February 27, 2013, was the day of the thesis defense by dr. Walter K.H. Kuchenbecker. Title of his thesis was Obesity and female infertility. Promotores were prof. J.A. Land and prof. B.H.R. Wolffenbuttel, co-promotores were dr. A. Hoek and dr. H. Groen .
Obesity in women is associated with an increase in infertility and more pregnancy complications. The cost per live birth after fertility treatment is almost two-fold higher in women with obesity compared to women of normal weight.
Obesity related infertility and pregnancy complications are determined by body fat distribution. Accumulation of fat around the abdomen and especially accumulation of intra-abdominal fat are a risk factor for infertility and pregnancy complications. Ultrasound measurement of intra-abdominal fat is a reliable, cheap and accessible tool to study the effects of intra-abdominal fat on female reproduction. The measurement of serum adipokines, the secretory products of adipose tissue, does not adequately reflect body fat distribution parameters. Weight loss in obese and infertile women is associated with more spontaneous pregnancies and a decrease in pregnancy complications. In anovulatory women with polycystic ovary syndrome, loss of intra-abdominal fat is associated with resumption of ovulation. In structured lifestyle programmes many women who are obese and infertile show poor compliance and experience difficulty in losing weight, leading to high drop-out rates. Future studies should aim to identify risk factors for drop-out and design individualised lifestyle programmes in order to limit drop¬-out. Weight loss medication and bariatric surgery may be considered in women with severe obesity and infertility in order to achieve sufficient weight loss and limit the serious obesity related pregnancy complications. In view of the serious obesity related pregnancy complications, women with a BMI > 35 kg/m2 should not be offered fertility treatment.