|Year : 2017 | Volume
| Issue : 1 | Page : 3-6
Prevalence of obesity and outcome of weight loss on reproduction: A study among women attending infertility clinic in Zaria, Northern Nigeria
Yakubu Aliyu, Adebiyi Gbadebo Adesiyun, Solomon Avidime, Abdullahi Jibril Randawa
Department of Obstetrics and Gynaecology, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
|Date of Web Publication||13-Sep-2017|
Adebiyi Gbadebo Adesiyun
Department of Obstetrics and Gynaecology, Ahmadu Bello University Teaching Hospital, Zaria
Source of Support: None, Conflict of Interest: None
Objective: Obesity is rising in the developing countries because of changing life style, and this has its burden on fertility and its management. This study determined the prevalence of obesity and clinical correlation of obesity with menstrual abnormalities, as well as the rate of spontaneous conception among obese infertile women on nonsurgical weight loss therapy. Methodology: A cross-sectional longitudinal study was done among women that presented with infertility to the gynecology clinic. The main outcomes measured were percentage of infertile women that are obese, menstrual pattern of these women, and spontaneous conception among obese infertile women following weight loss therapy. Results: Of the 205 patients, 68 (33.2%) were found to be obese; there was a significant association between obesity and abnormal menstrual pattern (P = 0.0002). Oligomenorrhea and hypomenorrhea were also found to be significantly associated with obesity (P = 0.009 and P = 0.022, respectively). Following average of 12-month follow up, spontaneous conception among obese infertile women while on weight loss therapy was 21.1%. Conclusion: The prevalence of obesity was high with a significant association between obesity and menstrual abnormalities. Weight loss among obese infertile women led to improvement in spontaneous conception.
Keywords: Conception, infertility, menstrual abnormality, obesity
|How to cite this article:|
Aliyu Y, Adesiyun AG, Avidime S, Randawa AJ. Prevalence of obesity and outcome of weight loss on reproduction: A study among women attending infertility clinic in Zaria, Northern Nigeria. Arch Med Surg 2017;2:3-6
|How to cite this URL:|
Aliyu Y, Adesiyun AG, Avidime S, Randawa AJ. Prevalence of obesity and outcome of weight loss on reproduction: A study among women attending infertility clinic in Zaria, Northern Nigeria. Arch Med Surg [serial online] 2017 [cited 2018 May 23];2:3-6. Available from: http://www.archms.org/text.asp?2017/2/1/3/214561
| Introduction|| |
In Sub-Saharan Africa, the desire to reproduce is an important event in most marriages and failure to do so places a lot of stress on the couple., This could lead to so many problems including psychosocial crises. Infertility affects about ten percent of couples. The causes of infertility may be due to male factors, female factors or combination of both. Female factors could be due to ovulatory dysfunctions, tubal/peritoneal factors among others. Ovulatory dysfunction is particularly common among obese women; they usually have oligoovulation or anovulation.
The prevalence of obesity is increasing at an alarming rate in many parts of the world; thus, proportion of women within reproductive age that may present with fertility problems is also set to increase. In caucasian population living in the west and north of Europe, Australia, and the United States, the prevalence of obesity is similarly high in men and women. Among Americans of African descent and in countries with relatively low gross national product, such as those in Central and Eastern Europe, Asia, Latin America, and Africa, the prevalence is 1.5–2 times higher among women and in group with relatively low socioeconomic status. In Nigeria, obesity has been reported to be commonly seen among the affluent business executives and middle-aged females with a sedentary lifestyle. It is also seen among those in the catering profession who are exposed to food preparation and consumption. In Nigeria and other developing countries, obesity is not generally regarded as disease until complication sets in. In fact, a mild degree of obesity is socially acceptable in African culture as a sign of affluence.
Obesity has assumed an epidemic proportion worldwide; it is the most common nutritional disorder in developed countries. In Northern Nigeria, the prevalence of obesity was said to be about 13.1%; it is associated with many conditions such as menstrual abnormalities, hormonal imbalance, recurrent miscarriage, and infertility. Other conditions associated with obesity are malignancies such as endometrial cancer, breast cancer, Type II diabetic mellitus, cardiovascular diseases, and osteoarthritis. Obesity is associated with ovulation dysfunctions, and ovulation dysfunction is responsible for about 10%–15% of female infertility, with reported upsurge in the prevalence of obesity; the number of patients with anovulatory infertility is set to be on the rise.
Delay in spontaneous conception has been reported in obese women, and the probability of pregnancy is said to be reduced by 5% for every unit of body mass index (BMI) that exceeds 29 kg/m 2. Furthermore, studies have demonstrated impaired success in assisted conception cycle, mainly due to oocyte and embryo quality even though there is no consensus of opinion whether the endometrium plays a role in the etiopathogenesis. This study determined the prevalence of obesity and clinical correlation of obesity with menstrual abnormalities among women attending infertility clinic. Spontaneous conception rate among obese infertile women on weight loss regimen was also sought.
| Methodology|| |
This study was a cross-sectional longitudinal study conducted over 15 months. Institutional ethical clearance was obtained. The study population were consenting infertile women attending infertility clinic. A total of 205 patients were enrolled for the study based on sample size arrived at with the formula of prevalence study. Height (stadiometer) was measured to the nearest 0.1 cm and weight (platform weighing scale) to the nearest 0.1 kg using a Seca machine. In this study, the BMI was used to assess obesity.
The patients were classified according to the World Health Organization.
- Underweight <18.5 kg/m 2
- Normal 18.5–24.9 kg/m 2
- Overweight 25–29.9 kg/m 2
- Class I obesity 30–34.9 kg/m 2
- Class II obesity 35–39.9 kg/m 2
- Class III obesity >40 kg/m 2
All obese patients had basic investigations that included pelvic sonography, hysterosalpingography, serum prolactin, and semen analysis. Patients with abnormality in any of these investigations were excluded from participating in the nonsurgical weight loss therapy while those with normal investigations were enrolled for weight loss treatment therapy and monitoring following consent.
These obese women on weight loss therapy were followed up on 4 weekly appointments for an average of 12 months. They were instructed to do physical exercise, to strictly adhere to diet modification as prescribed by nutritionist, and to keep their menstrual calendar.
The weight loss therapy included moderate-intensity aerobic physical activity (bicycling, running, brisk walking, jogging, dancing, swimming, general gardening, and playing basketball) for at least 2 h 30 min/week and low-calorie and high-protein diet. Those with missed menstrual period during the weight loss regimen were subjected to urine pregnancy test and subsequently had ultrasonography to confirm the pregnancy. Data were analyzed using SPSS 17.0 version, using P = 0.05.
| Results|| |
A total of 205 participants with infertility were recruited for the study. Mean age of the participants was 31.3 ± 6.4 years, the youngest woman was 18 years, and oldest was 48 years, and the mean age at menarche was 14.5 ± 1.5 years. Secondary infertility was the most common form of infertility seen in 133 (64.9%) participants. Out of 205 participants, 68 (33.2%) were found to have BMI of 30 kg/m 2 and above. A breakdown revealed that 10 (4.9%) were underweight, 66 (32.2%) were of normal BMI, 61 (29.8%) were overweight, 38 (18.5%) had Type I obesity, 23 (11.2%) had Type II obesity, and 7 (3.4%) were morbidly obese.
Out of 205 participants, 105 (51.2%) had normal menstrual pattern, 49 (23.9%) had hypermenorrhea, 38 (18.5%) had hypomenorrhea, and 28 (13.7%) had oligomenorrhea. Abnormal menstrual pattern was present in 47 (69.1%) of the obese participants while only 25 (37.9%) of those with normal BMI had abnormal menstrual pattern.
There is statistically significant relationship between obesity and menstrual abnormalities [Table 1]. Oligomenorrhea was present in 18 (75.0%) of the obese participants while only 6 (25.0%) of those with normal BMI had oligomenorrhea. There is statistically significant relationship between obesity and oligomenorrhea [Table 2]. Hypomenorrhea was present in 19 (70.4%) of the obese participants while only 8 (29.6%) of those with normal BMI had hypomenorrhea. There is a significant relationship between obesity and hypomenorrhea [Table 3]. There is no significant relationship (χ2 = 2.213, df = 1, P = 0.137) between obesity and hypermenorrhea.
Follow-up and outcomes of nonsurgical weight loss therapy
Nineteen (35.2%) patients fulfilled the criteria to participate in the nonsurgical weight loss therapy. The average weight loss was 5.8 kg with a range of 2.5–10.5 kg over an average of 12-month (range 7.5–12 months) follow-up. A total of 4 (21.1%) of the 19 women spontaneously conceived during the follow-up period, and there was no incidence of spontaneous miscarriage. There was normalization of previous menstrual abnormality in 12 (63.2%) of the 19 patients, and 3 (75%) of the 4 patients that became pregnant were from this latter category.
| Discussion|| |
Worldwide including most developing countries like Nigeria, there has been an increase in obesity level. This is mostly attributable to factor relating to high caloric intake and decreased energy expenditure. Obesity and its prevention have become a topical issue due to its association with numerous health risks including infertility. In this study, the prevalence of obesity among women attending infertility clinic was 33.2%; this is in consonance with the finding of a study done in River state, Nigeria, with obesity prevalence of 31.7% among adult. Similarly, a study in Egypt reported a prevalence rate of obesity of 35.7% among women, and in Saudi Arabia, about 38% were obese among infertile women. The possible reasons for this high prevalence of obesity obtained in this study could be attributed to the fact that the study setting is located in an urban area with many academic institutions. Thus, most of its inhabitants may have sedentary lifestyle with a high proportion adopting western diet. The obese participants were mostly aged 30 years and above accounting for 45 (66.2%) of the study population.
The mean age at menarche was 14.5 ± 1.5 years in this study; this is similar to the age of menarche among girls in southwestern Nigeria., Menstrual pattern abnormality was found in 100 (48.8%) of the 205 participants; this is in consonance with the values obtained in the USA where menstrual abnormality was found to be within 30%–47%. There was a statistically significant relationship between obesity and menstrual pattern abnormality P = 0.0002 in this series. This is in conformity with other studies that found a positive relationship between obesity and menstrual abnormalities.,, In this study, 13.7% had oligomenorrhea, which is similar to the finding reported by authors in a study done in the USA. However, in Mexico, they found that 18.3% of patients had oligomenorrhea. In the latter study, waist-to-hip ratio was used to measure obesity, in contrast to BMI used in this study. This difference in methodology could account for the differences in the prevalence rate of oligomenorrhea. Study has shown that the risks for amenorrhea and oligomenorrhea increase twofold by each unit increase of obesity grade. In this series, a significant relationship between obesity and oligomenorrhea (P = 0.009) was recorded. This is in conformity to the findings of other studies which showed positive association between obesity and menstrual cycle length abnormalities.,, Also found in this study was a significant relationship between obesity and hypomenorrhea (P = 0.022).
Following weight loss regimen, spontaneous conception rate of 21.1% was recorded in this study, and none of the patient had miscarriage. Although the power of this result could have been better if a case-controlled methodology was employed. This result goes to buttress the fact that weight loss in obese infertile women is associated with increased chance of spontaneous conception similar to findings from other studies., However, the rate of 21.1% in this series is lower than the figure from a study done in the USA, where 30% spontaneous conception rate was found following dietary modification and physical exercise. In the latter study, the participants underwent a weekly program aimed at lifestyle changes in relation to exercise and diet for 6 months; those that did not complete the 6 months were treated as a comparison group. Women in the study lost an average of 10.2 kg/m 2, and 60 of the 67 participants with anovulatory cycle resumed ovulation resulting in 18 (30%) spontaneous conception. The difference in spontaneous conception between the two studies could be due to difference in weight loss recorded which may not be unrelated to level of adherence to weight loss regimen.
Out of the four women that conceived spontaneously in this study, none of them had miscarriage. This is in contrast with the finding of a study done in the USA that recorded The high miscarriage rate in the USA study which is in contrast to the zero rate in this study, may be due to wide gap in the sample size of women that conceived spontaneously. In another study in the USA, they found spontaneous conceptions of 41.7%; in the index study, 13 obese infertile women underwent a behavioral change that included exercise and diet over 6 months. Women in the study group lost an average of 6.3 kg, with 12 of the 13 participants resuming ovulation and 5 (41.7%) conceived spontaneously. The differences in the result could be due to the fact that their sample size is very small.
In conclusion, there should be routine screening for obesity among women presenting to infertility clinic. Obese patients with infertility should be educated on weight reduction as an important approach toward attainment and sustenance of conception. Furthermore, public enlightenment on obesity, its effect, and prevention should be advocated toward decreasing the levels of obesity and its impact on health.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Idrissa A. Infertility. In: Kwawukume EY, Emuveyan EE, editors. Comprehensive Gynaecology in the Tropics. Accra: Graphic Packaging Limited; 2005. p. 333-45.
Lucia M. Anthropometric measurements and biochemical parameters in black women at the unit for reproductive care at universitas hospital Bloemfontein. Dissertation for the degree of Magister Scientiae(Dietetics). University of Free State, South Africa 2004;1-184. (scholar.ufs.ac.za).
Omoaregba JO, James BO, Lawani AO, Morakinyo O, Olotu OS. Psychosocial characteristics of female infertility in a tertiary health institution in Nigeria. Ann Afr Med 2011;10:19-24.
] [Full text]
Reilly JJ, Dorosty AR, Emmett PM, Avon Longitudinal Study of Pregnancy and Childhood Study Team. Identification of the obese child: Adequacy of the body mass index for clinical practice and epidemiology. Int J Obes Relat Metab Disord 2000;24:1623-7.
Seidiell JC. Epidemiology of obesity. Seminal Vasc Med 2005;5:3-14.
Popkin BM, Doak CM. The obesity epidemic is a worldwide phenomenon. Nutr Rev 1998;56:106-14.
Azinge EC. Obesity and its implication in thirty Nigerian patients in Lagos. Nig Q J Hosp Med 1997;7:49-52.
Bakari AG, Onyemelukwei GC, Sani BG, Aliyu IS, Hassan SS, Aliyu TM. Obesity overweight and underweight in sub urban Northern Nigeria. Int J Diabetics Metab 2007;15:68-9.
Heymsfield SB, Baumgarther RN, Pan S. Nutritional assessment of malnutrition by anthropometric methods. In: Shils ME, Olson JA, Shike M, Ross AC. Modern Nutrition in Health and Disease. 9th
ed. Philadelphia: Lippincott, Williams and Wilkins; 1999. p. 115-21.
Laquatra I. Nutrition for weight management. In: Mahan LK, Escott-Stump S, editors. Krause Food, Nutrition & Diet Therapy. Philadelphia: W.B. Saunders Company; 2004. p. 558-93.
Siminialayi IM, Emem-Chioma PC, Dapper DV. The prevalence of obesity as indicated by BMI and waist circumference among Nigerian adults attending family medicine clinics as outpatients in rivers state. Niger J Med 2008;17:340-5.
Miriam M. Growing Obesity in Africa Bad for Worker Productivity. Cape Town: (IPS) Inter Press Service; 2010.
Hamilton CJ, Jaroudi KA, Sieck UV. High prevalence of obesity in a Saudi infertility population. Ann Saudi Med 1995;15:344-6.
Oduntan SO, Ayeni O, Kale OO. The age of menarche in Nigerian girls. Ann Hum Biol 1976;3:269-74.
Abioye-Kuteyi EA, Ojofeitimi EO, Aina OI, Kio F, Aluko Y, Mosuro O, et al.
The influence of socioeconomic and nutritional status on menarche in Nigerian school girls. Nutr Health 1997;11:185-95.
Robert BF. Obesity and reproduction. J Lanc Gen Hosp 2009;4:4.
Hartz AJ, Barboriak PN, Wong A, Katayama KP, Rimm AA. The association of obesity with infertility and related menstural abnormalities in women. Int J Obes 1979;3:57-73.
Lambert-Messerlian G, Roberts MB, Urlacher SS, Ah-Ching J, Viali S, Urbanek M, et al.
First assessment of menstrual cycle function and reproductive endocrine status in Samoan women. Hum Reprod 2011;26:2518-24.
Castillo-Martínez L, López-Alvarenga JC, Villa AR, González-Barranco J. Menstrual cycle length disorders in 18- to 40-y-old obese women. Nutrition 2003;19:317-20.
Safaa A, Khaled Z. The overlooked role of obesity in infertility. J Fam Reprod Health 2008;2:115-23.
Pasquali R, Pelusi C, Genghini S, Cacciari M, Gambineri A. Obesity and reproductive disorders in women. Hum Reprod Update 2003;9:359-72.
Clark AM, Thornley B, Tomlinson L, Galletley C, Norman RJ. Weight loss in obese infertile women results in improvement in reproductive outcome for all forms of fertility treatment. Hum Reprod 1998;13:1502-5.
Clark AM, Ledger W, Galletly C, Tomlinson L, Blaney F, Wang X, et al.
Weight loss results in significant improvement in pregnancy and ovulation rates in anovulatory obese women. Hum Reprod 1995;10:2705-12.
[Table 1], [Table 2], [Table 3]