Department of Medicine, Boston VA Healthcare System and Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
Unit of Reproductive Endocrinology, 1(st) Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Greece.
Metabolism. 2020 Jun;107:154229. doi: 10.1016/j.metabol.2020.154229. Epub 2020 Apr 11.
Chronic energy deficiency can impair the hypothalamic-pituitary-gonadal (HPG) axis and lead to hypothalamic anovulation in underweight women. This review presents the syndromes related to underweight status that are associated with infertility, summarizes the underlying mechanisms, and reviews the available treatment options. Eating disorders, such as anorexia nervosa (AN), constitute the most common cause of infertility in underweight women, who, in addition, experience miscarriages, and sexual dysfunction. The relative energy deficiency in sports (RED-S; former terminology: athlete's triad) involves menstrual dysfunction due to low energy availability, which results in anovulation. Moreover, lipodystrophies, malnutrition, starvation, systematic illnesses (malignancies, endocrinopathies, infectious diseases, advanced chronic diseases, neurologic illnesses), and the utilization of drugs can cause excessive weight loss. They may result in fertility problems due to the loss of adipose tissue and the subsequent hormonal disturbances. Each of these conditions requires multidisciplinary management. Nutritional counseling should target the restoration of energy balance by increasing intake and reducing output. Medical treatment, recommended only for patients who did not respond to standard treatment, may include antipsychotics, antidepressants, or leptin administration. Finally, psychiatric treatment is considered an integral part of the standard treatment.
慢性能量不足可损害下丘脑-垂体-性腺（HPG）轴，导致体重不足妇女的下丘脑性无排卵。本综述介绍了与体重不足相关的与不孕相关的综合征，总结了潜在机制，并回顾了现有的治疗选择。饮食失调，如神经性厌食症（AN），是体重不足妇女不孕的最常见原因，此外，她们还会经历流产和性功能障碍。运动相关的相对能量不足（RED-S；以前的术语：运动员三联征）涉及由于能量供应不足导致的月经功能障碍，从而导致无排卵。此外，脂肪营养不良、营养不良、饥饿、系统性疾病（恶性肿瘤、内分泌疾病、传染病、晚期慢性疾病、神经疾病）以及药物的使用都会导致体重过度下降。由于脂肪组织的丧失和随后的激素紊乱，它们可能导致生育问题。这些情况中的每一种都需要多学科管理。营养咨询的目标应该是通过增加摄入量和减少输出来恢复能量平衡。仅对未对标准治疗产生反应的患者推荐使用医学治疗，包括抗精神病药、抗抑郁药或瘦素治疗。最后，精神科治疗被认为是标准治疗的一个组成部分。
