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Assisted Reproduction and Infertility
In Vitro Fertilisation at nine years of age
and, similarly, sons of obese women with
In 1994, our group demonstrated the suboptimal ovarian response PCOS have a higher bodyweight from early infancy and insulin
to FSH in overweight women.
A recent review reported reduced resistance in older age.
For the above reasons, clinicians taking
pregnancy rates associated with weight excess (BMI ≥25 kg/m
care of infertility in obese women, in particular those with a BMI in
and a significantly lower fecundability associated with being excess of 35kg/m
, should adopt measures to reduce their
overweight was found in the three largest retrospective studies bodyweight prior to exposing them to the risk of pregnancy, and an
(8,457, 5,019 and 3,586 in vitro fertilisation [IVF] cycles, important part of this defensive programme should be the use of an
respectively) to date.
The negative effect of obesity on the effective contraceptive method.
outcome of IVF cycles seems to be related to a woman’s age and,
interestingly, in a large retrospective study the highest impact on Restoring Health and Fertility with Diet
fecundability was observed in young women, while the effect was Weight loss in obese PCOS patients reduces ovarian volume and
less apparent in women in their mid-30s and disappeared after 36 microfollicle number and restores menstrual cyclicity, spontaneous
years of age (see Figure 2). or inducible ovulation and fertility,
so there is a strong indication
for lifestyle change. Biological improvements are achieved quickly
Complications and Risks of Pregnancy in with diet. A treatment including 16 weeks of aerobic training with
Women with Obesity and/or dietary restriction (fewer than 1,000 calories daily) induces a
Polycystic Ovary Syndrome significant increase in the mitocondrial content of skeletal muscle
Miscarriage associated with improved insulin resistance.
Since compliance in
PCOS is usually associated with an increased risk of miscarriage; this area of medicine is poor,
all of the various weight-
however, not all studies found a rise in risk.
Obesity also seems to management programmes, including diet, exercise, drugs and
be an independent risk factor for miscarriage, although this bariatric surgery, should be considered.
Guidelines for dietary and
complication has been reported mainly in pregnancies resulting lifestyle intervention are available,
and clinical studies on lifestyle
from assisted reproduction,
and the observation is still changes and insulin-sensitising agents
or thermogenetic drugs
A recent Finnish cross-sectional study failed to show report promising results associated with these strategies,
a raised risk of miscarriage in women with either PCOS or obesity. promoting fertility free from iatrogenic risks. ■
Pier Giorgio Crosignani is a Consultant for the
Antepartum complications such as gestational diabetes,
Research Programmes on Lifestyle and Women's
hypertensive disorders, thromboembolism, infections, pre-term Health at the Fondazione IRCCS Policlinico Institute
delivery and multiple pregnancies have been associated with
in Milan. He is a Professor of Obstetrics and
Gynaecology and was Chairman of the Department at
the University of Milan between 1979 and 2007. He is
co-founder, Past Chairman and an honorary member
of the European Society of Human Reproduction and
Embryology (ESHRE). Dr Crosignani is also Deputy
Stillbirths and congenital anomalies are increased in foetuses born
Editor of Human Reproduction (Oxford), a Fellow ad eundem of the Royal College of
to obese mothers. This is especially true where gestation occurs in Obstetricians and Gynaecologists and an honorary member of the Finnish Society
moreover, being overweight or obese in
of Obstetrics and Gynaecology and the Chicago Society of Obstetrics and
Gynecology. Since 1986, he has organised the annual ESHRE Capri Workshops
pregnancy programmes the foetus to become obese later in life.
on Reproductive Medicine.
In fact, obese mothers tend to have children with greater adiposity
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