol drinking, regular exercise, calorie intake, education, income, metabolic syndrome, age of menarche, parity, and stress perception. Of note, significant associations were only observed in subjects with obesity and abdominal obesity, but not in non-obese or non-abdominally obese subjects. U-shaped patterns were demonstrated in both obese and abdominally obese subjects, indicating that greater changes in body weight are associated with higher odds of menstrual irregularity. CONCLUSION We found a U-shaped pattern of association between body weight changes and menstrual irregularity among obese women in the general Korean population. This result indicates that not only proper weight management but also changes in body weight may influence the regulation of the menstrual cycle.
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Affiliation(s)
- Kyung Min Ko
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyungdo Han
- Department of Medical Statistics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Youn Jee Chung
- Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kun Ho Yoon
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong Gyu Park
- Department of Medical Statistics, College of Medicine, The Catholic University of Korea, Seoul, Korea.
| | - Seung Hwan Lee
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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Susko ML, Bloom MS, Neamtiu IA, Appleton AA, Surdu S, Pop C, Fitzgerald EF, Anastasiu D, Gurzau ES. Low-level arsenic exposure via drinking water consumption and female fecundity - A preliminary investigation. ENVIRONMENTAL RESEARCH 2017; 154:120-125. [PMID: 28061371 PMCID: PMC5328919 DOI: 10.1016/j.envres.2016.12.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 12/05/2016] [Accepted: 12/26/2016] [Indexed: 05/11/2023]
Abstract
High level arsenic exposure is associated with reproductive toxicity in experimental and observational studies; however, few data exist to assess risks at low levels. Even less data are available to evaluate the impact of low level arsenic exposure on human fecundity. Our aim in this pilot study was a preliminary evaluation of associations between low level drinking water arsenic contamination and female fecundity. This retrospective study was conducted among women previously recruited to a hospital-based case-control study of spontaneous pregnancy loss in Timiṣ County, Romania. Women (n=94) with planned pregnancies of 5-20 weeks gestation completed a comprehensive physician-administered study questionnaire and reported the number of menstrual cycles attempting to conceive as the time to pregnancy (TTP). Drinking water samples were collected from residential drinking water sources and we determined arsenic levels using hydride generation-atomic absorption spectrometry (HG-AAS). Multivariable Cox-proportional hazards regression with Efron approximation was employed to evaluate TTP as a function of drinking water arsenic concentrations among planned pregnancies, adjusted for covariates. There was no main effect for drinking water arsenic exposure, yet the conditional probability for pregnancy was modestly lower among arsenic exposed women with longer TTPs, relative to women with shorter TTPs, and relative to unexposed women. For example, 1µg/L average drinking water arsenic conferred 5%, 8%, and 10% lower likelihoods for pregnancy in the 6th, 9th, and 12th cycles, respectively (P=0.01). While preliminary, our results suggest that low level arsenic contamination in residential drinking water sources may further impair fecundity among women with longer waiting times; however, this hypothesis requires confirmation by a future, more definitive study.
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Affiliation(s)
- Michele L Susko
- Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, New York, United States
| | - Michael S Bloom
- Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, New York, United States; Department of Environmental Health Sciences, University at Albany, State University of New York, Rensselaer, New York, United States.
| | - Iulia A Neamtiu
- Health Department, Environmental Health Center, Cluj-Napoca, Romania; IMOGEN Research Institute, Cluj-Napoca, Romania
| | - Allison A Appleton
- Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, New York, United States
| | - Simona Surdu
- Department of Environmental Health Sciences, University at Albany, State University of New York, Rensselaer, New York, United States
| | - Cristian Pop
- Physico-chemical and Biotoxicological Analysis Laboratory, Environmental Health Center, Cluj-Napoca, Romania; Cluj School of Public Health - College of Political, Administrative and Communication Sciences, Babeṣ-Bolyai University, Cluj-Napoca, Romania; Faculty of Environmental Science and Engineering, Babeṣ-Bolyai University, Cluj-Napoca, Romania
| | - Edward F Fitzgerald
- Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, New York, United States; Department of Environmental Health Sciences, University at Albany, State University of New York, Rensselaer, New York, United States
| | - Doru Anastasiu
- University of Medicine and Pharmacy "Victor Babeṣ", Timiṣoara, Romania; Obstetrics and Gynecology Department of the Emergency County Hospital, Timiṣoara, Romania
| | - Eugen S Gurzau
- Health Department, Environmental Health Center, Cluj-Napoca, Romania; IMOGEN Research Institute, Cluj-Napoca, Romania; University of Medicine and Pharmacy "Iuliu Haṭieganu", Cluj-Napoca, Romania
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13
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Yuksel B, Kilic S, Yilmaz N, Goktas T, Keskin U, Seven A, Ulubay M, Batioglu S. Obesity is not a descriptive factor for oxidative stress and viscosity in follicular fluid of in vitro fertilization patients. Ir J Med Sci 2016; 186:641-646. [PMID: 27817165 DOI: 10.1007/s11845-016-1523-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 10/25/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Obesity's impact on micro-environmental oxidative stress and follicular fluid (FF) viscosity and whether or not it has any effect on in vitro fertilization (IVF) success is a matter of debate. AIMS In this study, our aim was to evaluate the levels of oxidative stress markers and the FF viscosity in obese and non-obese patients. METHODS Eighty norm-responder patients undergoing IVF were prospectively grouped according to their body mass indexes (BMI). Group 1 (n = 40) and group 2 (n = 40) had BMI values of ≤24.9 and ≥25.0, respectively. Total sulfhydryl (RSH) levels (nmol/m) and the formation of thiobarbituric acid-reactive substances (malondialdehyde, or MDA) (µmol/ml) in FFs were quantified. For the first time in our study, FF viscosity with changing BMI values was also determined. RESULTS The mean levels of MDA (µmol/ml) and RSH (nmol/ml) were not significantly different between groups (1.37 ± 0.51; 1.51 ± 0.51; p > 0.05 for MDA and 0.42 ± 0.30; 0.41 ± 0.20; p > 0.05 for RSH, respectively). Similarly, the FF viscosity (centipoise) was not different between groups (1.28 ± 0.28; 1.30 ± 0.19; p < 0.05, respectively). Independent of BMI, no correlation was found between FF levels of oxidative markers and the number of oocytes retrieved or the fertilization rates. CONCLUSIONS In our study, we found no difference in the levels of follicular oxidative and anti-oxidative markers or the follicular fluid viscosity with changing BMI values. We also demonstrated that the levels of oxidative stress markers and the viscosity of follicular fluid did not affect clinical outcomes.
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Affiliation(s)
- B Yuksel
- Department of Obstetrics, Gynecology and Infertility, Dumlupinar University Faculty of Medicine, Kutahya, Turkey.
| | - S Kilic
- Department of Obstetrics, Gynecology and Infertility, Bahcesehir University Faculty of Medicine, Istanbul, Turkey
| | - N Yilmaz
- Department of Infertility, Dr. Zekai Tahir Burak Women's Health Research Hospital, Ankara, Turkey
| | - T Goktas
- Department of Physiology, Gazi University School of Medicine, Ankara, Turkey
| | - U Keskin
- Department of Obstetrics, Gynecology and Infertility, Gulhane Military Medical Faculty, Ankara, Turkey
| | - A Seven
- Department of Obstetrics, Gynecology and Infertility, Dumlupinar University Faculty of Medicine, Kutahya, Turkey
| | - M Ulubay
- Department of Obstetrics, Gynecology and Infertility, Gulhane Military Medical Faculty, Ankara, Turkey
| | - S Batioglu
- Department of Infertility, Dr. Zekai Tahir Burak Women's Health Research Hospital, Ankara, Turkey
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14
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Watve M, Diwekar-Joshi M. What to expect from an evolutionary hypothesis for a human disease: The case of type 2 diabetes. HOMO-JOURNAL OF COMPARATIVE HUMAN BIOLOGY 2016; 67:349-368. [DOI: 10.1016/j.jchb.2016.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 07/28/2016] [Indexed: 12/29/2022]
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15
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Weiss RV, Clapauch R. Female infertility of endocrine origin. ACTA ACUST UNITED AC 2015; 58:144-52. [PMID: 24830591 DOI: 10.1590/0004-2730000003021] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 11/25/2013] [Indexed: 02/01/2023]
Abstract
Infertility is defined as the failure to conceive, with no contraception, after one year of regular intercourse in women<35 years and after 6 months in women>35 years. A review on causes, management and treatment of endocrine causes of was performed. Epidemiological data suggest that around 10% to 15% of couples are infertile. Anovulatory problems are responsible from 25% to 50% of causes of . Advanced age, obesity, and drugs, have a negative effect on fertility. Different hypothalamic, pituitary, thyroid, adrenal, and ovarian disorders may affect fertility as well. Infertility is a growing phenomenon in developed societies. We here provide information about how to identify endocrine patients with ovulatory dysfunction. Women must be advised about limiting factors to be avoided, in order to protect their fertility.
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Affiliation(s)
- Rita Vasconcellos Weiss
- Instituto Estadual de Diabetes e Endocrinologia Luiz Capriglione, Pontifícia Universidade Católica do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Ruth Clapauch
- Laboratory for Clinical and Experimental Research on Vascular Biology, Biomedical Center, Universidade do Estado do Rio de Janeiro
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16
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Dhurandhar EJ, Keith SW. The aetiology of obesity beyond eating more and exercising less. Best Pract Res Clin Gastroenterol 2014; 28:533-44. [PMID: 25194173 DOI: 10.1016/j.bpg.2014.07.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Revised: 06/06/2014] [Accepted: 07/05/2014] [Indexed: 01/31/2023]
Abstract
Although recent increases in availability of energy dense, processed foods and reductions in institutionally driven physical activity have created an environment that is permissible for obesity to occur, several other factors may contribute to the development of obesity in this context. We review evidence for eleven such factors: endocrine disruptors, intrauterine effects, epigenetics, maternal age, differential fecundity and assortative mating by body mass index, microorganisms, reduction in variability of ambient temperatures, smoking cessation, sleep debt, and pharmaceutical iatrogenesis. Evidence for the role of endocrine disruptors, microorganisms, ambient temperatures, sleep and reproductive factors is accumulating, but additional research is needed to confirm the causative role of these factors in human obesity. However, the role of certain pharmaceuticals and smoking cessation in development of human obesity is clear. Practice points for consideration and future research needed are highlighted for each factor.
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Affiliation(s)
- Emily J Dhurandhar
- Department of Health Behavior, Office of Energetics, Nutrition Obesity Research Center, University of Alabama at Birmingham, 1665 University Blvd, RPHB 227J, Birmingham, AL 35205, USA.
| | - Scott W Keith
- Department of Pharmacology and Experimental Therapeutics, Division of Biostatistics, Thomas Jefferson University, 1015 Chestnut St., Suite M100, Phildelphia, PA 19107, USA.
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17
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Evans MC, Rizwan M, Mayer C, Boehm U, Anderson GM. Evidence that insulin signalling in gonadotrophin-releasing hormone and kisspeptin neurones does not play an essential role in metabolic regulation of fertility in mice. J Neuroendocrinol 2014; 26:468-79. [PMID: 24824308 DOI: 10.1111/jne.12166] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 04/23/2014] [Accepted: 05/08/2014] [Indexed: 12/31/2022]
Abstract
Insulin in the brain plays an important role in regulating reproductive function, as demonstrated via conditional brain-specific insulin receptor (Insr) deletion (knockout). However, the specific neuronal target cells mediating the central effects of insulin on the reproductive axis remain unidentified. We first investigated whether insulin can act via direct effects on gonadotrophin-releasing hormone (GnRH) neurones. After clearly detecting Insr mRNA in an immunopurified GnRH cell fraction, we confirmed the presence of insulin receptor protein (InsR) in approximately 82% of GnRH neurones using dual-label immunohistochemistry. However, we did not observe any insulin-induced phospho-Akt (pAkt) or phospho-extracellular-signal-regulated kinase 1/2 in GnRH neurones, and therefore we investigated whether insulin signals via kisspeptin neurones to modulate GnRH release. Using dual-label immunohistochemistry, InsRs were detected only in approximately 5% of kisspeptin-immunoreactive cells. Insulin-induced pAkt was not observed in any kisspeptin-immunoreactive cells in either the rostral periventricular region of the third ventricle or arcuate nucleus in response to 200 mU of insulin treatment, although a more pharmacological dose (10 U) induced pronounced (> 20%) pAkt-kisspeptin coexpression in both regions. To confirm that insulin signalling via kisspeptin neurones does not critically modulate reproductive function, we generated kisspeptin-specific InsR knockout (KIRKO) mice and assessed multiple reproductive and metabolic parameters. No significant differences in puberty onset, oestrous cyclicity or reproductive competency were observed in the female or male KIRKO mice compared to their control littermates. However, significantly decreased fasting insulin (P < 0.05) and a nonsignificant trend towards reduced body weight were observed in male KIRKO mice. Thus, InsR signalling in kisspeptin cells is not critical for puberty onset or reproductive competency, although it may have a small metabolic effect in males.
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Affiliation(s)
- M C Evans
- Centre for Neuroendocrinology and Department of Anatomy, University of Otago School of Medical Sciences, Dunedin, New Zealand
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18
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Santangelo C, Varì R, Scazzocchio B, Filesi C, Masella R. Management of reproduction and pregnancy complications in maternal obesity: which role for dietary polyphenols? Biofactors 2014; 40:79-102. [PMID: 23983164 DOI: 10.1002/biof.1126] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 06/28/2013] [Accepted: 07/02/2013] [Indexed: 02/06/2023]
Abstract
Obesity is a global and dramatic public health problem; maternal obesity represents one of the main risk factors of infertility and pregnancy complications as it is associated with adverse maternal and offspring outcomes. In the last few years, adipose tissue dysfunction associated with altered adipocytokine secretion has been suggested to play a critical role in all the phases of reproductive process. Obesity is a nutrition-related disorder. In this regard, dietary intervention strategies, such as high intake of fruit and vegetables, have shown significant effects in both preserving health and counteracting obesity-associated diseases. Evidence has been provided that polyphenols, important constituents of plant-derived food, can influence developmental program of oocyte and embryo, as well as pregnancy progression by modulating several cellular pathways. This review will examine the controversial results so far obtained on adipocytokine involvement in fertility impairment and pregnancy complications. Furthermore, the different effects exerted by polyphenols on oocyte, embryo, and pregnancy development will be also taken in account.
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Affiliation(s)
- Carmela Santangelo
- Department of Veterinary Public Health and Food Safety, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
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Abstract
Numerous epidemiologic studies have implicated abdominal obesity as a major risk factor for insulin resistance, type 2 diabetes mellitus, cardiovascular disease, stroke, metabolic syndrome and its further expression, i.e., nonalcoholic fatty liver disease and death. Using novel models of visceral obesity, several studies have demonstrated that the relationship between visceral fat and longevity is causal, while the accrual of subcutaneous fat does not appear to play an important role in the etiology of disease risk. The need of reducing the visceral fat to improve survival, mainly taking into account the strict link between nonalcoholic fatty liver disease and the coronary artery disease is discussed.
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Affiliation(s)
- Carmine Finelli
- Center of Obesity and Eating Disorder, Stella Maris Mediterraneo Foundation Chiaromonte, Potenza, Italy
| | - Giovanni Tarantino
- Department of Clinical and Experimental Medicine, Federico II University Medical School of Naples, Naples, Italy.
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20
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Michalakis K, Mintziori G, Kaprara A, Tarlatzis BC, Goulis DG. The complex interaction between obesity, metabolic syndrome and reproductive axis: a narrative review. Metabolism 2013; 62:457-78. [PMID: 22999785 DOI: 10.1016/j.metabol.2012.08.012] [Citation(s) in RCA: 202] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Revised: 08/13/2012] [Accepted: 08/18/2012] [Indexed: 12/16/2022]
Abstract
The aim of this narrative review is to provide current evidence for the interaction between obesity, metabolic syndrome (MS) and reproductive axis. Gonadotropin-releasing hormone (GnRH) pulses and, consequently, normal function of reproductive (hypothalamus-pituitary-gonadal) axis depend on normal energy balance, which presupposes sufficient food intake, reasonable energy consumption and average thermoregulatory costs. In case of an energy imbalance, reproductive dysfunction may occur. In young women, excessive leanness is accompanied by puberty delay, whereas premature puberty might be a manifestation of obesity. In a similar way, obesity in men affects fertility. Excess adipose tissue results in increased conversion of testosterone to estradiol, which may lead to secondary hypogonadism through reproductive axis suppression. Moreover, oxidative stress at the level of the testicular micro-environment may result in decreased spermatogenesis and sperm damage. Products of the adipocyte, such as leptin, adiponectin and resistin, and gut peptides, such as ghrelin, are considered to be crucial in the interaction between energy balance and reproduction. Finally, an indirect evidence for the interplay between MS and reproductive axis is the fact that when treating components of one, parameters of the other can be improved as well. These therapeutic interventions include lifestyle modifications, pharmacological agents, such as sex hormone replacement therapy, and surgical procedures. Although many issues remain unclear, the elucidation of the complex interaction between MS and reproductive axis will have obvious clinical implications in the therapeutic approach of both entities.
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Affiliation(s)
- Konstantinos Michalakis
- First Department of Internal Medicine, Laikon University Hospital, Athens University Medical School, Greece
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22
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Bandealy A, Stahl C. Obesity, reproductive health, and bariatric surgery in adolescents and young adults. J Pediatr Adolesc Gynecol 2012; 25:277-9. [PMID: 23016156 DOI: 10.1016/j.jpag.2012.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Asad Bandealy
- Department of Pediatrics, University of Illinois at Chicago, Chicago, IL 60612, USA
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The effect of body mass index on the outcomes of first assisted reproductive technology cycles. Fertil Steril 2012; 98:102-8. [DOI: 10.1016/j.fertnstert.2012.04.004] [Citation(s) in RCA: 117] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Revised: 03/31/2012] [Accepted: 04/03/2012] [Indexed: 11/21/2022]
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24
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Mutsaerts MAQ, Groen H, Huiting HG, Kuchenbecker WKH, Sauer PJJ, Land JA, Stolk RP, Hoek A. The influence of maternal and paternal factors on time to pregnancy--a Dutch population-based birth-cohort study: the GECKO Drenthe study. Hum Reprod 2011; 27:583-93. [PMID: 22184203 DOI: 10.1093/humrep/der429] [Citation(s) in RCA: 110] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Both maternal and paternal factors have been suggested to influence a couple's fecundity. To investigate this, we examined the role of several maternal and paternal lifestyle and socio-demographic factors as determinants of time to pregnancy (TTP) in a Dutch birth-cohort. METHODS Groningen Expert Center for Kids with Obesity (GECKO) Drenthe is a population-based birth-cohort study of children born between April 2006 and April 2007 in Drenthe, a province of The Netherlands. Both partners received extensive questionnaires during pregnancy. Univariable and multivariable Cox regression analyses were used to determine the impact of the investigated factors on TTP. RESULTS A total of 4778 children were born, and the parents of 2997 children (63%) gave their consent to participate. After excluding unintended pregnancies and pregnancies as a result of fertility treatment, the data of 1924 couples were available for analysis. Hazards ratios and 95% confidence intervals of factors influencing TTP in multivariable Cox regression analysis were: maternal age 1.23 (0.98-1.54) for age <25 years, 1.17 (1.03-1.32) for age 25-30 years and 0.72 (0.61-0.85) for age >35 years (reference category: 30-35 years); paternal age: 1.31 (0.94-1.82) for age <25 years, 1.11 (0.97-1.28) for age 25-30 years and 0.91 (0.80-1.04 for age >35 years (reference category: 30-35 years); nulliparity: 0.76 (0.68-0.85) versus multiparity; menstrual cycle length: 1.12 (0.95-1.30) for 3 weeks, 0.72 (0.62-0.83) for 4-6 weeks, 0.68 (0.40-1.16) for >6 weeks and 0.66 (0.54-0.81) for irregular cycle (reference category: 4 weeks); prior contraceptive use: 0.78 (0.67-0.91) for no contraception, 1.68 (1.45-1.95) for condom use, 1.08 (0.89-1.33) for condom use combined with oral contraception, 1.40 (1.16-1.70) for intrauterine device and 0.50 (0.25-1.01) for contraceptive injection (reference category: oral contraception); and maternal educational level 0.75 (0.62-0.92) for low education level and 0.81 (0.73-0.90) for medium educational level (reference category: high educational level). CONCLUSIONS This population-based birth-cohort study performed in fertile couples who had conceived revealed neither maternal nor paternal modifiable lifestyle factors were significantly associated with TTP after adjustment for confounding by socio-demographic factors. In contrast, several non-modifiable maternal socio-demographic factors are significant predictors of a couple's fecundity.
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Affiliation(s)
- M A Q Mutsaerts
- Department of Obstetrics and Gynaecology, Groningen University Medical Center Groningen, University of Groningen, PO Box 30001, Groningen 9700 RB, The Netherlands.
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Schmidt L, Sobotka T, Bentzen JG, Nyboe Andersen A. Demographic and medical consequences of the postponement of parenthood. Hum Reprod Update 2011; 18:29-43. [PMID: 21989171 DOI: 10.1093/humupd/dmr040] [Citation(s) in RCA: 346] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Across the developed world couples are postponing parenthood. This review assesses the consequences of delayed family formation from a demographic and medical perspective. One main focus is on the quantitative importance of pregnancy postponement. METHODS Medical and social science databases were searched for publications on relevant subjects such as delayed parenthood, female and male age, fertility, infertility, time to pregnancy (TTP), fetal death, outcome of medically assisted reproduction (MAR) and mental well-being. RESULTS Postponement of parenthood is linked to a higher rate of involuntary childlessness and smaller families than desired due to increased infertility and fetal death with higher female and male age. For women, the increased risk of prolonged TTP, infertility, spontaneous abortions, ectopic pregnancies and trisomy 21 starts at around 30 years of age with a more pronounced effects >35 years, whereas the increasing risk of preterm births and stillbirths starts at around 35 years with a more pronounced effect >40 years. Advanced male age has an important but less pronounced effect on infertility and adverse outcomes. MAR treatment cannot overcome the age-related decline in fecundity. CONCLUSIONS In general, women have partners who are several years older than themselves and it is important to focus more on the combined effect of higher female and male age on infertility and reproductive outcome. Increasing public awareness of the impact of advanced female and male age on the reproductive outcome is essential for people to make well-informed decisions on when to start family formation.
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Affiliation(s)
- L Schmidt
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Denmark.
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Baig U, Belsare P, Watve M, Jog M. Can Thrifty Gene(s) or Predictive Fetal Programming for Thriftiness Lead to Obesity? J Obes 2011; 2011:861049. [PMID: 21773010 PMCID: PMC3136239 DOI: 10.1155/2011/861049] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2010] [Accepted: 02/18/2011] [Indexed: 01/01/2023] Open
Abstract
Obesity and related disorders are thought to have their roots in metabolic "thriftiness" that evolved to combat periodic starvation. The association of low birth weight with obesity in later life caused a shift in the concept from thrifty gene to thrifty phenotype or anticipatory fetal programming. The assumption of thriftiness is implicit in obesity research. We examine here, with the help of a mathematical model, the conditions for evolution of thrifty genes or fetal programming for thriftiness. The model suggests that a thrifty gene cannot exist in a stable polymorphic state in a population. The conditions for evolution of thrifty fetal programming are restricted if the correlation between intrauterine and lifetime conditions is poor. Such a correlation is not observed in natural courses of famine. If there is fetal programming for thriftiness, it could have evolved in anticipation of social factors affecting nutrition that can result in a positive correlation.
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Affiliation(s)
- Ulfat Baig
- Indian Institute of Science Education and Research, Pune 411021, India
| | - Prajakta Belsare
- Indian Institute of Science Education and Research, Pune 411021, India
| | - Milind Watve
- Indian Institute of Science Education and Research, Pune 411021, India
- Anujeeva Biosciences Pvt. Ltd., Pune 411030, India
| | - Maithili Jog
- Department of Biotechnology, Abasaheb Garware College, Pune 411004, India
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Tough SC, Siever JE, Jack M. Reproductive Assistance, Emotional Health, Obesity, and Time to Pregnancy Among Women Under 35 Years of Age. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2010; 32:1153-1162. [DOI: 10.1016/s1701-2163(16)34739-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
OBJECTIVE We aimed at (a) examining the rates of obesity over a 12-year period; (b) studying the effect of obesity and morbid obesity on gestational age and birth weight and (c) determining the influence of race on the association between maternal obesity and the gestational age of a newborn. STUDY DESIGN We conducted a retrospective analysis using data from the perinatal data set of mothers delivering at the George Washington University between 1992 and 2003. We stratified mother/infant pairs (n=14 183) into three groups on the basis of maternal prepregnancy body mass index (BMI): not obese (BMI<30), obese (BMI 30 to 39) and morbidly obese (BMI> or =40). We identified all spontaneous and induced preterm deliveries in each group. Bivariate and multivariate analyses were conducted to control for significant differences between groups. RESULT We identified obesity in 1707 (12%) and morbid obesity in 415 (3%) of the mothers. Obesity and morbid obesity increased over time during the study period. In crude analysis, mothers with obesity and morbid obesity were more likely to deliver prematurely (16.7 and 20.3%, respectively) when compared with nonobese women (14.5%), and were also more likely to have other complications including smoking, anemia, hypertension, diabetes and cesarean delivery. When controlling for these complications in a logistic regression model, obesity and morbid obesity were not associated with prematurity. CONCLUSION There is no direct link between obesity and prematurity. Prematurity is more likely caused by medical complications that frequently occur in obese women. Further studies are needed on this growing population to test whether providing adequate prenatal care can control the associated medical conditions and subsequently ameliorate the rate of prematurity.
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Ranta JK, Raatikainen K, Romppanen J, Pulkki K, Heinonen S. Increased time-to-pregnancy and first trimester Down's syndrome screening. Hum Reprod 2009; 25:412-7. [DOI: 10.1093/humrep/dep417] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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