Obesity and infertility: are hyperlipidemia and hyperinsulinemia the bad guys?

Reflections

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VOLUME 116, ISSUE 2, P365-366

Authors:

Anna Lena Zippl, M.D., Beata Seeber, M.D., Ludwig Wildt, M.D., Ph.D.

Abstract:

Reflections on "Gonadotropin response to insulin and lipid infusion reproduces the reprometabolic syndrome of obesity in eumenorrheic lean women: a randomized crossover trial" by Santoro et al.

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Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. 

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Go to the profile of Pandiyan  Natarajan
24 days ago

Obesity and Infertility. Occam's razor-Estrogen is probably the culprit- A clinical perspective.

Body weight plays a significant role in influencing the onset of puberty in children. Overweight and Obesity leads to early onset of puberty and menarche in girls. On the other hand, excess weight delays the onset of puberty in boys. This can clearly be explained from an Evolutionary Perspective.

Fat is the primary storage organ for Energy. Pubertal changes and Menarche indicate the biological preparedness of the individual for reproduction. Certain critical mass of fat is essential for the onset of pubertal changes. Fat cells also convert Androgens to Estrogens through the action of aromatase explaining the early onset of puberty and menarche in Excess weight girls and delayed puberty and menarche in Undernourished girls.

Excess weight (fat) leading to increased estrogen also explains the delayed puberty in boys.

Excess weight leads to several Cardio Metabolic changes both in men and women. The effect of excess weight on Fertility is more profound in women than in men. Excess weight leads to an Hyper estrogenic state which in turn affects the Hypothamao Hypophyseal Gonadal (HPG) axis leading Hypothalamo Pituitary dysfunction. Irregular cycles and PCOS are manifestations of Hypothalamo Pituitary dysfunction.

Obese women are hyper estrogenic and this suppresses FSH leading to an altered LH/FSH ratio as in PCOS. Obese women are also more prone to other diseases associated with Hyper estrogenism like Endometrial Carcinoma.

Obesity in men is more likely to produce sexual dysfunction, particularly diminution of libido and erectile dysfunction due to relative estrogen excess through peripheral conversion of androgens to estrogens. This has not been proven to alter the Semenogram.

Obesity does not lead to Hypogonadotrphic Hypogonadism. Obesity may lead to Hypothalamo Pituitary Dysfunction. Hyperlipedemia and hyperinsulinemia are consequences of Obesity and are unlikely to have a role in the HPG axis.

Applying the principle of Occam's razor, excess estrogen associated with Overweight and Obesity may contribute to Infertility and the other metabolic changes may have no role in Infertility as has been suggested. Weight Loss is not easy but essential. Life style modification is the only answer both for short term and for term health of the patient.

Professor Dr Pandiyan Natarajan,

Professor and Head of the Department of Andrology and Reproductive Medicine,

Chettinad Super Speciality Hospital,

Chettinad Academy of Research and Education,

Kelambakkam, Chennai.

Tamil nadu,

India-603103