Klenov Violet E, Jungheim Emily S
Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Washington University School of Medicine, Washington University, St. Louis, Missouri, USA.
Curr Opin Obstet Gynecol. 2014 Dec;26(6):455-60. doi: 10.1097/GCO.0000000000000113.
Over the last decade, the evidence linking obesity to impaired reproductive function has grown. In this article, we review this evidence and discuss the underlying pathophysiology.
Obese women are less likely than normal-weight women to achieve pregnancy. Female obesity adversely affects reproductive function through alterations in the hypothalamic-pituitary-ovarian axis, oocyte quality, and endometrial receptivity. It is unclear which mechanism contributes the most to subfecundity, and it is likely a cumulative process. Emerging data highlight the contribution of male obesity to impaired reproductive function and that couple obesity has synergistic adverse effects. Once pregnant, obese women are at higher risk for adverse pregnancy outcomes. Weight loss improves reproductive potential in obese patients. As obese women surpass 35 years of age, age may be more important than body mass index in determining reproductive potential.
Obstetrician gynecologists need to be aware of the negative impact of obesity on reproductive function so that they appropriately counsel their patients. Further work is needed to clarify the underlying pathophysiology responsible for adverse effects of obesity on reproduction so that novel treatment approaches may be developed.
在过去十年中，将肥胖与生殖功能受损联系起来的证据不断增加。在本文中，我们回顾了这一证据并讨论了潜在的病理生理学机制。
肥胖女性比体重正常的女性更难怀孕。女性肥胖通过下丘脑 - 垂体 - 卵巢轴、卵母细胞质量和子宫内膜容受性的改变对生殖功能产生不利影响。目前尚不清楚哪种机制对生育力低下的影响最大，而且这可能是一个累积过程。新出现的数据突出了男性肥胖对生殖功能受损的影响，以及夫妻双方肥胖具有协同的不利影响。一旦怀孕，肥胖女性出现不良妊娠结局的风险更高。减肥可提高肥胖患者的生殖潜能。当肥胖女性超过35岁时，在决定生殖潜能方面，年龄可能比体重指数更重要。
妇产科医生需要意识到肥胖对生殖功能的负面影响，以便为患者提供适当的咨询。需要进一步开展工作以阐明肥胖对生殖产生不利影响的潜在病理生理学机制，从而开发新的治疗方法。
