Obesity and reproduction: impact and interventions.

PURPOSE OF REVIEW: To examine the impact of obesity and potential intervention upon human reproduction in the domain of fertility, fertility treatment, pregnancy and its complications. RECENT
FINDINGS: The prevalence of obesity in women of reproductive age continues to increase, with recent recognition that visceral obesity is associated with greater metabolic disturbances and reduced fecundity, even in ovulating women. Although the efficacy of infertility treatment is reduced by obesity, this effect is not profound and indeed the argument for weight reduction in young women is better serviced by the obesity-dependent increases in perinatal and maternal risks during pregnancy and potential modification of long-term health. Although lifestyle modification alone can induce significant metabolic improvement, resumption of ovulation and reduction of perinatal risks, greater weight loss, and therefore greater potential benefit, can be achieved in combination with pharmacological agents or bariatric surgery.
SUMMARY: Obesity in women has a broad, negative impact upon human reproduction. Specific risks through pregnancy are real and may be addressed by lifestyle modification leading to weight loss and improved insulin sensitivity. Obese women undergoing fertility treatment should be advised of the increased and absolute increased risks they are undertaking, and fertility centres should adopt appropriate strategies.