Obesity and reproduction: a committee opinion

The purpose of this American Society for Reproductive Medicine Practice Committee report is to provide clinicians with principles and strategies the evaluation treatment couples infertility associated obesity. This revised document replaces titled “Obesity reproduction: an educational bulletin” last published in 2015 (Fertil Steril 2015;104:1116–26). Obesidad y Reproducción: una opinión de comité.El propósito este reporte del Comité Práctica Médica la Sociedad Americana Medicina Reproductiva es proveer a prestadores servicios médicos, principios estrategias para evaluación tratamiento parejas con infertilidad asociada obesidad. Este documento revisado reemplaza el titulado “Obesidad Un boletín educacional” publicado por última vez en 2015;104:1116– 26). comité. El DIALOG: You can discuss article its authors other readers at https://www.fertstertdialog.com/posts/33631Over past four decades, obesity (body mass index [BMI] > 30 kg/m2 Western nations) has become global epidemic affecting estimated 603.7 million adults, representing 12% world’s adult population (1Collaborators G.B.D.O. Afshin A. Forouzanfar M.H. Reitsma M.B. Sur P. Estep K. et al.Health effects overweight 195 countries over 25 years.N Engl J Med. 2017; 377: 13-27Crossref PubMed Scopus (2524) Google Scholar). In 1980, 19% women 13% men were obese (2Fryar C.D. Carroll M.D. Afful J. Prevalence overweight, obesity, severe among adults aged 20 over: United States, 1960–1962 through 2015–2016.NCHS Health E-Stats. 2018; By 2017–2018, 42% 43% obese. Severe (BMI 40 kg/m2) now affects 11.5% women. Ethnic disparities prevalence exist. Fifty-seven percent non-Hispanic black, 44% Hispanic, 40% white, 17% Asian are (3Hales C.M. Fryar Ogden C.L. adults: 2017-2018.NCHS Data Brief. 2020; : 1-8Google Fifty-one pregnant or time conception (4Deputy N.P. Dub B. Sharma A.J. trends prepregnancy normal weight - 48 New York City, District Columbia, 2011-2015.MMWR Morb Mortal Wkly Rep. 66: 1402-1407Crossref (87) Scholar).The Global Burden Disease Obesity Collaborators estimate that high BMI results 4,000,000 deaths worldwide annually, 7.1% all-cause mortality Scholar, 5Clinical guidelines on identification, evaluation, executive summary. Expert panel adults.Am Clin Nutr. 1998; 68: 899-917Crossref (1028) annual medical cost illness related approaches $150 billion, excluding maternal morbidity adverse perinatal outcomes (6Kim D.D. Basu Estimating care costs States: systematic review, meta-analysis, empirical analysis.Value Health. 2016; 19: 602-613Abstract Full Text PDF Scholar).Obesity reproduction, including ovulatory menstrual function, natural fertility fecundity rates, success safety, obstetric outcomes. ability deliver optimal be limited by difficulties transvaginal ultrasound imaging ovaries safety considerations, such as difficulty maintaining airway during oocyte retrieval. specialists are, thus, confronted challenge treating increasingly common setting Furthermore, previous assumptions loss interventions improve reproductive being challenged findings several recent studies (7Mutsaerts M.A. van Oers A.M. Groen H. Burggraaff J.M. Kuchenbecker W.K. Perquin D.A. al.Randomized trial lifestyle program infertile women.N 374: 1942-1953Crossref (123) 8Einarsson S. Bergh C. Friberg Pinborg Klajnbard Karlstrom al.Weight reduction intervention prior IVF: randomized controlled trial.Hum Reprod. 32: 1621-1630Crossref (53) 9Legro R.S. Dodson W.C. Kris-Etherton P.M. Kunselman A.R. Stetter Williams N.I. preconception polycystic ovary syndrome.J Endocrinol Metab. 2015; 100: 4048-4058Crossref (96) Scholar).This outlines human reproduction. An assessment therapeutic benefits modification, management, bariatric surgery offered. issues thresholds addressed.Definition obesityObesity disease excess body fat, it increases risk number conditions, type 2 diabetes, dyslipidemia, hypertension, coronary heart disease, cholelithiasis, endometrial postmenopausal breast cancer, stroke, osteoarthritis, (10Willett Manson J.E. Stampfer M.J. Colditz G.A. 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World Organization classification system commonly used nations outlined Table 1 (19World OrganizationWHO Technical Report Series 894.https://books.google.com/books?hl=en&lr=&id=AvnqOsqv9doC&oi=fnd&pg=PA1&dq=WHO+Technical+Report+Series+894&ots=6WF2ao_V8P&sig=x3I66StMIP9UkonTtJFRoEXrVfw#v=onepage&q=WHO%20Technical%20Report%20Series%20894&f=falseDate accessed: June 2, 2021Google Scholar).Table 1WHO obesity.ClassificationBMI (kg/m2)Risk comorbiditiesUnderweight<18.5Low (but problems increased)Normal range18.5–24.9AverageOverweight?25 Preobese25–29.9IncreasedObese?30 Obese class 130–34.9Moderate 235.0–39.9Severe 3?40Very severeNote: Adapted from: Obesity: preventing managing epidemic. WHO Consultation (WHO 894), 2000 = index; Organization. Open table new tab define level because represents reasonable cutoff balancing sensitivity specificity people (20Willett Dietz W.H. Guidelines healthy weight.N 1999; 341: 427-434Crossref (955) Of note, different cutoffs been recommended specific populations basis local adiposity-related population-specific associations between BMI, percentage health risks (21WHO ConsultationAppropriate body-mass implications policy strategies.Lancet. 2004; 363: 157-163Abstract (6743) easily accessible tools, but they do not account individual differences frame lean mass. Additionally, help determining classified nor differentiate pattern (i.e., “apple” vs. “pear” distribution), central greater metabolic risk. Adult readily interpretable more individuals, addresses tied 20Willett particularly significant reproductive-aged most accrues after age 19 years men. important chronic reduced (22Gaskins Rich-Edwards Missmer S.A. Chavarro Association changes female weight.Obstet 126: 850-858Crossref (21) impair reproduction both men, leading trying conceive subsequent complications pregnancy (23ACOG Bulletin No 156: pregnancy.Obstet 112-126Crossref (0) 24Craig J.R. Jenkins T.G. Carrell D.T. Hotaling Obesity, male infertility, sperm epigenome.Fertil Steril. 107: 848-859Abstract 25Broughton D.E. Moley K.H. infertility: potential mediators obesity's impact.Fertil 840-847Abstract (194) Scholar).Ovulation cycle abnormalitiesWomen increased amenorrhea, hyperandrogenism French surgeon/obstetrician Paré early 1633 (26Azziz R. Adashi E.Y. Stein Leventhal: 80 on.Am 214: 247.e1-247.e11Abstract Leventhal (27Stein I.F. M.L. Amenorrhea bilateral ovaries.Am 1935; 29: 181-191Abstract Scholar) reported three seven amenorrheic–oligomenorrheic patients their seminal description Stein–Leventhal syndrome. 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