METABOLIC HEALTH AS A DETERMINANT OF FEMALE FERTILITY: AN INTEGRATIVE REVIEW ON OBESITY, INSULIN RESISTANCE, AND EMERGING THERAPIES

Abstract

Infertility associated with obesity and insulin resistance is a clinical marker of systemic metabolic dysfunction and one of the major challenges in contemporary reproductive health. This integrative review aimed to synthesize recent evidence on the impact of metabolic interventions—lifestyle modification, pharmacological therapies, and bariatric surgery—on reproductive outcomes in women with infertility related to obesity and polycystic ovary syndrome. Searches were conducted in PubMed and the Virtual Health Library (BVS), restricted to the last five years, yielding 26 eligible studies. Findings showed that fertility restoration is directly related to the magnitude of metabolic improvement. Lifestyle interventions provide modest but limited benefits. Metformin remains a cornerstone therapy, while GLP-1 receptor agonists and SGLT2 inhibitors emerge as promising alternatives for ovulation induction and pregnancy improvement. In severe obesity, bariatric surgery demonstrated consistent effects in restoring ovulation, reducing obstetric complications, and increasing live birth rates. Metabolic health should therefore be recognized as a key determinant of female fertility, and the strategic incorporation of innovative pharmacological therapies and metabolic surgery has the potential to redefine clinical practice and inform public health policies in women’s health.