Endocrine Abstracts

With an increasing prevalence of overweight and obesity, there is abundant evidence linking these conditions with sub- and infertility in women. The evidence in men is less well developed but is emerging gradually. Even when fertility is achieved in women, there are many conditions of pregnancy that are increased including diabetes mellitus, hypertension, congenital abnormalities and peripartum problems. Children born also have an increased long-term problem of obesity and associated disorders. In males, there is evidence for a non-genomic transfer of metabolic disease to the offspring. Use of assisted reproduction is more comon and compromised by weight disorders.

Abnormalities of eggs, sperm, embryos and endometrium have been documented in overweight conditions in animals and humans.

Lifestyle modification to improve fertility is well documented but not accompanied by a strong literature of randomised trials or evidence-based interventions. It is alledged that >5% weight loss is effective at inducing pregnancy in overweight women. The respective roles of exercise, diet and pharmacology is yet to be determined.

The role of diet has not shown any benefit of any particular composition with most of the effect being due to the amount of calories consumed. It would seem logical to use a low calorie diet with a Mediterranean type composition. Exercise can be arranged to suit the ability of the person to participate and associated medical conditions. There is little evidence for benefit of medications, particularly metformin. A full metabolic profile should be doen prior to pregnancy, especially with respect to glucose.

Much needs to be done to determine, the epidemiology of weight disorders and infertility and outcomes of offspring. Randomised trials are essential to determine the most effective interventions. A better understanding of the pathophysiology of weight and metabolic disorders and fertility is urgently required.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This work was supported, however funding details are unavailable.