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Query: UMLS:C0028754 (obesity)
 124,988 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Transvaginal gamete intra-Fallopian transfer (GIFT) is a new treatment modality for patients with proven tubal patency, avoiding invasive laparoscopy. In this study 79 cycles of standard laparoscopic GIFT (group 1) were analysed in comparison to 40 cycles of transvaginal intratubal gamete transfer guided by tactile sensation (group 2). GIFT in group 1 was performed for standard indications; patients with severe intra-abdominal adhesions, distal tubal pathology, peritubal adhesions or extreme obesity were included in group 2. No difference in mean age, duration of infertility, oestradiol level and number of oocytes was found. In group 1 a clinical pregnancy rate of 33% per GIFT cycle (n = 79) was achieved. The clinical pregnancy rate in group 2 was 17.5% per gamete transfer cycle. In conclusion, transvaginal GIFT offers an acceptable chance for in-vivo fertilization to patients who cannot be treated laparoscopically despite having patent tubes and who refuse in-vitro fertilization.
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PMID:'Blind' transvaginal gamete intra-fallopian transfer in distal tubal and peritubal pathology: an evaluation in respect to the laparoscopic approach. 830 Aug 33

Endocrine studies were performed on fertile and infertile obese men and compared with fertile and infertile nonobese men in order to determine the independent and codependent effects of obesity and fertility status on the male hypothalamic-pituitary gonadal axis. The obese infertile group exhibited significant endocrinologic changes as compared with fertile nonobese control group which was not observed in any of the other three groups. Serum testosterone was significantly lower. The testosterone/estradiol ratio was significantly lower despite a lack of significant change in serum estradiol levels. Serum steroid hormone binding globulin (SHBG) was significantly lower which correlated with elevated bioavailability of both testosterone and estradiol in the obese infertile group. Serum luteinizing hormone levels were no different, suggesting that free testosterone levels were unchanged. Obese infertile men exhibit endocrinologic changes that are not observed in men with either obesity or infertility alone. Reduction of serum SHBG, total testosterone, and testosterone/estradiol ratio appear to be a marker of infertility among obese men.
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PMID:Effect of obesity and fertility status on sex steroid levels in men. 836 23

Early age at menarche, late age at menopause, and late age at first full-term pregnancy are linked to a modest increase in the risk of developing breast cancer. Some evidence suggests that the earlier the full-term pregnancy, the earlier the period of decreased susceptibility of breast tissue changes begins. Nulliparity is related to an increased risk for breast cancer diagnosed after 40 years old. Multiple full-term pregnancies decrease the risk of breast cancers diagnosed after 40 years regardless of the age at first birth. On the other hand, they may increase the risk for breast cancers diagnosed before 40 years old. Surgical removal of the ovaries protects against breast cancer. Breast feeding apparently protects against breast cancer in China, but a protective effect has not been established in the US. Other than shorter intervals between menstrual periods, which tend to increase the risk, research has not yet made clear the etiologic roles of menstrual cycle characteristics. Other unclear etiologic roles include increased intervals between births, spontaneous and induced abortion, infertility, multiple births at last pregnancy, and hypertension during pregnancy. Researchers tend to accept a mechanism to explain the epidemiologic characteristics of menstrual activity and the increased risk of breast cancer, but no mechanisms have emerged for the other likely risk factors. Greater exposure to estrogen and progesterone simultaneously are linked to early age at menarche, late age at menopause, and shorter menstrual cycle length. So far, data show that long-term combined estrogen/progestin hormone replacement therapy and long-term use of oral contraceptives increase the risk of breast cancer. Moderately increased risks linked to longterm estrogen replacement therapy and obesity in postmenopausal women indicate that estrogen alone influences breast cancer risk. Since much of the research on breast cancer risk factors are inconclusive, more research is needed, especially research examining the probability of prolonged exposure to both estrogens and progesterone concurrently.
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PMID:Reproductive factors and breast cancer. 840 11

Hypothyroidism is the condition most commonly treated with exogenous thyroid hormone. The goal of therapy is to normalize levels of serum thyrotropin (thyroid-stimulating hormone), which should be monitored by a high-sensitivity test. Adjustments in optimal dose may be necessary for a number of physiologic reasons (eg, decreased gastrointestinal absorption, pregnancy). Thyroid hormone therapy is also appropriate after surgery for thyroid cancer and for patients with goiter or benign thyroid nodules. In the absence of hypothyroidism, such treatment should not be used for obesity, fatigue, irregular menses, or infertility.
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PMID:Thyroid hormone therapy. What, when, and how much. 841 59

The joint effect of use of combination-type oral contraceptives and other exposure factors on risk of endometrial cancer was examined in data from a multicenter case-control study conducted in 5 areas of the United States. Cases were 405 women with histologically confirmed invasive epithelial endometrial cancer first treated at one of 7 participating hospitals. A total of 297 population-based controls of similar age, race, and geographic area were selected as a comparison group. Information on exposure factors was derived from in-person interviews. Combination-type oral contraceptive (COC) use was associated with a significant reduction in risk of endometrial cancer, with an adjusted odds ratio (OR) of 0.4 (95% confidence interval 0.3 to 0.7) for ever compared to never use. Long-term (> or = 10 years) users experienced a markedly lower risk (OR = 0.2). Women who discontinued COC use > or = 20 years earlier remained at reduced risk (OR = 0.7) compared with non-users. The negative association with COC use was apparent regardless of the presence or level of several other risk factors for endometrial cancer, including age, menopausal status, parity, obesity, ever-use of menopausal estrogens, smoking history, or history of infertility. The magnitude of the negative association observed in COC users, however, was considerably diminished in women with no full-term births and in women who subsequently used replacement estrogens for 3 or more years. These results provide new evidence that the protective effect of COC use lasts for 20 or more years after use is discontinued, and highlight several sub-groups of users in whom the level of protection is attenuated by the presence of other risk factors for this disease.
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PMID:Oral contraceptives and endometrial cancer: do other risk factors modify the association? 848 26

The criteria for the diagnosis of the polycystic ovary syndrome (PCOS) have still not been agreed universally. A population of 1741 women with PCOS were studied, all of whom had polycystic ovaries seen by ultrasound scan. The frequency distributions of the serum concentrations of follicle stimulating hormone (FSH), luteinizing hormone (LH), testosterone and prolactin and the body mass index, ovarian volume, uterine cross-sectional area and endometrial thickness were determined and compared with the symptoms and signs of PCOS. Obesity was associated with hirsutism and an elevated serum testosterone concentration and was also correlated with increased rates of infertility and cycle disturbance. The rates of infertility and cycle disturbance also increased with serum LH concentrations > 10 IU/l. A rising serum concentration of testosterone [mean and 95th percentiles 2.6 (1.1-4.8) nmol/l] was associated with an increased risk of hirsutism, infertility and cycle disturbance. The ovarian volume was correlated with serum concentrations of testosterone, LH and the body mass index, which was also correlated with the uterine area. This descriptive data from the largest reported series of women with PCOS enables the development of a management-orientated approach to the syndrome. Women who are overweight can expect an improvement in their symptoms if they lose weight. An elevated concentration of LH (> 10 IU/l) is associated with infertility and treatment should be chosen accordingly. If the serum testosterone concentration is > 4.8 nmol/l, other causes of hyperandrogenism should be excluded.
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PMID:Polycystic ovary syndrome: the spectrum of the disorder in 1741 patients. 856 49

Polycystic ovarian syndrome (PCO) is a relatively poorly defined type of steroidogenic abnormality, dependent on an overproduction of lutropin (LH). The PCO is characterized by infertility, amenorrhea or oligomenorrhea, obesity and hirsutism. The clinical symptoms are associated with typical morphological changes of the ovaries. It has been suggested that hyperplastic secondary interstitial cells and theca cells are the main site of excess androgen production. In PCO the elevation of androgens is observed, while the estrogen level is normal or slightly decreased. In the ovarian sex steroidogenic pathways, 17 alpha-hydroxylase, which produces androgens and aromatase, which converts androgens to estrogens are important regulatory enzymes. Major components of 17 alpha-hydroxylase and aromatase are cytochromes P450 17 alpha and P450 arom. Histochemical investigations revealed increased immunoreactivity with the antibody directed against P450 17 alpha in theca cells. In this review data from literature are presented and discussed regarding endocrinological and molecular background of PCO.
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PMID:[Molecular basis of polycystic ovarian syndrome]. 868 42

Thirty-seven women with a mean initial weight of 98.5 +/- 18.7 kg completed a group treatment program for obese, infertile women. The program lasted for 24 weeks and included regular exercise and group discussion of topics such as coping with the psychological impact of infertility, developing healthy eating patterns, and the effects of obesity on reproductive physiology. There was significant weight loss (mean weight loss 6.2 +/- 4.5 kg, p < 0.001) and improvement on measures of self-esteem, anxiety, depression, and general health. Twenty-nine women became pregnant during the follow-up period (21-36 months). Two women were avoiding pregnancy, so only six who had completed the group program and wished to become pregnant had not conceived by the end of the follow-up period. A further five women did not complete the program as they became pregnant while attending the group. Our results suggest that active measures to improve mood and self-esteem, along with better nutrition and weight reduction through diet and exercise, can produce considerable improvement in the outcome of treatment for infertility in obese women.
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PMID:Improved pregnancy rates for obese, infertile women following a group treatment program. An open pilot study. 873 12

In female mammals, reproduction is extremely sensitive to the availability of oxidizable metabolic fuels. When food intake is limited or when an inordinate fraction of the available energy is diverted to other uses such as exercise or fattening, reproductive attempts are suspended in favor of processes necessary for individual survival. Both reproductive physiology and sexual behaviors are influenced by food availability. Nutritional effects on reproductive physiology are mediated by changes in the activity of gonadotropin-releasing hormone (GnRH) neurons in the forebrain, whereas the suppression of sexual behaviors appears to be due, at least in part, to decreases in estrogen receptor in the ventromedial hypothalamus. Work using pharmacological inhibitors of glucose and fatty acid oxidation indicates that reproductive physiology and behavior respond to short-term (minute-to-minute or hour-to-hour) changes in metabolic fuel oxidation, rather than to any aspect of body size or composition (e.g., body fat content or fat-to-lean ratio). These metabolic cues seem to be detected in the viscera (most likely in the liver) and in the caudal hindbrain (probably in the area postrema). This metabolic information is then transmitted to the GnRH-secreting or estradiol-binding effector neurons in the forebrain. There is no evidence to date for direct detection of metabolic cues by these forebrain effector neurons. This metabolic fuels hypothesis is consistent with a large body of evidence and seems to account for the infertility that is seen in a number of situations, including famine, eating disorders, excessive exercise, cold exposure, lactation, some types of obesity, and poorly controlled diabetes mellitus.
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PMID:Control of fertility by metabolic cues. 925 2

The clinical presentation of PCOS is likely to be the end process of many pathogenic mechanisms, the definition of which is only now beginning to be unravelled. While the application of ultrasonography to the diagnosis of PCOS has undoubtedly added greatly to our understanding of the breadth of the disorder and our appreciation of its heterogeneity, careful distinction has to be made between polycystic ovaries and polycystic ovary syndrome in order to define optimal treatments, particularly in women with menstrual disturbance. In the presence of obesity, no treatment regimen can neglect weight reduction as the main thrust of intervention, no matter whether the goal be to improve hirsutism or infertility.
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PMID:Polycystic ovary syndrome: clinical aspects. 877 48


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