GOJAZNOST I REPRODUKTIVNA FUNKCIJA ŽENE -- MEHANIZMI NASTANKA I TERAPIJSKE IMPLIKACIJE. (Bosnian)

OBESITY AND REPRODUCTIVE FUNCTION IN WOMEN -- PATHOGENETIC ORIGINS AND THERAPEUTIC IMPLICATIONS. (English)

Obesity is nowadays considered as a cause of cardiovascular disease, type 2 diabetes, osteoarthritis, malignancies but also contributed to reproductive disorders and fertility problems. There is an increase in relative risk of anovulatory infertility in women with pronounced obesity, and an increased time to conception. Obesity in related to the increased risk for hyperandrogenism and anovulation in reproductive aged women as it is a case in women with polycystic ovary syndrome (PCOS) as the most prevalent hyperandrogenic condition. It was confirmed a close relation of adipokines, obesity, metabolic syndrome and reproductive consequences. A reduction of weight for 5-10% leads to the improvement in clinical, metabolic and reproductive characteristics as it is a case in women with PCOS. The administration of insulin sensitizers is leading to the decrease of hyperinsulinemia, insulin resistance, establishment of normal menstrual cyclicity and ovultion in significant proportion of women with PCOS. Obesity may influence ovarian stimulation by its prolongation, increase in the dose of gonadotrophins used, incidence of follicular asynchrony and interruption of stimulation. Surgcal treatment of obesity is an alternative therapeutic approach when the life style changes and pharmacotherapy is of no results. Till now, there are no enough evidence in favor for the bariatric surgery to be used in the treatment of obese women with PCOS. [ABSTRACT FROM AUTHOR]

Gojaznost se danas smatra uzrokom nastanka kardiovaskularne bolesti, tipa 2 dijabetesa, osteoartritisa, maligniteta, ali i faktorom koji doprinosi nastanku reproduktivnih poremećaja i problema plodnosti. Postoji povećan relativni rizik za nastanak anovulatornog infertiliteta u žena sa izraženom gojaznošću i produženo vreme do koncepcije. U žena u reproduktivnom periodu gojaznost je povezana sa povećanim rizikom za nastanak hiperandrogenizma i anovulacije, kao štoje slučaj u sindromupolicističnihjajnika (PCOS) kao najčešćem hiperandrogenom poremećaju. Postojivelikibroj dokaza u prilog postojanja bliskog odnosa adipokina, gojaznosti, metaboličkog sindroma i reproduktivnih posledica. Redukcija težine za 5-10% dovodi do poboljšanja u kliničkim, metaboličkim i reproduktivnim karakteristikama, kao štoje slučaj u žena sa PCOS. Primena insulinskih senzitajzera vodi sniženju hiperinsulinemije, insulinske rezistencije, uspostavljanju normalne menstrualne cikličnosti i ovulacije kod značajnog broja žena sa PCOS. Gojaznost može uticati na stimulaciju ovulacije njenim produžavanjem, povećanjem doze gonado-tropina, incidence folikularne asinhronije i prekida stimulacije. Hirurško lečenje gojaznosti predstavlja alternativni vid terapije u slučaju kada ni promena načina života ni farmakoterapijske mere ne daju povoljne rezultate. Za sada ne postoji dovoljno dokaza u prilog preporuke da se barijatrijska hirurgija koristi u lečenju gojaznih žena sa PCOS. [ABSTRACT FROM AUTHOR]

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