Obesity and Gynecology Obesity and Gynecology Second Edition Edited by Tahir A. Mahmood Victoria Hospital, Kirkcaldy, United Kingdom University of St. Andrews, St. Andrews, United Kingdom Sabaratnam Arulkumaran Division of Obstetrics and Gynaecology, St. George’s University of London, London, United Kingdom Frank A. Chervenak Lenox Hill Hospital, New York, NY, United States Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States Elsevier Radarweg 29, PO Box 211, 1000 AE Amsterdam, Netherlands The Boulevard, Langford Lane, Kidlington, Oxford OX5 1GB, United Kingdom 50 Hampshire Street, 5th Floor, Cambridge, MA 02139, United States Copyright © 2020 Elsevier Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. 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British Library Cataloguing-in-Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging-in-Publication Data A catalog record for this book is available from the Library of Congress ISBN: 978-0-12-817919-2 For Information on all Elsevier publications visit our website at https://www.elsevier.com/books-and-journals Publisher: Stacy Masucci Acquisitions Editor: Tari Broderick Editorial Project Manager: Sara Pianavilla Production Project Manager: Sreejith Viswanathan Cover Designer: Matthew Limbert Typeset by MPS Limited, Chennai, India Dedication To Aasia, Gayatri and Judy For their tolerance of our enthusiasm, support in times of happiness, succor in times of challenge, and endless love Tahir, Arul and Frank Contents List of contributors xiii Polycystic ovarian syndrome in adolescence 17 About the editors xvii Obstetric outcomes in obese adolescents 18 Preface—obesity in gynaecology xix Management principles 19 Management of polycystic ovarian syndrome in adolescence 20 Section 1 Psychological morbidity 21 Conclusion 21 Obesity and adolescence References 21 1. Obesity and the onset of 3. Obesity in polycystic ovary syndrome adolescence and infertility Zana Bumbuliene, Gabriele Tridenti and Ioannis E. Messinis, Christina I. Messini and Anastasia Vatopoulou Konstantinos Dafopoulos Obesity in childhood and adolescence: Introduction 23 definition 3 Obesity and infertility—possible mechanisms 23 Obesity in childhood and adolescence: Diet, lifestyle changes, and bariatric surgery 26 incidence 3 Clomiphene citrate 27 Obesity in children and adolescents: etiology 4 Aromatase inhibitors 28 Obesity and puberty: pathophysiology 7 Follicle-stimulating hormone 28 Obesity and pubertal development 8 Insulin sensitizers 29 Obesity in childhood and adolescence: clinical In vitro fertilization 29 manifestation 9 References 30 Obesity in children and adolescents: counseling 9 Obesity in children and adolescents: management 11 Section 2 References 11 Contraception 2. Obesity in adolescence 4. Obesity and sexual health Gail Busby and Mourad W. Seif Sharon Cameron and Michelle Cooper Introduction 15 Prevalence of childhood obesity: a global Introduction 37 perspective 15 Obesity and sexual behavior 37 Obesity and the pubertal transition 16 Obesity and sexual function 38 Factors affecting childhood and adolescent Obesity and sexual health outcomes 39 obesity 16 Conclusion 40 Adolescent obesity—adverse outcomes 16 References 40 vii viii Contents 5. Obesity and contraception Section 3 Sujeetha Damodaran and Krishnan Swaminathan Male and female Infertility Introduction 43 Risks of obesity in pregnancy 43 8. Obesity and hirsutism Classification of obesity based on body mass Mostafa Metwally index 43 Potential concerns with obesity and Introduction 77 contraception 43 Obesity and ovarian function 77 Obesity and contraceptive efficacy 44 Obesity and androgen production 77 Evidence (or lack of) for contraceptive Hirsutism 77 efficacy in overweight or obese women 45 Obesity and polycystic ovarian syndrome 78 Safety of hormonal contraceptives in obese The role of adrenal androgens in obese women women 46 with hirsutism 78 Obesity, contraception, and cardiovascular Management of hirsutism associated with disease 49 obesity 78 Obesity, contraception, and venous Treatment 79 thromboembolism 49 Conclusion 81 Obesity, contraception, and cancer 50 References 81 Contraceptive issues after bariatric surgery 50 Intrauterine contraceptive devices in obese women 51 Sterilization procedures in obese women 51 9. Obesity and female infertility References 52 Suresh Kini, Mythili Ramalingam and Tahir A. Mahmood 6. Contraceptive choices for women Introduction 83 before and after bariatric surgery Epidemiology 83 Pathophysiological basis of infertility in obese Agnieszka Jurga-Karwacka and Johannes Bitzer women 83 The clinical effects of obesity on female Introduction—Bariatric Surgery 57 infertility 85 Long acting contraceptives 58 Challenges of managing obese women 87 Progesterone-only injection 61 Treatment options 87 Oral hormonal contraception [56] 62 Conclusion 89 Progestogen-only pill 62 References 89 Safety and health benefits 62 Contraceptive patch and ring 63 Barrier method 63 Emergency contraception 63 10. Obesity and recurrent References 63 miscarriage Andrew C. Pearson and Tahir A. Mahmood 7. Long-term contraceptive care in obese Introduction 91 and superobese women Obesity and miscarriage 91 Johannes Bitzer Obesity and recurrent miscarriage 92 Polycystic ovarian syndrome 92 Introduction 67 Ovarian dysfunction 92 Combined hormonal contraceptives 67 Endometrial changes in obesity 93 Copper intrauterine device 68 Immunological factors 93 Levonorgestrel-containing intrauterine Male obesity and recurrent miscarriage 93 systems 69 Management 93 Etonogestrel-releasing implant 70 Conclusion 95 References 72 References 95 Contents ix 11. Obesity and assisted reproduction 15. Obesity, bariatric surgery, and male Mark Hamilton and Abha Maheshwari reproductive function Introduction 97 Man-wa Lui, Jyothis George and Prevalence of obesity in the assisted Richard A. Anderson reproduction sector 97 Introduction 135 Evidence of reduced fertility in the obese 97 Bariatric surgical techniques 135 Specific issues relating to assisted reproduction Pathophysiology in obesity 136 treatment 98 Obesity and spermatogenesis 138 Rationale for the use of assisted Obesity and Sertoli cell function 139 reproduction 98 Obesity and erectile dysfunction 139 Practical management of obese women Transgenerational epigenetic effects 139 undertaking assisted reproduction Practical considerations 139 treatment 99 References 140 Clinical procedures 99 Effect of obesity on the results of assisted reproduction treatment 100 16. Medical interventions to improve Safety issues for mothers and offspring 101 outcomes in infertile obese women Ethical issues relevant to access to services 102 planning for pregnancy Conclusion 103 References 103 Vikram Talaulikar Introduction 143 12. Obesity and sexual dysfunction in Impact of high body mass index on fertility and pregnancy 143 men Lifestyle interventions to improve outcomes in Darius A. Paduch and Laurent Vaucher infertile obese women planning for pregnancy 143 Physiology of sexual function 105 Dietary interventions 144 Sexual dysfunction and obesity-related Diet 144 comorbidities 110 Role of exercise 144 Multidisciplinary approach to treatment 113 Weight-loss medications and fertility outcomes 145 References 116 Metformin 145 Sibutramine 147 Orlistat 147 13. Male obesity—impact on semen Liraglutide 147 quality Barriers to weight loss 148 Conclusion 148 Vanessa Kay and Sarah Martins da Silva References 149 Introduction 119 Impact on semen quality 119 17. Surgical interventions to improve Combined semen parameters 120 fertility potential in obese men and Etiological theories 121 Treatment 123 women Conclusion 124 Joseph Chervenak and Frank A. Chervenak References 124 Introduction 151 Obesity and fertility 151 14. Evidence-based assisted reproduction Nonsurgical management of obesity 152 in obese women Bariatric surgery as a weight loss measure 152 Types of bariatric surgery 152 Brenda F Narice and Mostafa Metwally The impact of bariatric