Clinical and Experimental Reproductive Medicine

The Korean Society for Reproductive Medicine (대한생식의학회)
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Clinical Consideration of Obese Infertile Women

비만 불임여성에 대한 임상적 고찰

  • Nam, Yoon-Sung (Department of Obstetrics and Gynecology, College of Medicine, Pocheon CHA University) ;
  • Jeong, Chang-Jin (Department of Obstetrics and Gynecology, College of Medicine, Pocheon CHA University) ;
  • Kim, Nam-Keun (Institute for Clinical Research, College of Medicine, Pocheon CHA University) ;
  • Yoon, Tae-Ki (Department of Obstetrics and Gynecology, College of Medicine, Pocheon CHA University) ;
  • Cha, Kwang-Yul (Department of Obstetrics and Gynecology, College of Medicine, Pocheon CHA University)
  • 남윤성 (포천중문 의과대학 산부인과학교실) ;
  • 정창진 (포천중문 의과대학 산부인과학교실) ;
  • 김남근 (포천중문 의과대학 임상의학연구소) ;
  • 윤태기 (포천중문 의과대학 산부인과학교실) ;
  • 차광렬 (포천중문 의과대학 산부인과학교실)
  • Published : 2002.09.30
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Abstract

Objective : To analyze the clinical characteristics of obese infertile women. Material and Method: Height, weight, body mass index, menstrual pattern, glucose, insulin, glucose/insulin ratio, dehydroepiandrosterone sulfate (DHEA-S), testosterone, free testosterone and plasminogen activator inhibitor (PAI-1) of 15 obese infertile women were tested. Results: Of 15 obese infertile women, the number of diabetes mellitus, hyperinsulinemia, and insulin resistance was 2 (13%), 2 (13%), 2 (13%), respectively. The incidence of increased DHEA-S, testosterone, and free testosterone was 7 (47%), 1 (7%), 6 (40%), respectively. Notably, all patients showed increased PAI-1. Conclusions: Obesity is associated with infertility as well as many kinds of health problems. Obesity is closely related to insulin resistance and it also causes hyperandrogenism. Increased PAI-1 is one of the important causes of thrombophilia. Consequently, in the workup of obese infertile patient, many aspects of health problems should be considered.

Keywords

References

  1. Dunaif A, Futterweit W, Segal KR, Dobrjansky A. Profound peripheral insulin resistance, independent of obesity, in the polycystic ovary syndrome. Diabetes 1989; 38: 1165-74 https://doi.org/10.2337/diabetes.38.9.1165
  2. Meirow D, Yossepowitch O, Rosler A. Insulin resistant and non-resistant polycystic ovary syndrome present two clinical and endocrinologic subgroups. Hum Reprod 1995; 10: 1951-6 https://doi.org/10.1093/oxfordjournals.humrep.a136215
  3. Evans DJ, Hoffman RG, Kalkoff RK, Kissebah AH. Relationship of androgen activity to body fat topography, fat cell morphology, and metabolic aberrations in premenopausal women. J Clin Endocrinol Metab 1983; 57: 304-10 https://doi.org/10.1210/jcem-57-2-304
  4. Ohlson LO, Larsson B, Svardsudd K. The influence of body fat distribution on the incidence of diabetes mellitus. Diabetes 1985; 34: 1055-8 https://doi.org/10.2337/diabetes.34.10.1055
  5. Flier JS, Eastman RC, Minaker KL, Matteson D, Rowe JW. Acanthosis nigricans in obese women with hyperandrogenism: Characterization of an insulin-resistant state distinct from the type A and B syndromes. Diabetes 1985; 34: 101-7 https://doi.org/10.2337/diabetes.34.2.101
  6. Kissebah AH, Vydelingum N, Murray R. Relation of body fat distribution to metabolic complications of obesity. J Clin Endocrinol Metab 1982; 54: 254-60 https://doi.org/10.1210/jcem-54-2-254
  7. Billar RB, Rishardson D, Schwartz R, Posner B, Little B. Effect of chronically elevated androgen or estrogen on the glucose tolerance test and insulin response in female rhesus monkeys. Am J Obstet Gynecol 1987; 157: 1297-302 https://doi.org/10.1016/S0002-9378(87)80319-8
  8. Holmang A, Larsson BM, Brzezinska Z, Bjorntorp P. Effects of short -term testosterone exposure on insulin sensitivity of muscles in female rats. Am J Physiol 1992; 25: 851-5
  9. Moghetti P, Tosi F, Castello R. The insulin resistance in women with hyperandrogenism is partially reversed by antiandrogen treatment: evidence that androgens impair insulin action in women. J Clin Endocrinol Metab 1996; 81: 952-60 https://doi.org/10.1210/jc.81.3.952
  10. Dunaif A, Green G, Futterweit W. Suppression of hyperandrogenism does not improve peripheral or hepatic insulin resistance in the PCOS. J Clin Endocrinol Metab 1990; 70: 699-704 https://doi.org/10.1210/jcem-70-3-699
  11. Geffner ME, Kaplan SA, Bersch N, Golde DW, Landaw EM, Chang RJ. Persistence of insulin resistance in polycystic ovarian disease after inhibition of ovarian steroid secretion. Fertil Steril 1986; 45: 327-33 https://doi.org/10.1016/S0015-0282(16)49211-3
  12. Dunaif A. Insulin resistance and the polycystic ovary syndrome: mechanism and implications for pathogenesis. Endocr Rev 1997; 18: 774-800 https://doi.org/10.1210/er.18.6.774
  13. Stuart CA, Prince MJ, Peters EJ, Meyer WJ. Hyperinsulinemia and hyperandrogenemia: in vivo androgen response to insulin infusion. Obstet Gynecol 1987; 69: 921-5
  14. Stuart CA, Nagamani N. Insulin infusion acutely augments ovarian androgen production in normal women. Fertil Steril 1990; 54: 788-92 https://doi.org/10.1016/S0015-0282(16)53931-4
  15. Nestler JE, Barlascini CO, Matt DW. Suppression of serum insulin by diazoxide reduces serum testosterone levels in obese women with polycystic ovary syndrome. J Clin Endocrinol Metab 1989; 68: 1027-32 https://doi.org/10.1210/jcem-68-6-1027
  16. Nestler JE, Strauss JF. Insulin as an effector of human ovarian and adrenal steroid metabolism. Endocr Metab Clin North Am 1991; 20: 807-23
  17. Dunaif A. Insulin resistance and ovarian hyperandrogenism. Endocrinologist 1992; 2: 248-60 https://doi.org/10.1097/00019616-199207000-00007
  18. Barbieri RL, Makris A, Randall RW. Insulin stimulates androgen accumulation in incubations of ovarian stroma obtained from women with hyperandrogenism. J Clin Endocrinol Metab 1986; 62: 904-10 https://doi.org/10.1210/jcem-62-5-904
  19. Plymate SR, Matej LA, Jones RE, Freidl KE. Inhibition of sex hormone-binding globulin production in the human hepatoma (Hep G2) cell line by insulin and prolactin. J Clin Endocrinol Metab 1988; 67: 460-4 https://doi.org/10.1210/jcem-67-3-460
  20. Nestler JE. Sex hormone binding globulin. A marker for hyperinsulinemia and / or insulin resistance? J Clin Endocrinol Metab 1993; 76: 273-4
  21. Adashi EY, Hseueh AJW, Yen SCC. Insulin enhancement of luteinizing hormone and follicle stimulating hormone release by cultured pituitary cells. Endocrinology 1981; 108: 1441-9 https://doi.org/10.1210/endo-108-4-1441
  22. Nestler JE, Jakubowicz DJ. Decreases in ovarian cytochrome $P450_c17_a$ activity and serum free testosterone after reduction of insulin secretion in polycystic ovary syndrome. N Engl J Med 1996; 335: 617-23 https://doi.org/10.1056/NEJM199608293350902
  23. Dunaif A, Scott D, Finegood D, Quintana B, Whit - comb R. The insulin sensitizing agent troglitazone: a novel therapy for the polycystic ovary syndrome. J Clin Endocrinol Metab 1996; 81: 3299-306 https://doi.org/10.1210/jc.81.9.3299
  24. Dunaif A, Graf M. Insulin administration alters gonadal steroid metabolism independent of changes in gonadotropin secretion in insulin-resistant women with polycystic ovary syndrome. J Clin Invest 1989; 83: 23-9 https://doi.org/10.1172/JCI113864
  25. Dunaif A. Insulin resistance and ovarian dysfunction. In: Moller DE, editor. Insulin resistance. New York: John Wiley, 1993
  26. Estelles A, Grancha S, Gilabert J. Abnormal expression of plasminogen activator inhibitor in patients with gestational trophoblastic disease. Am J Pathol 1996; 149: 1229-39
  27. Halligan A, Bonnar J, Sheppard B. Haemostatic, fibrinolytic and endothelial variables in normal pregnancies and preeclamp sia. Br J Obstet Gynecol 1994; 101: 488-92 https://doi.org/10.1111/j.1471-0528.1994.tb13147.x
  28. Gris JC, Ripart -Neveu S, Maugard C. Respective evaluation of the prevalence of haemostasis abnormalities in unexplained primary early recurrent miscarriages. The Nimes Obstetricians and Haematologists (NOHA) Study. Thromb Haemost 1997; 77: 1096-103
  29. Gris JC, Neveu S, Mares P. Plasma fibrinolytic activators and their inhibitors in women suffering from early recurrent abortion of unknown etiology. J Lab Clin Med 1993; 122: 606-15
  30. Clifford K, Rai R, Watson H. Does suppressing luteinizing hormone secretion reduce the miscarriage rate? Results of a randomized controlled trial. BMJ 1996; 312: 1508-11 https://doi.org/10.1136/bmj.312.7045.1508