Obesity Epidemic and Its Impact on Female Fertility: Current Understanding and Future Directions

Obesity is a global epidemic with profound implications for fertility in women of reproductive age. This review summarizes how obesity affects fertility by disrupting the hypothalamic-pituitary-ovarian (HPO) axis, affecting oocyte quality and reserve, and compromising endometrial receptivity. The combination of these disruptions leads to reduced fertility rates, decreased success with assisted reproductive technologies (ARTs), and increased risk for adverse pregnancy outcomes. This review also examines the impact of interventions for weight loss, including lifestyle modifications, medications, and surgery, on female fertility. Overall, these interventions show promise in anovulatory cycles; however, their impact on live birth rates (LBRs) remains variable. Newer therapies, such as glucagon-like peptide 1 receptor agonists (GLP-1 RAs), have expanded the armamentarium of options for obesity management. Emerging data suggest potential roles for GLP-1 RAs in ovarian and endometrial function, suggesting broader applications in reproductive health. Given the complexity of obesity's impact on reproduction, a multidisciplinary approach incorporating lifestyle modification, pharmacotherapy, and, if necessary, surgery offers the most significant potential to optimize reproductive success.