Obesity suppresses ovarian follicle development in women with regular menstrual cycles
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ATLANTA — Women with obesity have fewer ovarian follicles that remained static for longer and regressed more slowly compared with those found in women with normal weight, according to findings presented at ENDO 2022.
“Obesity adversely impacts reproductive health in women, even in those that report regular and predictable menstrual cycles,” Marla Lujan, PhD, associate professor of nutritional sciences at Cornell University, told Healio. “Increasing rates of obesity warrant a better understanding of how ovarian function is compromised with obesity.”
Lujan and colleagues compared ovarian follicular growth between a cohort of 21 women with obesity and 35% or more body fat, and a group of 21 women without obesity. All participants were aged 19 to 38 years and self-reported having regular menstrual cycles. Serial ovarian transvaginal ultrasonography and venipuncture were conducted every other day for one complete inter-ovulatory interval. The grid method was used document follicles 2 mm or larger, and the identity method was used to assess follicles of at least 7 mm.
Women with obesity had fewer selectable follicles compared with the normal-weight cohort (mean number per participant, 4 vs. 8; P = .022). Follicles in women with obesity grew faster, but also remained static longer and regressed more slowly than in women with normal weight. Women with obesity had a lower anti-Müllerian hormone level than those with normal weight (4.4 ng/mL vs. 5.94 ng/mL; P = .023).
The obesity group had fewer follicles grow to 10 mm (1 vs. 2; P = .03) and fewer anovulatory follicles achieved dominance (0 vs. 1; P = .029) compared with the normal-weight group. Follicles were selected at a smaller diameter in women with obesity compared with normal weight (7.5 mm vs. 9.5 mm; P = .001).
“That follicles were selected for preferential growth at smaller diameters suggests shared defects with other reproductive conditions, such as polycystic ovary syndrome, that are associated with metabolic dysfunction,” Lujan said.
Progesterone levels after ovulation were lower in women with obesity compared with normal weight (4.95 ng/mL vs. 7.85 ng/mL; P = .001), and the obesity group had a higher prevalence of luteal phase defects than the normal-weight cohort when defined by integrated progesterone levels (76% vs. 29%; P = .002) or maximum progesterone levels (71% vs. 24%; P = .002).
“Our research provides evidence that follicle development is suppressed with obesity and that alterations in distinct stages of follicle development are associated with reduced reproductive hormone production,” Alexis Oldfield, BS, co-author and a PhD candidate at Cornell University, said in a press release.
Lujan said future research should focus on identifying the metabolic and nutritional factors that underlie the defects in folliculogenesis.
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Lujan M. OR06. Presented at: ENDO Annual Meeting; June 11-14, 2022; Atlanta (hybrid meeting).
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