الفهرس 
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Abstract
A case control study was carried out In order to study the relationship between secondary infertility and obesity among women attending the outpatient clinics in Dar Al- Mohafza Maternity Hospital (Dar Ismail) in Alexandria. The study included 200 women for patients and control groups (100 each) aiming at: identifying obesity among fertile and infertile women, investigating the relationship between secondary infertility and obesity, among obese women and identifying determinants of secondary infertility among obese women. The following results were obtained.
The age of female patients was almost similar to control group. However there was insignificant difference between the females of both groups in the age group (35-less than 45 year) (49% patients Vis. 52% control group).
The most common educational status of the patient and control groups was the university and Secondary education which represented 67%, and 24% in the patient group and 60%, and 24% in the control group respectively (p-value = 0.636 ). In both patients and control groups, most of the females were sedentary workers constituted 47% on each group, while the rest of the sample was distributed among the house wife and the manual workers (P value=0.587).
Among females, nearly half of the patients and control groups (46% patients and 52% control) were drinking coffee. Special habits were recorded in 35% of the patients group and 37%) of the control group (p-value=0.279). 33% of females had an irrelevant medical history among patients group and 41% among the control groups. The most common positive medical history in both groups was infection represented by 21% among patients group Vis 29% among control group. (P value=0.014, and 0.021 respectively).
Among male sex, hypertension was the most common positive medical history in both groups (52% of the patients group and 37% of the control group) (p-value=0.033). Positive histories of infection and combined diseases showed statistical difference between both groups (p-value =0.045, and 0.009 respectively). The percentage frequencies of females experienced previous cesarean section were slightly higher among control group (75%) than patients group (70%). Appendectomy and combined surgical interventions were slightly higher among control group (13% and4%), (9% and 2%) respectively.
The non-consanguineous marriages were more frequent among the control group (68%) than among the patients group (64%) (P-value = 0.013). On the other hand the frequency of consanguineous marriages among the patients (36%) was more frequent than among the control group (32%) and most of them were first cousin degree.
Regarding the duration of marriage, more than half of patients and controls were married form 5 to less than ten years. No significant difference was found (P=0.764).
Ninety-three percent of female patients were gravida 1-2, compared to 35% among the control group, while 59% of the control group were gravid a 3-4 compared to 7%
among the patients group. Statistical difference was recorded (p-value<0.001). Regarding parity, one or two was the most common in both groups but higher among patients group. It represented 99% among patients and 67% among controls. Statistical difference was recorded (p-value<0.001).
Abnormal menstrual rhythm was recorded more in patients group (35%) than that recorded in control group (27%). No statistical difference was recorded (P= 0.112). 26% of the patients had infertility for 1-5 years, and the remaining patients (74%) had infertility for more than 5years. Low FSH and LH levels were recorded more among those with advanced maternal age (50% and 44.2% for FSH and LH respectively) than those with young maternal ages (29.2% and 31.3% for FSH and LH respectively). No statistical significant difference was recorded (P= 0.034 and 0.184). Normal prolactin was recorded almost equal in both young (66.7%) and advanced maternal ages (65.4%).
Low FSH and LH were recorded more among those who smoke (47.4%) and drinking coffee (41.3%) than those who were not practicing this habits (34.3% and 28.6%). P-value was not significant (P=0.625 and 0.404 respectively). High prolactin was recorded more among smokers (36.8%) than those drinking coffee (32.6%) and those were not practicing this habit (34.3%). No statistical significant difference was recorded (P=0.947).
Low FSH and LH were more recorded among non-consanguineous patients (43.8% and 40.6%) than among DFC, FC, FCOR &SC (25%, 33.3%, 33.3% and 37.5%
respectively for FSH and 0.0%, 38.1%, 33.3% and 37.6% respectively) for LH. No statistical significant differences were recorded (P= 0.900 and 0.229 respectively). High prolactin was recorded more among FCOR (100%) and SC (62.5%) than what recorded among NC patients (31.3%). Significant statistical difference was recorded (P=0.026).
Low FSH & LH was recorded more among patients with positive medical history (63.4%, 60.4%) respectively. Normal FSH & LH were recorded more among patient with irrelevant medical history (63.6%, 60.6%). High prolactin was recorded more among patient with positive medical history (69.7%) and normal prolactin levels was more among patient with no medical history (69.7%). No Significant statistical differences were recorded.
Low FSH & LH was recorded more among patient with positive medical history (53.8% and 57.7%) than those with negative medical history (46.2% and42.3%) respectively. Normal prolactin was the same between both patient with positive and negative surgical history (76.9%). No Significant statistical differences were recorded.
Among those with normal BMI, special habits were positive more among control group (33.3%) than patients group (9.2%). Among those who had overweight, special habits were positive more among control group (50.8%) than among patients group (27.7%). On the other hand, among those who were obese, positive special habits were recorded more among patients (63.1%) than controls (15.9%). No statistical significant difference was recorded (p value =0.501 among patients and 0.159 control).
Among those with normal BMI, house wife, manual work and sedentary work were recorded more among control group (39.4% Vis 10.5%, 60% Vis 26.7% and 31.9% Vis 6.4% respectively). Also overweight was recorded more among controls than among patients. Obese personals were recorded more among patients than control group, for those
with house wife, manual work and sedentary work (55.3% Vis 21.2 %, 60% Vis 10% and 61.7% Vis 14.9%) respectively. No statistical differences were recorded (P =0,220 for patients and 0.217 for control).
Although the number of consanguineous patients (36%) was little bit higher than among control (32%), yet their distribution according to BMI classes was quite different. Among consanguineous group, normal BMI and overweighs were recorded more among control group (28.1%, 46.9%) than patients (11.1% and 25% for normal BMI and overweight respectively). Among obese persons consanguinity was recorded more among patients (63.9%) than among control group (25%). No statistical differences were recorded (P= 0.679 and 0.130 for patients and controls). Normal BMI was recorded more in the control group (40%) than that among patients (11%). Over weight was recorded more among the control group (44%) than that among the patients (30%). On the other hand obesity was recorded more among patients (59%) than those among control group (16%). The difference between the studied groups according to BMI was statistically significant (<0.001). Among patients group, overweight (30%) and obesity (59%) were more than those with normal BMI (11%). Among control group those with normal BMI (40%) were more than that of obese persons (16%).
Among patient group (59%) 59 patients were obese compared to 11% (11 patients) had normal BMI. On the other hand, we recorded 16%, (16 obese persons) compared to 40% (40 persons) non obese persons among the controls. Chi square test 2: showed statistical significant difference (P= <0.001).
Merging the overweight and obese persons together in one group revealed that among patient group, 89% patients were obese / overweight patients compared to 11% patients who had normal BMI .On the other hand, among the control group 60% persons recorded to be obese / overweight while 40% persons had normal BMI. Chi square test 2: showed statistical significant difference (P= <0.001).
Among normal BMI overweight and obese patients, Low gravidity was more among patients than control while high gravidity was more among control group. Among both normal BMI and overweight groups, the frequency of 1-2 gravidity among both patient and control groups (90.9 % Vis 30.0% and 96.7%Vis 34.1% respectively). No statistical differences were recorded (P-value =0.168 and 0.077). On the other hand among the obese group, the frequency of gravidity 1-2 was higher among patients (91.5%) than those among controls (50%), while among gravidity 3-4 the frequency of controls (43.8%) was higher than those among patients group (8.5%). No statistical difference was recorded (P= 0.168 and P= 0.077).
Positive history of abortions was almost equal in both patients and control while positive history of stillbirths was higher among obese control (18.8%) than among patients (8.5%). No statistical significance differences were recorded (P=7.370, 2.568 and 2.834). Among those with normal BMI, and overweight groups, normal rhythm was recorded more among control group (37% and 42.5%) than patients group (9.2% and 35.4%). Among obese persons, normal rhythm was recorded more among patients (55.4%) than control group (20.5%). Regarding abnormal rhythm, normal BMI and overweight were recorded more among controls (48.1% and 48.1%) than patients (14.3% and 20%) respectively. No
statistical significance differences were recorded (P=0.255 and 0.119 for patients and control respectively).
Among the 1-5 years infertility duration there was fluctuation of the percentages for normal BMI (27.3%), overweight (30%) and obese patients (23.7%). Also among infertility duration (10-15) years there was also fluctuation of the percentage among normal BMI (18.2%), overweight patients (6.7%) and obese patients (11.9%). No statistical significant difference was recorded (P=0.811).
Normal FSH was the lowest among the obese patient (42.4%) than among the overweight patients (86.7%) and still less than among those with normal BMI (81.85). Statistical significant difference was recorded (P= <0.001). Low LH was recorded more among the obese patients (54.2%) than that among those with normal BMI (18.2%) and overweight patients (13.3%). Statistical significant difference was recorded (P=<0.001). High Prolactin level was recorded more among obese patients (40.7%) than among those who had overweight (23.3%) and normal BMI (27.3%). No statistical significant difference was recorded (P= 0.233). Normal hystosalpingogram was recorded more among the obese patients (47.5%) than overweight patients (36.7%) and those with normal BMI (36.4%). No statistical significant difference was recorded (P= 0.636). On the other hand, normal laparoscopy was recorded more among those who had normal BMI (9.1%) than overweight patients (6.7%) and obese patients (3.4%). No statistical significant difference was recorded for prolactin (P= 0.706). However, there was statistical significant difference was recorded for FSH and LH (P=<0.001* and <0.001* respectively).
Studying the different risk factors among both patients and controls revealed no statistical differences regarding; advanced maternal age (above 35years) among both patients (50%) and controls (52%), presence of special habits (65%) among patients and (63%) among controls, parental consanguinity among patients (36%) and control (32%), abnormal menstrual rhythm among patients (35% and control (27%), positive medical and surgical histories among patients (33%, 74%) and controls (41%, 80%). On the other hand regarding abnormal BMI, there was a statistical difference between patients (89%) and controls (60%). P value was <0.001.