Metabolic disorders and infertility

Background. Metabolic disorders are highly prevalent in women of reproductive age, but their potential impact on fertility has been understudied and the importance of metabolic status for fertility remains underestimated. The aim . To assess the impact of metabolic risk factors on female fertility and to identify strategies for improving infertility treatment. Material and methods. The analysis included 40 studies (systematic reviews and meta-analyses, randomized controlled trials, and cohort studies for Russian-language studies). Results. Metabolic disorders, including hypertension, hyperglycemia, dyslipidemia, and obesity, account for up to 40% of observations among women of reproductive age. The mechanisms of their impact on fertility depend on the type of disorder but have a common feature - insulin resistance. The mechanisms of insulin resistance influence on the risk of female infertility include disruption of energy metabolism, activation of oxidative stress and effects on hormone secretion and endometrial receptivity, oocyte development, quality and implantation of embryos. Among the gynecological diseases associated with metabolic disorders and decreased fertility, the most common are endometriosis, anovulation and polycystic ovary syndrome (PCOS). In the treatment of infertility associated with obesity and PCOS, lifestyle changes (diet, physical activity, sleep, stress reduction) and drug therapy (insulin sensitizers) are considered. An alternative approach that offers the use of inositol (a combination of myo- and D-chiroinositol with folic acid and manganese) deserves attention. Conclusion. Overweight and insulin resistance are the most significant metabolic abnormalities in the pathogenesis of female infertility. A complex containing a combination of myo- and D-chiroinositol with a vitamin-mineral premix shows positive results in improving the metabolic profile and restoring fertility.