Impact of obesity on infertility in women

Analysis of risk factors for very early preterm and early preterm birth in twins following in vitro fertilization and intracytoplasmic sperm injection-assisted pregnancy: A retrospective study

To investigate the risk factors influencing very early preterm and early preterm births in twin pregnancies after in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). This retrospective study analyzed 2042 twin pregnancies that underwent embryo transfer via IVF/ICSI at the Reproductive Center of Sir Run Run Shaw Hospital between January 2019 and December 2022. Spontaneous very early, early preterm, and provider-initiated preterm births were examined separately. Based on gestational age, participants were categorized into three groups: very early preterm birth (<28 weeks), early preterm birth (≥28 to <34 weeks), and ongoing pregnancy (≥34 weeks). Univariate analysis was conducted to assess general conditions, among the three groups. Multiple logistic regression analysis was performed to identify independent risk factors for very early and early spontaneous preterm birth in twin pregnancies. A total of 2042 twin pregnancies were included in the study, with birth rates of 4.36% (89 of 2042) <28 weeks, 12.14% (248 of 2042) ≥28 to <34 weeks, and 83.50% (1705 of 2042) ≥34 weeks. The primary cause of provider-initiated preterm birth <28 weeks was placental factors, while hypertensive disorders of pregnancy (31.11%) were the predominant cause for preterm births ≥28 to <34 weeks. Multiple logistic regression analysis identified the independent risk factors for births <28 weeks (P < 0.05) as cervical cerclage, history of late miscarriage or premature birth, uterine adhesions, primary infertility of polycystic ovary syndrome (PCOS), monochorionic pregnancies, history of cervical surgery, uterine malformations, body mass index ≥25 kg/m2, and uterine longitudinal axis lengths <3.6 cm. Cervical cerclage, main factors of infertility (PCOS), adenomyosis, and uterine longitudinal axis lengths <3.6 cm were identified as independent risk factors for ≥28 to 34 weeks (P < 0.05). It is crucial to consider risk factors during IVF/ICSI treatment because of the high incidence of very early and early preterm twin pregnancies, which can be identified early and properly managed.

Pregnant women's experiences of nutrition care after previous bariatric surgery

PROBLEM

The rate of pregnancy following bariatric surgery is rising globally and is associated with health benefits but also increased risk of micronutrient deficiency, preterm birth and small for gestational age offspring. Bariatric surgery may limit women's ability to meet the nutrient demands of pregnancy, necessitating individualised nutrition therapy. However, little is known about women's experiences of, and preferences for nutrition-related care during pregnancy after bariatric surgery.

AIM

To describe women's experiences of pregnancy after bariatric surgery, focussing on nutrition-related care.

METHODS

This qualitative study interviewed women across Australia with a history of any bariatric surgery. Semi-structured telephone interviews were conducted after 36-weeks gestation and before childbirth. Data were analysed using reflexive thematic analysis.

FINDINGS

Thirteen women aged 26-37 participated. Three themes were generated: navigating healthcare, the personal toll of pregnancy after bariatric surgery, and women's agency. Despite a strong desire for specialised nutrition care, women encountered several barriers to accessing this. When care was available, it often did not meet women's needs due to healthcare professionals' limited understanding of the nutrition challenges faced in pregnancies following bariatric surgery. This compelled women to seek information outside their maternity care team and advocate for themselves during care.

DISCUSSION

These findings highlight the need to address barriers to accessing nutrition care for pregnant women following bariatric surgery. Improved understanding of pregnancy and post-operative symptoms may enable enhanced woman-centred care.

CONCLUSION

Greater awareness of bariatric surgery among all maternity care professionals is needed to improve opportunities for informed, shared decision-making with pregnant women.

Exposure to circadian disrupting environment and high-fat diet during pregnancy and lactation alter reproductive competence and lipid profiles of liver, mammary, plasma and milk of ICR mice

This study's objective was to determine the effects of pre-pregnancy obesity induced by a high-fat diet and exposure to circadian-disrupting light-dark phase shifts on birth littler size, pup survival to 24h and growth to lactation day 12, and their relationship to maternal feeding patterns, fecal corticosterone levels, milk composition, and lipid profiles of liver, plasma, mammary gland, and milk. A 2 by 2 factorial designed experiment of female ICR mice assigned to control (CON; 10% fat) or high-fat (HF; 60% fat) and either a 12-hour light-dark (LD) cycle or a chronic jet lag model of 6-hour phase-shifts (PS) in light-dark cycle every 3 days throughout pregnancy and lactation, resulted in 4 treatment groups: CON-LD, CON-PS, HF-LD and HF-PS. HF diet increased maternal pre-pregnancy body weight and elevated milk lactose. Whereas PS reduced milk lactose within the CON diet group, and increased maternal feed intake and fecal corticosterone levels. PS exposure also affected the time of day of birth. Neither PS nor HF affected birth litter size or pup survival. Only diet impacted final litter weight, with HF greater than CON. Among the 1204 lipids detected by multiple reaction monitoring (MRM)-profiling, diet altered 67.1% in milk, 58.1% in mammary gland, 27.2% in the liver, and 10.9% in plasma, with HF increasing the carbon length of diacylglycerols in the liver and milk, and carbon length of triacylglycerols in plasma, mammary gland and milk. Although exposure to PS had no overall impact on maternal lipid profiles, interactions (P < 0.05) were found between PS and diets in the phosphatidylcholine and phosphatidylethanolanine class of lipids. Findings support that high fat diet and exposure to circadian disrupting environments impact maternal feeding behavior and stress responses as well as lipid profiles, which may relate to their negative association with maternal health and offspring development.

Impact of maternal body mass index on pregnancy outcomes following frozen embryo transfer: A systematic review and meta-analysis

OBJECTIVE

There is still a significant gap in understanding how maternal body mass index (BMI) impacts outcomes of pregnancy after frozen embryo transfer (FET). This review aims to evaluate the effects of various BMI categories on clinical pregnancy and live birth rates in women undergoing FET.

METHODS

PubMed, Scopus, Embase, and Web of Science databases were searched for studies, published up to March, 2024, using the keywords "obesity", "overweight", "obese", "maternal body mass index," "pregnancy outcomes," "frozen embryo transfer,". Eligible studies were selected based on predefined inclusion criteria, statistical analysis was performed using a random-effects model, and ther results were presented as odds ratios (OR) with 95% confidence intervals (CI).

RESULTS

A total of 17 studies were included in the meta-analysis. Pooled findings indicate significantly reduced live birth rate in underweight (OR 0.93; 95% CI: 0.89, 0.98) and obese (OR 0.85; 95% CI: 0.77, 0.93) women but not in those who were overweight (OR 0.96; 95% CI: 0.92, 1.00), compared to those with normal BMI. Further, only those women who were underweight (OR 0.91; 95% CI: 0.85, 0.97) had reduced odds of clinical pregnancy rate but not those who were overweight (OR 0.99; 95% CI: 0.94, 1.05) or obese (OR 0.92; 95% CI: 0.82, 1.03).

CONCLUSION

Maternal BMI impacts pregnancy outcomes after frozen embryo transfer, with underweight and obese women having lower live birth rates and only underweight women showing reduced clinical pregnancy rates compared to those with normal BMI. These findings underscore the importance of addressing BMI in women undergoing FET to improve pregnancy outcomes.

Fermented Lignan-Enriched Soy Beverage Ameliorates the Metabolic Effects of a High-Fat Diet on Female Mice

Fermented vegetable beverages have potential beneficial effects on the health associated with the production of bioactive flavonoids and lignans by selected bacterial strains. Here, we studied the effects of a soy beverage and a soy beverage fermented by Bifidobacterium pseudocatenulatum INIA P815, both supplemented with lignan extracts, in a female mouse model on a high-fat diet followed for 16 weeks. The high-fat diet induced an increase in adipose tissue and plasma cholesterol as well as modified the fecal microbiota. Mice groups receiving any of the beverages showed a reduction in the mean area of ovarian fat tissue adipocytes and exhibited bioactive flavonoids and lignans in plasma and tissues, accompanied by a higher antioxidant activity in plasma. The group of mice subjected to the fermented beverage also demonstrated a lower increase in plasma cholesterol levels, an increase in short-chain fatty acid production, and higher levels of daidzein, genistein, enterolignans, and herbacetin in the plasma and organs. Moreover, the fertility of the mice that received the fermented beverage was also enhanced, resulting in a higher percentage of blastocysts per female mouse. Therefore, the consumption of the beverage fermented by B. pseudocatenulatum INIA P815 could be favoring the health of mice by ameliorating, to some extent, the effects of a high-fat diet.

Delivery mode and subsequent birth rate: A nationwide register-based analysis in Finland

OBJECTIVE

The study aimed to calculate the subsequent birth rate for different delivery modes, comparing them with spontaneous vaginal deliveries, using a comprehensive nationwide high-quality registry.

METHODS

Data from the National Medical Birth Register (MBR) were used to evaluate the birth rate after different delivery modes. All first deliveries for a mother during the years 2004 to 2016 were included. For these women, all second pregnancies from the MBR during the years 2004 to 2018 were retrieved and combined with the data of the first deliveries. A Cox regression model was used to evaluate the risk for the second pregnancy after giving birth the first time. The results were interpreted with adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs).

RESULTS

A total of 375 619 women with a first and second pregnancy leading to birth were included in this study. Of these, a total of 50 579 women underwent assisted vaginal delivery, 50 429 had an unplanned cesarean section (CS), 22 021 had elective CS, and 252 593 had spontaneous vaginal delivery as a mode of delivery in their first pregnancy. Women with assisted vaginal delivery (aHR, 1.23 [CI, 1.21-1.24]) and unplanned CS (aHR, 1.03 [CI, 1.02-1.05]) had higher birth rates after the first birth, and women with elective CS as a mode of delivery had lower birth rates (aHR, 0.86 [CI, 0.84-0.88]) when compared with women who had spontaneous vaginal delivery.

CONCLUSION

The findings of this study indicate that the CS operation itself is not the only cause of the observed lower birth rate; rather, there are underlying factors that have a greater impact on birth rates.

Diet-induced obesity alters the ovarian chemical biotransformation and oxidative stress response proteins both basally and in response to 7,12-dimethylbenz[a]anthracene exposure

7,12-Dimethylbenz[a]anthracene (DMBA) is a polycyclic aromatic hydrocarbon that causes female infertility via DNA damage, and the ovary has the capacity to mitigate DMBA exposure via the action of proteins including the glutathione S-transferase (GST) family. Due to previous findings of DNA damage and a reduced ovarian chemical biotransformation response to DMBA exposure in hyperphagia-induced obese mice, this study investigated the hypothesis that diet-induced obesity would hamper the ovarian biotransformative response to DMBA exposure. Six-week-old C57BL6/J mice were fed either a normal rodent diet (L) or a high fat high sucrose diet (O) until the O group was ∼30% heavier than the L. Both L and O mice were exposed to either corn oil (C) or DMBA (1 mg/kg) for 7 d. Liver weight was increased (P < 0.05) in obese mice exposed to DMBA but no effect on spleen weight, uterine weight, ovary weight, estrous cyclicity, or circulating 17β-estradiol and progesterone were observed. Primordial and preantral follicle numbers were higher (P < 0.05) in the obese mice and there was a tendency (P = 0.055) for higher antral follicles in DMBA-exposed obese mice. The ovarian proteome was identified by LC-MS/MS analysis to be altered both by diet-induced obesity and by DMBA exposure with changes observed in levels of proteins involved in oocyte development and chemical biotransformation, including GST isoform pi. Fewer proteins were affected by the combined exposure of diet and DMBA than by a single treatment, indicating that physiological status impacts the response to DMBA exposure.

Obesity and overweight and associated factors among women with infertility undergoing assisted reproductive technology treatment in a low income setting

Elevated Body Mass Index in infertile women has important implications for medically assisted reproduction. The prevalence and impact of elevated BMI on assisted reproductive technology treatment outcomes in low-income settings remain under-studied and little known. This study investigated the prevalence of elevated BMI and associated socio-demographic characteristics among infertile women in Ghana. Retrospective analysis of five-years data of 3,660 infertile women attending clinic in Ghana for assisted conception treatment was carried out. The data was analysed using the SPSS-22; descriptive statistics performed and chi square used to assess associations between categorical variables, p-value below 0.05 was considered statistically significant. Overall, 76.83% of women with infertility had elevated BMI, of whom 39.56% were obese and 37.27% were overweight. Majority of participants with elevated BMI was aged between 30-49 years. (p < 0.001). Infertility prevalence and BMI increased with increasing level of education (p < 0.003). Secondary infertility was more common among overweight or obese women. Traders had the highest prevalence of overweight and obesity followed by civil servants and health workers. Elevated BMI was highly prevalent among women seeking infertility care in Ghana, particularly so among those with secondary infertility. Traders had the highest prevalence of elevated BMI, probably reflecting their predominantly sedentary lifestyles.

A Bird's-Eye Overview of Leptin and Female Reproduction -with Mammalian Comparisons

Leptin, a key regulator of reproductive physiology, influences various processes in vertebrates, including oocyte proliferation, embryogenesis, the onset of puberty, ovarian function, and follicle development. In mammals, leptin affects steroidogenesis, folliculogenesis, and hormonal regulation through the hypothalamic-pituitary-gonadal axis. Instead, in avian species, leptin-controlled mechanisms are poorly understood, because birds do not produce leptin in adipocytes. In birds, leptin is expressed in the brain, pituitary glands, and gonads, where it enhances ovarian function and egg-laying performance, particularly during feed deprivation. In this review, we discuss and summarize the recently discovered role of leptin in regulating ovarian function during different life stages in birds and compare it with its function in mammals.

The hidden impact of GLP-1 receptor agonists on endometrial receptivity and implantation

Increasing infertility rates represent a growing medical challenge in modern societies resulting from a complex interplay of sociocultural trends, lifestyle factors, exposure to environmental toxins, and underlying health problems. Women's fertility is particularly vulnerable to these shifts. The obesogenic lifestyle not only accelerates weight gain, but also disrupts ovulation driving the rise in infertility. Among several medications used for treating obesity and type 2 diabetes, glucagon-like peptide-1 receptor agonists (GLP-1RAs) show promising improvement in female fertility most likely by stimulating ovulation. However, the effects of GLP-1RAs on the endometrium remain unclear. Further studies are needed to investigate the impact of GLP-1RAs on endometrial receptivity and embryo implantation and early development. The aim of this study is to address the knowledge gap regarding the effects of GLP-1RAs on human reproduction, with special focus on the endometrium. Understanding these mechanisms may help to develop new strategies for improving fertility treatment, reduce implantation failure and address potential safety concerns regarding teratogenicity and adverse developmental outcomes for children born to women conceiving during or soon after GLP-1RA treatment.

GLP-1R/NPY2R regulate gene expression, ovarian and adrenal morphology in HFD mice

Glucagon-like peptide-1 receptor (GLP-1R) and neuropeptide Y receptors (NPYRs) are expressed in reproductive tissues contributing to the regulation of gonadal function. This exploratory study examines the potential impact of their modulation by assessing the effects of exendin-4 (Ex-4) and peptide YY (PYY) (3-36) on endocrine ovaries and adrenals in high-fat diet (HFD) mice. Ex-4 and PYY(3-36) reduced blood glucose and energy intake, with no effects on body weight. While HFD did not impact the estrous cycle, Ex-4 increased metestrus frequency and decreased diestrus frequency resulting in 0% mice experiencing repeated diestrus or becoming acyclic. Luteinizing hormone levels were significantly higher in the Ex-4 and PYY(3-36) groups compared to the normal diet and HFD controls. In the adrenals, reduced capsule and zona glomerulosa thickness caused by HFD was reversed after peptide treatments. Within the ovaries, HFD increased the number of atretic follicles, an effect that disappeared after Ex-4 and PYY(3-36) treatments. Ex-4 also increased the number of corpora lutea owing to the prolonged metestrus phase. Gene expression analysis within the adrenals revealed the upregulation of Insr and the downregulation of Prgtr in HFD mice, while Ex-4 downregulated the expression of Gipr. The ovarian gene expression of Gipr, Npy1r and Prgtr was downregulated by Ex-4 treatment, while PYY(3-36) significantly downregulated the Prgtr expression compared to HFD mice. These data indicate that manipulating GLP-1R and NPY2R leads to changes in the reproductive physiology of mice. In addition, the observed alterations in the morphology and gene expression in the adrenals and ovaries imply a direct impact of these peptides on female reproductive function.

Measuring Dietary Intake of Pregnant Women Post-Bariatric Surgery: Do Women Meet Recommendations?

Background: Bariatric surgery is increasingly offered to women of childbearing age and significantly reduces food intake and nutrient absorption. During pregnancy, associated risks, including micronutrient deficiency, are accentuated. This study describes maternal dietary intake and adherence to dietary recommendations in pregnant women with a history of bariatric surgery. Methods: Women aged 18-45 with singleton pregnancies post-bariatric surgery were recruited at <23 weeks of gestation and followed until birth. Dietary intake was measured using three non-consecutive 24 h recalls at enrolment and at 28 and 36 weeks using the standardized tool ASA24-Australia. Micronutrient supplementation dose and adherence was reported using the Brief Medication Adherence Questionnaire. Mean macronutrient intake was calculated from all diet recalls. Micronutrient intake was determined from diet recalls and from supplementation. Intake was compared to the recommended daily intakes for pregnancy. Results: Sixty-three women participated in the study. The participants met 65 ± 17.3% (mean ± SD) of estimated energy requirements, 53(23)% (median(IQR)) of fiber requirements, and exceeded fat and saturated fat recommendations. Dietary intake levels of iron, folate, zinc, calcium, and vitamin A were below recommended levels. Gastric bypass recipients consumed significantly less folate (p = 0.008), vitamin A (p = 0.035), and vitamin E (p = 0.027) than women post-gastric sleeve or gastric band. Multivitamins were used by 80% (n = 55) of participants at study enrolment, which increased their mean intake of all micronutrients to meet recommendations. Conclusions: Women who conceive post-bariatric surgery may require targeted support to meet the recommended nutrient intake. Micronutrient supplementation enables women to meet nutrient recommendations for pregnancy and is particularly important for gastric bypass recipients.

Transforming growth factor β-2 is rhythmically expressed in both WT and BMAL1-deficient hypothalamic neurons and regulates neuropeptide Y: Disruption by palmitate

The hypothalamus contains neuropeptide Y (NPY)-expressing neurons that control food intake and regulate energy homeostasis. During the development of obesity, neuroinflammation occurs in the hypothalamus before peripheral tissues, but the cytokines involved have not been thoroughly studied. Among them is the transforming growth factor beta (TGF-β) family of cytokines. Herein, we demonstrate that Tgfb 1-3, as well as its receptors Tgfbr1 and Tgfbr2, exhibit high levels of expression in the whole hypothalamus, primary hypothalamic culture, and immortalized hypothalamic neurons. Of interest, only Tgfb2 mRNA displays circadian expression in the immortalized hypothalamic neurons and maintains this rhythmicity in BMAL1-KO-derived hypothalamic neurons that are deficient of inherent clock gene rhythmicity. Although BMAL2 may serve as an alternative rhythm generation mechanism in the absence of BMAL1, its knockdown did not affect Tgfb2 expression. Treatment of immortalized NPY-expressing neurons with TGF-β2 upregulates the core circadian oscillators Bmal1 and Nr1d1, and importantly, also Npy mRNA expression. With obesity, the hypothalamus is exposed to elevated levels of palmitate, a saturated fatty acid that promotes neuroinflammation by upregulating pro-inflammatory cytokines. Palmitate treatment disrupts the expression of TGF-β signaling components, increases BMAL1 binding to the Tgfb2 5' regulatory region, and upregulates Npy mRNA, whereas antagonizing TGFBRI attenuates the upregulation of Npy. These results suggest that hypothalamic neuronal TGF-β2 lies at the intersection of circadian rhythms, feeding neuropeptide control, and neuroinflammation. A better understanding of the underlying mechanisms that link nutrient excess to hypothalamic dysfunction is critical for the development of effective prevention and treatment strategies.

The Contribution of Precision Nutrition Intervention in Subfertile Couples

BACKGROUND/AIM

Subfertility is characterized by a decrease in reproductive efficiency, which can result in delayed pregnancy, and affects one in six individuals during their lifetime. The present narrative review aims to evaluate the contribution of precision nutrition to changes in fertility in subfertile couples.

METHODS

The literature review was carried out through bibliographic research in the PubMed, Scopus, SciELO and Google Scholar databases. The following search criteria were applied: (1) original articles and narrative, systematic or meta-analytic reviews, and (2) the individual or combined use of the following keywords: "genetic variation", "nutrigenetics", "precision nutrition", "couple's subfertility", and "couple's infertility". A preliminary reading of all the articles was carried out, and only those that best fit the themes and subthemes of the narrative review were selected.

RESULTS

Scientific evidence suggests that adherence to a healthy diet that follows the Mediterranean pattern is associated with increased fertility in women and improved semen quality in men, better metabolic health and reduced levels of inflammation and oxidative stress, as well as maintaining a healthy body weight. The integration of different tools, such as nutrigenetics, predictive biochemical analyses, intestinal microbiota tests and clinical nutrition software, used in precision nutrition interventions can contribute to providing information on how diet and genetics interact and how they can influence fertility.

CONCLUSIONS

The adoption of a multidisciplinary and precision approach allows the design of dietary and lifestyle recommendations adapted to the specific characteristics and needs of couples with subfertility, thus optimizing reproductive health outcomes and achieving successful conception.

Nitrate-Nitrite-Nitric Oxide Pathway, Oxidative Stress, and Fertility Outcomes in Morbidly Obese Women Following Bariatric Surgery: A Systematic Review

Obesity reduces nitric oxide (NO) production due to endothelial nitric oxide synthase (eNOS) dysfunction, resulting in oxidative stress, mitochondrial dysfunction, and chronic inflammation. These factors have a negative impact on reproductive health, including oocyte quality, endometrial receptivity, and embryo implantation. When oxidative stress affects eNOS function, the nitrate-nitrite-nitric oxide (NO3-NO2-NO) pathway provides an alternate route for NO production. Bariatric surgery has been found to restore NO production, reduce oxidative stress, and improve fertility in morbidly obese women. This review investigates the molecular mechanisms by which bariatric surgery affects eNOS activity, the NO3-NO2-NO pathway, and oxidative stress reduction, with an emphasis on intracellular activities including mitochondrial biogenesis and NO production. A systematic review employing PRISMA criteria included articles published between 2000 and 2024 from PubMed, Scopus, and Embase that investigated NO3-NO2 pathways, oxidative stress markers, hormonal alterations, and reproductive outcomes in morbidly obese women following bariatric surgery. After evaluating 1542 studies, 11 were selected for the final analysis. Results showed a 45% increase in NO3-NO2 levels (p < 0.001), a 35% reduction in oxidative stress indicators (p < 0.01), a 60% increase in pregnancy rates, and a 50% increase in spontaneous ovulation rates following surgery. These benefits were connected to improved mitochondrial function and endometrial receptivity as a result of reduced oxidative stress and inflammation. The NO3-NO2-NO route is critical in compensating for lower NO generation under oxidative stress and hypoxia, and bariatric surgery significantly improves this pathway to optimize blood flow, mitochondrial function, and reproductive results.

Follicular fluid and plasma lipidome profiling and associations towards embryonic development outcomes during ART treatment

Introduction

It is well acknowledged that lipids assume a critical role in oocyte maturation and early embryonic metabolism, this study aimed to evaluate the relationship between the lipid composition of plasma and follicular fluid (FF), and the consequences of embryonic development. This study compared the lipidomic profiles of paired plasma and FF samples obtained from sixty-five Chinese women who underwent assisted reproductive technology (ART) treatments.

Methods

Non-targeted lipidomics analysis.

Result

Results not only indicated similarities in lipid composition between these biofluids, but also revealed a number of unique differences. The biomatrix distinction was found to be primarily driven by lipids belonging to the lysophosphatidylcholines (LPC), phosphatidylethanolamines (PE), ether PE, and triglyceride (TG) classes. In addition, specific species from these subclasses were discovered to be correlated with embryo development outcomes during ART. Notably, the composition of the fatty acyl chains appeared to play a crucial role in these associations. Furthermore, thirteen plasma lipid variables were identified, represented by Phosphatidylcholine 18:014:0 and PE P-18:020:1, which correlated with successful blastocyst formation (BF).

Discussion

The present study demonstrated that FF has a distinctive lipid composition, setting it apart from plasma; and the association observed with embryonic development underscored an important role of lipid composition in the healthy development of oocytes.

Integrated Insights into Metabolic and Bariatric Surgery: Improving Life Quality and Reducing Mortality in Obesity

Metabolic and bariatric surgery (MBS) is an effective intervention for patients with severe obesity and metabolic comorbidities, particularly when non-surgical weight loss methods prove insufficient. MBS has shown significant potential for improving quality of life and metabolic health outcomes in individuals with obesity, yet it carries inherent risks. Although these procedures offer a multifaceted approach to obesity treatment and its clinical advantages are well-documented, the limited understanding of its long-term outcomes and the role of multidisciplinary care pose challenges. With an emphasis on quality-of-life enhancements and the handling of postoperative difficulties, the present narrative review seeks to compile the most recent findings on MBS while emphasizing the value of an integrated approach to maximize patient outcomes. Effective MBS and patients' management require a collaborative team approach, involving surgeons, dietitians, psychologists, pharmacists, and other healthcare providers to address not only physiological but also psychosocial patient needs. Comparative studies demonstrate the efficacy of various MBS methods, including Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy that may considerably decrease morbidity and mortality in individuals with obesity. Future studies should target long-term patient treatment, and decision making should be aided by knowledge of obesity, comorbidity recurrence rates, and permanence of benefits.

Impaired IL-27 signaling aggravates macrophage senescence and sensitizes premature ovarian insufficiency induction by high-fat diet

Premature ovarian insufficiency (POI) critically affects female reproductive health, with obesity being a significant and recognized risk factor. Interleukin-27 (IL-27), known for its role in immune modulation and inflammation, has garnered attention in metabolic syndrome research. Nonetheless, the role of these immunometabolic factors on the initiation of POI remains to be unraveled. Our investigation delves into the influence of impaired IL-27 signaling on POI induction, particularly under the challenge of a high-fat diet (HFD). We analyzed patients' serum profiles and established a correlation of increased serum triglycerides with decreased IL-27 levels in POI cases. Experiments on C57BL/6 mice lacking the IL-27 receptor alpha (Il27ra-/-) revealed that when subjected to HFD, these mice developed hallmark POI symptoms. This includes escalated lipid deposition in both liver and ovarian tissues, increased ovarian macrophages cellular aging, and diminished follicle count, all pointing to compromised ovarian function. These findings unveil a novel pathway wherein impaired IL-27 signaling potentiates the onset of POI in the presence of HFD. Understanding the intricate interplay between IL-27, metabolic alterations, and immune dysregulation sheds light on potential therapeutic avenues for managing POI, offering hope for improved reproductive health outcomes.

The Role of Gut Microbiota in the Onset and Progression of Obesity and Associated Comorbidities

Obesity, a global public health problem, is constantly increasing, so the concerns in preventing and combating it are increasingly focused on the intestinal microbiota. It was found that the microbiota is different in lean people compared to obese individuals, but the exact mechanisms by which energy homeostasis is influenced are still incompletely known. Numerous studies show the involvement of certain bacterial species in promoting obesity and associated diseases such as diabetes, hypertension, cancer, etc. Our aim is to summarize the main findings regarding the influence of several factors such as lifestyle changes, including diet and bariatric surgery, on the diversity of the gut microbiota in obese individuals. The second purpose of this paper is to investigate the potential effect of various microbiota modulation techniques on ameliorating obesity and its comorbidities. A literature search was conducted using the PubMed database, identifying articles published between 2019 and 2024. Most studies identified suggest that obesity is generally associated with alterations of the gut microbiome such as decreased microbial diversity, an increased Firmicutes-to-Bacteroidetes ratio, and increased SCFAs levels. Our findings also indicate that gut microbiota modulation techniques could represent a novel strategy in treating obesity and related metabolic diseases. Although some mechanisms (e.g., inflammation or hormonal regulation) are already considered a powerful connection between gut microbiota and obesity development, further research is needed to enhance the knowledge on this particular topic.

The Impact of High Adiposity on Endometrial Progesterone Response and Metallothionein Regulation

CONTEXT

Obesity is a disease with deleterious effects on the female reproductive tract, including the endometrium.

OBJECTIVE

We sought to understand the effects of excess adipose on the benign endometrium.

METHODS

A physiologic in vitro coculture system was developed, consisting of multicellular human endometrial organoids, adipose spheroids, and menstrual cycle hormones. Native human endometrial tissue samples from women with and without obesity were also analyzed. Benign endometrial tissues from premenopausal women ages 33 to 53 undergoing hysterectomy were obtained following written consent at Northwestern University Prentice Women's Hospital, Chicago, Illinois. Gene expression, protein expression, chromatin binding, and expression of DNA damage and oxidative damage markers were measured.

RESULTS

Under high adiposity conditions, endometrial organoids downregulated endometrial secretory phase genes, suggestive of an altered progesterone response. Progesterone specifically upregulated the metallothionein (MT) gene family in the epithelial cells of endometrial organoids, while high adiposity significantly downregulated the MT genes. Silencing MT genes in endometrial epithelial cells resulted in increased DNA damage, illustrating the protective role of MTs. Native endometrium from women with obesity displayed increased MT expression and oxidative damage in the stroma and not in the epithelium, indicating the cell-specific impact of obesity on MT genes.

CONCLUSION

Taken together, the in vitro and in vivo systems used here revealed that high adiposity or obesity can alter MT expression by decreasing progesterone response in the epithelial cells and increasing oxidative stress in the stroma.

Analysis of Inflammatory Markers in Response to Induction of Reprometabolic Syndrome by a Eucaloric High Fat Diet in Normal Weight Women

Obesity is associated with chronic low-level inflammation and is known to contribute to metabolic dysfunction and hypogonadotropic hypogonadism, which we have previously termed the 'Reprometabolic Syndrome.' To investigate potential factors involved in obesity-related reproductive endocrine dysfunction, we conducted a secondary analysis of inflammatory markers in a sample of normal weight women exposed to a one-month eucaloric high-fat diet (HFD), which, as reported earlier, induced the relative hypogonadotropic hypogonadism characteristic of Reprometabolic Syndrome. Eighteen healthy women with a BMI between 18.0-24.9 kg/m2 and regular menstrual cycles participated in the study. Frequent blood sampling was performed during the early follicular phase before and after the one-month eucaloric HFD intervention (48% of calories from fat). Serum samples pooled from each participant were analyzed using immunoassay to measure levels of 30 cytokines, interleukins, and chemokines. Differences between pre- and post-HFD intervention measures were examined by one-sample t-tests. Exposure to the eucaloric HFD did not result in changes in body weight. HFD-induction of Reprometabolic Syndrome in normal weight women was associated with a significant elevation only in the anti- inflammatory cytokine IL-10 (p = 0.04). Eotaxin, IL-6 and MIP-1β also increased in response to the HFD, but not statistically significantly (p = 0.07). Results suggest that the increase in multiple inflammatory markers, typically associated with obesity, are not primary mediators of the relative hypogonadotropic hypogonadism of Reprometabolic Syndrome. Clinical Trials Registration Number: NCT02653092; Date of Registration: January 6, 2016.

Weight Loss Programs: Why Do They Fail? A Multidimensional Approach for Obesity Management

PURPOSE OF REVIEW

Despite the prevalence of weight loss programs, their success rates remain discouraging, with around half of individuals regaining lost weight within two years. The primary objective of this review is to explore the factors contributing to the failure of weight loss programs and to provide insights into effective weight management strategies.

RECENT FINDINGS

Factors contributing to the failure of weight loss programs include the impracticality of restrictive diets, potential metabolic impacts, limited focus on lifestyle changes, genetic predispositions, psychological influences, socioeconomic status, and medical conditions. A holistic approach considering these factors is crucial for safe and sustainable weight loss. Key findings indicate the importance of holistic approaches to weight management, including lifestyle modifications, medical interventions, and behavioral and psychological strategies. Effective weight loss strategies emphasize low-calorie, nutrient-rich diets, regular physical activity, and interventions tailored to individual needs. Combining multiple approaches offers the best chance of successful weight management and improved health outcomes. This review provides insights into the complexities of obesity management and the factors contributing to the failure of weight loss programs. It highlights the necessity of adopting a holistic approach that addresses dietary habits, physical activity, genetic factors, psychological well-being, and socioeconomic influences. Recommendations include implementing lifestyle modifications, medical interventions when necessary, and integrating behavioral and psychological support to achieve sustainable weight loss and mitigate the global health challenge posed by obesity.

The germline coordinates mitokine signaling

The ability of mitochondria to coordinate stress responses across tissues is critical for health. In C. elegans, neurons experiencing mitochondrial stress elicit an inter-tissue signaling pathway through the release of mitokine signals, such as serotonin or the Wnt ligand EGL-20, which activate the mitochondrial unfolded protein response (UPRMT) in the periphery to promote organismal health and lifespan. We find that germline mitochondria play a surprising role in neuron-to-periphery UPRMT signaling. Specifically, we find that germline mitochondria signal downstream of neuronal mitokines, Wnt and serotonin, and upstream of lipid metabolic pathways in the periphery to regulate UPRMT activation. We also find that the germline tissue itself is essential for UPRMT signaling. We propose that the germline has a central signaling role in coordinating mitochondrial stress responses across tissues, and germline mitochondria play a defining role in this coordination because of their inherent roles in germline integrity and inter-tissue signaling.

Trajectory of primordial follicle depletion is accelerated in obese mice in response to 7,12-dimethylbenz[a]anthracene exposure†

Both obesity and exposure to environmental genotoxicants, such as 7,12-dimethylbenz[a]anthracene, negatively impair female reproductive health. Hyperphagic lean KK.Cg-a/a (n = 8) and obese KK.Cg-Ay/J (n = 10) mice were exposed to corn oil as vehicle control (CT) or 7,12-dimethylbenz[a]anthracene (1 mg/kg/day) for 7d intraperitoneally, followed by a recovery period. Obesity increased liver and spleen weight (P < 0.05), and 7,12-dimethylbenz[a]anthracene exposure decreased uterine weight (P < 0.05) in obese mice. Primordial follicle loss (P < 0.05) caused by 7,12-dimethylbenz[a]anthracene exposure was observed in obese mice only. Primary (lean P < 0.1; obese P < 0.05) and secondary (lean P < 0.05, obese P < 0.1) follicle loss initiated by 7,12-dimethylbenz[a]anthracene exposure continued across recovery. Reduced pre-antral follicle number in lean mice (P < 0.05), regardless of 7,12-dimethylbenz[a]anthracene exposure, was evident with no effect on antral follicles or corpora lutea number. Immunofluorescence staining of DNA damage marker, γH2AX, did not indicate ongoing DNA damage but TRP53 abundance was decreased in follicles (P < 0.05) of 7,12-dimethylbenz[a]anthracene-exposed obese mice. In contrast, increased (P < 0.05) superoxide dismutase was observed in the corpora lutea of 7,12-dimethylbenz[a]anthracene-exposed obese mice and reduced (P < 0.05) TRP53 abundance was noted in preantral and antral follicles of 7,12-dimethylbenz[a]anthracene-exposed obese mice. This study indicates that obesity influences ovotoxicity caused by a genotoxicant, potentially involving accelerated primordial follicle activation and hampering normal follicular dynamics.

Single-cell transcriptomic profiling unveils insights into ovarian fibrosis in obese mice

BACKGROUND

Adiposity profoundly impacts reproductive health in both humans and animals. However, the precise subpopulations contributing to infertility under obese conditions remain elusive.

RESULTS

In this study, we established an obese mouse model through an eighteen-week high-fat diet regimen in adult female mice. Employing single-cell RNA sequencing (scRNA-seq), we constructed a comprehensive single-cell atlas of ovarian tissues from these mice to scrutinize the impact of obesity on the ovarian microenvironment. ScRNA-seq revealed notable alterations in the microenvironment of ovarian tissues in obese mice. Granulosa cells, stromal cells, T cells, and macrophages exhibited functional imbalances compared to the control group. We observed heightened interaction strength in the SPP1-CD44 pairing within lgfbp7+ granulosa cell subtypes and Il1bhigh monocyte subtypes in the ovarian tissues of obese mice. Moreover, the interaction strength between Il1bhigh monocyte subtypes and Pdgfrb+ stromal cell subtypes in the form of TNF - TNFrsf1α interaction was also enhanced subsequently to obesity, potentially contributing to ovarian fibrosis pathogenesis.

CONCLUSIONS

We propose a model wherein granulosa cells secrete SPP1 to activate monocytes, subsequently triggering TNF-α secretion by monocytes, thereby activating stromal cells and ultimately leading to the development of ovarian fibrosis. Intervening in this process may represent a promising avenue for improving clinical outcomes in fertility treatments for obese women.

Comparative efficacy of exercise, diet and/or pharmacological interventions on BMI, ovulation, and hormonal profile in reproductive-aged women with overweight or obesity: a systematic review and network meta-analysis

BACKGROUND

The increasing prevalence of obesity worldwide poses a significant threat to reproductive function owing, in part, to hormonal disturbances caused by negative feedback between excess adiposity and the hypothalamic-pituitary-ovarian axis. Consequently, finding the most appropriate strategies to lose weight and improve ovulation in women with overweight or obesity is a clinically relevant matter that needs to be investigated. A comprehensive comparison of the independent and combined efficacy of lifestyle and/or pharmacological interventions on BMI, ovulation, and hormonal profile in women with overweight or obesity at risk of anovulatory infertility would facilitate improving fertility strategies in this population.

OBJECTIVE AND RATIONALE

This study aimed to evaluate the comparative efficacy of exercise, diet, and pharmacological interventions on BMI, ovulation, and hormonal profile in reproductive-aged women with overweight or obesity.

SEARCH METHODS

A systematic review was performed by searching PubMed, Scopus, Web of Science, PsycINFO, and Cochrane Library up to 14 December 2023, for randomized controlled trials assessing the effects of exercise, diet and/or pharmacological interventions (i.e. weight-lowering drugs or ovulation inducers) on BMI, ovulation, and/or hormonal profile in reproductive-aged women with overweight or obesity. We performed frequentist random-effect network meta-analyses and rated the certainty of the evidence. The primary outcomes were BMI and ovulation rate, and the secondary outcomes were serum reproductive hormone levels (gonadotrophins, androgens, or oestrogens). We performed sensitivity analyses, including the studies that only involved women with PCOS.

OUTCOMES

Among 1190 records screened, 148 full texts were assessed for eligibility resulting in 95 trials (9910 women), of which 53% presented a high or unclear risk of bias. The network meta-analyses revealed that, compared to control: diet combined with weight-lowering drugs (mean difference (MD) -2.61 kg/m2; 95% CI -3.04 to -2.19; τ2 = 0.22) and adding exercise (MD -2.35 kg/m2; 95% CI -2.81 to -1.89; τ2 = 0.22) led to the greatest decrease in BMI; exercise combined with diet and ovulation inducers (risk ratio (RR) 7.15; 95% CI 1.94-26.40; τ2 = 0.07) and exercise combined with diet and weight-lowering drugs (RR 4.80; 95% CI 1.67-13.84; τ2 = 0.07) produced the highest increase in ovulation rate; and exercise combined with diet and weight-lowering drugs was the most effective strategy in reducing testosterone levels (standardized mean difference (SMD) -2.91; 95% CI -4.07 to -1.74; τ2 = 2.25), the third most effective strategy in increasing sex hormone-binding globulin levels (SMD 2.37; 95% CI 0.99-3.76; τ2 = 2.48), and it was coupled with being ranked first in terms of free androgen index reduction (SMD -1.59; 95% CI -3.18 to 0.01; τ2 = 1.91). The surface under the cumulative ranking curve scores suggested that: diet combined with weight-lowering drugs is the strategy most likely (94%) to produce the highest BMI reduction; and exercise combined with diet and ovulation inducers is the strategy most likely (89%) to produce the highest ovulation rate improvement. The sensitivity analyses, which exclusively included studies involving women diagnosed with PCOS, were consistent with the results presented above.

WIDER IMPLICATIONS

Overall, the findings of this network meta-analysis indicate that the combination of exercise, diet, and pharmacological interventions is effective for weight loss, improving ovulation, and normalizing the androgen levels of women with overweight or obesity. Although higher quality studies are needed, these results support that the optimal treatment strategy for women with overweight or obesity wishing to conceive must consider exercise, diet, and pharmacological interventions during the shared decision-making process.

Analysis of determinants of infertility among women at <i>in vitro</i> fertilization clinic in Surabaya

In social life and global health, infertility is common. History of abdominal surgery, body mass index (BMI), endometriosis, menstrual history, and polycystic ovarian syndrome (PCOS) have not been fully explained as female infertility factors. This study examined infertility causes at ASHA in vitro fertilization Primasatya Husada Citra (PHC) Hospital Surabaya. This quantitative study was cross-sectional. In May-July 2023, 82 childbearing-age women with infertility issues visited the hospital and completed questionnaires. Description and analysis were performed using the Wilcoxon rank test to evaluate menstrual history, BMI, PCOS, endometriosis, and abdominal surgery history in relation to infertility. Infertility was statistically associated with abdominal surgery history (P=0.008), BMI (P=0.000), endometriosis diagnosis (P=0.000), and PCOS (P=0.000). Women with abdominal surgery, endometriosis, and PCOS had significant infertility. Women’s infertility can be caused by ovulation disorders, tubal and pelvic disorders, or uterine disorders, but one-third of cases are unexplained. Infertility treatment may benefit from addressing abdominal surgery history, BMI, endometriosis, and PCOS. Early intervention and targeted care based on these determinants may improve fertility outcomes and reduce unexplained infertility.

The epoxiconazole and tebuconazole fungicides impair granulosa cells functions partly through the aryl hydrocarbon receptor (AHR) signalling with contrasted effects in obese, normo-weight and polycystic ovarian syndrome (PCOS) patients

Polycystic ovarian syndrome (PCOS), frequently associated to obesity, is the main reproductive disorder in women in age to procreate. Some evidence suggests that pesticides can result in alterations of the female reproductive system, including polycystic ovary syndrome (PCOS). Here, we detected two fungicides, Tebuconazole (Tb) and Epoxiconazole (Epox) in the soils and waters of French area. Our hypothesis is that these two triazoles could be associated to the etiology of PCOS. We used the human KGN cell line and primary human granulosa cells (hGCs) from different group of patients: normal weight non PCOS (NW), normal weight PCOS (PCOS NW), obese (obese) and obese PCOS (PCOS obese). We exposed in vitro these cells to Tb and Epox from 0 up to 10 mM for 24 and 48 h and analysed cell viability and steroidogenesis. In hGCs NW, cell viability was reduced from 12.5 µM for Tb and 75 µM for Epox. In hGCs NW, Epox decreased progesterone (Pg) and estradiol (E2) secretions and inhibited STAR, HSD3B and CYP19A1 mRNA expressions from 25 µM and increased AHR mRNA expression from 75 µM. Tb exposure also reduced steroid secretion and STAR and CYP19A1 mRNA expressions and increased AHR mRNA expression but at cytotoxic concentrations. Silencing of AHR in KGN cells reduced inhibitory effects of Tb and Epox on steroid secretion. Tb and Epox exposure decreased more steroid secretion in hGCs from obese, PCOS NW and PCOS obese groups than in NW group. Moreover, we found a higher gene expression of AHR within these three groups. Taken together, both Epox and Tb reduced steroidogenesis in hGCs through partly AHR and Tb was more cytotoxic than Epox. These triazoles alter more strongly PCOS and/or obese hGCs suggesting that human with reproductive disorders are more sensitive to triazoles exposure.

Genes linked to obesity-related infertility: bridging the knowledge gap

Genetic factors play a pivotal role in the complex relationship between obesity and infertility. This article delves into the genetics of obesity-related infertility, focusing on the essential genes and mechanisms in both sexes. We explored infertility factors in obese females, focusing on polycystic ovary syndrome (PCOS) and the influence of genes like insulin receptor (INSR), androgen receptor (AR), and follicle-stimulating hormone receptor (FSHR). Epigenetic changes are believed to contribute to PCOS-related infertility. The impact of adipokines and inflammation on obesity-related infertility has been discussed, with genes such as fat mass and obesity (FTO) and melanocortin-4-receptor (MC4R) playing significant roles. Genetic factors affecting sperm quality and function, including nuclear receptor subfamily 3 group C member 1 (NR3C1) and methylenetetrahydrofolate reductase (MTHFR), have been investigated in obesity-related infertility in males. Hormonal dysregulation influenced by genetic markers, such as leptin receptor (LEPR), tumor necrosis factor-alpha (TNF-α), and interleukin-6 (IL-6), was also examined. Genetic factors play a vital role in obesity-related infertility in both sexes. Genes involved in metabolism, hormonal regulation, and inflammation contribute to the complex association between obesity and infertility. Epigenetic changes further complicate the relationship. Understanding these genetic mechanisms is essential to address obesity-related infertility and develop personalized interventions.

A preliminary report comparing the effect of Asafoetida with oral contraceptive on polycystic ovarian syndrome in a double-blind randomized trial

Objective

Polycystic ovarian syndrome (PCOS) is the most common cause of infertility and endocrine disorders in women of childbearing age. In Persian medicine, Ferula assafoetida L. (Asafoetida) was recommended for treating PCOS. The present study was conducted to compare the effect of Asafoetida with oral contraceptive tablets on PCOS patients.

Materials and Methods

Patients with PCOS (n=30) were enrolled in a double-blind randomized clinical trial. On Day 5 of the menstrual cycle, patients received two periods of 21-day treatment, with 7 days rest between the two treatments. On a daily basis, half of the patients (n=15) received Asafoetida (1 g), and the rest received low dose oral contraceptive (LD; one tablet). Menstrual status, anthropometric characteristics, hematology and biochemistry parameters, ovarian ultrasound examination and hirsutism were evaluated prior to the initiation of the experiment and 14 days after the end of treatment. The occurrence of menstrual cycles and pregnancy was assessed eight months after the end of treatment.

Results

The incidence of pregnancy was greater in patients who received Asafoetida compared to those who received LD (p=0.019). The time intervals between menstrual cycles became shorter in both groups (p<0.05). The occurrence of regular menstrual cycles remained longer in the Asafoetida compared to the LD group (p=0.001). Concentrations of triglycerides, cholesterol, HDL and LDL were significantly increased after treating with LD (p<0.05).

Conclusion

In PCOS patients, the occurrence of regular menstrual cycles and the incidence of pregnancy were improved following treatment with Asafoetida. This medicament could be considered a safe treatment for patients with PCOS.

Beyond Weight Loss: A Comprehensive Review of Pregnancy Management following Bariatric Procedures

The increasing prevalence of bariatric surgery among women of childbearing age raises critical questions about the correct management of pregnancy following these procedures. This literature review delves into the multifaceted considerations surrounding pregnancy after bariatric surgery, with a particular focus on the importance of preconception counselling, appropriate nutrition assessment, and the necessity of correct folic acid supplementation. Key areas of investigation include nutrient absorption challenges, weight gain during pregnancy, and potential micronutrient deficiencies. Examining the relationship between bariatric surgery and birth defects, particularly heart and musculoskeletal issues, uncovers a twofold increase in risk for women who underwent surgery before pregnancy, with the risk emphasized before folic acid fortification. In contrast, a nationwide study suggests that infants born to mothers with bariatric surgery exhibit a reduced risk of major birth defects, potentially associated with improved glucose metabolism. In addition, this review outlines strategies for managing gestational diabetes and other pregnancy-related complications in individuals with a history of bariatric surgery. By synthesizing existing literature, this paper aims to provide healthcare providers with a comprehensive framework for the correct management of pregnancy in this unique patient population, promoting the health and well-being of both mother and child.

Impact of a hypocaloric dietary intervention on antral follicle dynamics in eumenorrheic women with obesity

STUDY QUESTION

Do antral follicle dynamics change in women with obesity and regular ovulatory cycles after a 6-month hypocaloric dietary intervention?

SUMMARY ANSWER

After a 6-month hypocaloric dietary intervention, women with obesity and regular ovulatory cycles displayed evidence of improved antral follicle dynamics defined by the emergence of more dominant follicles, larger ovulatory follicle diameter at selection, and increased luteal progesterone concentrations compared to pre-intervention.

WHAT IS KNOWN ALREADY

Precise events in antral folliculogenesis must occur in order for natural and regular monthly ovulation. In healthy women of reproductive age, antral follicles are recruited for growth in a wave-like fashion, wherein a subset of follicles are selected for preferential growth, and typically, one dominant follicle culminates in ovulation. Women with obesity and regular ovulatory cycles display evidence of suppressed antral follicle development, as evidenced by fewer recruitment events, fewer selectable and dominant follicles, smaller diameter of the ovulatory follicle at selection, and a higher prevalence of luteal phase defects. While improvements in gonadotropin and ovarian steroid hormone concentrations after weight loss have been documented in eumenorrheic women with obesity, the precise impact of weight loss on antral follicle dynamics has not been evaluated.

STUDY DESIGN, SIZE, DURATION

A pre-post pilot study of 12 women who participated in a 6-month hypocaloric dietary intervention.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Twelve women with obesity (total body fat ≥35%) underwent transvaginal ultrasonography and venipuncture every-other-day for one inter-ovulatory interval (IOI) both before (baseline) and during the final month (Month 7) of a six-month hypocaloric dietary intervention. Participants were aged 24-34 years and had a self-reported history of regular menstrual cycles (25-35 days). Follicle number and diameter (≥2 mm) were quantified at each study visit, and individual growth profiles for all follicles ≥7 mm were determined. Blood samples were assayed for reproductive hormones. Follicle dynamics and reproductive hormone concentrations were compared pre- and post-intervention. Further, post-intervention follicle and endocrine dynamics (Month 7 IOI) were compared to an age-matched reference cohort of lean women with regular ovulatory cycles (total body fat <35%, N = 21).

MAIN RESULTS AND THE ROLE OF CHANCE

Participants lost an average of 11% of their original body weight with the hypocaloric dietary intervention. More dominant follicles were detected (≥10 mm) at Month 7 compared to baseline (0. 3 ± 0.4 versus 0.4 ± 0.5 follicles, P = 0.001), and ovulatory follicles were selected at larger diameters post-intervention (7.3 ± 2.0 versus 10.9 ± 2.6 mm, P = 0.007). Luteal progesterone concentrations were increased at Month 7 compared to baseline (5.3 ± 3.65 versus 6.3 ± 4.74 ng/ml, P < 0.0001). However, risk for luteal phase dysfunction as judged by the prevalence of a luteal phase length <10 days, integrated luteal progesterone levels <80 ng/ml or peak progesterone <10 ng/ml did not differ pre- versus post-intervention (all, P > 0.05). In Month 7, follicle dynamics and endocrine profiles were similar to the reference cohort across all measures.

LIMITATIONS, REASONS FOR CAUTION

This study does not inform on the earliest stages of ovarian follicle development and is limited to providing knowledge on the later stages of antral follicle development. This study cannot fully address causation between weight loss and sustained improvements in antral follicle dynamics. The data cannot be extrapolated to comment on potential improvements in fertility and fecundity with weight loss. The small group sizes limit statistical power.

WIDER IMPLICATIONS OF THE FINDINGS

The increasing prevalence of obesity necessitates an understanding of the mechanisms that underlie potential improvements in reproductive health outcomes with weight loss. Women with obesity and regular ovulatory cycles who undertook a 6-month hypocaloric dietary intervention demonstrated improvements consistent with benefits of lifestyle intervention on reproductive health even in those without overt signs of reproductive dysfunction. Potential improvements in the cellular makeup of follicles, which may underlie the restoration of normal follicle development and amelioration of subfertility, require further investigation.

STUDY FUNDING/COMPETING INTEREST(S)

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. The authors have no competing interests.

TRIAL REGISTRATION NUMBER

NCT01927432 and NCT01785719.

[Influence of adherence to a mediterranean diet and nutritional status on ovarian reserve]

OBJECTIVE

Currently, esterility affects between 15% and 20% of couples of fertile age. Female reproductive success is mainly determined by age and ovarian reserve (OR). Recent studies highlight the influence of modifiable factors such as dietary habits and nutritional status on OR. In this regard, the Mediterranean Diet (MD) is postulated as a standard of healthy eating. Therefore, the objective of this paper was to analyze the influence of adherence to DM and nutritional status on the OR of infertile women.

METHODS

A descriptive cross-sectional study was carried out, lasting one year, between February 2022 and February 2023, in a sample of forty-five female patients who attended the Gynaecology-Esterility consultation at the Marina Salud Hospital in Denia (Spain) due to genital desire older than one year. An exploratory descriptive analysis based on univariate statistics was performed.

RESULTS

The mean age of the sample (n=45) was 31.84 (±3.99) years, with an average BMI of 26.27 (±6.08) kg/m2, with 44.4% (n=20) having excess body weight. The RO was measured based on AMH, with an average value of 2.32 (±1.59) ng/ml and RFA, with an average of 19.80 (±14.13) antral follicles. A statistically significant association was found between low adherence to DM and lower anti-Müllerian hormone (AMH; p=0.025) levels. In addition, an association was found between low consumption of vegetables (p=0.044), excessive consumption of red meat (p=0.027) and carbonated beverages (p=0.015) with insufficient AMH levels, indicative of low OR. Low fruit consumption was also found to be associated with low oestradiol levels (p=0.045). Statistically significant associations were also found reflecting the influence of nutritional status on OR.

CONCLUSIONS

One of the main factors conditioning the success of ART (assisted reproductive technology) is the woman's OR. The most widely used parameter to assess OR is AMH. Lifestyle and diet are modifiable factors that can influence OR. High adherence to DM and consumption of vegetables is associated with higher levels of AMH; however, high intake of red meat and carbonated beverages is associated with lower levels. Nutritional status, adherence to DM and dietary habits influence the status of OR, so it would be advisable to promote programmes to improve the population's diet in order to improve reproductive health.

Obesity attenuates the beneficial effect of an intrauterine infusion of autologous platelet-rich plasma during in vitro fertilization

OBJECTIVE

To assess how obesity, normal weight (NW) versus overweight/obese (OW/OB), impacts platelet-rich plasma's (PRP) effectiveness during in vitro fertilization and how obesity affects platelets during the menstrual cycle.

METHODS

Endometrial mean thickness (EMT), embryo implantation, and clinical pregnancy were assessed using a self-controlled retrospective study that enrolled 59 patients with two failed cycles and treated with autologous PRP (three-dose scheme). The NHANES dataset was used to assess platelet changes during the menstrual cycle, using the mean platelet volume to platelet count ratio (MPR) index. The COSINOR packages for R were used to determine rhythmicity.

RESULTS

PRP treatments significantly improved the EMT (2.5 ± 1.4 mm, P<0.001), unaffected by obesity. After the PRP treatment, one patient spontaneously became pregnant; therefore, 58 patients underwent embryo transfer (62 cycles), of which in 39 cycles the embryos implanted (63.9%). This was a significant improvement from their previous cycle (vs. 22.6%, P<0.001). Clinical pregnancy also improved with the PRP treatment over the previous cycle (57.4% vs. 16.1%, P<0.001). When stratified by obesity, there was an appreciable decrease in embryo implantation and clinical pregnancy rates for the OW/OB group; nevertheless, the PRP treatment significantly improved embryo implantation and clinical pregnancy (P<0.05). A rhythm was observed with the MPR index (P<0.05) only for the NW group, suggesting that the platelets normally fluctuate during the menstrual cycle.

CONCLUSION

PRP improved embryo implantation and clinical pregnancy rates; however, these beneficial effects were attenuated by obesity. PRP presumptively promoted a change in the uterine environment to mimic the normal findings associated with normal-weight women.

Pathophysiology of obesity-related infertility and its prevention and treatment by potential phytotherapeutics

BACKGROUND

Obesity is a complex multifactorial disease in which the accumulation of excess body fat has adverse health effects, as it can increase the risk of several problems, including infertility, in both men and women. Obesity and infertility have risen together in recent years. Against this background, the present review aims to highlight the impact of obesity on infertility and the underlying pathophysiology of obesity-related infertility (ORI) in men and women, and to provide readers with knowledge of current trends in the effective development of phytotherapeutics for its treatment.

METHODS

We thoroughly searched in PubMed, MEDLINE, Scopus, EMBASE, and Google Scholar to find all relevant papers on ORI and the therapeutic effects of phytotherapeutics on ORI in men and women.

RESULTS

The extensive search of the available literature revealed that obesity affects reproductive function through several complex mechanisms such as hyperlipidaemia, hyperinsulinaemia, hyperandrogenism, increased body mass index, disruption of the hormonal milieu, systemic inflammation, oxidative stress, alterations in epigenetics and dysbiosis. On the other hand, several studies reported that phytotherapeutics has a broad therapeutic spectrum of action by improving sex hormone homeostasis, ovarian dysfunction, menstrual cycle and inhibiting ovarian hyperplasia, as well as down-regulating ovarian apoptosis, inflammation and oxidative stress, and controlling metabolic dysfunction in obese women. Male infertility is also addressed by phytotherapeutics by suppressing lipogenesis, increasing testosterone, 3β-HSD and 17β-HSD levels, improving sperm parameters and attenuating testicular dyslipidaemia, oxidative stress, inflammation and germ cell apoptosis.

CONCLUSIONS

In the present review, we discussed the effects of obesity on reproductive dysfunction in men and women and the underlying pathophysiology of ORI. In addition, the therapeutic effect of phytotherapeutics against ORI was highlighted.

Food, nutrition, and fertility: from soil to fork

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.

Metabolic hormones are integral regulators of female reproductive health and function

The female reproductive system is strongly influenced by nutrition and energy balance. It is well known that food restriction or energy depletion can induce suppression of reproductive processes, while overnutrition is associated with reproductive dysfunction. However, the intricate mechanisms through which nutritional inputs and metabolic health are integrated into the coordination of reproduction are still being defined. In this review, we describe evidence for essential contributions by hormones that are responsive to food intake or fuel stores. Key metabolic hormones-including insulin, the incretins (glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1), growth hormone, ghrelin, leptin, and adiponectin-signal throughout the hypothalamic-pituitary-gonadal axis to support or suppress reproduction. We synthesize current knowledge on how these multifaceted hormones interact with the brain, pituitary, and ovaries to regulate functioning of the female reproductive system, incorporating in vitro and in vivo data from animal models and humans. Metabolic hormones are involved in orchestrating reproductive processes in healthy states, but some also play a significant role in the pathophysiology or treatment strategies of female reproductive disorders. Further understanding of the complex interrelationships between metabolic health and female reproductive function has important implications for improving women's health overall.

Sleeve gastrectomy as a bridge to maternity in a patient with obesity, infertility and tetraplegia. A case report

Traumatic spinal cord injury (SCI) is a major cause of severe and permanent disability in young adults. Overweight and obesity are commonly observed among patients affected with SCI, with reports of a prevalence of over 60 and 30% respectively. Case report: A 34 year-old woman suffering from tetraplegia after sustaining a traumatic injury to C5-C6 at age 23 as a result of a motor vehicle accident was presented to our hospital's multidisciplinary bariatric team due to class II obesity. At the time of presentation to the team, eleven years after the accident, her BMI was calculated to be 39 Kg/m2 (weight 97 kg, height 1.57 meters). She was diagnosed with infertility while seeking pregnancy, and referred to our bariatric unit for weight loss. In addition, she had overcome the physical limitations of her injury, had a regular job and was engaged in regular physical activities such as swimming. In May 2017, she underwent laparoscopic sleeve gastrectomy (LSG) without complications and was discharged on postoperative day 2. 17 months following LSG, with a normal BMI, she became naturally pregnant. She had emergency cesarean at 35 weeks due to pneumonia but both patient and child recovered without sequelae. Currently, 4 years after surgery she maintains 37.11% total weight loss (weight 61 kg). She reports having a better quality of life with fewer medical intercurrencies. Conclusions: Patients with SCI and obesity, particularly women seeking to conceive, may be benefited by being referred to bariatric teams for assessment and treatment to improve results associated with sustained weight reduction.

Attenuation of palmitic acid-induced lysyl oxidase overexpression in the ovary contributes to the improvement of ovulation in obesity by metformin

STUDY QUESTION

Does palmitic acid (PA), the most common saturated free fatty acid (FFA) in individuals with obesity, contribute to anovulation through upregulation of the collagen-crosslinking enzyme lysyl oxidase (LOX) in the ovary?

SUMMARY ANSWER

Increased PA in individuals with obesity can cause LOX upregulation via the activation of hypoxia-inducible factor-1α (HIF-1α), resulting in abnormal collagen deposition in the ovary and anovulation, which can be ameliorated by metformin therapy.

WHAT IS KNOWN ALREADY

The underlying cause of anovulation in individuals with obesity is poorly defined, and accumulating evidence indicates that hormonal disturbance, insulin resistance, and inflammation may all play a role in the development of ovulation disorders in individuals with obesity. However, it remains to be determined whether PA plays a role in the regulation of LOX expression, thus disrupting ovarian extracellular matrix (ECM) remodelling in the ovary and resulting in impaired ovulation in individuals with obesity.

STUDY DESIGN SIZE DURATION

PA concentration and LOX protein abundance and activity in follicular fluid and ovarian tissue were compared between control (n = 21) subjects, patients with obesity with ovulation (n = 22), and patients with obesity with anovulation (n = 16). The effect of PA on LOX protein expression, and the underlying mechanism, was examined in primary human granulosa cells in vitro. The improvements in obesity conditions induced by LOX inhibition combined with metformin were investigated in a high-fat diet-induced obese rat model.

PARTICIPANTS/MATERIALS SETTING METHODS

The abundance of PA concentration and LOX activity was measured via a LOX activity assay and ELISA, respectively. The effect of PA on LOX protein expression was examined in the presence or absence of inhibitors of signalling molecules and siRNA-mediated knockdown of the putative transcription factor. Chromatin immunoprecipitation assays were subsequently conducted to further identify the responsible transcription factor. The role of metformin in the treatment of anovulation by LOX inhibition was investigated in a high-fat diet (HFD)-induced obese rat model. The numbers of retrieved total oocytes and metaphase II oocytes were recorded upon ovarian stimulation. Masson's trichrome staining was used to measure the total collagen content, and immunohistochemical staining and western blotting were used to measure LOX, HIF-1α, and collagen I and IV in the ovary.

MAIN RESULTS AND THE ROLE OF CHANCE

Significantly increased FFA, LOX, and collagen abundance were observed in the ovaries of obese women with anovulation, compared to healthy controls or obese women with ovulation. In a HFD-induced obese rat model, metformin corrected the distortion of ovarian morphology by decreasing LOX and collagen protein abundance in the ovary and improving oestrous cyclicity and ovulation. PA increased LOX expression via the activation of HIF-1α in human granulosa cells, which was attenuated by metformin.

LARGE SCALE DATA

N/A.

LIMITATIONS REASONS FOR CAUTION

Several other saturated and polyunsaturated FFAs, such as stearic acid and arachidonic acid, are also increased in the blood of individuals with obesity, and increased levels of other FFAs may also contribute to the development of anovulation in individuals with obesity, which needs to be further verified in the future.

WIDER IMPLICATIONS OF THE FINDINGS

Elevated PA in individuals with obesity can cause LOX dysregulation via activation of HIF-1α, resulting in abnormal collagen deposition in the ovary and anovulation. This dysregulation can be ameliorated by metformin therapy through its local effect on ECM remodelling in the ovary, which is independent of its systemic effect on insulin sensitivity and chronic inflammation.

STUDY FUNDING/COMPETING INTERESTS

This work was supported by the National Natural Science Foundation of China (grant numbers 82101730, 82130046, and 31900598) and Innovative Research Team of High-level local Universities in Shanghai (SHSMU-ZLCX20210201). All the authors declare no conflicts of interest in relation to this work.

Obesity and its impact on female reproductive health: unraveling the connections

In the modern era, the escalating global prevalence of obesity has profound implications on female reproductive health. Obesity, transcending mere lifestyle choices, has evolved into a complex disorder affecting physiological and metabolic functions. Concurrently, female infertility is rising as a significant global health issue. Obesity, with its extensive systemic effects, is pinpointed as a major disruptor. The convergence of these health challenges reveals a multifaceted scenario: on one hand, obesity directly impacts female reproductive health, particularly in the context of conditions like polycystic ovary syndrome (PCOS) and menstrual disturbances; on the other, the psychosocial consequences of infertility might intensify weight-gain patterns, forming a challenging cycle. Additionally, the economic implications of treating obesity-related infertility are considerable. This review delves into the myriad ways obesity affects female reproductive health, drawing insights from epidemiological, clinical, and molecular studies. It explores the epidemiological relationship between obesity and PCOS, the influence of obesity on menstrual disturbances, and the broader impact of obesity on female infertility. Weight loss, through pharmacological interventions, surgical methods, or lifestyle adjustments, emerges as a promising strategy. Lastly, the efficacy of assisted reproductive technologies, such as IVF, is influenced by obesity, underscoring the importance of an optimal body mass index. The review also highlights the molecular and physiological mechanisms underlying the impact of obesity on female reproductive health, including the disruption of the hypothalamic-pituitary-ovary axis, altered adipokine secretion, and the role of chronic inflammation and oxidative stress.

Is there any truth in the myth that IVF treatments involve weight gain?

Purpose

To examine body weight change in women undergoing in vitro fertilization and embryo transfer (IVF-ET) using antagonist protocol after up to three treatment cycles.

Methods

A prospective cohort study among IVF patients treated between 2018 and 2019. Each patient underwent weight measurement three times during the treatment cycle: before treatment, at the beginning of the hormonal stimulation, and at the completion of the cycle, on the day of the pregnancy test. Data were also analyzed according to the body mass index (BMI) groups for normal weight, overweight, and obese patients. Finally, weight changes were recorded following altogether 519 treatment cycles, 240, 131, and 148 cycles, for normal weight, overweight, and obese patients, respectively.

Results

The change in the patient's weight was clinically non-significant either during the waiting period or during gonadotropin administration, and overall, during the first, second, or third treatment cycles. The recorded mean total weight change of 0.26 ± 1.85, 0.4 ± 1.81, and 0.17 ± 1.7, after the first, second, or third treatment cycles, represent a change of 0.36%, 0.56%, and 0.23% of their initial weights, respectively. This change of less than 1% of the body weight falls short of the clinically significant weight gain of 5%-7%. Analyzing the data for the various BMI groups, the changes observed in body weight were under 1%, hence with no clinical significance.

Conclusion

The findings of the study reject the myth that hormone therapy involves clinically significant weight gain, and this can lower the concerns of many patients who are candidates for treatment of assisted reproductive technology.

Cellular atlases of ovarian microenvironment alterations by diet and genetically-induced obesity

Obesity, which can arise from genetic or environmental factors, has been shown to cause serious damages to the reproductive system. The ovary, as one of the primary regulators of female fertility, is a complex organ comprised of heterogeneous cell types that work together to maintain a normal ovarian microenvironment (OME). Despite its importance, the effect of obesity on the entire ovary remains poorly documented. In this study, we performed ovary single-cell and nanoscale spatial RNA sequencing to investigate how the OME changed under different kinds of obesity, including high-fat diet (HFD) induced obesity and Leptin ablation induced obesity (OB). Our results demonstrate that OB, but not HFD, dramatically altered the proportion of ovarian granulosa cells, theca-interstitial cells, luteal cells, and endothelial cells. Furthermore, based on the spatial dynamics of follicular development, we defined four subpopulations of granulosa cell and found that obesity drastically disrupted the differentiation of mural granulosa cells from small to large antral follicles. Functionally, HFD enhanced follicle-stimulating hormone (FSH) sensitivity and hormone conversion, while OB caused decreased sensitivity, inadequate steroid hormone conversion, and impaired follicular development. These differences can be explained by the differential expression pattern of the transcription factor Foxo1. Overall, our study provides a powerful and high-resolution resource for profiling obesity-induced OME and offers insights into the diverse effects of obesity on female reproductive disorders.

Decomposing the rural-urban disparities in overweight and obesity among women of reproductive age in Nigeria

BACKGROUND

Overweight and obese women face various reproductive and other health challenges, and in some cases, even mortality. Despite evidence of rural-urban disparities in overweight and obesity among women of reproductive age, there is limited evidence regarding the predictors of these disparities. This study aims to investigate the factors associated with overweight and obesity and examine the contributors to rural-urban disparities in overweight and obesity among women of reproductive age in Nigeria.

METHODS

We utilized the 2018 Nigeria Demographic and Health Survey dataset. The survey employed a two-stage cluster sampling technique based on Nigeria's 2006 census enumeration areas for sample selection. Overweight and obesity were defined as a body mass index (BMI) ≥ 25. Data analyses were conducted using the Logistic Regression Model and the threefold Blinder-Oaxaca decomposition model (α0.05).

RESULTS

The study revealed that older women (OR = 2.44; CI = 2.11-2.83), those with higher wealth (OR = 2.05; CI = 1.81-2.31), contraceptive users (OR = 1.41; CI = 1.27-1.57), and residents of the South-South region (OR = 1.24; CI = 1.07-1.45) were more likely to be overweight/obese. The decomposition analysis indicated that the mean predicted prevalence of overweight and obesity is 35.5% in urban areas, compared to 21.1% in rural areas of Nigeria. Factors such as wealth status, educational level, media exposure, and contraceptive use were identified as significant contributors to these disparities.

CONCLUSION

The findings underscore the importance of addressing socioeconomic disparities when designing healthcare interventions to reduce the burden of overweight and obesity, particularly in urban areas. Prioritizing these factors can facilitate efforts to promote healthier lifestyles and enhance overall well-being.

Effect of laparoscopic sleeve gastrectomy on related variables of obesity complicated with polycystic ovary syndrome

BACKGROUND

Polycystic ovary syndrome (PCOS) is closely related to obesity, and weight loss can significantly improve the metabolic, endocrine and reproductive functions of obese individuals with PCOS. However, the efficacy of laparoscopic sleeve gastrectomy (LSG) for obesity with PCOS are unclear.

AIM

The purpose of the study was to investigate the effect of LSG on related variables in obese patients with PCOS.

METHODS

A retrospective analysis was performed on 32 obese patients with PCOS who received LSG treatment at the Third Hospital of Shanxi Medical University from 2013 to 2020. The changes in anthropometric indices, insulin, testosterone, estradiol, follicle stimulating hormone (FSH), luteinizing hormone (LH), menstrual cycle and LH/FSH ratio before and 1 mo, 3 mo, 6 mo and 12 mo after the operation were statistically analyzed.

RESULTS

At 1 mo, 3 mo, 6 mo and 12 mo after surgery, the anthropometric indices, such as body weight and body mass index, of all patients were lower than those before the operation. The percentage excess weight loss (EWL%) at 1 mo, 3 mo, 6 mo and 1 year of follow-up were 25, 40, 46 and 65, respectively. The PCOS-related indices, such as insulin, testosterone, estradiol, follicle stimulating hormone (FSH), luteinizing hormone (LH) and menstrual cycle, were improved to varying degrees. During the 1-year follow-up, the average serum testosterone decreased from preoperative 0.72 ng/mL to 0.43 ng/mL (P < 0.05), average fasting insulin level (9.0 mIU/mL, preoperative 34.2 mil, LH level, 4.4 mIU/mL, preoperative 6.1 mIU/mL). The level of FSH (3.8 U/L, 4.8 U/p0.05) and the ratio of LH/FSH (0.7, 1.3/p0.05) were more relieved than those before surgery. During the postoperative follow-up, it was found that the menstrual cycle of 27 patients (nasty 27) returned to normal, and 6 patients (18%) who intended to become pregnant became pregnant within 1 year after surgery.

CONCLUSION

The weight loss effect of LSG is obvious and affirmative, and the endocrine index of obese patients with PCOS is also improved to some extent, although the mechanism is not clear. Laparoscopic sleeve gastrectomy is expected to become a backup choice for patients with polycystic ovaries in the future.

Assessing the influence of preconception diet on female fertility: a systematic scoping review of observational studies

BACKGROUND

Preconception diet is a proposed modifiable risk factor for infertility. However, there is no official guidance for women in the preconception period as to which dietary approaches may improve fertility.

OBJECTIVE AND RATIONALE

A comprehensive synthesis of the relevant evidence is key to determine the potentially effective dietary patterns and components as well as evidence gaps, and to provide information for nutritional recommendations for couples planning a pregnancy.

SEARCH METHODS

In this systematic scoping review, four electronic databases (Medline and EMBASE via Ovid processing, CAB Direct, and CINAHL via EBSCO) were searched for observational studies (prospective and retrospective cohort, cross-sectional, and case-control studies) from inception to 27 September 2021. Eligible studies included women of reproductive age during the preconception period, and evaluated exposures related to preconception diet and outcomes related to fertility. Results were synthesized using a descriptive approach.

OUTCOMES

A total of 36 studies were eligible for inclusion (31 prospective, 3 cross-sectional, and 2 case-control studies) and were published between 2007 and 2022. Of the assessed dietary exposures, increased adherence to the Mediterranean diet displayed the strongest and most consistent association with improved clinical pregnancy rates. Reducing trans fatty acids (TFAs), saturated fatty acids, and discretionary food intake (fast food and sugar-sweetened beverages) were associated with improvements in live birth, clinical pregnancy rates, and related ART outcomes. The dietary components of seafood, dairy, and soy demonstrated inconsistent findings across the few included studies.

WIDER IMPLICATIONS

Due to heterogeneity and the limited available literature on most exposures, there is insufficient evidence to support any specific dietary approach for improving fertility. However, following some of the dietary approaches outlined in this review (anti-inflammatory diets, reducing TFA, and discretionary food intake) are consistent with broad healthy eating guidelines, have little to no associated risk, and offer a plausible set of possible benefits. This warrants further exploration in randomized controlled trials.

Obesity from a sign of being rich to a disease of the new age: A historical review

Background and Objective

Obesity has historically been seen as a sign of wealth and social privilege, as can be inferred from studying the ancient works. We aimed to report the causes, diagnostic approaches, and treatment among the authentic books of traditional Iranian medicine.

Methods

We searched the original versions of historical books and used a narrative approach to report the history of obesity.

Results

Obesity was often seen as an indicator of complete health. Obesity in healthy women was a requirement for beauty, based on descriptions of women from the Zoroaster period and from antiquity to the late Qajar period. This point of view existed during various ages. However, after the constitutional period, the view of obesity changed into that of an illness, due to modern ideas and offshore role models, especially during the Pahlavi era. This change led to serious attempts to treat obesity. Obesity is a critical problem that needs immediate attention to prevent substantial health consequences. Different medical paradigms have presented their criteria and foundations throughout history. The emphasis of Iranian alternative medicine was on prevention and the maintenance of health, with the next step being treatment. Prevention, treatment, consuming medicinal plants, and recovery have often been written about in the traditional books of medicine.

Conclusions

Throughout the traditional Iranian medical texts, physicians have made recommendations about maintaining an appropriate body weight. The best treatment was prevention and a healthy lifestyle. The treatments for controlling and restricting obesity included paying attention to nourishment, mobility, and even the habitat.

A high-sugar diet, but not obesity, reduces female fertility in Drosophila melanogaster

Obesity is linked to reduced fertility in various species, from Drosophila to humans. Considering that obesity is often induced by changes in diet or eating behavior, it remains unclear whether obesity, diet, or both reduce fertility. Here, we show that Drosophila females on a high-sugar diet become rapidly obese and less fertile as a result of increased death of early germline cysts and vitellogenic egg chambers (or follicles). They also have high glycogen, glucose and trehalose levels and develop insulin resistance in their fat bodies (but not ovaries). By contrast, females with adipocyte-specific knockdown of the anti-obesity genes brummer or adipose are obese but have normal fertility. Remarkably, females on a high-sugar diet supplemented with a separate source of water have mostly normal fertility and glucose levels, despite persistent obesity, high glycogen and trehalose levels, and fat body insulin resistance. These findings demonstrate that a high-sugar diet affects specific processes in oogenesis independently of insulin resistance, that high glucose levels correlate with reduced fertility on a high-sugar diet, and that obesity alone does not impair fertility.

The germline coordinates mitokine signaling

The ability of mitochondria to coordinate stress responses across tissues is critical for health. In C. elegans , neurons experiencing mitochondrial stress elicit an inter-tissue signaling pathway through the release of mitokine signals, such as serotonin or the WNT ligand EGL-20, which activate the mitochondrial unfolded protein response (UPR MT ) in the periphery to promote organismal health and lifespan. We find that germline mitochondria play a surprising role in neuron-to-peripheral UPR MT signaling. Specifically, we find that germline mitochondria signal downstream of neuronal mitokines, like WNT and serotonin, and upstream of lipid metabolic pathways in the periphery to regulate UPR MT activation. We also find that the germline tissue itself is essential in UPR MT signaling. We propose that the germline has a central signaling role in coordinating mitochondrial stress responses across tissues, and germline mitochondria play a defining role in this coordination because of their inherent roles in germline integrity and inter-tissue signaling.

Comprehensive Review of Anesthetic Evaluation and Management in Obese Female Patients Undergoing In Vitro Fertilization

Obesity has become a global health epidemic with profound implications for various medical specialties, including reproductive medicine. This comprehensive review focuses on the anesthetic evaluation and management of obese patients undergoing in vitro fertilization (IVF) procedures. Obesity, as defined by BMI, is associated with infertility and poses unique challenges for anesthetic care. The review also addresses the timing of anesthesia concerning IVF procedures, the impact of obesity on IVF success rates, and the importance of emotional and psychological support for obese patients undergoing IVF. Challenges and future directions in the field are highlighted, focusing on ongoing research, emerging technologies, and the role of multidisciplinary teams in managing these complex cases. In conclusion, this review underscores the critical role of tailored anesthesia and perioperative care in optimizing outcomes for obese patients undergoing IVF. It provides valuable insights for anesthetic providers, reproductive specialists, and healthcare teams, emphasizing the need for a patient-centered approach to address the unique challenges posed by obesity in the context of assisted reproductive technology.