Panminerva Medica Impact of Body Mass Index on Female Fertility And
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Panminerva Medica EDIZIONI MINERVA MEDICA ARTICLE ONLINE FIRST This provisional PDF corresponds to the article as it appeared upon acceptance. A copyedited and fully formatted version will be made available soon. The final version may contain major or minor changes. Impact of body mass index on female fertility and ART outcomes Majdi IMTERAT, Ashok AGARWAL, Sandro Cassiano ESTEVES, Jenna MEYER, Avi HARLEV Panminerva Medica 2018 Jun 28 DOI: 10.23736/S0031-0808.18.03490-0 Article type: Review Article © 2018 EDIZIONI MINERVA MEDICA Article first published online: June 28, 2018 Manuscript accepted: June 20, 2018 Submission Date: May 31, 2018 Subscription: Information about subscribing to Minerva Medica journals is online at: http://www.minervamedica.it/en/how-to-order-journals.php Reprints and permissions: For information about reprints and permissions send an email to: [email protected] - [email protected] - [email protected] EDIZIONI MINERVA MEDICA COPYRIGHT© EDIZIONI MINERVA MEDICA Imterat M et al Body mass index and female fertility Impact of body mass index on female fertility and ART outcomes Majdi IMTERAT1 MD *, Ashok AGARWAL2 MD PhD, Sandro C. ESTEVES3 MD PhD, Jenna MEYER4, and Avi HARLEV5 MD Author affiliations 1Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel; 2American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, Ohio, USA; 3ANDROFERT, Andrology and Human Reproduction Clinic, Referral Center for Male Reproduction, Campinas, SP, Brazil; 4Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; 5Fertility and IVF Unit, Soroka University Medical Center, Ben Gurion University of the Negev, Beer Sheva, Israel. Short title: body mass index and female fertility Acknowledgements: None. Financial Support: This research received no specific grant from any funding agency, commercial or not-for-profit sectors. Conflicts of interest: None. *Corresponding author: Majdi Imterat, MD, Department of Obstetrics and Gynecology Soroka University Medical Center, 151 Izak Rager Ave. Beer-Sheva 84101, Israel Phone: +972-52-8868007, Fax: +972-8-8605662, email: [email protected] ORCID ID: 0000 0001 7174 8591 Table of Contents This document is protected by international copyright laws. No additional reproduction is authorized. It is permitted for personal use to download and save only one file and print only one copy of this Article. It is not permitted to make additional copies (either sporadically or systematically, either printed or electronic) of the Article for any purpose. It is not permitted to distribute the electronic copy of the article through online internet and/or intranet file sharing systems, electronic mailing or any other means which may allow access to the Article. The use of all or any part of the Article for any Commercial Use is not permitted. The creation of derivative works from the Article is not permitted. The production of reprints for personal or commercial use is not permitted. It is not permitted to remove, cover, overlay, obscure, block, or change any copyright notices or terms of use which the Publisher may post on the Article. It is not permitted to frame or use framing techniques to enclose any trademark, logo, or other proprietary information of the Publisher. COPYRIGHT© EDIZIONI MINERVA MEDICA Imterat M et al Body mass index and female fertility 1. Abstract 2. Introduction 3. Overview of Body Mass Index a. Epidemiology b. Pathways associating BMI and the reproductive system 4. Effects of BMI on fecundity a. Overweight (Obesity) 1. Background 2. Impact on Ovulation 3. Endometrium Receptivity b. Underweight c. Risks to adverse pregnancy complication 5. Assisted reproductive technology a. Background b. Indications for treatment c. Metabolic factors affecting ART results 6. Effects of BMI on ART outcomes 7. Do Lifestyle Modifications Affect ART Outcome? 8. Conclusions 9. References This document is protected by international copyright laws. No additional reproduction is authorized. It is permitted for personal use to download and save only one file and print only one copy of this Article. It is not permitted to make additional copies (either sporadically or systematically, either printed or electronic) of the Article for any purpose. It is not permitted to distribute the electronic copy of the article through online internet and/or intranet file sharing systems, electronic mailing or any other means which may allow access to the Article. The use of all or any part of the Article for any Commercial Use is not permitted. The creation of derivative works from the Article is not permitted. The production of reprints for personal or commercial use is not permitted. It is not permitted to remove, cover, overlay, obscure, block, or change any copyright notices or terms of use which the Publisher may post on the Article. It is not permitted to frame or use framing techniques to enclose any trademark, logo, or other proprietary information of the Publisher. COPYRIGHT© EDIZIONI MINERVA MEDICA Imterat M et al Body mass index and female fertility Abstract As the global mean body mass index (BMI) is on the rise, the importance of understanding exactly how female fertility is impacted by once outlier BMI values, becomes ever more important. Studies have implicated abnormal BMI impacts the female reproductive system by contributing to anovulation, irregular menses, adverse oocyte quality, endometrial alterations, and hormonal imbalances that ultimately result in female infertility, which could complicate natural conception efforts and request considering assisted reproductive technology (ART) in such couples. With an increase in the demand for ART, it is crucial to understand what factors can be altered by the female BMI, in order to maximize the opportunity for successful pregnancy. The current study aimed to review the information about the effect of BMI on the female fertility and ART outcomes. The complex nature of the female reproductive system leaves space for multiple factors to adversely affect its processes. Imbalances in the hypothalamus-pituitary-ovarian axis can impede efforts for couples to conceive. Leptin and estrogen are two hormones that have been implicated in regulating BMI as well as reproductive physiology. Lifestyle modifications prior to, and during ART have shown promise enhancing fecundity. The intricacies female reproductive system leaves much to the unknown, and often with conflicting results. Further research is required to fully elucidate what facets of female fertility are influenced by BMI, and how the healthcare provider can facilitate successful outcomes. The current review will enable a better consultation and treatment. Key words: fecundity, infertility, reproduction, obesity, underweight, estrogen, leptin, insulin, endometrium, ovulation, lifestyle. This document is protected by international copyright laws. No additional reproduction is authorized. It is permitted for personal use to download and save only one file and print only one copy of this Article. It is not permitted to make additional copies (either sporadically or systematically, either printed or electronic) of the Article for any purpose. It is not permitted to distribute the electronic copy of the article through online internet and/or intranet file sharing systems, electronic mailing or any other means which may allow access to the Article. The use of all or any part of the Article for any Commercial Use is not permitted. The creation of derivative works from the Article is not permitted. The production of reprints for personal or commercial use is not permitted. It is not permitted to remove, cover, overlay, obscure, block, or change any copyright notices or terms of use which the Publisher may post on the Article. It is not permitted to frame or use framing techniques to enclose any trademark, logo, or other proprietary information of the Publisher. COPYRIGHT© EDIZIONI MINERVA MEDICA Imterat M et al Body mass index and female fertility Introduction Body Mass Index (BMI) has long been known to affect various aspects of human health. An abnormal BMI alters the ability for the body to function normally; whether above or below a healthy range, these extremes hinder regular physiology. The effects of BMI on female fertility have been detailed to a degree. There has not been a consensus on how exactly BMI impacts the reproductive system, and even less agreement on the effects BMI has had on assisted reproductive technology (ART) outcomes. Thus, conflicting reports on how exactly BMI affects female fertility are abundant in the literature. It has been suggested that reproductive system malfunction may result from impaired follicular recruitment, impedance of oocyte development, reduced fertilization rates, or the like. This lack of accord on pathophysiology and impact of an abnormal BMI, complicates the caregiver’s ability to adequately address and counteract the effects abnormal BMI on the reproductive system function in general and fertility in particular. The goal of this review is to provide a comprehensive accumulation of the literature regarding the various effects of BMI and associated molecular pathways on ART, as well as to assess any modifications necessary when treating individuals outside the normal BMI range. This document is protected by international copyright laws. No additional reproduction is authorized. It is permitted for personal use to