Obesity Does not Compromise Ovarian Reserve Markers in Infertile Women

Abstract

Introduction In the literature, conflicting results from studies examining the relationship between obesity and ovarian reserve have been reported. The purpose of the study is to investigate whether obesity adversely affects serum concentrations of ovarian reserve markers in infertile women with different ovarian reserve status.

Materials and Methods A total of 402 women were assigned to three groups according to body mass index (BMI; < 25 kg/m²: normal, n = 198; 25.0 – 29.9 kg/m²: overweight, n = 126; and ≥ 30 kg/m²: obese, n = 78). The women were also divided into two groups according to waist circumference (WC; < 80 cm: normal, n = 103; and ≥ 80 cm: obese, n = 299). Participants were also categorized into three types of ovarian reserve patterns: normal (n = 146), high (n = 112), and poor ovarian reserve (n = 144). The serum anti-Mullerian hormone (AMH), estradiol (E2), and follicle-stimulating hormone (FSH) levels were assayed and compared in all groups.

Results There were no significant differences in BMI and WC in the three ovarian reserve groups. There were significant differences between all ovarian reserve groups for AMH, E2, and FSH (p < 0.001 for all). The comparisons of ovarian reserve parameters (AMH, E2, and FSH) and obesity parameters (BMI and WC) revealed no significant differences in women with all ovarian reserve patterns.

Conclusion The parameters of ovarian reserve do not seem to be affected by increased BMI and WC. Thus, AMH may be considered as a reliable marker of ovarian reserve.

Zusammenfassung

Einleitung In der Literatur werden aus Studien, welche die Beziehung zwischen Übergewicht und ovarieller Reserve untersuchten, widersprüchliche Ergebnisse gemeldet. Ziel dieser Studie war es, zu untersuchen, ob Übergewicht negative Auswirkungen auf Konzentrationen von Markern von ovarieller Reserve im Blut bei unfruchtbaren Frauen mit unterschiedlicher ovarieller Reserve hat.

Material und Methoden Insgesamt wurden 402 Frauen in die Studie aufgenommen und gemäß ihrem Body-Mass-Index in 3 verschiedene Gruppen eingeteilt (BMI; < 25 kg/m²: normal, n = 198; 25.0 – 29.9 kg/m²: übergewichtig, n = 126; ≥ 30 kg/m²: adipös, n = 78). Die Frauen wurden auch gemäß ihrem Taillenumfang in 2 Gruppen eingeteilt (TU; < 80 cm: normal, n = 103; sowie ≥ 80 cm: adipös, n = 299). Die Teilnehmerinnen wurden auch nach ihrer ovariellen Reserve in eine von 3 Kategorien eingeteilt: normale (n = 146), hohe (n = 112) und mangelhafte ovarielle Reserve (n = 144). Der Anti-Müller-Hormon-(AMH-)Spiegel, die Serum-Estradiol-(E2)-Werte und die FSH-Werte (FSH: follikelstimulierendes Hormon) wurden bei allen Gruppen untersucht und verglichen.

Ergebnisse Es gab keine signifikanten Unterschiede bezüglich BMI und TU zwischen den 3 Gruppen mit unterschiedlicher ovarieller Reserve. Es gab signifikante Unterschiede zwischen allen 3 Gruppen mit unterschiedlicher ovarieller Reserve bezüglich der AMH-, E2- und FSH-Werte (p < 0,001 für alle). Ein Vergleich der Parameter für die ovarielle Reserve (AMH, E2 und FSH) und der Adipositasparameter (BMI und TU) zeigte keine signifikanten Unterschiede zwischen Frauen mit unterschiedlicher ovariellen Reserve.

Schlussfolgerung Es scheint, dass die Parameter der ovariellen Reserve nicht durch einen höheren BMI oder einen weiten Taillenumfang beeinflusst werden. AMH darf daher als zuverlässiger Marker für die ovarielle Reserve betrachtet werden.

Key words

obesity - body mass index - waist circumference - ovarian reserve

Schlüsselwörter

Übergewicht - Body-Mass-Index - Taillenumfang - ovarielle Reserve

• References

• 1 Ravussin E, Swinburn BA. Pathophysiology of obesity. Lancet 1992; 340: 404-408
• 2 World Health Organization. Preventing and managing the global epidemic. Report of the World Health Organization on obesity. Geneva: World Health Organization; 1997
• 3 World Health Organization. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organization Technical Report Series 894. Geneva: World Health Organization; 2000
• 4 Onat A, Avci GS, Barlan MM. et al. Measures of abdominal obesity assessed for visceral adiposity and relation to coronary risk. Int J Obes Relat Metab Disord 2004; 28: 1018-1025
• 5 Sonmez A, Bayram F, Barcin C. et al. Waist Circumference Cutoff Points to Predict Obesity, Metabolic Syndrome, and Cardiovascular Risk in Turkish Adults. Int J Endocrinol 2013; 2013: 767202
• 6 Haslam DW, James WP. Obesity. Lancet 2005; 366: 1197-1209
• 7 Gundogan K, Bayram F, Gedik V. et al. Metabolic syndrome prevalence according to ATP III and IDF criteria and related factors in Turkish adults. Arch Med Sci 2013; 9: 243-253
• 8 Satman I, Omer B, Tutuncu Y. et al. TURDEP-II Study Group. Twelve-year trends in the prevalence and risk factors of diabetes and prediabetes in Turkish adults. Eur J Epidemiol 2013; 28: 169-180
• 9 Epplein M, Reed SD, Voigt LF. et al. Risk of complex and atypical endometrial hyperplasia in relation to anthropometric measures and reproductive history. Am J Epidemiol 2008; 168: 563-570
• 10 Boots C, Stephenson MD. Does obesity increase the risk of miscarriage in spontaneous conception: a systematic review. Semin Reprod Med 2011; 29: 507-513
• 11 Marshall NE, Spong CY. Obesity, pregnancy complications, and birth outcomes. Semin Reprod Med 2012; 30: 465-471
• 12 Jungheim ES, Travieso JL, Hopeman MM. Weighing the impact of obesity on female reproductive function and fertility. Nutr Rev 2013; 71 (Suppl. 01) S3-S8
• 13 Rittenberg V, Seshadri S, Sunkara SK. et al. Effect of body mass index on IVF treatment outcome: an updated systematic review and meta-analysis. Reprod Biomed Online 2011; 23: 421-439
• 14 Gupta S, Sharma D, Surti N. et al. Ovarian reserve testing: systematic review of the literature. Arch Med Sci 2009; 5: S143-S150
• 15 Durlinger AL, Visser JA, Themmen AP. Regulation of ovarian function: the role of anti-müllerian hormone. Reproduction 2002; 124: 601-609
• 16 Visser JA, de Jong FH, Laven JS. et al. Anti-Müllerian hormone: a new marker for ovarian function. Reproduction 2006; 131: 1-9
• 17 Fritz MA, Speroff L. Female Infertility. In: Fritz MA, Speroff L. eds. Clinical gynecologic Endocrinology and Infertility. 8th ed. Philadelphia: Lippincott Williams & Wilkins; 2011: 1137-1190
• 18 Seifer DB, Maclaughlin DT. Mullerian inhibiting substance is an ovarian growth factor of emerging clinical significance. Fertil Steril 2007; 88: 539-546
• 19 Fedorcsák P, Dale P, Storeng R. et al. Impact of overweight and underweight on assisted reproduction. Hum Reprod 2004; 11: 2523-2528
• 20 Freeman EW, Gracia CR, Sammel MD. et al. Association of anti-mullerian hormone levels with obesity in late reproductive-age women. Fertil Steril 2007; 87: 101-106
• 21 Georgopoulos NA, Saltamavros AD, Decavalas G. Serum AMH, FSH, and LH levels in PCOS. Fertil Steril 2010; 93: e13
• 22 Nardo LG, Christodoulou D, Gould D. et al. Anti-mullerian hormone levels and antral follicle count in women enrolled in in vitro fertilization cycles: relationship to lifestyle factors, chronological age and reproductive history. Gynecol Endocrinol 2007; 23: 486-493
• 23 Wunder DM, Bersinger NA, Yared M. et al. Statistically significant changes of antimüllerian hormone and inhibin levels during the physiologic menstrual cycle in reproductive age women. Fertil Steril 2008; 89: 927-933
• 24 Park AS, Lawson MA, Chuan SS. et al. Serum anti-müllerian hormone concentrations are elevated in oligomenorrheic girls without evidence of hyperandrogenism. J Clin Endocrinol Metab 2010; 95: 1786-1792
• 25 The Rotterdam ESHRE and ASRM-sponsored PCOS consensus workshop group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril 2004; 81: 19-25
• 26 Committee on Gynecologic Practice. Committee opinion No. 618: Ovarian reserve testing. Obstet Gynecol 2015; 125: 268-273
• 27 Su HI, Sammel MD, Freeman EW. et al. Body size affects measures of ovarian reserve in late reproductive age women. Menopause 2008; 15: 857-861
• 28 De Pergola G, Maldera S, Tartagni M. et al. Inhibitory effect of obesity on gonadotropin, estradiol, and inhibin B Levels in fertile women. Obesity (Silver Spring) 2006; 14: 1954-1960
• 29 Steiner AZ, Stanczyk FZ, Patel S. et al. Antimullerian hormone and obesity: insights in oral contraceptive users. Contraception 2010; 81: 245-248
• 30 Gracia CR, Freeman EW, Sammel MD. et al. The relationship between obesity and race on inhibin B during the menopause transition. Menopause 2005; 12: 559-566
• 31 Sowers M, Zheng H, Tomey K. et al. Changes in body composition in women over six years at midlife: ovarian and chronological aging. J Clin Endocrinol Metab 2007; 92: 895-901
• 32 Freeman EW, Sammel MD, Gracia CR. et al. Follicular phase hormone levels and menstrual bleeding status in the approach to menopause. Fertil Steril 2005; 83: 383-392
• 33 Halawaty S, El Kattan E, Azab H. et al. Effect of obesity on parameters of ovarian reserve in premenopausal women. J Obstet Gynaecol Can 2010; 32: 687-690
• 34 Shaw CM, Stanczyk FZ, Egleston BL. et al. Serum antimüllerian hormone in healthy premenopausal women. Fertil Steril 2011; 95: 2718-2721
• 35 Sahmay S, Usta T, Erel CT. et al. Is there any correlation between amh and obesity in premenopausal women?. Arch Gynecol Obstet 2012; 286: 661-665
• 36 Moy V, Jindal S, Lieman H. et al. Obesity adversely affects serum anti-müllerian hormone (AMH) levels in Caucasian women. J Assist Reprod Genet 2015; 32: 1305-1311
• 37 Moslehi N, Shab-Bidar S, Ramezani Tehrani F. et al. Is ovarian reserve associated with body mass index and obesity in reproductive aged women? A meta-analysis. Menopause 2018;
• 38 Hill MJ, Uyehara CF, Hashiro GM. et al. The utility of serum leptinand follicular fluid leptin, estradiol, and progesterone levels during an in vitro fertilization cycle. J Assist Reprod Genet 2007; 24: 183-188
• 39 Lin Q, Poon SL, Chen J. et al. Leptin interferes with 30,50-cyclic adenosine monophosphate (cAMP) signaling to inhibit steroidogenesis in human granulosa cells. Reprod Biol Endocrinol 2009; 7: 115
• 40 Brannian JD, Zhao Y, McElroy M. Leptin inhibits gonadotrophinstimulated granulosa cell progesterone production by antagonizing insulin action. Hum Reprod 1999; 14: 1445-1448