Background: Obesity is significantly associated to several reproductive disorders in women. However, the molecular mechanisms involved in this association are complex and still not completely understood. The aim of our study was to determine the prevalence of reproductive disturbances in a group of women with morbid obesity.
Methods: We conducted a cross sectional study in 50 women with a body mass index (BMI) ≥40 kg/m2 collected in the endocrinology department of La Rabta hospital over a period of 6 months (October 2017March 2018). Patients with hypothyroidism and Cushing syndrome were excluded. Clinical, biological and ovary ultrasound findings were collected in all participants.
Results: The average age of our patients was 34.2±7.51 years. Their mean BMI was 44.53±3.97 kg/m2 and their waist circumference was 123.38±10.89 cm. Menstrual cycle disturbance were found in 46% of our population: 42% had spaniomenorrhea and the remaining 4% had secondary amenorrhea. Twenty seven percent of cases had infertility: it was primary in 20% and secondary in 7%. The prevalence of hyperandrogenism was 46%. Polycystic ovary syndrome was diagnosed in 40% of our patients. During pregnancy, a history of miscarriage was found in 57% with a mean number of abortion of 1.1±1.5. Furthermore, women with morbid obesity had an elevated risk of complications during pregnancy as gestational diabetes mellitus and pregnancy induced hypertension were present in 37% and 22%, respectively.
Conclusion: Female morbid obesity affects reproductive function by altering the hypothalamic- pituitary-ovarian axis, oocyte quality, endometrial receptivity and causing adverse pregnancy outcomes. This can be explained by the presence of a condition of functional hyperandrogenism and hyperinsulinaemia, which accompanies the insulin-resistant state in severely obese patients. Weight loss can improve reproductive potential in these patients.
18 - 21 May 2019
European Society of Endocrinology