Obesity and Fertility

It is generally accepted that obesity adversely affects female reproductive function
[ 12 – 14 ]. However, the mechanisms are not fully understood and are a popular area
of research. Obesity likely affects reproductive health through a cumulative process
starting with abnormalities in the hypothalamic–pituitary–ovarian (HPO) axis.
Abnormal signalling through the hypothalamus and pituitary may affect follicular
recruitment and infl uence subsequent oocyte quality thus contributing to overall
subfertility in obese women. Studies of women undergoing assisted reproductive

technologies (ART) provide a unique opportunity for direct visualization of repro-
ductive tissues in obese women and have demonstrated that obesity also has direct

effects on oocytes, embryos and on the endometrium. Several retrospective studies

have associated obesity with increased risk for miscarriage in spontaneous concep-
tions [ 15 ], as well as in obese women receiving donor oocytes after IVF [ 16 , 17 ].

The pathophysiology underlying this association is complex and likely