The impact of obesity on in vitro fertilization outcomes in women Alex Legge Dalhousie Medicine, Class of 2014 Supervisors: Dr. R. Bouzayen, Dr. D. Young, Dr. L. Hamilton DMRF/Faculty of Medicine Summer Studentship (June – August 2011) Objectives • Describe the epidemiology of obesity • Describe the effects of obesity on the male & female reproductive systems • Review the available literature on obesity & in vitro fertilization • Describe our study & it’s findings Body Mass Index (BMI) BMI (kg/m2) Weight Risk of Health Classification Complications <18.5 Underweight Increased 18.5-24.99 Normal Weight Least 25-29.99 Overweight Increased 30+ Obese 30-34.99 Class 1 Obesity High 35-39.99 Class 2 Obesity Very High 40+ Class 3 Obesity Extremely High A growing problem… Adolescent Obesity Between 1978/79 and 2004: The percentage of Canadian adolescents (age 12- 17)with a BMI > 25 kg/m2 increased from 14% to 29% Obesity rates for Canadian adolescents (age 12-17) increased from 3% to 9% Medical Complications of Obesity Source: Batch & Baur. MJA 2005; 182 (3): 130-135. Obesity & Reproduction MEN Abnormal hormone profiles Impaired sperm parameters Infertility WOMEN Menstrual irregularities/Anovulation Polycystic ovary syndrome (PCOS) Infertility Obesity & Male Reproduction Abnormal hormone profiles Male obesity is associated with:  Decreased serum total testosterone levels Aggerholm et al. 2007, Jensen et al. 2004, Wu et al. 2008, etc.  Decreased Testosterone/Estradiol ratio Jarow et al. 1993, Fejes et al. 2006  Decreased serum SHBG levels Aggerholm et al. 2007, Jensen et al. 2004, Wu et al. 2008, etc. Obesity & Male Reproduction Sperm Parameters Belloc et al. 2011 Fertility & Sterility  5874 male patients at a private ART clinic in France  Compared semen parameters for normal weight and obese patients, controlling for age  Semen volume, sperm concentration, total sperm count, and sperm motility were all significantly decreased in the obese group (P<0.001) Obesity & Male Reproduction Sperm Parameters Duits et al. 2010 Fertility & Sterility  1466 men visiting fertility clinic as part of subfertile couple  Compared semen parameters between underweight, normal weight, overweight, and obese men  Controlled for age, smoking, alcohol use, DM  No statistically significant differences in semen quality between BMI groups