الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 112 |  |  |
| | | from | 112 | | |
Abstract
The metabolic syndrome has received considerable attention in recent years because of its association with increasing glycommon pathophysiologic states such as heart failure, type 2 diabetes mellitus, and erectiledys function . Metabolic syndrome is considered the main threat for public health in the 21st century and is associated with an increased risk of cardiovasculardisease, irrespective of which metabolic syndrome definition is used. Metabloic syndrome is associated with an approximate doubling of cardiovascular disease risk and a 5-fold increased risk for incident type 2 diabetes mellitus. Metabolic syndrome is a cluster of risk factors that are predictive of progression to type 2 diabetes mellitus and coronary heart disease. It includes clustering of abdominal obesity, insulin resistance, dyslipidemia and elevated blood pressure and associated with other comorbidities including prothrombotic state, proinflammatory state, non alcoholic fatty liver disease and reproductive disorders. Abdominal obesity and insulin resistance appear to be at the core of pathophysiology of metabolic syndrome and its components. Insulin resistance is present in the majority of patients with metabolic syndrome. According to WHO currently more than 1 billion adults are overweight and at least 300 million of them are clinically obese. Metabolic syndrome affects many systems of body including reproductive system causing subfertility problems in male and female. Obesity is one of the major components of metabolic syndrome and has a major role in these subfertility problems. The rising incidence of obesity and associated metabolic disturbances highlights a loss of controlin this homeostatic system, which has effects on reproduction. A significant proportion of the infertileor sub-fertile population are obese or overweight, witha plethora of reproductive complications including menstrualdysfunction, anovulation and miscarriage. The development ofobesity and insulin resistance commonly go hand-in-hand withthe development of fertility problems.Adipose tissue produce an array of adipokines, as wellas eliciting cell mediated effects via pro-inflammatory andanti-inflammatory cells, producing various cytokines and chemokines. These adipokineshave a role in female fertility, regarding their complex interactions withenergy metabolism at the level of hypothalamus, pituitary, and gonads. The major subfertility problem in female with metabolic syndrome is the polycystic ovary syndrome. It is the most common metabolic abnormality in reproductive-aged women, occurring globally in 6% to 10% of this population. Identification of such women is most important in that they constitute the largest group of women at risk for the development of cardiovascular disease and type 2 diabetes mellitus. It is estimated that more than 50% of these women are undiagnosed. The syndrome is associated with obesity, hyperinsulinemia, elevated luteinizing hormone levels (associated with ovulation), elevated androgen levels (virilization), hirsutism (male hair growth), follicular atresia(ovarian growth failure), ovarian growth and cyst formation, anovulation (failure to ovulate) and amenorrhea (absence of menstruation or irregular periods). The presence of obesity and insulin resistance contributes to the metabolic derangements of the polycystic ovary syndrome. Diagnosis of polycystic ovary syndrome is important not only for infertility problems but also can prevent development of diabetes mellitus and cardiovascular disease. Diagnosis done by history-taking, gynecologic ultrasonography, laparoscopic examination and level of serum androgens. Ratio of LH to FSH can be helpful. Also assessments of associated conditions or risks is important as fasting biochemical screen and lipid profile, 2-hour oral glucose tolerance test (GTT) and exclusion of other disorders that may cause similar symptoms asprolactin, TSH and 17-hydroxyprogesterone. There is an established association between female obesity and infertility but a similar link is yet to be proven in men. The prevalence of overweight (BMI > 25) and obesity (BMI > 30) is on the increase, especially in industrialised countries. Metabolic syndrome affect male fertility through many theories including sperm chromatin integrity theory, oxidative stress theory, hormonal imbalance theory, increased scrotal temperature theory and sexual dysfunction theory. Although geography, ethnicity, lifestyle, age, and sex all affect the development of metabolic syndrome, low testosterone considered risk factor for metabolic syndromein men. Hypogonadism is more prevalent than previously thought, is stronglyassociated with metabolic syndrome, and may be a risk factor for diabetesand cardiovascular disease. Egypt is one of the countries in the world where the problem of obesity has been nearing an epidemic level. Currently, nearly 70% of adult women and 48% of men in Egypt are overweight or obese .Obesity may result from changing in lifestyle, dietary habits, physical activity and the social and cultural environment. It is well documented that morbidity and mortality rates increase with increase in body weight. Since, many of chronic diseases are positively associated with obesity as type 2 diabetes mellitus in particular, hypertension, some forms of cancer and cardiovascular disease. Also obesity affects male and female fertility by many ways. These are the main causes of morbidity and mortality in most countries. Therefore, prevention and control of obesity can play an important role in reducing the risk for most of the chronic diseases. In conclusion metabolic syndrome is an alert to physicians to pay attention to these risk factors to prevent progression to disease. So early diagnosis and management of these risk factors can prevent development of diabetes mellitus and coronary heart disease as well as improving male and female fertility. So, early diagnosis of MetS in female by simple tests as OGTT, fasting blood glucose and lipid profile can predict occurrence of MetS also we can confirm occurrence of PCOS by other tests as LH:FSH ratio and other tests. Early and proper management will improve fertility also will prevent occurrence of CVD and DM. Also, early diagnosis of MetS in male by these simple tests and proper management will improve fertility as well as preventing development of CVD and DM.