肥胖合并不孕症的诊治

Diagnosis and treatment of obesity with infertility.

在过去的几十年里,超重和肥胖的发生率一直呈指数级增长,现已成为一种全球性的流行病,导致相应的健康支付成本上升。女性肥胖率明显高于男性,生育和肥胖之间的关系复杂,涉及下丘脑-垂体-卵巢轴、神经内分泌系统和脂肪组织。肥胖如何降低生育力的确切病理生理学机制尚不清楚,可能是多因素的,包括无排卵、胰岛素抵抗和促性腺激素的改变。关于卵母细胞质量或子宫内膜容受性是否在肥胖不孕症患者中起更大的作用也存在争议。虽然目前无足够的证据表明孕前或辅助生殖技术治疗前母体的减重干预可以提高活产率,但可以明确的是,减重干预可以降低体外受精(IVF)相关并发症和妊娠并发症的风险,增加健康妊娠和活产的概率。

Over the past few decades,the incidence of overweight and obesity have been increasing expo⁃nentially and have now become a global epidemic,leading to an increase in corresponding health payment costs.The obesity rate in women is significantly higher than that in men,and the relationship between fertility and obesity is complex,involving the hypothalamicpituitary-ovarian axis,neuroendocrine system,and adipose tissue.The exact pathophysiological mechanism by which obesity reduces fertility is still unclear and may be multifactorial,including anovulation,insulin resistance,and changes in gonadotropin.There is also controversy over whether oocyte quality or endometrial receptivity play a greater role in obese and infertile patients.Although there is currently insufficient evi⁃dence to suggest that maternal weight loss interventions before pregnancy or assisted reproductive therapy can improve live birth rates.But it can be clarified that weight loss intervention can reduce the risk of IVF related complications and pregnancy complications,and increase the probability of healthy pregnancy and live birth.