Reproductive potential in obese women

• Irina V. Bekbaeva
• Ekaterina V. Mukovnikova
• Sergey I. Kyrtikov
• Nozimabonu M. Zokirova
• Khalid Haddad
• Ekaterina A. Kuzmina
• Aylar A. Orazmuradova

Abstract

The article discusses the main reasons for decline in reproductive potential of obese women. Mechanisms of influence of excess adipose tissue on ovarian reserve, oocytes and endometrium are described detail. Complications of pregnancy, childbirth, postpartum period, perinatal complications in obese patients are described.

Keywords:obesity; infertility; reproductive potential; stillbirth; ovarian reserve; endometrium

REFERENCES

1. World Obesity Atlas, 2022. URL: https://www.worldobesity.org/

2. Grigoryan O.R., Mikheev R.K., Andreeva E.N., Dedov I.I. Ovarian reserve in women with obesity. Ozhirenie i metabolism [Obesity and Metabolism]. 2019; 16 (3): 69–75. DOP: https://doi.org/10.14341/omet9862 (in Russian)

3. Lin X.H., Wang H., Wu D.D., Ullah K., Yu T.T., Ur Rahman T., et al. High leptin level attenuates embryo development in overweight/obese infertile women by inhibiting proliferation and promotes apoptosis in granule cell. Horm Metab Res. 2017; 49 (7): 534–41. DOI: https://doi.org/10.1055/s-0043-107617 Epub 2017 May 30. PMID: 28561185.

4. Negrón A.L., Radovick S. High-fat diet alters LH secretion and pulse frequency in female mice in an estrous cycle-dependent manner. Endocrinology. 2020; 161 (10): bqaa146. DOI: https://doi.org/10.1210/endocr/bqaa146 PMID: 32841330; PMCID: PMC7486692.

5. Chosich J., Bradford A.P., Allshouse A.A., Reusch J.E., Santoro N., Schauer I.E. Acute recapitulation of the hyperinsulinemia and hyperlipidemia characteristic of metabolic syndrome suppresses gonadotropins. Obesity (Silver Spring). 2017; 25 (3): 553–60. DOI: https://doi.org/10.1002/oby.21754 Epub 2017 Feb 3. PMID: 28158916; PMCID: PMC5323271.

6. Santoro N., Schauer I.E., Kuhn K., Fought A.J., Babcock-Gilbert S., Bradford A.P. Gonadotropin response to insulin and lipid infusion reproduces the reprometabolic syndrome of obesity in eumenorrheic lean women: a randomized crossover trial. Fertil Steril. 2021; 116 (2): 566–74. DOI: https://doi.org/10.1016/j.fertnstert.2021.03.005 Epub 2021 Apr 8. PMID: 33838870; PMCID: PMC8349763.

7. Silvestris E., De Pergola G., Rosania R., Loverro G. Obesity as disruptor of the female fertility. Reprod Biol Endocrinol. 2018; 16: 22. DOI: https://doi.org/10.1186/s12958-018-0336-z

8. Hamilton J.A.M., van der Steeg J.W., Hamilton C.J.C.M., de Bruin J.P. A concise infertility work-up results in fewer pregnancies. Hum Reprod Open. 2021; 4: hoab033. DOI: https://doi.org/10.1093/hropen/hoab033 eCollection 2021.

9. Mathyk B.A., Quaas A.M. Obesity and IVF: weighing in on the evidence. J Assist Reprod Genet. 2021; 38 (2): 343–5. DOI: https://doi.org/10.1007/s10815-021-02068-6

10. Bellver J. BMI and miscarriage after IVF. Curr Opin Obstet Gynecol. 2022; 34 (3): 114–21.

11. Kawwass J.F., Kulkarni A.D., Hipp H.S., Crawford S., Kissin D.M., Jamieson D.J. Extremities of body mass index and their association with pregnancy outcomes in women undergoing in vitro fertilization in the United States. Fertil Steril. 2016; 106 (7): 1742–50. DOI: https://doi.org/10.1016/j.fertnstert.2016.08.028 Epub 2016 Sep 22. PMID: 27666564.

12. Atzmon Y., Shoshan-Karchovsky E., Michaeli M., Aslih N., Shrem G., Ellenbogen A., et al. Obesity results with smaller oocyte in in vitro fertilization/intracytoplasmic sperm injection cycles-a prospective study. J Assist Reprod Genet. 2017; 34 (9): 1145–51. DOI: https://doi.org/10.1007/s10815-017-0975-6 Epub 2017 Jun 17. PMID: 28624860; PMCID: PMC5581790.

13. Weghofer A., Kushnir V.A., Darmon S.K., Jafri H., Lazzaroni-Tealdi E., Zhang L., et al. Age, body weight and ovarian function affect oocyte size and morphology in non-PCOS patients undergoing intracytoplasmic sperm injection (ICSI). PLoS One. 2019; 14 (10): e0222390. DOI: https://doi.org/10.1371/journal.pone.0222390 PMID: 31647816; PMCID: PMC6812759.

14. Lainez N.M., Coss D. Obesity, neuroinflammation, and reproductive function. Endocrinology. 2019; 160 (11): 2719–36. DOI: https://doi.org/10.1210/en.2019-00487

15. Goldsammler M., Merhi Z., Buyuk E. Role of hormonal and inflammatory alterations in obesity-related reproductive dysfunction at the level of the hypothalamic-pituitary-ovarian axis. Reprod Biol Endocrinol. 2018; 16: 45. DOI: https://doi.org/10.1186/s12958-018-0366-6

16. Hu Q., Lee J., Nelson J., Harris M., Ess R.H., Rogers C.R., et al. The association between preconception body mass index and subfertility among Hispanic and non-Hispanic women: A cross-sectional study from Utah’s Pregnancy Risk Assessment Monitoring System survey (2012–2015). Utah Womens Health Rev. 2020; 2020. URL: https://uwhr.utah.edu/2020/07/

17. Zhang Y., Zhang J., Zhao J., Hong X., Zhang H., Dai Q., et al. Couples’ prepregnancy body mass index and time to pregnancy among those attempting to conceive their first pregnancy. Fertil Steril. 2020; 114 (5): 1067–75. DOI: https://doi.org/10.1016/j.fertnstert.2020.05.041 Epub 2020 Oct 14. PMID: 33066977.

18. Fang Y., Liu J., Mao Y., He Y., Li M., Yang L., et al. Pre-pregnancy body mass index and time to pregnancy among couples pregnant within a year: A China cohort study. PLoS One. 2020; 15 (4): e0231751. DOI: https://doi.org/10.1371/journal.pone.0231751 PMID: 32324768; PMCID: PMC7179844.

19. Sundaram R., Mumford S.L., Buck Louis G.M. Couples' body composition and time-to-pregnancy. Hum Reprod. 2017; 32 (3): 662–8. DOI: https://doi.org/10.1093/humrep/dex001 PMID: 28158570; PMCID: PMC5400044.

20. Han L., Wang H., Li L., Li X., Ge J., Reiter R.J., et al. Melatonin protects against maternal obesity-associated oxidative stress and meiotic defects in oocytes via the SIRT3-SOD2-dependent pathway. J Pineal Res. 2017; 63 (3). DOI: https://doi.org/10.1111/jpi.12431

21. Wan Y., Muhammad T., Huang T., Lv Y., Sha Q., Yang S., et al. IGF2 reduces meiotic defects in oocytes from obese mice and improves embryonic developmental competency. Reprod Biol Endocrinol. 2022; 20 (1): 101. DOI: https://doi.org/10.1186/s12958-022-00972-9

22. Lee J.C., Bernardi L.A., Boots C.E. The association of euploid miscarriage with obesity. F S Rep. 2020; 1 (2): 142–8. DOI: https://doi.org/10.1016/j.xfre.2020.05.011 PMID: 34223230; PMCID: PMC8244338.

23. Cozzolino M., García-Velasco J.A., Meseguer M., Pellicer A., Bellver J. Female obesity increases the risk of miscarriage of euploid embryos. Fertil Steril. 2021; 115 (6): 1495–502. DOI: https://doi.org/10.1016/j.fertnstert.2020.09.139

24. Kutchi I., Chellammal P., Akila A. Maternal obesity and pregnancy outcome: in perspective of new Asian Indian guidelines. J Obstet Gynaecol India. 2020; 70 (2): 138–44. DOI: https://doi.org/10.1007/s13224-019-01301-8

25. Cooper D.B., Yang L. Pregnancy and Exercise. In: StatPearls [Internet]. 2022. URL: https://www.ncbi.nlm.nih.gov/books/NBK430821/

26. Kelly A.C., Powell Th.L., Jansson Th. Placental function in maternal obesity. Clin Sci (Lond). 2020; 134 (8): 961–84. DOI: https://doi.org/10.1042/CS20190266

27. Gonzalez M.B., Robker R.L., Rose R.D. Obesity and oocyte quality: significant implications for ART and emerging mechanistic insights. Biol Reprod. 2022; 106 (2): 338–50. DOI: https://doi.org/10.1093/biolre/ioab228 PMID: 34918035.

28. Ikedionwu Ch.A., Dongarwar D., Yusuf K.K., Ibrahimi S., Salinas-Miranda A.A., Salihu H.M. Pre-pregnancy maternal obesity, macrosomia, and risk of stillbirth: A population-based study. Eur J Obstet Gynecol Reprod Biol. 2020; 252: 1–6. DOI: https://doi.org/10.1016/j.ejogrb.2020.06.004

29. Supramaniam P.R., Mittal M., McVeigh E., Lim L.N. The correlation between raised body mass index and assisted reproductive treatment outcomes: a systematic review and meta-analysis of the evidence. Reprod Health. 2018; 15 (1): 34. DOI: https://doi.org/10.1186/s12978-018-0481-z PMID: 29486787; PMCID: PMC5830337.

30. Wu L.L., Russell D.L., Wong S.L., Chen M., Tsai T.S., St John J.C., et al. Mitochondrial dysfunction in oocytes of obese mothers: transmission to offspring and reversal by pharmacological endoplasmic reticulum stress inhibitors. Development. 2015; 142 (4): 681–91. DOI: https://doi.org/10.1242/dev.114850

31. Desmet K.L.J., Marei W.F.A., Richard C., Sprangers K., Beemster G.T.S., Meysman P., et al. Oocyte maturation under lipotoxic conditions induces carryover transcriptomic and functional alterations during post-hatching development of good-quality blastocysts: novel insights from a bovine embryo-transfer model. Hum Reprod. 2020; 35 (2): 293–307. DOI: https://doi.org/10.1093/humrep/dez248

32. Marei W.F.A., Smits A., Mohey-Elsaeed O., Pintelon I., Ginneberge D., Bols P.E.J., et al. Differential effects of high fat diet-induced obesity on oocyte mitochondrial functions in inbred and outbred mice. Sci Rep. 2020; 10 (1): 9806. DOI: https://doi.org/10.1038/s41598-020-66702-6

33. Yun Y., Wei Z., Hunter N. Maternal obesity enhances oocyte chromosome abnormalities associated with aging. Chromosoma. 2019; 128 (3): 413–21. DOI: https://doi.org/10.1007/s00412-019-00716-6

34. Haikin Herzberger E., Miller N., Ghetler Y., Tamir Yaniv R., Neumark E., Shulman A., et al. A prospective study of C-reactive protein in patients with obesity during IVF. Hum Fertil (Camb). 2021; 24 (3): 182–7. DOI: https://doi.org/10.1080/14647273.2019.1605459

35. Gonzalez M.B., Lane M., Knight E.J., Robker R.L. Inflammatory markers in human follicular fluid correlate with lipid levels and Body Mass Index. J Reprod Immunol. 2018; 130: 25–9. DOI: https://doi.org/10.1016/j.jri.2018.08.005 Epub 2018 Aug 22. PMID: 30174020.

36. Bou Nemer L., Shi H., Carr B.R., Word R.A., Bukulmez O. Effect of body weight on metabolic hormones and fatty acid metabolism in follicular fluid of women undergoing in vitro fertilization: A pilot study. Reprod Sci. 2019; 26 (3): 404–11. DOI: https://doi.org/10.1177/1933719118776787 Epub 2018 May 20. PMID: 29779472.

37. Andreas E., Reid M., Zhang W., Moley K.H. The effect of maternal high-fat/high-sugar diet on offspring oocytes and early embryo development. Mol Hum Reprod. 2019; 25 (11): 717–28. DOI: https://doi.org/10.1093/molehr/gaz049

38. Al-Aqbi M., Hart R., Ajuogu P., de Touw T.V., McFarlane J., Smart N. Follicular fluid leptin as a marker for pregnancy outcomes in women undergoing IVF treatment: a systematic review and meta-analysis. Hum Fertil (Camb). 2022; 25 (1): 33–42. DOI: https://doi.org/10.1080/14647273.2019.1710271

39. Ding X., Kou X., Zhang Y., Zhang X., Cheng G., Jia T. Leptin siRNA promotes ovarian granulosa cell apoptosis and affects steroidogenesis by increasing NPY2 receptor expression. Gene. 2017; 633: 28–34. DOI: https://doi.org/10.1016/j.gene.2017.08.028

40. Li H., Wang H., Zhu J., Xu J., Jiang Y., Chen W., et al. Decreased DNA repair ability: A mechanism for low early embryonic development potential of oocytes from overweight patients after fertilization in IVF cycles. Front Endocrinol (Lausanne). 2021; 12: 756336. DOI: https://doi.org/10.3389/fendo.2021.756336

41. Wang S., Wang J., Jiang Y., Jiang W. Association between blood lipid level and embryo quality during in vitro fertilization. Medicine (Baltimore). 2020; 99 (13): e19665. DOI: https://doi.org/10.1097/MD.0000000000019665

42. Zeng X., Xie Y.J., Liu Y.T., Long S.L., Mo Z.C. Polycystic ovarian syndrome: Correlation between hyperandrogenism, insulin resistance and obesity. Clin Chim Acta. 2020; 502: 214–21. DOI: https://doi.org/10.1016/j.cca.2019.11.003 Epub 2019 Nov 13. PMID: 31733195.

43. Sirotkin A.V., Fabian D., Babeľová Kubandová J., Vlčková R., Alwasel S., Harrath A.H. Body fat affects mouse reproduction, ovarian hormone release, and response to follicular stimulating hormone. Reprod Biol. 2018; 18 (1): 5–11. DOI: https://doi.org/10.1016/j.repbio.2017.12.002 Epub 2017 Dec 8. PMID: 29233485.

44. Moreta L.E., Hanley W., Lee J.A., Copperman A.B., Stein D. Elevated Body Mass Index in donor oocyte recipients does not affect implantation of euploid embryos. J Womens Health (Larchmt). 2022; 31 (9): 1364–8. DOI: https://doi.org/10.1089/jwh.2021.0433

45. Setton R., Chung A., Zimmerman L., Melnick A., Rosenwaks Z., Spandorfer S.D. Body mass index is not associated with donor oocyte recipient success: an ideal study using a paired analysis of sibling-oocytes. F S Rep. 2020; 1 (1): 25–9. DOI: https://doi.org/10.1016/j.xfre.2020.05.001

46. Rhee J.S., Saben J.L., Mayer A.L., Schulte M.B., Asghar Z., Stephens C., et al. Diet-induced obesity impairs endometrial stromal cell decidualization: a potential role for impaired autophagy. Hum Reprod. 2016; 31 (6): 1315–26. DOI: https://doi.org/10.1093/humrep/dew048

47. Misharina E.V., Abashova E.I., Potin V.V. Obesity and ovarian insufficiency Zhurnal akusherstva i zhenskikh bolezney [Journal of Obstetrics and Women’s Diseases]. 2016; 65 (5): 64–74. (in Russian)

19. Sundaram R., Mumford S.L., Buck Louis G.M. Couples' body composition and time-to-pregnancy // Hum. Reprod. 2017. Vol. 32, N 3. P. 662-668. DOI: https://doi.org/10.1093/humrep/dex001 PMID: 28158570; PMCID: PMC5400044.

20. Han L., Wang H., Li L., Li X., Ge J., Reiter R.J. et al. Melatonin protects against maternal obesity-associated oxidative stress and meiotic defects in oocytes via the SIRT3-SOD2-dependent pathway // J. Pineal Res. 2017. Vol. 63, N 3. DOI: https://doi.org/10.1111/jpi.12431

21. Wan Y., Muhammad T., Huang T., Lv Y., Sha Q., Yang S. et al. IGF2 reduces meiotic defects in oocytes from obese mice and improves embryonic developmental competency // Reprod. Biol. Endocrinol. 2022. Vol. 20, N 1. P. 101. DOI: https://doi.org/10.1186/s12958-022-00972-9

22. Lee J.C., Bernardi L.A., Boots C.E. The association of euploid miscarriage with obesity // F S Rep. 2020. Vol. 1, N 2. P. 142-148. DOI: https://doi.org/10.1016/j.xfre.2020.05.011 PMID: 34223230; PMCID: PMC8244338.

23. Cozzolino M., García-Velasco J.A., Meseguer M., Pellicer A., Bellver J. Female obesity increases the risk of miscarriage of euploid embryos // Fertil. Steril. 2021. Vol. 115, N 6. P. 1495-1502. DOI: https://doi.org/10.1016/j.fertnstert.2020.09.139

24. Kutchi I., Chellammal P., Akila A. Maternal obesity and pregnancy outcome: in perspective of new Asian Indian guidelines // J. Obstet. Gynaecol. India. 2020. Vol. 70, N 2. P. 138-144. DOI: https://doi.org/10.1007/s13224-019-01301-8

25. Cooper D.B., Yang L. Pregnancy and Exercise // StatPearls [Internet]. 2022. URL: https://www.ncbi.nlm.nih.gov/books/NBK430821/

26. Kelly A.C., Powell Th.L., Jansson Th. Placental function in maternal obesity // Clin. Sci. (Lond.). 2020. Vol. 134, N 8. P. 961-984. DOI: https://doi.org/10.1042/CS20190266

27. Gonzalez M.B., Robker R.L., Rose R.D. Obesity and oocyte quality: significant implications for ART and emerging mechanistic insights // Biol. Reprod. 2022. Vol. 106, N 2. P. 338-350. DOI: https://doi.org/10.1093/biolre/ioab228 PMID: 34918035.

28. Ikedionwu Ch.A., Dongarwar D., Yusuf K.K., Ibrahimi S., Salinas-Miranda A.A., Salihu H.M. Pre-pregnancy maternal obesity, macrosomia, and risk of stillbirth: A population-based study // Eur. J. Obstet. Gynecol. Reprod. Biol. 2020. Vol. 252. P. 1-6. DOI: https://doi.org/10.1016/j.ejogrb.2020.06.004

29. Supramaniam P.R., Mittal M., McVeigh E., Lim L.N. The correlation between raised body mass index and assisted reproductive treatment outcomes: a systematic review and meta-analysis of the evidence // Reprod. Health. 2018. Vol. 15, N 1. P. 34. DOI: https://doi.org/10.1186/s12978-018-0481-z PMID: 29486787; PMCID: PMC5830337.

30. Wu L.L., Russell D.L., Wong S.L., Chen M., Tsai T.S., St John J.C. et al. Mitochondrial dysfunction in oocytes of obese mothers: transmission to offspring and reversal by pharmacological endoplasmic reticulum stress inhibitors // Development. 2015. Vol. 142, N 4. P. 681-691. DOI: https://doi.org/10.1242/dev.114850

31. Desmet K.L.J., Marei W.F.A., Richard C., Sprangers K., Beemster G.T.S., Meysman P. et al. Oocyte maturation under lipotoxic conditions induces carryover transcriptomic and functional alterations during post-hatching development of good-quality blastocysts: novel insights from a bovine embryo-transfer model // Hum. Reprod. 2020. Vol. 35, N 2. P. 293-307. DOI: https://doi.org/10.1093/humrep/dez248

32. Marei W.F.A., Smits A., Mohey-Elsaeed O., Pintelon I., Ginneberge D., Bols P.E.J. et al. Differential effects of high fat diet-induced obesity on oocyte mitochondrial functions in inbred and outbred mice // Sci. Rep. 2020. Vol. 10, N 1. P. 9806. DOI: https://doi.org/10.1038/s41598-020-66702-6

33. Yun Y., Wei Z., Hunter N. Maternal obesity enhances oocyte chromosome abnormalities associated with aging // Chromosoma. 2019. Vol. 128, N 3. P. 413-421. DOI: https://doi.org/10.1007/s00412-019-00716-6

34. Haikin Herzberger E., Miller N., Ghetler Y., Tamir Yaniv R., Neumark E., Shulman A. et al. A prospective study of C-reactive protein in patients with obesity during IVF // Hum. Fertil. (Camb.). 2021. Vol. 24, N 3. P. 182-187. DOI: https://doi.org/10.1080/14647273.2019.1605459

35. Gonzalez M.B., Lane M., Knight E.J., Robker R.L. Inflammatory markers in human follicular fluid correlate with lipid levels and Body Mass Index // J. Reprod. Immunol. 2018. Vol. 130. P. 25-29. DOI: https://doi.org/10.1016/j.jri.2018.08.005 Epub 2018 Aug 22. PMID: 30174020.

36. Bou Nemer L., Shi H., Carr B.R., Word R.A., Bukulmez O. Effect of body weight on metabolic hormones and fatty acid metabolism in follicular fluid of women undergoing in vitro fertilization: A pilot study // Reprod. Sci. 2019. Vol. 26, N 3. P. 404-411. DOI: https://doi.org/10.1177/1933719118776787 Epub 2018 May 20. PMID: 29779472.

37. Andreas E., Reid M., Zhang W., Moley K.H. The effect of maternal high-fat/high-sugar diet on offspring oocytes and early embryo development // Mol. Hum. Reprod. 2019. Vol. 25, N 11. P. 717-728. DOI: https://doi.org/10.1093/molehr/gaz049

38. Al-Aqbi M., Hart R., Ajuogu P., de Touw T.V., McFarlane J., Smart N. Follicular fluid leptin as a marker for pregnancy outcomes in women undergoing IVF treatment: a systematic review and meta-analysis // Hum. Fertil. (Camb.). 2022. Vol. 25, N 1. P. 33-42. DOI: https://doi.org/10.1080/14647273.2019.1710271

39. Ding X., Kou X., Zhang Y., Zhang X., Cheng G., Jia T. Leptin siRNA promotes ovarian granulosa cell apoptosis and affects steroidogenesis by increasing NPY2 receptor expression // Gene. 2017. Vol. 633. P. 28-34. DOI: https://doi.org/10.1016/j.gene.2017.08.028

40. Li H., Wang H., Zhu J., Xu J., Jiang Y., Chen W. et al. Decreased DNA repair ability: A mechanism for low early embryonic development potential of oocytes from overweight patients after fertilization in IVF cycles // Front. Endocrinol. (Lausanne). 2021. Vol. 12. Article ID 756336. DOI: https://doi.org/10.3389/fendo.2021.756336

41. Wang S., Wang J., Jiang Y., Jiang W. Association between blood lipid level and embryo quality during in vitro fertilization // Medicine (Baltimore). 2020. Vol. 99, N 13. Article ID e19665. DOI: https://doi.org/10.1097/MD.0000000000019665

42. Zeng X., Xie Y.J., Liu Y.T., Long S.L., Mo Z.C. Polycystic ovarian syndrome: Correlation between hyperandrogenism, insulin resistance and obesity // Clin. Chim. Acta. 2020. Vol. 502. P. 214-221. DOI: https://doi.org/10.1016/j.cca.2019.11.003 Epub 2019 Nov 13. PMID: 31733195.

43. Sirotkin A.V., Fabian D., Babeľová Kubandová J., Vlčková R., Alwasel S., Harrath A.H. Body fat affects mouse reproduction, ovarian hormone release, and response to follicular stimulating hormone // Reprod. Biol. 2018. Vol. 18, N 1. P. 5-11. DOI: https://doi.org/10.1016/j.repbio.2017.12.002 Epub 2017 Dec 8. PMID: 29233485.

44. Moreta L.E., Hanley W., Lee J.A., Copperman A.B., Stein D. Elevated Body Mass Index in donor oocyte recipients does not affect implantation of euploid embryos // J. Womens Health (Larchmt.). 2022. Vol. 31, N 9. P. 1364-1368. DOI: https://doi.org/10.1089/jwh.2021.0433

45. Setton R., Chung A., Zimmerman L., Melnick A., Rosenwaks Z., Spandorfer S.D. Body mass index is not associated with donor oocyte recipient success: an ideal study using a paired analysis of sibling-oocytes // F S Rep. 2020. Vol. 1, N 1. P. 25-29. DOI: https://doi.org/10.1016/j.xfre.2020.05.001

46. Rhee J.S., Saben J.L., Mayer A.L., Schulte M.B., Asghar Z., Stephens C. et al. Diet-induced obesity impairs endometrial stromal cell decidualization: a potential role for impaired autophagy // Hum. Reprod. 2016. Vol. 31, N 6. P. 1315-1326. DOI: https://doi.org/10.1093/humrep/dew048

47. Мишарина Е.В., Абашова Е.И., Потин В.В. Ожирение и репродуктивная функция женщины // Журнал акушерства и женских болезней. 2016. Т. 65, № 5. С. 64-74.

All articles in our journal are distributed under the CC BY-NC-ND 4.0 (Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International)