title: Does obesity compromise ovarian reserve markers? A clinician's perspective.
abstract: OBJECTIVE
  The aim of the study was to ascertain if increasing body mass index (BMI) adversely affects ovarian reserve among infertile women of Asian origin undergoing in vitro fertilization (IVF).
  
  
  METHODS
  This prospective study on 183 women was carried out in the infertility clinic of All India Institute of Medical Sciences, New Delhi, India. Blood hormonal assay in all patients including follicle-stimulating hormone (FSH), luteinizing hormone (LH) and inhibin B was performed on day 2/3 of a spontaneous cycle. A transvaginal ultrasonographic examination on day 2-5 of the menstrual cycle was done for antral follicle count (AFC) and ovarian volume. A correlation between BMI and ovarian reserve parameters like FSH, LH, inhibin B, antral follicle count and ovarian volume was noted.
  
  
  RESULTS
  Age was comparable in the three BMI groups. The mean duration of infertility was 8.38 years. Compared to the normal weight, the overweight and obese women had a statistically significantly low inhibin B (p < 0.0259). The AFC when taken together on both sides was not statistically significant between the groups; however, the overweight and obese women had a significantly low AFC (p < 0.0129) on the right side.
  
  
  CONCLUSIONS
  Incorporating anti-mullerian hormone, a newer marker for ovarian reserve, may benefit these obese infertile women. Further work is required to elucidate the mechanisms underlying the effect of obesity on inhibin B as a marker of ovarian reserve in infertile women. The best marker to check the ovarian reserve is perhaps the woman's performance during an IVF cycle. However, considering the psychological and financial stress of the procedure, it may seem wise to consider counseling of obese women on their expected performance in the first cycle of IVF through such studies.
authors.affiliation: Departments of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Neena
authors.initials: N
authors.lastname: Malhotra
authors.forename: Anupama
authors.initials: A
authors.lastname: Bahadur
authors.forename: Neeta
authors.initials: N
authors.lastname: Singh
authors.forename: Mani
authors.initials: M
authors.lastname: Kalaivani
authors.forename: Suneeta
authors.initials: S
authors.lastname: Mittal
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood*; D015992:Body Mass Index; D005260:Female; D005307:Fertilization in Vitro; D005640:Follicle Stimulating Hormone / Q000097:blood; D006801:Humans; D007194:India; D007247:Infertility, Female / Q000473:pathology / Q000503:physiopathology* / Q000628:therapy; D007265:Inhibins / Q000097:blood*; D007986:Luteinizing Hormone / Q000097:blood; D009765:Obesity / Q000150:complications* / Q000473:pathology / Q000503:physiopathology; D006080:Ovarian Follicle / Q000473:pathology; D010053:Ovary / Q000503:physiopathology*; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; C422364:inhibin B; D007265:Inhibins; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone