G. William Bates

Effect of body weight reduction on plasma androgens in obese, infertile women.

Although a variety of disorders are associated with polycystic ovarian disease (PCOD), obesity, hirsutism, and menstrual dysfunction are the most frequent manifestations. We investigated the possibility that obesity per se may give rise to androgen excess through alterations in estrogen metabolism and, consequently, through alterations in gonadotropin secretion. Eighteen obese, infertile women with PCOD were compared with 20 control women. Plasma androstenedione (A) was 252 +/- 18 ng/dl (mean +/- standard error of the mean [SEM]) in the obese women compared with 173 +/- 9 ng/dl in the controls (P less than 0.001); plasma testosterone (T) was 66 +/- 5.7 ng/dl, compared with 41 +/- 3 ng/dl (P less than 0.001). Thirteen of the obese women lost greater than 15% of their body weight by dietary restriction; ten of these women (77%) conceived spontaneously. In seven of the ten women who conceived, we remeasured plasma androgens following weight reduction but prior to conception. A decreased from 295 +/- 19 ng/dl to 179 +/- 5 ng/dl; T decreased from 75 +/- 8 ng/dl to 39 +/- 5 ng/dl (P less than 0.001). We conclude that obesity may play a role in the genesis of PCOD.

Reproductive failure in women who practice weight control

Forty-seven women (29 with unexplained infertility and 18 with menstrual dysfunction) practiced weight control by caloric restriction in order to maintain a fashionable body habitus. All of these women were below ideal body weight (IBW) when compared with Metropolitan Life Insurance Company tables for height and weight. When 36 of these women followed a dietary regimen designed to increase their weight to predicted IBW, 19 of 26 infertile women (73%) conceived spontaneously; 9 of 10 women (90%) with secondary amenorrhea resumed menstruation. Eleven women (23%) would not accept their practice of weight control as the cause of reproductive failure and did not participate in the study. Differences in the serum gonadotropin luteinizing hormone:follicle-stimulating hormone (LH:FSH) ratio were found to be significantly related to differences in the percentage of IBW. The practice of weight control may be a cause of unexplained infertility and menstrual disorders in otherwise healthy women.

Uterine Function and Abnormalities Causing Infertility

The uterus fulfills a number of roles in reproduction. At the cervix, the uterus traps seminal fluid in the cervical secreations where spermatozoa are either stored in crypts for later use or immediately swim cephalad into the fallopian tubes. With ejaculation of semen into the posterior fornix of the vagina, the uterus begins a series of rhythmic contractions that aid the transport of spermatozoa to the fallopian tubes. This process is mediated by prostaglandins contained within the seminal fluid (1) and sperm can be found in the human fallopian tubes as early as 5 minutes after insemination (2).