Gambineri Alessandra, Laudisio Daniela, Marocco Chiara, Radellini Stefano, Colao Annamaria, Savastano Silvia
1Endocrinology Unit, Department of Medical and Surgical Sciences, Centre for Applied Biomedical Research (C.R.B.A.), S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
2Endocrinology Unit, Department of Medical and Surgical Sciences, Federico II University Medical School of Naples, Naples, Italy.
Int J Obes Suppl. 2019 Apr;9(1):65-72. doi: 10.1038/s41367-019-0009-1. Epub 2019 Apr 12.
Obesity is associated with infertility in women through multiple and complex mechanisms. Briefly, the adipose tissue through the production of many factors, such as leptin, free fatty acids (FFA), and cytokines may affect both ovarian and endometrium functions, with a final alteration in oocyte maturation and endometrial epithelium receptivity. In addition, through the development of peripheral insulin resistance obesity produces a condition of functional hyperandrogenism and hyperestrogenism that contribute to produce anovulation and to reduce endometrial receptivity and, therefore participate to cause infertility. Weight loss is able to restore fertility in most cases, but there are no practical indications to guide the clinician to choice the best method among increased physical activity, diet, drugs, and bariatric surgery.
肥胖通过多种复杂机制与女性不孕相关。简而言之，脂肪组织通过产生许多因子，如瘦素、游离脂肪酸（FFA）和细胞因子，可能会影响卵巢和子宫内膜的功能，最终改变卵母细胞成熟和子宫内膜上皮的接受性。此外，通过外周胰岛素抵抗的发展，肥胖产生功能性高雄激素血症和高雌激素血症，这有助于导致无排卵并降低子宫内膜接受性，从而导致不孕。在大多数情况下，体重减轻能够恢复生育能力，但没有实用的指征来指导临床医生在增加体育活动、饮食、药物和减肥手术中选择最佳方法。
