IVF Unit, Department of Obstetrics and Gynecology, Fırat University Medical School, Elazig, Turkey.
Semin Reprod Med. 2012 Dec;30(6):507-16. doi: 10.1055/s-0032-1328879. Epub 2012 Oct 16.
Obesity has grown to epidemic proportions, and currently nearly half of the reproductive-age women are overweight or obese. Risks, success rates, and economic aspects of infertility treatments in obese women have been extensively investigated. Unfavorable ovarian stimulation characteristics like increased gonadotropin consumption, fewer selected follicles, and lower number of retrieved oocytes have been observed in obese women undergoing assisted reproductive technologies (ART). There seems to be a strong association between increased body mass index and lower pregnancy and live-birth rates and increased miscarriage rate. Coexisting factors like age and polycystic ovary syndrome status have also been blamed for these adverse effects. The mechanisms underlying those adverse outcomes, whether ovarian or endometrial, still remain to be fully elucidated. Moreover, maternal, perinatal, and neonatal complications have also been reported to be higher in obese pregnant women. Hence in some countries strict restrictions exist for access to elective fertility treatment in obese women. However, it is controversial if these policies are socially and ethically acceptable. Furthermore, because weight reduction is not an easy task, it may lead to the decreased probability of conception due to the advancing reproductive age for many obese women. Thus weight reduction should be encouraged and patients counseled accordingly, but whether restriction for fertility treatment is implemented in obese women remains a matter of debate. There remains much to be known regarding the association between obesity and ART.
肥胖已达到流行的程度，目前近一半的育龄妇女超重或肥胖。肥胖女性的不孕治疗的风险、成功率和经济方面已经得到了广泛的研究。在接受辅助生殖技术（ART）的肥胖女性中，观察到了不良的卵巢刺激特征，如增加促性腺激素的消耗、较少选择的卵泡和较少的卵母细胞回收。似乎存在一个强烈的关联，即体重指数增加与较低的妊娠和活产率以及较高的流产率有关。共存的因素，如年龄和多囊卵巢综合征状态，也被归咎于这些不利影响。这些不良后果的机制，无论是卵巢还是子宫内膜，仍有待充分阐明。此外，肥胖孕妇也被报道有更高的母体、围产期和新生儿并发症。因此，在一些国家，对肥胖妇女获得选择性生育治疗的限制非常严格。然而，这些政策在社会和伦理上是否可以接受仍然存在争议。此外，由于减肥不是一件容易的事情，对于许多肥胖的女性来说，由于生育年龄的增加，可能会导致受孕的概率降低。因此，应该鼓励减肥，并相应地对患者进行咨询，但是否对肥胖女性实施生育治疗限制仍然是一个争论的问题。关于肥胖与 ART 之间的关联，还有很多需要了解。
