College of Medicine, Mohammed Bin Rashid University of Medicine, and Health Sciences, Building 14, Al Razi St., Umm Hurair 2, Dubai Healthcare City, P.O. Box 505055, Dubai, United Arab Emirates.
Best Pract Res Clin Obstet Gynaecol. 2023 Jul;89:102336. doi: 10.1016/j.bpobgyn.2023.102336. Epub 2023 Apr 8.
Infertility is a significant global health issue, with a negative impact on people's wellbeing and human rights. Despite the longstanding association between obesity and infertility, there remains uncertainty, about the precise mechanisms underpinning this association and best management strategies. In this article, we aimed to address these uncertainties by reviewing the recent literature, and focusing on studies which evaluated live birth rates. We found that just over half of the studies, investigating the relationship between preconception maternal weight and live birth rates found an inverse correlation. There was, however, insufficient evidence, that preconception maternal lifestyle or pharmacological interventions in obese women with infertility, resulted in improved live birth rates. The implications for clinical practice and future research are highlighted. For example, the need to consider some flexibility in applying strict preconception body mass index targets, limiting access to fertility treatment, and a need for large clinical trials of new pharmacological options and bariatric surgery.
不孕是一个重大的全球健康问题,对人们的幸福感和人权有负面影响。尽管肥胖与不孕之间存在长期关联,但对于这种关联的确切机制和最佳管理策略仍然存在不确定性。在本文中,我们旨在通过回顾最近的文献来解决这些不确定性,并重点关注评估活产率的研究。我们发现,在调查孕前母体体重与活产率之间关系的研究中,只有略多于一半的研究发现存在反比关系。然而,没有足够的证据表明,对不孕肥胖女性进行孕前生活方式或药物干预可以提高活产率。本文强调了这对临床实践和未来研究的影响。例如,需要考虑在限制获得生育治疗的情况下,在应用严格的孕前体重指数目标方面具有一定的灵活性,并且需要进行新的药物选择和减肥手术的大型临床试验。