Question

• Explain the primary mechanisms that underlie the effects of obesity and underweight on fertility in women and men.

• Identify two mechanisms by which a negative energy balance can influence fertility

Answer 1

Obesity is a major cause of many morbidities in human beings.

Infertility one of an important medical condition by which many females and males suffer.

In women, Obesity is most commonly associated with PCOD(Polycystic Ovarian Disease).
PCOD is the most common endocrine disorder of reproductive age females affecting 4-12% females.

PCOD is a syndrome manifested by amenorrhea, hirsutism, obesity and enlarged ovaries.

Most patients of PCOD are obese (BMI>30kg/m2). The risk of PCOD increases with obesity.
Insulin resistance/ hyperinsulinemia is also associated with Obesity and PCOD which affects the fertility of females.
Insulin resistance is defined as reduced glucose uptake response to a given amount of insulin 70-75% PCOD patients will have hyperinsulinemia which itself contributes to hyperandrogenism in two ways:

1. By stimulating the synthesis of androgens from ovary along with LH.
2. By decreasing sex hormone-binding globulin.

Insulin resistance appears to stem from a post binding abnormality in Insulin Receptor-mediated signal transduction.
Insulin sensitivity is decreased more in obese women with PCOD than lean women.

A flowchart will excellently defined the effects of obesity on fertility....

Obesity effect on fertility ovary ovary Id adipose tissue tissue pitutary Early follicle atresia liver delayed terus • Stromal decidualization . endometrial Receptivity delcuyed meiotic - maturation - ② Aneuploidia - ® Fallialar tropins •TNF-a o IL 6 6 OSHIG (Sen Hormon Binding globulin apoptosis o Androgen o estrogen ® • insulin Resistance infertitity


P ecos (polycystic ovenian Syndrome) 1 no [Steln Levinthal Syndrome] older = PCOD = disease. Now = Synchrome - at the level of overy. 1680/ producing Excess androgens 6 o Arrest of follicular growth. I ovary © No dominent follicle • Upto 75% of these a amovulation. Androgen also have insuline Excess in Circulation. Resistence hyper insulinemia.] dyslipidemias - Hirsutism. I o upto 50.). will also have jobesity. ] _ o. I t Alipere metu bolic syndrome androgen & • Pesistiutty L4 to contributing to - further stimulate e stimulate ovary Anovulation. ovary to Release Androgen. Scanned with CamScanner

of a peos can have - HAIRAN, Synchronne hype androgen grönthosis E t . Nigricans o Cuteneous markes of IR coitania, for dy • Neck Nape • Axilla (Rotterdamn's criteria) o groin If a of the following 3 o Euder breast tissue are met them we will make provisional dx of pcos. O amenorthea / oligomenorrhea. Lo anovulations — Break throw bleeding. menorrhagia - can be a presentation." (Not Required for dx) obese have this [thin giylı | presenta alt more © amenorrhea /oligo. - Blood love of Radeogen - S testos @ huyen gyhogenania and loo hypu anchogenisn. > eonelde M - upto Tonglde severe alevalion - Not in pcos - seen in tumor of androgeni 0 - - pcos - 150 hylde / La<200 ugldi Ica Scanned with CamScanner

→ if q pt have only hissution **Ocp provide – endo metrial protection. 7 Pts have only hissution DOC - ocps. to endline — Spironolacion. to groline apre cyproterore acetate byth line metformin h 5th line (for insulin can't use for hirsutism Danazolin I inhibit gn RH on Rh Qgonist croutingius) Resistance) add ē Ocps- H other - flutamide i finasteride Liketoconazole danazol itself has severe androgerie SIE topical Agent for Hirsutism. ty to topical efbonithine. My of Infertility - Tovulation indiction. I we mwlti folliculon micka anovulation. I the line I mu delelope It advise Ist advise - weight long letrozole weight loss CSÈRM) > clomiphene tCitrate aromatase Inhibitor o dose it causes monofollicular development Antagonistic ом. - Estrogen Reflex rin 5 d. " can be given Ds Dg Scanned with CamScanner O₂ - D6

Now let's talk about the effect and mechanism of Negative Energy Balance on fertility.
As we know when we take less calories and our energy expenditure is high then it is known as Negative Energy Balance.
I am posting a flowchart which will explain how it affects fertility.

Negative energy balance Impaired GnRH Sevestion Mobilisation of proteins f adipose tissue as an energy source Impaired LH production Ketosis Impaired liver function pode oestrus Inadequate LH demonstęation stimulath Invuased levels of TAG Errors in - Heat detection delayed ovulation Impaiced function of uterine macrophages & neutrophills PCOD Retained placenta Inflammation Endometerum low pregnancy rates

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