Obesity and fertility

obesità e fertilità
  1. What is obesity?
  2. Does obesity influence the menstrual cycle and fertility?
  3. Obesity and Polycystic Ovary Syndrome

What is obesity?

Obesity is a syndrome characterised by an excessive and abnormal increase in body weight, with an excessive formation of body fat in the tissues. There are two types of obesity:

  • Android obesity: characterised by the distribution of the body’s extra fat primarily around the neck, shoulders and over the upper abdominal region of the body.
  • Gynoid obesity: characterised by the distribution of the body’s extra fat in the lower parts of the body (thighs, glutes, lower abdominal region) and by a poor development of muscles, frequent in women.

Does obesity influence the menstrual cycle and fertility?

The physiological mechanisms related to gender, in particular the effects of hormones, play a significant role in feminine obesity. The impact of being overweight and especially of obesity has alarmingly increased in female population of childbearing potential. Recent studies have shown that overweight women are affected by disorders of the menstrual cycle. This confirms the fact that excess weight has plays an important role in those mechanisms involved with infertility. In fact, obese women can be affected by those complications related to obesity like diabetes, arterial hypertension, stroke and arteriosclerosis but can also be affected by problems of the reproductive system. Much more than women of healthy weight, obese women are frequently affected by amenorrhea that is the absence of menstrual cycle. The analysis of the hormonal profile of obese women has shown that obesity and excessive weight in general are often associated to infertility because women are in a state of hypogonadotrophic hypogonadism, which means that there is an alteration of the hypothalamus-hypophysis-ovary axis that regulates the menstrual cycle through the synthesis of gonadotropins like FSH and LH.

In addition, obesity also modifies the levels of insulin produced by the pancreas, causing an overproduction of androgens, which, correlated to an increase in the production of oestrogens, impacts on the menstrual cycle causing disorders, reduction of ovulation and therefore low levels of fertility. Last but not least, fat deposits in the ovaries can interfere with follicular and embryonic development in case of pregnancy.

Obesity and Polycystic Ovary Syndrome

The most widespread problem of obese women is the Polycystic Ovary Syndrome (PCOS), which is characterised by hyperandrogenemia, ovulation absence, hirsutism, acne and altered morphology of the ovaries. Obesity amplifies the hyperandrogenemia of PCOS, thus impacting on the fertility rate and on anovulatory cycles.

Pregnancy rate for obese women treated for infertility is lower than for women of healthy weight and even after fertility treatments, the risk of miscarriage is very high.

Obesity is an important risk factor related to a series of gynaecological diseases. It is therefore important, especially for young adolescents, to set prevention strategies that allow the normalization of body weight for obese or overweight adolescents because this can increase the chances of recovery of the menstrual cycle and of ovulation.

Sexually transmitted diseases during adolescence

malattie sessualmente trasmissibili
  1. What to we need to know about sexually transmitted diseases (STDs)?
  2. What are the complications related to STDs?

What to we need to know about sexually transmitted diseases (STDs)?

Sexually transmitted diseases (STDs) have a high impact on sexually active adolescents’ health and also have an increasing incidence around the world, without any socio-economic distinction. The reason for this should be traced back both to a low knowledge of the most common pathologies and to promiscuity that is highly evident especially in adolescents. It is crucial to follow screening guidelines and to use diagnostic tests for immediate treatment to avoid complications. A STD diagnosis is substantial for everyone and in particular for adolescents. All STDs can be caused by:

  • Bacteria
  • Virus
  • Protozoa
  • Parasites or fungi

The most diffused virus is the Papilloma virus while for the sexually transmitted diseases the most common is Chlamydia. Other common infections in adolescents include gonorrhoea, syphilis, trichomonas, and herpes simplex (HSV). Such infections can be contracted also after a single and isolated sexual intercourse with an infected partner. The risk is higher for those that have several occasional intercourses but is also extended to those who have stable relationships considering that the microorganism can remain silent for long periods of time and thus the subject may discover being infected after a long time.

What are the complications related to STDs?

The complications of STDs can include:

  • Serious infections
  • Chronic pain
  • Infertility
  • Cancer
  • Detrimental effects on the uterus

Every year, about half of the new sexually transmitted infections occur in adolescents aged 15-24. In fact, the highest rates of sexually transmitted diseases are in young people, adults and adolescents. The identification of these infections depends on different types of screening for every STD. It is therefore important to divulge information on their sexual health to make sure they understand and know about the risks and the appropriate diagnostic practices for each sexually transmitted disease.

Hormonal contraception: pill and ring

pillola contraccettiva e anello vaginale
  1. Hormonal contraception: more information about the contraceptive pill
  2. Hormonal contraception: contraceptive ring, what do we need to know?

Hormonal contraception: more information about the contraceptive pill

According to the World Health Organisation guidelines, hormonal contraception can be used in complete safety from the age of menarche onwards. Still today, contraceptive pills are the most effective contraceptive method used by the majority of women to protect themselves from unwanted pregnancies. The new pill is a combined oral contraceptive (COC) and acts by inhibiting ovulation through the intake of the first seven pills, while the remaining pills maintain ovulation absence. The contraceptive pill is considered 100% effective and for this reason it is considered the most safe among the different contraceptive methods. In fact, unwanted pregnancies that occur during the use of contraceptive pills are most likely related to mistakes in the pill’s intake. The contraindications related to the pill are the same for both adults and adolescents that use the COC pill, which reveals to be very useful during a stable relationship. However, the use of condoms is still necessary to prevent sexually transmitted diseases. The pill is also indicated for those adolescents that experience irregular cycles because with its use periods become more regular, flow decreases and a significant reduction of pain related to menstruation is observable. Also acne, that is a quite common condition that can affect adolescents, improves with the use of the pill. Pills with “high” and “low” oestrogen dosage exist on the market. Before modern days, pills contained very high oestrogen levels, which caused many side effects. For this reason, research has focused on the production of pills with lower ethinyl estradiol quantity, changing from 50 micrograms to only 15/20 micrograms contained in modern pills. To make sure to take the right decision and avoid any discomfort or side effect, before taking any type of pill it is crucial to undergo all the examinations prescribed by the gynaecologist.

Hormonal contraception: contraceptive ring, what do we need to know?

In Italy, the only existing type of contraceptive ring is sold in pharmacies with medical prescription. It is a device with a 4 mm thickness and 54 mm diameter containing two different feminine hormones, progesterone and oestrogen. Such hormones are slowly released at low quantities and enter general circulation impeding fertilization by blocking the ovary’s release of the follicle. It has several advantages because of the synergy between the two hormones: oestrogen increases the effectiveness of progesterone giving a greater ovulation-inhibiting effect, and mainly maintains the development of the endometrium and provides a good control of the menstrual cycle. To make sure it works correctly, it is necessary to follow instructions: it must be inserted inside the vagina on the first day of menstruation and must be removed after exactly three weeks. During the week in which the ring is removed, vaginal bleeding similar to menstruation is observable usually after 2 or 3 days from the ring’s removal. It is advisable to remove the ring at approximately the same time it has been inserted. The new ring will have to be positioned exactly one week after the removal of the previous one, on the same day and at the same time also in case of continued bleeding. The ring has a contraceptive effectiveness of over 99% but like other hormonal contraceptives it does not protect from sexually transmitted diseases.

Physiology of the Menstrual Cycle

menopausa donne consigli
  1. What is the menstrual cycle?
  2. Which are the phases of the menstrual cycle?
  3. Which are the principal hormones involved?
  4. What happens during the menstrual cycle?

What is the menstrual cycle?

The menstrual cycle is a sequence of physiological and periodical changes of the feminine reproductive system. It is regulated by hormones produced by the ovaries and the hypophysis. All women have their first menstrual cycle during puberty and will cyclically have it until menopause, with interruptions only during pregnancy. The ovarian cycle, and likewise the menstrual cycle, lasts on average 28 days and consists of three phases which follow one another and that are strictly correlated to the hormones that are secreted during the cycle.

Which are the phases of the menstrual cycle?

  • Menstrual phase: during which the endometrium tends to flake off and is expelled through the vagina with menstruation
  • Proliferative phase: during which the endometrium is restored
  • Secretory phase: during which the endometrium becomes thicker to accommodate the fertilized egg

Which are the principal hormones involved?

Sometimes the menstrual cycle causes abdominal pain during the pre-menstrual phase with a series of disorders that affect women during the days immediately before menstruation. Menstrual cycles, also known as periods, last 25-35 days, with an average of 28 days for women aged in their 20s and 26 days for women in their 40s. In a normal menstrual cycle, cyclical changes of the following four principal hormones take place:

  • Luteinizing hormone (LH)
  • Follicle-stimulating hormone (FSH)
  • Oestrogen
  • Progesterone

The process involving changes in these hormones is usually associated to a change in body temperature. Through the central nervous system, the hypothalamus releases the gonadotrophin-releasing hormone (GnRH), which regulates the release of LH and FSH, which then subsequently regulate the secretion of oestrogen. After this, the levels of FSH and oestrogens increase, ovarian folliclesdevelop and mature. About seven days after ovulation, if no fertilization has occurred, the production of hormones starts to slow down. It is during the last days of the cycle, with the decline in hormonal levels and the first days of menstruation, during which such hormonal levels are low, that women are affected by the most annoying disorders. Cycles are counted from the first day of the menstrual flow when the levels of all four hormones are low.

What happens during the menstrual cycle?

Menstrual bleeding is the external symptom of the above-mentioned cycle in women, which occurs at the end of the luteal and at the beginning of the follicular phases of the ovarian cycle. In 80% of women during ovulation, menstrual bleeding occurs for 3-6 days with heavier flow on the second day with a loss of about 33 ml of blood (10-84). In women aged 35-50, a reduction of bleeding can be observed, while older women usually lose 6 ml more than younger ones. The menstrual cycle is closely linked and controlled by endocrine, autocrine and paracrine factors that regulate follicular development, ovulation and endometrial remodelling.

Female sexual anatomy: from infancy to adolescence

apparato genitale femminile
  1. The genital tract: how does it change?
  2. The vulva: what does it include?

The genital tract: how does it change?

The genital tract undergoes a series of changes throughout life, the majority of which occurs during puberty. In the first stages of development, female and male genitalia are indistinguishable and even though gender is determined during fecundation, it becomes clinically apparent at the 12th week of embryonic life, during which, in the absence of androgens, the differentiation of tissues leads to the external feminine phenotype. In females, ovarian differentiation begins at about 8 weeks gestation, stem cells differentiate themselves in oogonium and then in oocytes with the first meiotic cell division until puberty. Under the influence of oestrogens, Muller’s ducts differentiate themselves in internal genitalia, and Wolff’s ducts form the female external genitalia, of which the lower vagina, the labia and the clitoris. The genital system can be divided into two triangles, the anterior urogenital triangle and the posterior anal triangle. The anterior triangle includes the external genitalia and the urethral opening, commonly referred to as vulva.

The vulva: what does it include?

The vulva includes:

  • Labia majora: two fibroadipose folds, after puberty they are covered in hair and rich in sebaceous, apocrine and eccrine glands
  • Labia minora: two folds with no hair that are constituted by neurovascular structures, sebaceous follicles, sweat glands and muscles
  • Batholin’s glands: secrete mucus to maintain an adequate lubrication
  • Clitoris: the feminine erectile organ is 5 mm long in children and in pre-pubertal age and 1-2 cm in mature females
  • Vaginal orifice: surrounded by the hymen, incomplete mucous membrane that matures during puberty under the influence of oestrogens, becoming thicker and more elastic.

The internal feminine genitalia are:

  • Vagina: limited by bladder, urethra and rectum
  • Uterus: fibro-muscular organ divided into the lower cervix and upper uterine body. It is composed of three layers: endometrium, myometrium, and perimetrium. At birth the cervix is twice the length of the uterine body. During puberty, this ratio is inverted and in adult women the uterine body is two or three times the size of the cervix

The uterine annexes consist of the ovaries and of the fallopian tubes.

  • The Fallopian tubes: their function includes the transportation of ovules and spermatozoa and the creation of an environment adequate for conception
  • Ovaries: vary on the basis of age, menstrual cycle and under hormonal influence.

A correct understanding of the feminine reproductive system is crucial for an accurate evaluation and treatment of developmental anomalies.