The dramatic increase in the prevalence of obesity coincides with a decline in reproductive health indices in both sexes. Energy excess mediates changes to the regulatory mechanisms of the reproductive system. Obese individuals exhibit increased estrogen concentrations, due to the overexpression of aromatase in the adipose tissue; via a negative feedback loop, men present with symptoms of hypogonadotropic hypogonadism. These hormonal changes, along with increased oxidative stress, lipotoxicity and disturbances in the concentrations of adipokines, directly affect the gonads, peripheral reproductive organs and the embryo. Clinical evidence is somewhat contradicting, with only some studies advocating worse semen parameters, increased incidence of erectile dysfunction, increased doses of ovulation induction medications, and worse live birth rates in assisted reproductive technology (ART) cycles in obese individuals compared with those of normal weight. Similar conclusions are drawn about patients with insulin resistance syndromes, namely polycystic ovary syndrome (PCOS). As far as treatment options are concerned, lifestyle changes, medical therapy and bariatric surgery may improve the reproductive outcome, although the evidence remains inconclusive. In this review, we summarize the evidence on the association of obesity and reproductive health on both the molecular and the clinical level, and the effect of weight-loss interventions on reproductive potential.

中文翻译：

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体内多余脂肪对男性和女性生殖的影响。

肥胖症患病率的急剧上升与男女生殖健康指数的下降同时发生。过剩的能量介导了生殖系统调节机制的变化。肥胖者由于脂肪组织中芳香化酶的过度表达而导致雌激素浓度升高。通过负反馈回路，男性表现为性腺功能减退性腺功能减退症。这些荷尔蒙的变化，以及增加的氧化应激，脂毒性和脂肪因子浓度的紊乱，直接影响性腺，周围生殖器官和胚胎。临床证据有些矛盾，只有一些研究主张精液参数更差，勃起功能障碍的发生率增加，排卵诱导药物的剂量增加，与正常体重的肥胖者相比，肥胖个体在辅助生殖技术（ART）周期中的活产率更低。关于患有胰岛素抵抗综合征，即多囊卵巢综合征（PCOS）的患者也得出了类似的结论。就治疗选择而言，尽管证据尚无定论，但生活方式的改变，药物治疗和减肥手术可能会改善生殖结果。在这篇综述中，我们总结了肥胖与生殖健康在分子和临床水平上的关联以及减肥干预对生殖潜能的影响的证据。即多囊卵巢综合征（PCOS）。就治疗选择而言，尽管证据尚无定论，但生活方式的改变，药物治疗和减肥手术可能会改善生殖结果。在这篇综述中，我们总结了肥胖与生殖健康在分子和临床水平上的关系以及减肥干预对生殖潜能的影响的证据。即多囊卵巢综合征（PCOS）。就治疗选择而言，尽管证据尚无定论，但生活方式的改变，药物治疗和减肥手术可能会改善生殖结果。在这篇综述中，我们总结了肥胖与生殖健康在分子和临床水平上的关联以及减肥干预对生殖潜能的影响的证据。