Chronic energy deficiency can impair the hypothalamic-pituitary-gonadal (HPG) axis and lead to hypothalamic anovulation in underweight women. This review presents the syndromes related to underweight status that are associated with infertility, summarizes the underlying mechanisms, and reviews the available treatment options. Eating disorders, such as anorexia nervosa (AN), constitute the most common cause of infertility in underweight women, who, in addition, experience miscarriages, and sexual dysfunction. The relative energy deficiency in sports (RED-S; former terminology: athlete's triad) involves menstrual dysfunction due to low energy availability, which results in anovulation. Moreover, lipodystrophies, malnutrition, starvation, systematic illnesses (malignancies, endocrinopathies, infectious diseases, advanced chronic diseases, neurologic illnesses), and the utilization of drugs can cause excessive weight loss. They may result in fertility problems due to the loss of adipose tissue and the subsequent hormonal disturbances. Each of these conditions requires multidisciplinary management. Nutritional counseling should target the restoration of energy balance by increasing intake and reducing output. Medical treatment, recommended only for patients who did not respond to standard treatment, may include antipsychotics, antidepressants, or leptin administration. Finally, psychiatric treatment is considered an integral part of the standard treatment.

中文翻译：

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体重过轻对女性和男性生殖的影响。

慢性能量不足会损害体重过轻的女性的下丘脑-垂体-性腺（HPG）轴并导致下丘脑无排卵。这篇综述介绍了与不孕症相关的体重不足状态的综合症，总结了潜在的机制，并综述了可用的治疗方案。饮食失调（例如神经性厌食症（AN））是体重过轻的女性不孕的最常见原因，此外，这些女性还会发生流产和性功能障碍。运动中的相对能量缺乏症（RED-S；以前的术语：运动员的三合会）涉及因能量利用率低而导致的月经不调，从而导致无排卵。此外，脂肪营养不良，营养不良，饥饿，系统性疾病（恶性肿瘤，内分泌病，传染病，晚期慢性疾病，神经系统疾病），并且使用药物可能会导致体重过多减轻。由于脂肪组织的丢失和随后的激素紊乱，它们可能会导致生育问题。这些条件中的每一个都需要多学科管理。营养咨询应通过增加摄入量和减少产量来恢复能量平衡。仅建议对标准治疗无效的患者接受药物治疗，可能包括抗精神病药，抗抑郁药或瘦素。最后，精神病治疗被认为是标准治疗的组成部分。这些条件中的每一个都需要多学科管理。营养咨询应以增加摄入量和减少产量为目标，以恢复能量平衡。仅建议对标准治疗无反应的患者进行药物治疗，可能包括抗精神病药，抗抑郁药或瘦素。最后，精神病治疗被认为是标准治疗的组成部分。这些条件中的每一个都需要多学科管理。营养咨询应通过增加摄入量和减少产量来恢复能量平衡。仅建议对标准治疗无效的患者接受药物治疗，可能包括抗精神病药，抗抑郁药或瘦素。最后，精神病治疗被认为是标准治疗的组成部分。