Obesity, insulin resistance and assisted conception

Abstract

Obesity and infertility are intrinsically linked, with both maternal and paternal obesity adversely affecting fecundity and assisted conception outcomes. The potential mechanisms linking obesity to altered gonadal function are not known but may speculatively include an altered adipokine milieu, but further research is required. Regardless of mechanisms, any reduction in fertility is not overcome by assisted conception, with maternal obesity associated with increased gonadotrophin requirements, lower oocyte yields, reduced fertilisation and impaired pregnancy rates. Furthermore in those who achieve pregnancy all maternal and perinatal risks are increased in conjunction with obesity, further reducing the probability of a healthy offspring. Optimisation of preconceptual weight irrespective of whether it is a spontaneous or assisted conception is essential to minimise these risks. Fortunately assisted conception provides us with a unique opportunity to engage with patients prior to achieving a pregnancy, and clinicians must exploit this ensuring that patients are fully informed as to the advantages of providing the best possible maternal environment and the positive impact it will have on their offspring. Br J Diabetes Vasc Dis 2009;9:23—266