Abstract:

Obesity impairs female oocyte quality, induces polycystic ovary syndrome (PCOS), and reduces male sperm motility and DNA integrity, by disrupting the hypothalamic-pituitary-gonadal axis function, triggering insulin resistance, and exacerbating oxidative stress and inflammatory responses. Consequently, it significantly increases the risks of infertility, pregnancy complications, and sexual dysfunction. Weight loss can substantially enhance fertility by improving metabolic disorders and chronic inflammatory states, regulating hormone levels, and modulating gut microbiota. Novel anti-obesity agents, such as glucagon-like peptide 1 (GLP-1) receptor agonists, have been widely acknowledged in clinical practice due to their remarkable weight-reducing efficacy. Meanwhile, bariatric surgery, as a potent weight loss intervention, remains irreplaceable in clinical settings. Notably, different weight loss approaches exert distinct impacts on reproductive health. Pharmacological weight loss can improve ovulatory function and pregnancy rates in patients with PCOS; however, close attention should be paid to gestational safety and body weight rebound following drug withdrawal. For obese women, bariatric surgery can achieve more significant improvement in menstrual recovery, spontaneous ovulation, and assisted reproductive outcomes. Postoperatively, strict control of the conception timing and regular monitoring of nutritional status are imperative. While its effect on male semen quality remains controversial, its beneficial role in improving sexual function has been well established. In the future, further investigations are needed to explore the long-term effects of different weight loss modalities on offspring health, and individualized weight management strategies should be formulated to optimize reproductive health management.

Key words: Obesity, Reproductive health, Anti-obesity agents, Bariatric surgery, Glucagon-like peptide 1