Dr. Sharda Jain
Dr. Jyoti Agarwal
Dr. Abhishek Parihar
Dr. Jyoti Bhaskar
Dr. Yogesh Agarwala
Obesity
And
Female Infertility
This PPT is dedicated to Obese women
Content
Epidemic of obesity
Obesity in India
is obese women at risk infertility ?
What is the spectrum ?
What is the mecha...
Available on slideshare.net
Obesity
And
Female Infertility
OBESITY
“AN EMERGING MENACE”
1. > 1 Billion overweight
2. > 300 Million – Obese
3. 26% of non pregnant
women ages 20 – 39 ...
PREVALENCE OF OBESITY
is on increase!! ( 1986 – 2000 )
1. BMI > 30 kg / m2
- doubled
2. Morbid Obesity > 40 kg /m2
quadrup...
Obesity in Men & Women in
Reproductive Age in India
Country Male Female
India 9 12 (2000)
12 16 (2001)
Punjab 30 37.5
Gujr...
• BMI (Body Mass Index)
= Weight in kg / Height in M2
• Waist : Hip Ratio
men > 0.88
women > o.85
Women Waist = 35”
Quanti...
BODY MASS INDEX
-2.5 in each category for
INDIANS
Wonder Why - One Always Gain Weight,
Despite Dieting And Exercise
or just drinking water !!!
Complete
mechanism
Possible Mechanism in
Obesity
• The Complex mechanism of obesity
linking fat excess to metabolic syndrome
is not well unde...
An important underlying mechanism may be
a genetic predisposition to factors
associated with infertility, including alleli...
Obesity, Metabolic Syndrome & Infertility
Adipokine Possible Physiologic Role Values in Metabolic syndrome
Lepitin Regulat...
Obesity is The Root Cause of Some
of the Serious Diseases
Metabolic Disorders
• In Indians , types 2 diabetes and
hyperten...
Obesity is The Root Cause of Some
of the Serious Disease
CARDIOVASCULAR DISEASES
– Obese women have 30% higher
risk of dea...
Morbid Obesity : Takes Heavy
Toll on Women’s Health
- Globally . morbid obesity is responsible for the
following co-morbid...
IMPACT OF OBESITY ON
LONGEVITY
• 2.5 million deaths attributed annually to
obesity
• Direct relationship between increasin...
OBESITY & PSYCHOSOCIAL
HEALTH in WOMAN
1. Poor body image
2. Social stigmatisation (‘a laughing matter’)
3. Lower educatio...
OBESITY in women creates
OBESOGENIC ENVIRONMENT
1. Women at greater risk from obesity than
men all across the world
2. At ...
Obesity & Reproductive Health
• Amenorrhea, anovulation , sub fertility and
infertility is increasingly occurring with hig...
Obesity is strongly associated with
PCOS,
central obesity hyperandrogenism, and insulin
resistance with compensatory hyper...
Is obese women at risk of infertility
an obese woman is about thrice
as likely to be infertile as a
normal woman
it is see...
OBESITY & ASSISTED
REPRODUCTION
1. Obesity leads to poorer prognosis
with Assisted Reproduction
2. Pregnancy Rates in ART ...
Obese women : not only have a lower
chance of pregnancy following
In Vitro Fertilization,
they require higher doses of
gon...
Causes of Poor Pregnancy Rate
Endometrial Factor
It is postulated that lower pregnancy rate associated
with obesity is cau...
• In women with assisted conception,
obesity may further potentiate this
infammatory response, increasing the
known risks ...
OBESITY & PREGNANCY
1. Obesity leads to twinning and
rate of miscarriage
2. rates of medical complications
( pregnancy ind...
OBESITY & PREGNANCY
1. Adverse impact on labor
I.e. increase rate of fetal deathe , still birth &
neonatal death & cong. M...
Management of Obesity
in general
1st
line of management : Lifestyle changes like modification
of diet , physical activity ...
Treatment Modalities
For Infertility in Obesity
Life – Style &
Nutrition
Changes
• Diet
• Exercise
• Psychological
Counsel...
Even 5% Weight loss improves
fertility outcome
Impacts Fertility Outcomes
Word of caution
Prior to ART therapy
Weight loss should be the fist – line
treatment even 5% weight loss improves
fertilit...
Points to Remember
• The new “Fad” diets promoting low- carbs
and only liquid intake show only short –
terms results
• Gen...
Bariatric Surgery
A serious approach to serious problem
LAP Adjustable Gastric Banding
Given - up in India
SLEEVE Gastract...
Our Experience with
Beriatric surgery
Total cases - 17
Unmarried - 5
All started having regular periods of 30 – 45
days Go...
ENHANCED FERTILITY attempt
with Beriatric Surgery
Before
ENHANCED FERTILITY after Beriatric Surgery
Take Home Messages
• Prevalence of obesity has doubled since 1970 s & so is the
infertility in obese women -.
• In obese w...
ADDRESS
11 Gagan Vihar, Near Karkari
Morh Flyover, Delhi - 51
CONTACT US
9650588339, 011-22414049,
WEBSITE :
www.lifecarec...
Thank You
Obesity in female infertility by dr. sharda jain, Dr. jyoti Agarwal , Dr. Jyoti Bhaskar , Dr. Abhishek Parihar, Dr. Yogesh...
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Obesity in female infertility by dr. sharda jain, Dr. jyoti Agarwal , Dr. Jyoti Bhaskar , Dr. Abhishek Parihar, Dr. Yogesh Agarwal

  1. 1. Dr. Sharda Jain Dr. Jyoti Agarwal Dr. Abhishek Parihar Dr. Jyoti Bhaskar Dr. Yogesh Agarwala Obesity And Female Infertility
  2. 2. This PPT is dedicated to Obese women
  3. 3. Content Epidemic of obesity Obesity in India is obese women at risk infertility ? What is the spectrum ? What is the mechanism ? What we can do about it ? Pregnancy outcome of treatment ART in obesity Role of Beriatric surgery
  4. 4. Available on slideshare.net Obesity And Female Infertility
  5. 5. OBESITY “AN EMERGING MENACE” 1. > 1 Billion overweight 2. > 300 Million – Obese 3. 26% of non pregnant women ages 20 – 39 are overweight / obese W H O
  6. 6. PREVALENCE OF OBESITY is on increase!! ( 1986 – 2000 ) 1. BMI > 30 kg / m2 - doubled 2. Morbid Obesity > 40 kg /m2 quadrupled Super Obesity > 50 kg /m2 – five fold Increase Buchwald et al Surg for obesity & realated diseases(2005) 371-381
  7. 7. Obesity in Men & Women in Reproductive Age in India Country Male Female India 9 12 (2000) 12 16 (2001) Punjab 30 37.5 Gujrat 15 17 UP 16 12 Haryana 14 17
  8. 8. • BMI (Body Mass Index) = Weight in kg / Height in M2 • Waist : Hip Ratio men > 0.88 women > o.85 Women Waist = 35” Quantification of Obesity
  9. 9. BODY MASS INDEX -2.5 in each category for INDIANS
  10. 10. Wonder Why - One Always Gain Weight, Despite Dieting And Exercise or just drinking water !!! Complete mechanism
  11. 11. Possible Mechanism in Obesity • The Complex mechanism of obesity linking fat excess to metabolic syndrome is not well understood. • But several experimental studies have shown that altered production of adipokines play a main role in development and progression of this disorder
  12. 12. An important underlying mechanism may be a genetic predisposition to factors associated with infertility, including allelic variants in cytokine genes known to stimulate inflammation or those known to down regulate the anti-inflammatory response Possible mechanism of Infertility in obesity
  13. 13. Obesity, Metabolic Syndrome & Infertility Adipokine Possible Physiologic Role Values in Metabolic syndrome Lepitin Regulation of food intake regulation of SNS activity Increased adiponectin Insulin – sensitizing hormone protection of liver cells from negative effects of fat increase Reduced resistin Part of the inflammatory pattern linked to adipose tissue excess No changes visfatin Part of the inflammatory pattern linked to adipose tissue excess Increased Omentin Protection of endothelial cells reduced chemerin Regulation of adipogenesis Increased RBP - 4 May impair insulin sensitivity may impair liver function Unclear cytokines Part of the inflammatory pattern linked to adipose tissue excess increased
  14. 14. Obesity is The Root Cause of Some of the Serious Diseases Metabolic Disorders • In Indians , types 2 diabetes and hypertension has a close link to obesity • 60 million people suffered from diabetes in 2012 and will exceed 100 million by 2030 • People with BMI >35.0 kg/m have a 6-fold higher risk of diabetes
  15. 15. Obesity is The Root Cause of Some of the Serious Disease CARDIOVASCULAR DISEASES – Obese women have 30% higher risk of death , due to – circulatory system diseases than weight individuals CANCER •Obese women showed more than two times higher rate of breast cancer as compares with their normal weight counterpart
  16. 16. Morbid Obesity : Takes Heavy Toll on Women’s Health - Globally . morbid obesity is responsible for the following co-morbidities 7-41% of cancer cases like breast colon, rectum, kidney, pancreas etc 44% of diabetes cases 23%of ischemic heart disease cases Hyptension , dyslipidemia ,asthma., osteoarthritis gall bladder disease etc.
  17. 17. IMPACT OF OBESITY ON LONGEVITY • 2.5 million deaths attributed annually to obesity • Direct relationship between increasing BMI and relative risk of dying prematurely Nurses health studyNurses health study • In morbidly obese life expectancy is reduced by 9 yrs in women 12 yrs in men Framingham dataFramingham data
  18. 18. OBESITY & PSYCHOSOCIAL HEALTH in WOMAN 1. Poor body image 2. Social stigmatisation (‘a laughing matter’) 3. Lower education levels 4. Lower rates of marriage 5. Lower socio economic levels
  19. 19. OBESITY in women creates OBESOGENIC ENVIRONMENT 1. Women at greater risk from obesity than men all across the world 2. At disproportionate risk from complications of obesity 3. Rates of obesity are in women in India & world over
  20. 20. Obesity & Reproductive Health • Amenorrhea, anovulation , sub fertility and infertility is increasingly occurring with higher body weight • Obese women are more likely to experience irregular menstrual cycle, anovulation, and signs of androgen excess, particurly when the excess weight occurred during adolescent
  21. 21. Obesity is strongly associated with PCOS, central obesity hyperandrogenism, and insulin resistance with compensatory hyperinsulinenia Obesity & Reproductive Health
  22. 22. Is obese women at risk of infertility an obese woman is about thrice as likely to be infertile as a normal woman it is seen that adolescent obesity is associated with a threefold increased risk of lifetime nulliparity and a fourfold increased risk of lifetime nulligravidity Polotsky AJ, hailper SM skurnick JH, LO JC sternfeld B, santoro N associated of adolescent women’s health across the nation (SWAN) fertility steril 2010;93:2004- 11) Yes
  23. 23. OBESITY & ASSISTED REPRODUCTION 1. Obesity leads to poorer prognosis with Assisted Reproduction 2. Pregnancy Rates in ART halved for women with BMI > 35 kg/m2
  24. 24. Obese women : not only have a lower chance of pregnancy following In Vitro Fertilization, they require higher doses of gonadotropins and have an increased miscarriage rate OBESITY & ASSISTED REPRODUCTION
  25. 25. Causes of Poor Pregnancy Rate Endometrial Factor It is postulated that lower pregnancy rate associated with obesity is caused by altered receptivity of endomertium due to disturb endometrium function Oocyte factor Obese women using donor Oocytes eliminates bad effect of quality of egg & however reduced Live birth rate with increasing BMI regardless of Oocytes source is seen. LUKE B, et al. fujimoto VY the effect of maternal body mass index (BMI) and oocyte source on assisted reproductive technology(ART)pregnancy rates andobstetric outcomes. Fertile sterile 2009;92 suppl 1:s52
  26. 26. • In women with assisted conception, obesity may further potentiate this infammatory response, increasing the known risks for adverse reproductive outcome, including fetal loss and stillbirths associated with higher body weight Causes of Poor Pregnancy Rate
  27. 27. OBESITY & PREGNANCY 1. Obesity leads to twinning and rate of miscarriage 2. rates of medical complications ( pregnancy induced hypertension, pre eclampsia, gestational diabetes, thromboembolism….)
  28. 28. OBESITY & PREGNANCY 1. Adverse impact on labor I.e. increase rate of fetal deathe , still birth & neonatal death & cong. Malformation. 2. Higher rates of post partum events & complications
  29. 29. Management of Obesity in general 1st line of management : Lifestyle changes like modification of diet , physical activity and daily habits 2nd line of Management : introduction of pharmacotherapy for patients with BMI above 25 with co – morbidities and BMI above 27 with no co- morbidity Bariatric Surgery : Bariatric Surgery may be an option for treatment of extreme obesity (BMI > 32) when diet and exercise 1 2 3
  30. 30. Treatment Modalities For Infertility in Obesity Life – Style & Nutrition Changes • Diet • Exercise • Psychological Counseling Surgical Intervention • Bariatric surgery ART • IUI • IVF • ICSI Pharmacological intervention Appetite suppressant, Weight Loss Drugs (Orlistat) Drugs Increase sucidal tendency
  31. 31. Even 5% Weight loss improves fertility outcome Impacts Fertility Outcomes
  32. 32. Word of caution Prior to ART therapy Weight loss should be the fist – line treatment even 5% weight loss improves fertility outcome. • Dietary weight loss, Regular physical exercise , elimination of tabacco of alcohol consumption behavior modification and stress management may be of benefit ESHRE human reproduction 2010;25:578-83
  33. 33. Points to Remember • The new “Fad” diets promoting low- carbs and only liquid intake show only short – terms results • Genes may influence your fats stored , distributed and consumed during exercises family influence. • Medical conditions like hypothyroidism, Cushing syndrome , polycystic ovary syndrome and depression needs due medical care
  34. 34. Bariatric Surgery A serious approach to serious problem LAP Adjustable Gastric Banding Given - up in India SLEEVE Gastractomy & Gastric Bypass surgery are the only alternative Safety of operation in India – in good hands - is as safe as Lap. Cholecystectomy
  35. 35. Our Experience with Beriatric surgery Total cases - 17 Unmarried - 5 All started having regular periods of 30 – 45 days Got married. Two had spontaneous pregnancy & delivered 12 cases – Married Two had pregnancy with IUI & three had IVF ICSI pregnancy 7 Pregnancy Hypertension, DM, Cholesterol has magical relief
  36. 36. ENHANCED FERTILITY attempt with Beriatric Surgery Before
  37. 37. ENHANCED FERTILITY after Beriatric Surgery
  38. 38. Take Home Messages • Prevalence of obesity has doubled since 1970 s & so is the infertility in obese women -. • In obese women - it can result in hyperandrogenism , PCOS, and other metabolic co-morbidities like DM, Hypertension • Obese women undergoing IVF needs higher doses of gonadoprophines & have a lower pregnancy rate • Pregnancy performance in obese women is highly subnormal • With Bariatric Surgery in morbidly obese women - there is big help in ART cycles
  39. 39. ADDRESS 11 Gagan Vihar, Near Karkari Morh Flyover, Delhi - 51 CONTACT US 9650588339, 011-22414049, WEBSITE : www.lifecarecentre.in www.drshardajain.com www.lifecareivf.com E-MAIL ID Sharda.lifecare@gmail.com Lifecarecentre21@gmail.com info@lifecareivf.com &
  40. 40. Thank You

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