Sains Malaysiana 52(12)(2023): 3475-3484

http://doi.org/10.17576/jsm-2023-5212-10

Relationship between Obesity and Infertility among Women with Polycystic Ovarian Syndrome Treated at the National Population and Family Development Board (NPFDB) Malaysia

(Hubungan antara Keobesitian dan Ketidaksuburan dalam Kalangan Wanita dengan Sindrom Ovari Polisistik Dirawat di Lembaga Penduduk dan Pembangunan Keluarga Negara (LPPKN) Malaysia)

HASNOORINA HUSIN^1,2, MOHD AZIZUDDIN MOHD YUSSOF¹, ASMAH HAMID², ISMARULYUSDA ISHAK² & SITI BALKIS BUDIN^3,*

¹Biomedical Unit, Division of Human Reproductive, National Population and Family Development Board, 12B, Jalan Raja Laut, 50350 Kuala Lumpur, Malaysia

²Center for Toxicology and Health Risk, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur Campus, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia

³Center for Diagnostic^, Therapeutic and Investigative^, Studies, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur Campus, Jalan Raja Muda Abdul Aziz,

50300 Kuala Lumpur, Malaysia

Received: 8 December 2023/Accepted: 18 December 2023

Abstract

Polycystic ovarian syndrome (PCOS) is a metabolic dysfunction and is closely related to infertility in women. Obesity has an impact on the clinical manifestations of PCOS. This study was designed to determine the relationship between obesity and infertility among women with PCOS treated at the National Population and Family Development Board (NPFDB) Malaysia. This is a cross-sectional study with a simple random sampling technique involving infertile women attending NPFDB Subfertility Clinic, Kuala Lumpur, Malaysia, from January 2018 to December 2019. Clinical and menstrual history were recorded, and subjects underwent physical examination by a medical doctor. Subjects were diagnosed with PCOS based on Rotterdam criteria, and blood was taken for reproductive hormone, blood glucose, cholesterol, and triglyceride determination. A total of 179 infertile women completed the study, and 84 (47%) were diagnosed with PCOS. Results showed a significant increase in follicle-stimulating hormone (FSH) levels along with a significant reduction in progesterone level (p<0.05) in PCOS women compared to non-PCOS women. A total of 44% of PCOS women were found to be obese, and they exhibited significantly higher blood pressure and triglyceride level but lower high-density lipoprotein (HDL) level (p<0.05). Chi-square (χ2) showed PCOS women who are obese are more likely to experience ovulatory dysfunction, as evidenced by oligo- and amenorrhea, compared to non-obese women with PCOS. In addition, they were also presented with significantly higher testosterone levels (p<0.05) and reduced progesterone levels compared to non-obese PCOS women. This study showed that PCOS women with obesity had more prominent ovulatory dysfunction and reproductive hormonal imbalance than non-obese PCOS women. These findings suggest that PCOS women with obesity are more prone to develop infertility.

Keywords: Infertility; obesity; polycystic ovarian syndrome

Abstrak

Sindrom ovari polisistik (PCOS) adalah disfungsi metabolik dan berkait rapat dengan ketidaksuburan pada wanita. Keobesitian pula mempunyai kesan ke atas manifestasi klinikal PCOS. Kajian ini direka untuk menentukan hubungan antara keobesitian dan ketidaksuburan dalam kalangan wanita dengan PCOS yang dirawat di Lembaga Penduduk dan Pembangunan Keluarga Negara (LPPKN) di Malaysia. Kajian ini merupakan kajian keratan rentas dengan teknik persampelan rawak mudah melibatkan wanita tidak subur yang menghadiri Klinik Subfertiliti di LPPKN, Kuala Lumpur, Malaysia dari Januari 2018 hingga Disember 2019. Sejarah klinikal dan haid direkodkan dan subjek menjalani pemeriksaan fizikal oleh doktor perubatan. Subjek didiagnosi menghidap PCOS berdasarkan kriteria Rotterdam dan darah diambil untuk penentuan aras hormon reproduktif, glukosa, trigliserida dan kolesterol. Seramai 179 orang wanita tidak subur menyelesaikan kajian ini dan 84 (47%) daripadanya telah didiagnosis mengalami PCOS. Hasil kajian mendapati hormon perangsang folikel (FSH) adalah lebih tinggi dan progesteron adalah lebih rendah dengan ketara (p<0.05) pada wanita PCOS berbanding wanita tanpa PCOS. Seramai 44% wanita PCOS didapati obes dan mempunyai tekanan darah dan trigliserida yang lebih tinggi serta aras lipoprotein berketumpatan tinggi (HDL) lebih rendah dengan ketara (p<0.05). Khi kuasa dua (χ2) menunjukkan wanita PCOS yang mengalami obesiti mengalami disfungsi ovulasi yang ketara yang ditunjukkan oleh oligo dan amenorea berbanding wanita PCOS bukan obes. Tambahan pula, tahap testosteron adalah lebih tinggi secara signifikan (p<0.05) dan progesteron lebih rendah pada wanita PCOS yang obes. Sebagai kesimpulan kajian ini mendedahkan bahawa wanita PCOS dengan obesiti mempunyai disfungsi ovulasi dan ketidakseimbangan hormon reproduktif yang lebih ketara berbanding wanita PCOS bukan obes. Penemuan ini menunjukkan bahawa wanita PCOS dengan obesiti lebih cenderung untuk mengalami ketidaksuburan.

Kata kunci: Kobesitian; ketidaksuburan; sindrom ovari polisistik

REFERENCES

Allahbadia, G.N. & Merchant, R. 2011. Polycystic ovary syndrome and impact on health. Middle East Fertility Society Journal 16(1): 19-37.

Aswini, R. & Sabeena Jayapalan. 2017. Modified Ferrimann Gallwey score in hirsutism and its association with metabolic syndrome. International Journal of Trichology 9(1): 7-13.

Barthelmess, E.K. & Naz, R.K. 2015. Polycystic ovary syndrome: Current status and future perspective. Frontier in Bioscience (Elite Ed.) 6(1): 104-119.

Bee Koon Poh, Boon Koon Ng, Mohd Din Siti Haslinda, Safii Nik Shanita, Jyh Eiin Wong, Siti Balkis Budin, Abdul Talib Ruzita, Lai Ong Ng, Ilse Khouw & A. Karim Narimah. 2013. Nutritional status and dietary intakes of children aged 6 months to 12 years: Findings of the Nutrition Survey of Malaysian Children (SEANUTS Malaysia). The British Journal of Nutrition 110: 21-35.

Benksim, A., Elkhoudri, N., Addi, R.A., Baali, A. & Cherkaoui, M. 2018. Difference between primary and secondary infertility in Morocco: Frequencies and associated factors. International Journal of Fertility & Sterility 12(2): 142-146.

Best, D., Avenell, A. & Bhattacharya, S. 2017. How effective are weight-loss interventions for improving fertility in women and men who are overweight or obese? A systematic review and meta-analysis of the evidence. Human Reproductive Update 23(6): 681-705.

Borruel, S., Fernandez-Duran, E., Alpañés, M., Martí, D., Alvarez-Blasco, F. & Luque-Ramírez, M. & Escobar-Morreale, H.F. 2013. Global adiposity and thickness of intraperitoneal and mesenteric adipose tissue depots are increased in women with polycystic ovary syndrome. Journal of Clinical Endocrinology Metabolism 98: 1254-1263.

Broughton, D.E. & Moley, K.H. 2017. Obesity and female infertility: Potential mediators of obesity’s impact. Fertility Sterility 107: 840-847.

Bruyneel, A., Catteau, J.S., Decanter, C., Clouqueur, E., Tomaszewski, C. & Subtil, D. 2014. Polycystic ovary syndrome: What are the obstetrical risks? Gynecology Obstetric Fertility 42: 104-111.

Celik, C., Tasdemir, N., Abali, R., Bastu, E. & Yilmaz, M. 2014. Progression to impaired glucose tolerance or type 2 diabetes mellitus in polycystic ovary syndrome: A controlled follow-up study. Fertility Sterility 101(4): 1123-1128.e1.

Chong, C.T., Lai, W.K., Mohd Sallehuddin, S. & Ganapathy, S.S. 2023. Prevalence of overweight and its associated factors among Malaysian adults: Findings from a nationally representative survey. PLoS ONE 18(8): e0283270.

Daniilidis, A. & Dinas, K. 2009. Long-term health consequences of polycystic ovarian syndrome: A review analysis. Hippokratia 13(2): 90-92.

Deatsman, S., Vasilopoulos, T. & Rhoton-Vlasak, A. 2016. Age and fertility: A study on patient awareness. JBRA Assisted Reproductive 20(3): 99-106.

Deshpande, P.S. & Gupta, A.S. 2019. Causes and prevalence of factors causing infertility in a public health facility. Human Reproduction Science 12(4): 287-293.

Diamanti, K.E. & Dunaif, A. 2012. Insulin resistance and the polycystic ovary syndrome revisited:  An update on mechanisms and implications. Endocrinology Revision 33(6): 981-1030.

Diamanti, K.E., Xyrafis, X., Boutzios, G. & Christakou, C. 2008. Pancreatic beta-cells dysfunction in polycystic ovary syndrome. Panminerva Medicine 50(4): 315-325.

Dixon, D.L., Riche, D.M. & Kelly, M.S. 2021. Chapter 32 Dyslipidemia. In DiPiro’s Pharmacotherapy: A Pathophysiological Approach. 12th ed., edited by DiPiro, J.T., Yee, G.C., Haines, S.T., Nolin, T.D., Ellingrod, V.L. & Posey, M. McGraw Hill.

Dunaif, A., Segal, K.R., Futterweit, W. & Dobryansky, A. 2012. Profound peripheral insulin resistance, independent of obesity, in polycystic ovary syndrome. Diabetes 38: 1165-1174.

Glintborg, D. & Andersen, M. 2010. An update on the pathogenesis, inflammation, and metabolism in hirsutism and polycystic ovary syndrome. Gynecology Endocrinology 26: 281-296.

Hart, R. & Doherty, D.A. 2015. The potential implications of a PCOS diagnosis on a woman’s     

long-term health using data linkage. Journal Clinical Endocrinology Metabolism 100: 911-919.

Haqq, L., Farlane, J., Dieberg, G. & Smart, N. 2014. Effect of lifestyle intervention on the reproductive endocrine profile in women with polycystic ovarian syndrome: A systematic review and meta-analysis. Endocrine Connection 3(1): 36-46.

Institute for Public Health. 2020. National Health and Morbidity Survey (NHMS). https://iku.gov.my/images/IKU/Document/REPORT/2020/report/2_Report_NHMS2020_Vol-2.pdf 1: 18-3085-44207 Accessed 1 February 2022.

Jaacks, L.M., Vandevijvere, S., Pan, A., McGowan, C.J., Wallace, C., Imamura, F., Mozaffarian, D., Swinburn, B. & Ezzati, M. 2019. The obesity transition: Stages of the global epidemic. Lancet Diabetes Endocrinology 7(3): 231-240.

Jabatan Statistik Malaysia. 2023. Vital statistic Malaysia 2023. https://www.dosm.gov.my        

Accessed 11 November 2023.

Komathy, T., Yusri Sham, Hasnoorina Husin, Norazlina Abdul Samad & Nor Hamizan Hashim. 2021. Laboratory standard operation procedures. In Clinical Manual Management of Subfertility, edited by Mohd Azizuddin. Malaysia: National Population and Family Development Board (LPPKN). pp. 35-56.

Lungu, A.O., Zadeh, E.S., Goodling, A., Cochran, E. & Gorden, P. 2012. Insulin resistance is a sufficient basis for hyperandrogenism in lipodystrophic women with polycystic ovarian syndrome. Journal Clinical Endocrinology Metabolism 97: 563-567.

Lyngs, J., Toft, G., Hoyer, B.B., Guldbrandsen, K., Olsen, J. & Ramalu, H. 2014. Moderate alcohol intake and menstrual cycle characteristics. Human Reproduction 29: 351-358.

Mirza, F.G., Patki, A. & Pexman-Fieth, C. 2016. Dydrogesterone use in early pregnancy. Gynecological Endocrinology 32(2): 97-106.

MyGovernment. 2016. Demography of population Malaysia. Department of Information, Government of Malaysia. https://www.malaysia.gov.my/portal/content/30114 Accessed 9 May 2022.

Osibogun, O., Ogunmoroti, O. & Michos, E.D. 2020. Polycystic ovary syndrome and cardiometabolic risk: Opportunities for cardiovascular disease prevention. Trend in Cardiovascular Medicine30(7): 399-404.

Palomba, S., Daolio, J., Romeo, S., Battaglia, F.A., Marci, R. & La Sala, G.B. 2018. Lifestyle and fertility: The influence of stress and quality of life on female fertility. 2018. Reproduction Biology Endocrinology 16(1): 113.

Pandey, P., Maheshwari, A. & Bhattacharya, S. 2010. Should access to fertility treatment be determined by female body mass index? Human Reproductive 25(4): 815-820.

Panidis, D., Macut, D., Tziomalos, K., Papadakis, E., Mikhailidis, K., Kandaraki, E.A. Tsourdi, E.A., Tantanasis, T., Mavromatidis, G. & Katsikis, I. 2013. Prevalence of metabolic syndrome in women with polycystic ovary syndrome. Clinical Endocrinology (Oxf) 78(4): 586-592.

Poh, B.K., Lee, S.T., Yeo, G.S., Tang, K.C., Noor Afifah, A.R., Siti Hanisa. A., Parikh, P., Wong, J.E., Ng, A.L.O. & SEANUTS Study Group. 2019. Low socioeconomic status and severe obesity are linked to poor cognitive performance in Malaysian children. BMC Public Health. 19(Suppl 4): 541.

Randeva, H.S., Tan, B.K., Weickert, M.O., Lois, K., Nestler, J.E. & Sattar, N. 2012. Cardiometabolic aspects of the polycystic ovary syndrome. Endocrinology Review 33: 812-841.

Reyes, M.E., Ortega, G.C., Martinez, C.N., Arcc, S.L., Estrada, G.G. & Moran, C. 2016. Association of obesity and overweight with the prevalence of insulin resistance, pre-diabetes and clinical-biochemical characteristics among infertile Mexican women with polycystic ovary syndrome: A cross-sectional study. BMJ Open 6(7): 12107.

Robert, W. 2012. Dyslipidemia in PCOS. Steroids 77: 295-299.

Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. 2004. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovarian syndrome. Human Reproductive 19: 41-47.

Sangaraju, S.L., Yepez, D., Grandes, X.A., Talanki Manjunatha, R. & Habib, S. 2022. Cardio-metabolic disease and polycystic ovarian syndrome (PCOS): A narrative review. Cureus14(5): e25076.

Sareh Dashti, Latiffah Abdul Latiff, Habibah Abdul Hamid, Suriani Mohamed Saini, Azrin Shah Abu Bakar, Nur Amirah Inani Sabri, Maimunah Ismail & Ali Jafarzadeh Esfehani. 2019. Prevalence of polycystic syndrome among Malaysian female university staff. Journal of Midwifery and Reproductive Health 7(1): 1560-1568.

Sidika, E.K. 2017. New biomarkers for diagnosis and management of polycystic ovary syndrome. Clinica Chimica Acta 471: 248-253.

Sirmans, S.M. & Pate, K.A. 2014. Epidemiology, diagnosis and management of polycystic ovary syndrome. Clinical Epidemiology 6: 1-13.

Teede, H., Deeks, A. & Moran, L. 2010. Polycystic ovary syndrome: A complex condition with

psychological, reproductive and metabolic manifestations that impact health across the lifespan. BMC Medicine 8(4): 1-10.

Teede, H.J., Misso, M.L., Costello, M.F., Dokras, A., Laven, J., Moran, L., Piltonen, T., Norman, R.J. & International PCOS Network. 2018. Recommendation from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Fertility Sterility 110(3): 364-379.

Vahratian, A. & Smith, Y.R. 2009. Should access to fertility-related services be conditional on body mass index? Human Reproductive Update 24(7): 1532-1537.

Women’s Health, U.S. Department of Health and Human Services. 2015. https://www.women-shealth.gov/publications/our-pub;ications/fact-sheet/polycystic-ovary-syndrome.pdf  Accessed 23 February 2021.

*Corresponding author; email: balkis@ukm.edu.my