الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Obesity is one of the most serious common conditionworldwidecarrying many healthconsequences, includingreproductive disorders. There is a very high prevalence of obese women in theinfertile population and many studies have highlighted the link between obesity and infertility.More recent data show that ovulatory infertility can be largely attributable to overweight.
Obese women are almost three times as non-obese women to be at risk of infertility. Recent studies showed that women with central obesity take longer to become pregnant, indicating that fat distribution plays a role in the chance of becoming pregnant.In addition, high Body Mass Indexis associated with lower success rates following assisted reproduction.
It has been demonstrated that weight loss can improve the fertility of obese womenthrough decreasinghyperandrogenism,improvingmenstrual function the recovery of better ovulation, together withimproved response to ovarian stimulationin infertility treatment. Therefore, various weight management interventions, including healthy dietary intervention,is considered for overweight and obese infertile women.
Adherence toMediterranean diet rich in olive oil, vegetables, fruits, whole grains, legumes and beans and fish increases the chance of becoming pregnant after infertility treatment. Mediterranean diet is rich in Vegetable oils that are rich in linoleic acid, considered precursors ofprostaglandins, important for the initiation of the menstrual cycle, growth, and development offollicles, ovulation., and optimizing endometrial receptivity.
The study investigated the effect of dietaryintervention through Mediterranean diet on success rate of Intra Cytoplasmic Sperm Injection.To assess the effect of the loss of body weight on hormonal profile,oocyte development and success of pregnancy in obese women. It was an interventional study with a control group. Obese ovarian infertile women were candidates for assisted reproduction through Intra Cytoplasmic Sperm Injection technique, aged between20- 40 years,normogonadotrophic, having Body Mass Index ≤ 30 kg/m2 . Females were interviewed using a preplanned questionnaire including socioeconomic characteristics, obesity profile and nutritional status .Anthropometric measurements were taken including weight in kg, height in cm, BMI in kg/m2,total body fat percentage, waist circumference in cm, hipcircumference in cm. After at least 10% of weight loss, women were referred for fertilization procedure.
Hormonal profile as early follicular phase (day 3) serum E2, FSH, free and total testosterone levels were evaluated. All obese females undergone the same ovarian stimulation protocol. Assessment of fertilization and cleavage was done. The impact of weight reduction on ICSI outcome was assessed through the number of mature oocytes,the grading of embryos obtained,serum oestradiol and progesterone on day of hCGadministration,implantation rateand pregnancy rate.
The results of the present study showed the following:
• Obese women have poor outcomes following fertility treatment compared to normal weight females.
• High Body Mass Index is associated with low success rate of pregnancy followingIntra Cytoplasmic Sperm Injection.
• High fat percent and abdominal adiposity affects fertility treatment.
• Dietary intervention through healthy Mediterranean diet , improves weight, fat percent and BMI in obese females.
• Weight loss and decrease in fat percentin adherenceto the Mediterranean diet increases success rate of Intra Cytoplasmic Sperm Injection.
• Reduction in BMI leads to better results in Intra Cytoplasmic Sperm Injection through better responseto FSH stimulation, number of sacs and embryo quality .
• Dietary intervention in adherence to Mediterraneandiet,improved hormonal profile includingDay 3 FSH, basal oestrogen,total testosterone and free testosterone.
• Mediterranean diet enriched inPolyunsaturated Fatty Acid enhances blood levelofestradiol (E2)Gonadotropin Releasing Hormone, prostaglandins and ovarian function.
• Mediterraneandietpositively affects number of embryos transferred and number of sacs in obese females undergoing Intra Cytoplasmic Sperm Injection
• Mediterranean diet has a positive effect on success of occurrence of pregnancy in obese females through Intra Cytoplasmic Sperm Injection.
from the results of this study the following can be recommended:
• Reduction of bodyweight of obese females by at least 10% should be undergone before undergoing Intra Cytoplasmic Sperm Injection.
• Regular follow up of anthropometric measurements through weight reduction protocol should be considered until reaching reduction in fat percent and Body Mass Index.
• Dietary intervention in females undergoing fertility treatment should be through adherence to healthy Mediterranean diet before Intra Cytoplasmic Sperm Injection.
• Mediterranean diet should be rich in fish,olive oil, fruits ,vegetableswhole grains,and consequently rich in Polyunsaturated Fatty Acid.
• Routine Nutritional counsellingshould be routinely done in both nutrition andfertility treatmentclinics, throughhealthy nutritional advices to females undergoing assisted reproduction.