The Subcutaneous Abdominal Fat and Not the Intraabdominal Fat Compartment Is Associated with Anovulation in Women with Obesity and Infertility

Kuchenbecker, Walter K. H.; Groen, Henk; Zijlstra, Tineke M.; Bolster, Johanna H. T.; Slart, Riemer H. J. A.; Jagt, Erik J. van der; Kobold, Anneke C. Muller; Wolffenbuttel, Bruce H. R.; Land, Jolande A.; Hoek, Annemieke

doi:10.1210/jc.2009-1915

Cited by 44 publications

(40 citation statements)

References 34 publications

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“…[18][19][20][21] The program was developed according to the recommendations of the National Institutes of Health 22 and was piloted in a singlecenter study. 23,24 It included six outpatient visits and four telephone consultations during a 24-week period.…”

Section: Lifestyle Interventionmentioning

confidence: 99%

Randomized Trial of a Lifestyle Program in Obese Infertile Women

Mutsaerts¹,

Oers²,

Groen³

et al. 2016

N Engl J Med

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BACKGROUNDSmall lifestyle-intervention studies suggest that modest weight loss increases the chance of conception and may improve perinatal outcomes, but large randomized, controlled trials are lacking. METHODSWe randomly assigned infertile women with a body-mass index (the weight in kilograms divided by the square of the height in meters) of 29 or higher to a 6-month lifestyle intervention preceding treatment for infertility or to prompt treatment for infertility. The primary outcome was the vaginal birth of a healthy singleton at term within 24 months after randomization. RESULTSWe assigned women who did not conceive naturally to one of two treatment strategies: 290 women were assigned to a 6-month lifestyle-intervention program preceding 18 months of infertility treatment (intervention group) and 287 were assigned to prompt infertility treatment for 24 months (control group). A total of 3 women withdrew consent, so 289 women in the intervention group and 285 women in the control group were included in the analysis. The discontinuation rate in the intervention group was 21.8%. In intention-to-treat analyses, the mean weight loss was 4.4 kg in the intervention group and 1.1 kg in the control group (P<0.001). The primary outcome occurred in 27.1% of the women in the intervention group and 35.2% of those in the control group (rate ratio in the intervention group, 0.77; 95% confidence interval, 0.60 to 0.99). CONCLUSIONSIn obese infertile women, a lifestyle intervention preceding infertility treatment, as compared with prompt infertility treatment, did not result in higher rates of a vaginal birth of a healthy singleton at term within 24 months after randomization. (Funded by the

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Section: Lifestyle Interventionmentioning

confidence: 99%

Randomized Trial of a Lifestyle Program in Obese Infertile Women

Mutsaerts¹,

Oers²,

Groen³

et al. 2016

N Engl J Med

Self Cite

240

260

View full text Add to dashboard Cite

show abstract

“…In addition, high level of AKR1C 1, 2 may further reduce local concentrations of DHT and progesterone. Intra-adipose sex steroid metabolism may play an important role in determining gynoid vs. android patterns of body fat; increased metabolism of progesterone (anti-glucocorticoid action) and synthesis of androgen by AKR1C isoforms were positively correlated with adiposity in women [18,24]. Furthermore, the total amount of steroid within adipose tissue was found 40-400 times greater than plasma [25]; a positive gradient between tissue and plasma was also reported [26].…”

Section: Discussionmentioning

confidence: 95%

“…This set of data indicated that adipose tissues may convert estrogen, progesterone and androgens from their precursors (especially from androstenedione) instead of from cholesterol and subcutaneous fat may be an important steroid-inactivating organ. SAT especially abdominal and trunk fat accumulation, is associated with anovulation, a major feature of PCOS [24]. We compared the mRNA levels of sex steroid synthesis and inactivating enzymes in SAT between PCOS and control women.…”

Section: Discussionmentioning

confidence: 99%

The expression of sex steroid synthesis and inactivation enzymes in subcutaneous adipose tissue of PCOS patients

Wang¹,

Li²,

Zhao³

et al. 2012

The Journal of Steroid Biochemistry and Molecular Biology

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“…Obese women with a BMI >27 kg/m 2 have a relative risk (RR) of anovulatory infertility of 3.1 (95% CI, 2.2-4.4) compared with their lean counterparts with a BMI 20.0-24.9 kg/m 2 (33,34). Body fat distribution also is important because anovulatory women have a greater waist circumference and more abdominal fat than ovulatory women of similar BMI (35). A case-control study of 2,527 women with anovulatory infertility versus 46,718 control subjects (mostly married parous nurses without infertility) noted a relationship between BMI at 18 years of age and the RR of subsequent anovulatory infertility (1.0, BMI 20.0-21.9; 1.3, BMI 24-25.9; 1.7, BMI 26-27.9; 2.4, BMI 28-29.9; 2.7, BMI 30-31.9; and 2.7, BMI >32 kg/m 2 ) (33).…”

Section: Ovulatory Dysfunctionmentioning

confidence: 99%