INTRODUCTION:

An obese person has accumulated so much body fat has negative effect in their health. If the person body weight is higher than 20% it is considered as obese. If body mass index is between 25 and 29.9.It is considered as overweight⁽¹⁾. It is an abnormal or excessive fat accumulation that affects health. It is a serious disease which include high cholesterol level, cancer, non-insulin, diabetes mellitus, gall bladder disease, heart disease, sleep apnea and renal failure⁽²⁾. The BMI is the simplest method to measure the body fat of human body. Infertility is defined as inability to conceive a child in a stable relationship during regular intercourse without contraceptive methods⁽³⁾. An voluntary cycles and enclometriosis are the main causes of female infertility. The risk factors of male infertility include age, chronic disease and obesity as well as infectious diseases⁽⁴⁾. Both obesity and infertility are the important risk factors of physiological disturbance and poor quality of life among women and men in reproductive age⁽⁵⁾.

MECHANISM OF OBESITY:

There is hormonal and physical mechanism. Abdominal or visceral fat leads to changes in hormones level and causes inflammation and secretes adipokines. Obese men present with elevated estrogen and testosterone. In obese individuals reduced spermatogenesis with severe hypotestosteronemia may lead to infertility⁽⁶⁾. Although abnormal levels of reproductive hormones lead to fertility problems in obese persons. Most environmental toxins are fat soluble accumulate in fatty tissue and leads to obesit⁽⁷⁾. Many obese person have physical problems related to decreased fertility which leads to increased scrotal temperature and sleep apnea^(8).Sleep apnea is a disorders affecting 4% of middle aged men. The disorder is characterized by repetitive collapse of pharyngeal airway during sleep resulting in hypoxia and hypercapnia^(9).

OBESITY IN FEMALE INFERTILITY:

Obesity can lead to infertility in females. If young female put on weight during reproductive age it leads to polycystic ovarian disease and dampen the pregnancy⁽¹⁰⁾^.This overweight leads to abnormal hormone level that affect the reproductive process and ovulation production due to the overproduction of insulin⁽¹¹⁾^.Obese women have abnormalities in their ovary. This is associated with irregular menstrual cycles, an ovulation. Excess body fat causes production of gonadotropin releasing hormone results in regular ovulation in women⁽¹^2).

IMPACT OF OBESITY ON INFERTILITY OF WOMEN:

In obese women most important secretion like gonadotropin secretion are affected because of the increased peripheral aromatization of androgens to estrogens⁽¹³⁾^. The insulin resistance and hyperinsulinemia in obese women leads to hyperandrogenemia. The sex hormone-binding globulin, growth hormone and insulin-like growth factor binding proteins are decreased and leptin levels are increased⁽¹⁴⁾^. Thus, the neuro-regulation of the hypothalamic-pituitary-gonadal axis deteriorates. These alterations may explain impaired ovulatory function and reproductive health⁽¹⁵⁾^. Because of lower implantation and pregnancy rates, higher miscarriage rates, fetal complications during pregnancy and increased maternal. An obese woman has a lower chance to give birth to a healthy newborn^(16).

OBESITY IN MALE INFERTILITY:

Infertility occurs not only in female but also affect males. Male infertility can be detected by semen analysis test. Male infertility is caused by physical problems that prevent the sperm ejaculation from the semen^(17,18). Male infertility problems like sexual problems, hormonal problems, genetic disease, and sexually transmitted disease. Obesity impinges on the reproductive system and fertility through its effect on erectile dysfunction and semen parameters. Semen parameters ascribed to obesity include sperm concentration, abnormal morphology, abnormal motility, compromised chromatin integrity⁽¹⁹⁾^. DNA fragmentation is a common abnormal sperm parameter observed in obese males and lead to fertility problems^(20).

IMPACT OF OBESITY ON MALE INFERTILITY

There is now emerging evidence that male obesity impacts negatively on male reproductive potential not only reducing sperm quality, but in particular altering the physical and molecular structure of germ cells in the testes and ultimately mature sperm⁽²¹⁾^. The molecular profile of germ cells in the testes and sperm from obese males is altered with changes to epigenetic modifiers⁽²²⁾^. The increasing prevalence of male obesity calls for better public health awareness at the time of conception, with a better understanding of the molecular mechanism involved during spermatogenesis required along with the potential of interventions in reversing these deleterious effects^(23).

RISK FACTORS OF OBESITY:

The person who are obese have lot of risk factors like high cholesterol and triglycerides, type 2 diabetes, high blood pressure, metabolic syndrome, heart disease, stroke, cancer, sleep apnea, non alcoholic fatty liver disease, gyncolic problems, osteoarthritis, skin problem⁽²⁴⁾^.It also affect the quality of life like depression, disability, physical discomfort, sexual problems, shame and social isolation.

TREATMENT OF OBESITY:

Obesity can be cured by the lifestyle changes, pharmacological interventions and surgical options⁽²⁵⁾^.Lifestyle changes can lead to weight loss including diet modification. Eating plan should be maintained over long period of time. Medication used to treat obesity. Two anti obesity medication are approved by food and drug administration. Orbistol reduce intestinal fat inhibiting pancreatic lipase. Sibutramine act on brain inhibit neither deactivation of nor epinephrine. Surgical method like in-vitro fertilization is used for obese patients facing problems such as ED or physical fertility problems. Scrotal lipectomy is a treatment available for infertility. Bariatric surgery is the use of surgical intervention in the treatment of obesity by reducing the portion of stomach or small intestine.

RECENT ADVANCES IN TREATMENT OF OBESITY:

Even-though lifestyle modification remains the cornerstone of anti-obesity intervention, it only produces short-term weight loss as patients have generally experienced significant weight regain after just two years. Anti-obesity medications are categorised according to three modes of action like following:

1. inhibitors of fat absorption

2. inhibitors of the endocannabinoid system

3. Modifiers of central nervous system neurotransmission of norepinephrine, dopamine and serotonin.

Orlistat is the only anti-obesity drug approved by the European Medicines Act and the Food and Drug Administration^(26). This drug is a pancreatic lipase inhibitor that binds to lipase in the gut lumen, preventing the hydrolysis and normal metabolism of dietary fat and hence reducing its absorption.

CONCLUSION:

Obesity is a monumental challenge to health and healthcare systems and tackling it will require a multifaceted approach. This includes an important and growing role for pharmacotherapy^(27). Existing medical therapy with orlistat is not entirely satisfactory and there have been many setbacks in anti-obesity drug development. Although weight loss is the gold standard of treatment in women with a high BMI, ART treatment should not be delayed too much because of increasing age.

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Received on 04.11.2017 Modified on 07.12.2017

Research J. Pharm. and Tech 2018; 11(7): 3183-3185.

DOI: 10.5958/0974-360X.2018.00585.1