The study of correlation between BMI and infertility. Dr. seyed mohammadreza fouladi

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2 The study of correlation between BMI and infertility Dr. seyed mohammadreza fouladi

3 Female Infertility Infertility is a generally defined as one year unprotected intercourse without contraception. Approximately 85 90% of healthy young couples conceive within I year, most within 6 months. Contrary to popular perception, the overall incidence of infertility has remained relatively unchanged over the past 3 decades. The evaluation and treatment of infertility have changed dramatically during that time. 1 ART techniques. 2 Greater numbers of women attempting pregnancy at older ages. 3 Media attention and to raise public awareness of infertility and modern treatments.

4 Normal conception

5 Causes of Infertility

6 Female Infertility The first U.S. census was in At that time, the crude birth rate was 55 per 1,000 total population; The crude birth rate in 2007 was 15% lower than in 1990 (16.7 per 1,000 population), but increased from 2002 (13.9 per 1,000), which was a record low for the nation. Even barring any changes in the causes and prevalence of infertility, the absolute numbers of infertile women in the U.S. can be expected to decline in the years ahead

7 Aging and Fertility Studies of fertility in the Hutterites illustrate how fertility declines with advancing age. Whereas only 2.4% of Hutterite women were infertile, II % bore no children after age 34, 33% were infertile by age 40, and 87% were infertile at age 45. Overall, fertility rates are 4 8% lower in women aged years, 15 19% lower in those aged 30 34,26 46% lower in woman aged 35 39, and as much as 95% lower for women aged years. Miscarriage rates in natural conception cycles are generally low before age 30 (7 15%) and rise with age

8 Aging and Fertility Success rates achieved with ART also decline as age increases. Data collected by the Centers for Disease Control women in all age groups and Prevention (CDC) in the U.S. since 1989 demonstrate consistently that age is the single most important factor affecting the probability of success with ART. The available evidence indicates that both the age related decline in female fertility and the increase in risk of miscarriage can be attributed to an increase in the proportion of abnormal oocytes in an aging and shrinking follicular pool.

9 Causes of Infertility

10 Ovarian Reserve Tests Age over 35. Unexplained infertility. Family history of early menopause Previous ovarian surgery Smoking Demonstrated poor response to exogenous gonadotropin stimulation

11 Ovarian Reserve Tests Biochemical tests include both hbasal measurements, such as FSH, estradiol, the clomiphene citrate. FSH levels greater than 10 IU/l(10 20 IU/L) have high specificity (80 100%)for predicting poor response to stimulation, but their sensitivity for identifying such women is generally low the basal FSH is normal and the estradiol concentration is elevated (>60 80 pg/ml), the likelihood of poor response to stimulation is increased and the chance for pregnancy is decreased. The basal serum estradiol concentration, by itself, has little value as an ovarian reserve Test but can provide additional information that helps in the interpretation of the basal FSH level. l

12 Ovulatory Dysfunction A serum progesterone measurement is the simplest, most common, objective and reliable test of ovulatory function, as long as it is appropriately timed A progesterone concentration less than 3 ng/ml implies anovulation,

13 Causes of Infertility

14 Lifestyle and Environmental Factors BMI (between 20 and 25 kg/m2) Up to 13% of female infertility ili may relate to smoking. Heavy alcohol consumption in women may y p y decrease fertility

15 Definition of Obesity Obesity is an excess storage of triglycerides in adipose cells. There is a difference between obesity and overweight.'? Obesity is an excess of body fat. The body mass index is the ratio of weight divided by the height squared (in metric units): BMI =kilograms/meters2 Overweight :BMI = Obesity : BMI=30 and higher Obesity is associated with four major risk factors for atherosclerosis: hypertension, diabetes, hypercholesterolemia, and hypertriglyceridemia.

16 Obesity 64.1% of U.S. women were overweight or obese (28.6% overweight and 35.5% obese) in In Iran the first survey shows 11.1% of men and 25.2% of women were obese While 6.3% of men and 5.2% of women were underweight. About 59% of American adults do zero vigorous physical activity in their leisure time. Almost 17% of school aged children and adolescents in 2008 were obese and 32% overweight. Hypertension, heart disease, type 2 diabetes mellitus, metabolic syndrome, gout, gallbladder disease, obstructive sleep apnea, osteoarthritis

17 prevalence of obesity in women compared with men One reason may be the fact that women have a lower metabolic rate than men, even when adjusted for differences in body composition and level of activity. Another reason that more women gain weight with age is the postmenopausal loss of the increase in metabolic rate that is associated with the luteal phase of the menstrual cycle.

18 WHO

19 Descriptive Statistics N Minimum Maximum Mean Std. Deviation height weight age Infertility BMI Valid N (listwise) 46

20 Descriptive Statistics Mean Std. Deviation N BMI Infertility

21 Correlations BMI Infertility BMI Pearson Correlation ** Sig. (2 tailed).001 N Infertility Pearson Correlation.459 ** 1 Sig. (2 tailed).001 N **. Correlation is significant at the 0.01 level (2 tailed).

22 Group Statistics Std. Std. Error BMI2 N Mean Deviation Mean Infertility Normal lbmi Over Normal BMI

23 Chi Square Tests

24 Chi Square Tests Value df Asymp. Sig. (2 sided) Exact Sig. (2 sided) Exact Sig. (1 sided) Pearson Chi Square a Continuity Correction b THANKS FOR YOUR ATTENTION Likelihood Ratio Fisher's Exact Test Linear by Linear Association N of Valid Cases 46 a. 1 cells (25.0%) have expected tdcount less than 5. The minimum i expected tdcount is b. Computed only for a 2x2 table