女性肥胖对辅助生殖技术的影响  

The impact of maternal obesity on Assisted Reproductive Technology

作　　者：严欢苗 朱依敏[1] Yan Huan-miao;Zhu Yi-min(Department of Reproductive Endocrinology,Women’s Hospital,Zhejiang University Schoolof Medicine,Zhejiang Hangzhou 310006,China)

机构地区：[1]浙江大学医学院附属妇产科医院,浙江杭州310006

出　　处：《实用妇科内分泌电子杂志》2019年第6期94-96,99,共4页Electronic Journal of Practical Gynecological Endocrinology

基　　金：浙江省自然科学基金(NO.LZ15H040001)

摘　　要：肥胖会增加排卵障碍的风险,严重损害女性的生育力,造成女性不孕。随着育龄期肥胖妇女人数的不断增加,越来越多肥胖妇女求助于辅助生殖技术治疗不孕。因此,目前有大量的动物实验及临床流行病学调查研究关于肥胖对辅助生殖技术的影响。相较于正常体重女性,肥胖妇女在进行ART助孕时,促排卵所需的促性腺激素剂量增加,促排时间延长,成熟卵泡及获卵率、受精率低,妊娠率降低,流产率增高。赠卵模型表明卵母细胞质量是影响肥胖妇女IVF结局的主要因素,子宫内膜容受性的影响并不显著。此外,母亲肥胖还会增加妊娠并发症、分娩并发症及胎儿异常的风险,影响子代的健康,增加子代对慢性疾病的易感性。肥胖妇女在进行ART前减重,可以降低流产率、增高妊娠率及活产率,但随着年龄的增长,卵巢储备功能会逐渐减退,因此需权衡年龄及减重对ART的影响。在考虑年龄及卵巢功能的前提下,我们建议肥胖女性在进行ART助孕前通过运动及健康饮食来积极改善生活方式,以改善ART结局。Obesity has negative impacts on women’s fertility as a cause of anovulation.With the increasing prevalence of obesity,a growing number of obese women are seeking Assisted Reproductive Technology(ART)as a treatment for infertility.Therefore,there are a large number of animal experiments and clinical epidemiological studies on the impact of obesity on ART.Compared with non-obese women,obese women need the higher dosage of gonadotropin and the longer time of ovulation induction.And following IVF/ICSI cycles,obese women have less mature follicles,lower rates of fertilization and pregnancy,higher rate of abortion,as well as more difficulties of oocyte retrieval.Oocyte donation model shows that oocyte quality is the main factor responsible for the poor outcome of ART in obese women,and the role of endometrium or its environment seems to be small.Additionally,pregnancy in obese women is associated with escalating risks of complications for both mothers and fetus.Besides,longerterm consequences of studies suggest that maternal obesity risks offspring’s health later in life and increases susceptibility to adult chronic disease.Weight loss prior to ART in obese women is associated with significantly improved pregnancy rate and live birth rate,and reduced abortion rate.It is well established that fertility declines with age,so the potential benefits of weight loss need to be carefully balanced against the potential adverse effects of the elder age.Considering age and ovarian reserve,we suggest that obese women modify lifestyle by healthy diet and regular exercise prior to ART to improve the outcomes of ART.

关 键 词：肥胖 BMI 辅助生殖技术 妊娠结局 减重 

分 类 号：R71[医药卫生—妇产科学]