Obesity and fertility. Position statement | Endocrinología, Diabetes y Nutrición (English ed.)

array:24 ["pii" => "S2530018023000355" "issn" => "25300180" "doi" => "10.1016/j.endien.2023.03.003" "estado" => "S300" "fechaPublicacion" => "2023-03-01" "aid" => "1360" "copyright" => "SEEN and SED" "copyrightAnyo" => "2022" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "pgl" "cita" => "Endocrinol Diabetes Nutr. 2023;70 Supl 1:110-5" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S2530016422002385" "issn" => "25300164" "doi" => "10.1016/j.endinu.2022.10.002" "estado" => "S300" "fechaPublicacion" => "2023-03-01" "aid" => "1360" "copyright" => "SEEN y SED" "documento" => "article" "crossmark" => 1 "subdocumento" => "pgl" "cita" => "Endocrinol Diabetes Nutr. 2023;70 Supl 1:110-5" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "DOCUMENTO DE CONSENSO" "titulo" => "Obesidad y fertilidad. Documento de posicionamiento" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "110" "paginaFinal" => "115" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Obesity and fertility. Position statement" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2133 "Ancho" => 2925 "Tamanyo" => 367436 ] ] "descripcion" => array:1 [ "es" => "Esquema del abordaje la prevención y el tratamiento del sobrepeso u obesidad asociado a infertilidad." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "I. Miñambres, A. de Hollanda, N. Vilarrasa, S. Pellitero, M.A. Rubio, L. Flores, A. Caixàs, S. Lobo, J.I. Martinez Salamanca, B. Acevedo, V. Moizé, A. Andreu, J. Escalada" "autores" => array:14 [ 0 => array:2 [ "nombre" => "I." "apellidos" => "Miñambres" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "de Hollanda" ] 2 => array:2 [ "nombre" => "N." "apellidos" => "Vilarrasa" ] 3 => array:2 [ "nombre" => "S." "apellidos" => "Pellitero" ] 4 => array:2 [ "nombre" => "M.A." "apellidos" => "Rubio" ] 5 => array:2 [ "nombre" => "L." "apellidos" => "Flores" ] 6 => array:2 [ "nombre" => "A." "apellidos" => "Caixàs" ] 7 => array:2 [ "nombre" => "S." "apellidos" => "Lobo" ] 8 => array:2 [ "nombre" => "J.I." "apellidos" => "Martinez Salamanca" ] 9 => array:2 [ "nombre" => "B." "apellidos" => "Acevedo" ] 10 => array:2 [ "nombre" => "V." "apellidos" => "Moizé" ] 11 => array:2 [ "nombre" => "A." "apellidos" => "Andreu" ] 12 => array:2 [ "nombre" => "J." "apellidos" => "Escalada" ] 13 => array:1 [ "colaborador" => "en representación SEEN, SEEDO, SEF, AEU, SEGO, SEDYN" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2530018023000355" "doi" => "10.1016/j.endien.2023.03.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2530018023000355?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2530016422002385?idApp=UINPBA00004N" "url" => "/25300164/00000070000000S1/v3_202306211155/S2530016422002385/v3_202306211155/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2530018023000379" "issn" => "25300180" "doi" => "10.1016/j.endien.2023.01.001" "estado" => "S300" "fechaPublicacion" => "2023-03-01" "aid" => "1381" "copyright" => "SEEN and SED" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "pgl" "cita" => "Endocrinol Diabetes Nutr. 2023;70 Supl 1:116-25" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Consensus document" "titulo" => "Executive summary of the consensus document on hypophysitis of the Neuroendocrinology Area of Knowledge of the Spanish Society of Endocrinology and Nutrition" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "116" "paginaFinal" => "125" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Resumen ejecutivo del documento de consenso sobre hipofisitis del Área de Conocimiento de Neuroendocrinología de la Sociedad Española de Endocrinología y Nutrición" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1894 "Ancho" => 2007 "Tamanyo" => 335859 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Ipilimumab-induced hypophysitis. Pituitary MRI with coronal T1 (A) and sagittal T1 (B) sequence with paramagnetic contrast in a 59-year-old man with uveal melanoma with liver metastases who developed ipilimumab-induced hypophysitis. Coronal T1 (C) and sagittal T1 (D) pituitary MRI with paramagnetic contrast in a 46-year-old woman with uveal melanoma who developed ipilimumab-induced hypophysitis." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Pedro Iglesias, Betina Biagetti, Fernando Guerrero-Pérez, Almudena Vicente, Fernando Cordido, Juan J. Díez" "autores" => array:7 [ 0 => array:2 [ "nombre" => "Pedro" "apellidos" => "Iglesias" ] 1 => array:2 [ "nombre" => "Betina" "apellidos" => "Biagetti" ] 2 => array:2 [ "nombre" => "Fernando" "apellidos" => "Guerrero-Pérez" ] 3 => array:2 [ "nombre" => "Almudena" "apellidos" => "Vicente" ] 4 => array:2 [ "nombre" => "Fernando" "apellidos" => "Cordido" ] 5 => array:2 [ "nombre" => "Juan J." "apellidos" => "Díez" ] 6 => array:1 [ "colaborador" => "on behalf of the Neuroendocrinology Area of Knowledge of the Spanish Society of Endocrinology and Nutrition (SEEN)" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S2530016423000162" "doi" => "10.1016/j.endinu.2023.01.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2530016423000162?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2530018023000379?idApp=UINPBA00004N" "url" => "/25300180/00000070000000S1/v2_202304211110/S2530018023000379/v2_202304211110/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2530018023000367" "issn" => "25300180" "doi" => "10.1016/j.endien.2023.03.004" "estado" => "S300" "fechaPublicacion" => "2023-03-01" "aid" => "1371" "copyright" => "SEEN and SED" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "pgl" "cita" => "Endocrinol Diabetes Nutr. 2023;70 Supl 1:103-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Consensus document" "titulo" => "Executive summary of the position statement of the Spanish Societies SEQCML/SEEN/SEEP. Recommendations for the measurement of sex steroids in clinical practice" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "103" "paginaFinal" => "109" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Resumen ejecutivo del documento de posicionamiento SEQCML/SEEN/SEEP. Recomendaciones para la medición de esteroides sexuales en la práctica clínica" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1429 "Ancho" => 2508 "Tamanyo" => 220982 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Immunoassay (A–C). Example of competitive chemiluminescent immunoassay. A) The method is based on a specific antibody that recognises the analyte of interest. B) The antibody is incubated with the sample (containing the analyte of interest and other molecules) and with the labelled analyte. Analyte and labelled analyte compete for binding to the antibody. C) The chemiluminescent signal from the labelled analyte bound to the antibody is recorded. In the example, the recorded signal will be inversely proportional to the amount of analyte originally present in the sample. Mass spectrometry (D–H). Example of liquid chromatography with tandem mass spectrometry (LC-MS/MS). D,E) Extraction of the serum sample with organic solvent. This step cuts out possible interferers. F) Separation of sample components by liquid chromatography. G) Selection of the specific ions of the analytes. H) Representation of the results. The area of the chromatographic peak is directly proportional to the amount of analyte originally present in the sample." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Gregori Casals, Roser Ferrer Costa, Eulàlia Urgell Rull, Héctor F. Escobar-Morreale, Jesús Argente, Gemma Sesmilo, Betina Biagetti" "autores" => array:7 [ 0 => array:2 [ "nombre" => "Gregori" "apellidos" => "Casals" ] 1 => array:2 [ "nombre" => "Roser" "apellidos" => "Ferrer Costa" ] 2 => array:2 [ "nombre" => "Eulàlia" "apellidos" => "Urgell Rull" ] 3 => array:2 [ "nombre" => "Héctor F." "apellidos" => "Escobar-Morreale" ] 4 => array:2 [ "nombre" => "Jesús" "apellidos" => "Argente" ] 5 => array:2 [ "nombre" => "Gemma" "apellidos" => "Sesmilo" ] 6 => array:2 [ "nombre" => "Betina" "apellidos" => "Biagetti" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S253001642200266X" "doi" => "10.1016/j.endinu.2022.11.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S253001642200266X?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2530018023000367?idApp=UINPBA00004N" "url" => "/25300180/00000070000000S1/v2_202304211110/S2530018023000367/v2_202304211110/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "Consensus document" "titulo" => "Obesity and fertility. Position statement" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "110" "paginaFinal" => "115" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "I. Miñambres, A. de Hollanda, N. Vilarrasa, S. Pellitero, M.A. Rubio, L. Flores, A. Caixàs, S. Lobo, J.I. Martinez Salamanca, B. Acevedo, V. Moizé, A. Andreu, J. Escalada" "autores" => array:14 [ 0 => array:3 [ "nombre" => "I." "apellidos" => "Miñambres" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "◊" "identificador" => "fn0005" ] ] ] 1 => array:4 [ "nombre" => "A." "apellidos" => "de Hollanda" "email" => array:1 [ 0 => "amdehol@clinic.cat" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "◊" "identificador" => "fn0005" ] 2 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "N." "apellidos" => "Vilarrasa" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "S." "apellidos" => "Pellitero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "d" "identificador" => "aff0020" ] ] ] 4 => array:3 [ "nombre" => "M.A." "apellidos" => "Rubio" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "e" "identificador" => "aff0025" ] ] ] 5 => array:3 [ "nombre" => "L." "apellidos" => "Flores" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "f" "identificador" => "aff0030" ] ] ] 6 => array:3 [ "nombre" => "A." "apellidos" => "Caixàs" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "g" "identificador" => "aff0035" ] ] ] 7 => array:3 [ "nombre" => "S." "apellidos" => "Lobo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "h" "identificador" => "aff0040" ] ] ] 8 => array:3 [ "nombre" => "J.I." "apellidos" => "Martinez Salamanca" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "i" "identificador" => "aff0045" ] ] ] 9 => array:3 [ "nombre" => "B." "apellidos" => "Acevedo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "j" "identificador" => "aff0050" ] ] ] 10 => array:3 [ "nombre" => "V." "apellidos" => "Moizé" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "k" "identificador" => "aff0055" ] ] ] 11 => array:3 [ "nombre" => "A." "apellidos" => "Andreu" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "l" "identificador" => "aff0060" ] ] ] 12 => array:3 [ "nombre" => "J." "apellidos" => "Escalada" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "m" "identificador" => "aff0065" ] ] ] 13 => array:2 [ "colaborador" => "on behalf of SEEN, SEEDO, SEF, AEU, SEGO, SEDYN" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "◊" "identificador" => "fn0005" ] ] ] ] "afiliaciones" => array:13 [ 0 => array:3 [ "entidad" => "Servicio de Endocrinología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), CIBER de Diabetes y Enfermedades Metabólicas (CIBERDEM), Sociedad Española de Endocrinología y Nutrición (SEEN), Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Endocrinología, Hospital Clínic, Barcelona, Centro de Investigación Biomédica en red Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Sociedad Española de Endocrinología y Nutrición (SEEN), Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Endocrinología y Nutrición, Hospital Universitario de Bellvitge-IDIBELL, CIBER de Diabetes y Enfermedades Metabólicas (CIBERDEM), Sociedad Española de Endocrinología y Nutrición (SEEN), Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Endocrinología, Hospital Universitari Germans Trias i Pujol, Institut d'Investigació, Badalona, Sociedad Española de Endocrinología y Nutrición (SEEN), Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Servicio de Endocrinología. Hospital Clínico San Carlos, Madrid, IDISSC, Facultad de Medicina, Universidad Complutense, Madrid, Sociedad Española de Endocrinología y Nutrición (SEEN), Spain" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Servicio de Endocrinología y Nutrición, Hospital Clínic, Barcelona, CIBER de Diabetes y Enfermedades Metabólicas (CIBERDEM), Sociedad Española para el Estudio de la Obesidad, SEEDO, Sociedad Española de Endocrinología y Nutrición (SEEN), Spain" "etiqueta" => "f" "identificador" => "aff0030" ] 6 => array:3 [ "entidad" => "Servicio de Endocrinología y Nutrición, Hospital Universitari Parc Taulí, Institut d’Investigació i Innovació Parc Taulí (I3PT), Departamento de Medicina Universitat Autònoma de Barcelona, Sabadell, Sociedad Española de Endocrinología y Nutrición (SEEN), Sociedad Española para el Estudio de la Obesidad, SEEDO, Spain" "etiqueta" => "g" "identificador" => "aff0035" ] 7 => array:3 [ "entidad" => "Servicio de Obstetricia y Ginecología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Grupo de Interés de Endocrinología Reproductiva, Sociedad Española de Fertilidad (SEF), Spain" "etiqueta" => "h" "identificador" => "aff0040" ] 8 => array:3 [ "entidad" => "Servicio de Urología, Hospital Universitario Puerta de Hierro, Majadahonda, Lyx Instituto de Urología, Universidad Francisco de Vitoria, Asociación Española de Urología, Spain" "etiqueta" => "i" "identificador" => "aff0045" ] 9 => array:3 [ "entidad" => "Servicio de Ginecología y Obstetricia, Unidad de Reproducción Asistida, Hospital Fundación Jiménez Díaz, Madrid, Profesor asociado de Medicina de la Universidad Autónoma de Madrid (UAM), Sociedad Española de Ginecología y Obstetricia (SEGO), Spain" "etiqueta" => "j" "identificador" => "aff0050" ] 10 => array:3 [ "entidad" => "Servicio de Endocrinología y Nutrición, Hospital Clínic, Barcelona, Sociedad Española de Dietética y Nutrición (SEDYN), Spain" "etiqueta" => "k" "identificador" => "aff0055" ] 11 => array:3 [ "entidad" => "Servicio de Endocrinología y Nutrición, Hospital Clínic, Barcelona, Sociedad Española de Dietética y Nutrición (SEDYN), Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Spain" "etiqueta" => "l" "identificador" => "aff0060" ] 12 => array:3 [ "entidad" => "Departamento de Endocrinología y Nutrición, Clínica Universidad de Navarra, Pamplona, Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Sociedad Española de Endocrinología y Nutrición (SEEN), Spain" "etiqueta" => "m" "identificador" => "aff0065" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Obesidad y fertilidad. Documento de posicionamiento" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2219 "Ancho" => 2931 "Tamanyo" => 341364 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Diagram of the approach to the prevention and treatment of overweight or obesity associated with infertility." ] ] ] "textoCompleto" => "The position statement has been produced by the Sociedad Española de Endocrinología y Nutrición (SEEN) [Spanish Society of Endocrinology and Nutrition], through its Grupo de trabajo de Obesidad (GOSEEN) [Working Group on Obesity], to highlight the relationship between obesity and infertility and propose an approach and specific treatment based on scientific evidence, but without attempting an in-depth review of obesity and infertility. Other societies involved in the care of these patients have subscribed to this position: Sociedad Española para el Estudio de la Obesidad (SEEDO) [Spanish Society for the Study of Obesity]; Sociedad Española de Fertilidad (SEF) [Spanish Fertility Society]; Asociación Española de Urología (AEU) [Spanish Association of Urology]; Sociedad Española de Ginecología y Obstetricia (SEGO) [Spanish Society of Obstetrics and Gynaecology]; and the Sociedad Española de Dietética y Nutrición (SEDYN) [Spanish Society of Dietetics and Nutrition]. Our aim is to show that people with obesity and infertility require specialised and multidisciplinary treatment and, in the event of being candidates for bariatric surgery, should be considered as a priority group when the likelihood of pregnancy is diminishing in the short term due to age.Infertility as a disorder associated with obesityObesity is a chronic disease of epidemic proportions in the western world and has become one of the most difficult challenges facing public health. In Spain, the estimated prevalence of overweight in the adult population (aged 25–64) is 39.3% and that of obesity, 21.6% (22.8% in males and 20.5% in females), increasing with the age of the population.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> If the current rate of growth continues, by 2030, 29.4% of Spanish adults will suffer from obesity.<a class="elsevierStyleCrossRef" href="#bib0010">2</a>Obesity is associated with, or is the direct cause of, many other well-known disorders and diseases, such as hypertension, type 2 diabetes mellitus, dyslipidaemia, sleep apnoea-hypopnoea syndrome, fatty liver disease, bone and joint diseases and the risk of developing different cancers.<a class="elsevierStyleCrossRef" href="#bib0015">3</a> This means that people with obesity have increased cardiovascular risk and morbidity and mortality rates.<a class="elsevierStyleCrossRef" href="#bib0020">4</a> Obesity is also the cause of lesser-known diseases, such as both female and male infertility, which can significantly compromise the health and quality of life of those affected.<a class="elsevierStyleCrossRef" href="#bib0025">5</a> In Spain, depending on the definition, infertility attributable to the female can be as high as 17.5% in the 30–49 age group.<a class="elsevierStyleCrossRef" href="#bib0030">6</a> About 23% of women who undergo in-vitro fertilisation techniques are overweight or obese.<a class="elsevierStyleCrossRef" href="#bib0035">7</a> The significance of obesity in the aetiology of infertility is difficult to determine due to the multifactorial contributions.Female obesity and infertilityObese women are less likely to conceive spontaneously. Excess weight is associated with anovulatory menstrual cycles, with the likelihood of anovulatory infertility in women with a body mass index (BMI) ≥32 kg/m2 estimated to be more than double that of women with normal weight (RR 2.7 [2–3.7]).<a class="elsevierStyleCrossRefs" href="#bib0040">8,9</a> There is a common association between obesity and polycystic ovarian syndrome (PCOS), this being the most frequent cause of infertility due to anovulation.<a class="elsevierStyleCrossRef" href="#bib0050">10</a> Obesity exacerbates different reproductive and metabolic aspects of PCOS, contributing to an increased likelihood of irregular menstruation and oligo-anovulation and having a negative impact on fertility in these patients. In this context, obesity can lead to changes, including insulin resistance, an increase in androgens, a reduction in sex hormone binding globulin (SHBG) and increased peripheral conversion of androgens to oestrogens, which in turn are the causes of altered secretion of gonadotropins by the hypothalamus and hinder the formation of follicles.<a class="elsevierStyleCrossRefs" href="#bib0055">11,12</a>However, anovulation is not the only cause of subfertility associated with obesity. It is estimated that for every point increase in BMI above 29 kg/m2, the chances of spontaneous pregnancy are reduced by 5% in women with ovulatory cycles.<a class="elsevierStyleCrossRef" href="#bib0065">13</a> Possible causes of this phenomenon may be the impact of obesity on sexual desire and on the quality of the ova and their capacity to be fertilised, and alterations in the endometrium which hinder implantation and contribute to a higher rate of abortions.Obesity seems to have a negative impact on assisted reproductive technology (ART). Patients with obesity treated by controlled ovarian stimulation require higher hormone doses, more days of stimulation, and a higher rate of cancellation due to inadequate response.<a class="elsevierStyleCrossRef" href="#bib0070">14</a> According to data from the Society for Assisted Reproductive Technology (SART),<a class="elsevierStyleCrossRef" href="#bib0075">15</a> a high BMI leads to a decrease in the number of oocytes retrieved and the quality of the embryos, as well as a reduction in the rates of fertilisation and implantation and in the live birth rate, which falls from 31.4% in women with BMI in the normal range to 21.2% in cases of BMI above 50 kg/m2. The causes of less success in assisted reproduction in obese women are multiple but may include alterations in folliculogenesis, implantation defects and alterations in embryonic development.<a class="elsevierStyleCrossRef" href="#bib0070">14</a> However, a recent systematic review concludes that the negative impact of obesity on clinical pregnancy, live birth and spontaneous abortion rates after ART is weak in absolute terms and more consistent studies are needed on this subject.<a class="elsevierStyleCrossRef" href="#bib0080">16</a>Although not the focus of this statement, pre-pregnancy obesity increases the risk of obstetric complications such as gestational diabetes, pregnancy-induced hypertension, caesarean section and macrosomia, complicating the final part of the pregnancy, in addition to increasing the risk of obesity in the offspring.<a class="elsevierStyleCrossRef" href="#bib0085">17</a>Male obesity and infertilityThe male factor accounts for 20–50% of infertility cases in couples<a class="elsevierStyleCrossRef" href="#bib0090">18</a> and obesity may play a significant role. Two systematic reviews substantiate that if the male partner is obese, there is a greater risk of him being sterile (OR: 1.66 [95% CI, 1.53–1.79]) and poorer outcomes in ART.<a class="elsevierStyleCrossRefs" href="#bib0095">19,20</a> The causes are multiple and are detailed below.Firstly, as in women, obesity in men, causes a cascade of hormonal changes, which can lead to functional hypogonadotropic hypogonadism. This is caused by the decrease in SHBG, the aromatisation of androgens to oestrogens in adipose tissue, which, combined with other mechanisms, including insulin resistance, hyperleptinaemia and low-grade inflammatory state, cause a decrease in the secretion of gonadotropins.<a class="elsevierStyleCrossRefs" href="#bib0105">21,22</a>In addition, obesity in men is associated with a higher rate of erectile dysfunction, which can occur in up to 75% of men with grade 2 and 3 obesity.<a class="elsevierStyleCrossRef" href="#bib0115">23</a> This association may be due to the hormonal changes described, the presence of metabolic syndrome or treatments for that, or secondary vascular damage.In terms of semen quality, the data are less conclusive, although some studies report a higher prevalence of oligozoospermia and asthenozoospermia,<a class="elsevierStyleCrossRefs" href="#bib0095">19,24,25</a> alterations in the DNA, a reduction in mitochondrial activity and an increase in oxidative stress in the sperm in people with obesity.<a class="elsevierStyleCrossRefs" href="#bib0130">26–28</a> It has been suggested that these changes could be secondary to functional hypogonadotropic hypogonadism itself, to an increase in scrotal temperature secondary to increased adiposity, or to the detrimental effect of the proinflammatory state and oxidative stress on spermatogenesis.<a class="elsevierStyleCrossRef" href="#bib0145">29</a>Impact of weight loss on fertilityIn women, weight loss through lifestyle changes or bariatric surgery has been shown to restore ovulation, regularise menstrual cycles and improve fertility.<a class="elsevierStyleCrossRefs" href="#bib0150">30,31</a> Although the impact of weight loss on the success of fertility treatments is less clear, current evidence suggests that it could help achieve a greater number of spontaneous pregnancies, in addition to reducing the necessary dose of gonadotropin treatment.<a class="elsevierStyleCrossRefs" href="#bib0025">5,32,33</a>Although pharmacological treatment of obesity offers proven health benefits,<a class="elsevierStyleCrossRef" href="#bib0170">34</a> the information available on the improvement of fertility is limited and has only been studied in women.<a class="elsevierStyleCrossRefs" href="#bib0175">35–37</a> Studies are therefore needed to evaluate whether or not weight loss through anti-obesity drugs improves fertility results, in addition to defining for each specific drug the precise moment it should be discontinued, according to the pharmacokinetics and pharmacodynamics, before planning the pregnancy.In men, weight loss, either through lifestyle changes or bariatric surgery, leads to a clear improvement in the hormonal changes characteristic of functional hypogonadism secondary to obesity<a class="elsevierStyleCrossRefs" href="#bib0190">38–42</a> and in erectile function.<a class="elsevierStyleCrossRef" href="#bib0215">43</a> At present, the data on sperm parameters are less clear. Improvement in spermatogenesis after lifestyle intervention has been found in isolated studies,<a class="elsevierStyleCrossRef" href="#bib0220">44</a> but the effects of bariatric surgery do not seem to provide any benefit.<a class="elsevierStyleCrossRef" href="#bib0225">45</a>The amount of weight loss necessary to see any benefits in parameters related to fertility is variable. However, with weight loss of 5–10% achieved through diet and exercise, there is an improvement in functional hypogonadism associated with obesity, irregular menstruation and anovulation associated with PCOS, and even in the pregnancy rate.<a class="elsevierStyleCrossRefs" href="#bib0025">5,40,46</a>Recommendations on the treatment of excess weight and obesity in people with infertilityIn view of the currently available evidence, assessing for excess weight or obesity should be mandatory at Andrology or Gynaecology consultations for infertility. To achieve this, it will simply be necessary to measure weight, height and waist circumference (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). In the presence of obesity and infertility, treatment should focus primarily on achieving a healthy weight loss which is sustained over time through lifestyle changes, including diet modification, physical exercise and behavioural changes. This first approach is the basis of any intervention aimed at weight loss and should be considered in all overweight and obese patients who come to the Gynaecology or Andrology clinic because of infertility. As a negative synergistic effect on fertility has been observed when both partners are obese,<a class="elsevierStyleCrossRefs" href="#bib0235">47,48</a> weight loss is recommended for both partners, although the effect on male fertility is less conclusive. It should also be noted that a preventive approach probably offers a wider window of action. As a gynaecology appointment for routine check-up is often the only contact a woman of childbearing potential has with the healthcare system, this consultation is a key point in the prevention of excess weight and obesity. We therefore recommend the systematic assessment of patients in whom excess weight or obesity are identified, and referral to the general practitioner or Endocrinology and Nutrition specialist in order to establish an agreed treatment plan.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>In people with BMI ≥27 kg/m2 with associated complications, or ≥30 kg/m2, along with lifestyle modifications, the addition of drugs to reduce body weight should be considered, bearing in mind that the evidence regarding improvement in fertility is limited and any drug treatment should be stopped before attempts to become pregnant or starting fertility treatment, in accordance with each drug's pharmacokinetics and summary of product characteristics. In cases of grade 2 obesity (BMI ≥35 kg/m2) with obesity-associated disorders or grade 3 obesity (BMI ≥40 kg/m2), the possibility of bariatric surgery should be considered, bearing in mind that the resulting effects on fertility are clearer in women, with less evidence in men.<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> summarises the approach to the prevention and treatment of obesity associated with infertility. We have to take into account, however, that despite the negative impact of obesity on fertility, in women aged 38 or over the negative impact of age is much greater and, in these cases, achieving pregnancy should take priority over weight loss.<a class="elsevierStyleCrossRef" href="#bib0245">49</a>Areas for improvement in the treatment of obesity associated with infertilityThe approach to excess weight and obesity therefore has to be multidisciplinary, including both the general practitioner, endocrinologists, dietitians/nutritionists, psychologists, physical exercise specialists, nurses, gynaecologists and urologists. Effective communication between the different healthcare professionals is key to agreeing on the best approach in each case. Unfortunately, such multidisciplinary programmes are few and far between and obesity units are limited to the treatment of severe obesity. It is essential to promote the creation of these programmes in Primary Care in coordination with endocrinologists specialising in the treatment of obesity, in order to respond to the growing demand, and where patients with a lesser degree of obesity can receive care.In the case of drug treatment for excess weight and obesity, as we are awaiting the approval of new agents which are more potent in terms of achieving weight loss, studies will be needed to assess their impact on fertility, and others on the pharmacoeconomics, in order to obtain financing from the National Health System.The long and restrictive waiting lists for bariatric surgery represent another limitation in the treatment of obesity in the context of infertility. In view of the already discussed impact of age on fertility, this position paper specifically proposes prioritisation on bariatric surgery waiting lists for women aged over 35 with severe obesity and infertility, bearing in mind that the recommendation is to wait at least 12 months after the bariatric intervention before becoming pregnant.This document also asserts that, despite the huge repercussions it has on health, obesity continues to be a stigmatised chronic disease with little recognition, from the perspective of both society and healthcare. There are currently very few units for the correct treatment of obesity, there is a lack of funding by the National Health System for drug treatment, and there are long waiting lists for bariatric surgery. This situation contributes to the deterioration in the quality of life and life expectancy of people with obesity. There is little recognition of the association between obesity and infertility and only through the training of healthcare professionals and increasing awareness among people with obesity and society in general, including the health authorities, will it be possible to promote new strategies to ensure proper assessment and the implementation of an effective treatment for improving both female and male fertility. A multidisciplinary approach to this disease is key to improving the care of these patients.Information for patientsObesity can be considered an epidemic disease throughout the world, both in western and developing countries. A chronic disease, obesity is associated with, or is the direct cause of, many other well-known health problems and disorders, such as high blood pressure, type 2 diabetes, dyslipidaemia, respiratory disease and joint problems, and even an increased risk of cancer. This means that people with obesity have increased cardiovascular risk and morbidity and mortality rates. Obesity is also the cause of lesser-known diseases, such as both female and male infertility, which can significantly compromise the health and quality of life of those affected. The aim of this joint paper by the societies SEEN, SEEDO, SEGO, SEF, AEU and SEDYN is to draw attention to the impact of obesity on fertility, both male and female, and agree on a common approach. Specifically, it proposes prioritising severely obese women over 35 on the bariatric surgery waiting list. Our aim is to draw attention to the need to allocate National Health System resources for the creation of multidisciplinary units to address obesity, both at a hospital and Primary Care level, and to the need to reduce waiting lists for obesity surgery, assess the financing of anti-obesity drugs and develop strategies with the potential to impact on fertility in patients with obesity." "textoCompletoSecciones" => array:1 [ "secciones" => array:8 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Infertility as a disorder associated with obesity" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Female obesity and infertility" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Male obesity and infertility" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Impact of weight loss on fertility" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Recommendations on the treatment of excess weight and obesity in people with infertility" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Areas for improvement in the treatment of obesity associated with infertility" ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Information for patients" ] 7 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:3 [ "etiqueta" => "◊" "nota" => "They have similarly contributed to this manuscript." "identificador" => "fn0005" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2219 "Ancho" => 2931 "Tamanyo" => 341364 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Diagram of the approach to the prevention and treatment of overweight or obesity associated with infertility." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:49 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of general obesity and abdominal obesity in the Spanish Adult Population (Aged 25–64 years) 2014–2015: the ENPE Study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J. Aranceta-Bartrina" 1 => "C. Pérez-Rodrigo" 2 => "G. Alberdi-Aresti" 3 => "N. Ramos-Carrera" 4 => "S. Lázaro-Masedo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rec.2016.02.009" "Revista" => array:6 [ "tituloSerie" => "Rev Esp Cardiol (Engl Ed)" "fecha" => "2016" "volumen" => "69" "paginaInicial" => "579" "paginaFinal" => "587" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27133458" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "World Obesity Atlas 2022. <a target="_blank" href="https://s3-eu-west-1.amazonaws.com/wof-files/World_Obesity_Atlas_2022.pdf">https://s3-eu-west-1.amazonaws.com/wof-files/World_Obesity_Atlas_2022.pdf</a>." ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The SEEN comprehensive clinical survey of adult obesity: Executive summary" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.D. Ballesteros Pomar" 1 => "N. Vilarrasa García" 2 => "M.Á Rubio Herrera" 3 => "M.J. Barahona" 4 => "M. Bueno" 5 => "A. Caixàs" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.endinu.2020.05.003" "Revista" => array:6 [ "tituloSerie" => "Endocrinol Diabetes Nutr (Engl Ed)" "fecha" => "2021" "volumen" => "68" "paginaInicial" => "130" "paginaFinal" => "136" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32933882" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Overweight, obesity, andmortality in a largeprospective cohort of persons 50–71 years old" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "K.F. Adams" 1 => "A. Schatzkin" 2 => "T.B. Harris" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa055643" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med." "fecha" => "2006" "volumen" => "355" "paginaInicial" => "763" "paginaFinal" => "778" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16926275" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Obesity and reproduction: a committee opinion" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Practice Committee of the American Society for Reproductive Medicine. Electronic address: asrm@asrm.org" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.fertnstert.2021.08.018" "Revista" => array:6 [ "tituloSerie" => "Fertil Steril" "fecha" => "2021" "volumen" => "116" "paginaInicial" => "1266" "paginaFinal" => "1285" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34583840" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Calibrated prevalence of infertility in 30- to 49-year-old women according to diferent approaches: a cross-sectional population-based study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Cabrera-León" 1 => "V. Lopez-Villaverde" 2 => "M. Rueda" 3 => "M.N. Moya-Garrido" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/humrep/dev226" "Revista" => array:6 [ "tituloSerie" => "Hum Reprod." "fecha" => "2015" "volumen" => "30" "paginaInicial" => "2677" "paginaFinal" => "2685" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26370663" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Female obesity impairs in vitro fertilization outcome without affecting embryo quality" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J. Bellver" 1 => "Y. Ayllón" 2 => "M. Ferrando" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.fertnstert.2008.12.032" "Revista" => array:6 [ "tituloSerie" => "Fertil Steril." "fecha" => "2010" "volumen" => "93" "paginaInicial" => "447" "paginaFinal" => "454" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19171335" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Adolescent body mass index and infertility caused by ovulatory disorder" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J.W. Rich-Edwards" 1 => "M.B. Goldman" 2 => "W.C. Willett" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/0002-9378(94)90465-0" "Revista" => array:6 [ "tituloSerie" => "Am J Obstet Gynecol" "fecha" => "1994" "volumen" => "171" "paginaInicial" => "171" "paginaFinal" => "177" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8030695" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Body mass index and ovulatory infertility" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "F. Grodstein" 1 => "M.B. Goldman" 2 => "D.W. Cramer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/00001648-199403000-00016" "Revista" => array:6 [ "tituloSerie" => "Epidemiology" "fecha" => "1994" "volumen" => "5" "paginaInicial" => "247" "paginaFinal" => "250" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8173001" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pregnancy complications in women with polycystic ovary syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S. Palomba" 1 => "M.A. de Wilde" 2 => "A. Falbo" 3 => "M.P. Koster" 4 => "G.B. La Sala" 5 => "B.C. Fauser" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/humupd/dmv029" "Revista" => array:7 [ "tituloSerie" => "Hum Reprod Update." "fecha" => "2015" "volumen" => "21" "numero" => "5" "paginaInicial" => "575" "paginaFinal" => "592" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26117684" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The adverse effects of obesity on reproduction" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.E. Norman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1530/REP-10-0297" "Revista" => array:7 [ "tituloSerie" => "Reproduction" "fecha" => "2010" "volumen" => "140" "paginaInicial" => "343" "paginaFinal" => "345" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20802106" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S187887501930227X" "estado" => "S300" "issn" => "18788750" ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Metabolic effects of obesity on reproduction" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R. Pasquali" 1 => "A. Gambineri" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s1472-6483(10)61179-0" "Revista" => array:6 [ "tituloSerie" => "Reprod Biomed Online" "fecha" => "2006" "volumen" => "12" "paginaInicial" => "542" "paginaFinal" => "551" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16790096" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Obesity affects spontaneous pregnancy chances in subfertile, ovulatory women" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J.W. Van der Steeg" 1 => "P. Steures" 2 => "M.J. Eijkemans" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/humrep/dem371" "Revista" => array:6 [ "tituloSerie" => "Hum Reprod" "fecha" => "2008" "volumen" => "23" "paginaInicial" => "324" "paginaFinal" => "328" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18077317" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Obesity and Reproduction" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "N. Mahutte" 1 => "C. Kamga-Ngande" 2 => "A. Sharma" 3 => "C. Sylvestre" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jogc.2018.04.030" "Revista" => array:6 [ "tituloSerie" => "J Obstet Gynaecol Can." "fecha" => "2018" "volumen" => "40" "paginaInicial" => "950" "paginaFinal" => "966" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29921431" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pregnancy outcomes decline with increasing body mass index: analysis of 239,127 fresh autologous in vitro fertilization cycles from the 2008–2010 Society for Assisted Reproductive Technology registry" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M.P. Provost" 1 => "K.S. Acharya" 2 => "C.R. Acharya" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.fertnstert.2015.11.008" "Revista" => array:6 [ "tituloSerie" => "Fertil Steril" "fecha" => "2016" "volumen" => "105" "paginaInicial" => "663" "paginaFinal" => "669" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26627120" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Overweight, obesity and assisted reproduction: a systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L.M. Ribeiro" 1 => "L.M.P. Sasaki" 2 => "A.A. Silva" 3 => "E.S. Souza" 4 => "A. Oliveira Lyrio" 5 => "C.M.G. Figueiredo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ejogrb.2022.01.019" "Revista" => array:6 [ "tituloSerie" => "Eur J Obstet Gynecol Reprod Biol." "fecha" => "2022" "volumen" => "271" "paginaInicial" => "117" "paginaFinal" => "127" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/35183001" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Maternal obesity in early pregnancy and risk of adverse outcomes" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "I. Bautista-Castaño" 1 => "P. Henriquez-Sanchez" 2 => "N. Alemán-Perez" 3 => "J.J. Garcia-Salvador" 4 => "A. Gonzalez-Quesada" 5 => "J.A. García-Hernández" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1371/journal.pone.0080410" "Revista" => array:3 [ "tituloSerie" => "PLoS One" "fecha" => "2013" "volumen" => "8" ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0090" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Incidenceandmain causes of infertility in a resident population (1,850,000) of three French regions (1988–1989)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Thonneau" 1 => "S. Marchand" 2 => "A. Tallec" 3 => "M.L. Ferial" 4 => "B. Ducot" 5 => "J. Lansac" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/oxfordjournals.humrep.a137433" "Revista" => array:6 [ "tituloSerie" => "Hum Reprod" "fecha" => "1991" "volumen" => "6" "paginaInicial" => "811" "paginaFinal" => "816" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1757519" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0095" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Paternal obesity negatively affects male fertility and assisted reproduction outcomes: a systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.M. Campbell" 1 => "M. Lane" 2 => "J.A. Owens" 3 => "H.W. Bakos" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rbmo.2015.07.012" "Revista" => array:5 [ "tituloSerie" => "Reprod Bio Med Online." "fecha" => "2015" "volumen" => "31" "paginaInicial" => "593" "paginaFinal" => "604" ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0100" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of male body mass index on assisted reproduction treatment outcome: an updated systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "R. Mushtaq" 1 => "J. Pundir" 2 => "C. Achilli" 3 => "O. Naji" 4 => "Y. Khalaf" 5 => "T. El-Toukhy" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rbmo.2018.01.002" "Revista" => array:6 [ "tituloSerie" => "Reprod Biomed Online." "fecha" => "2018" "volumen" => "36" "paginaInicial" => "459" "paginaFinal" => "471" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29452915" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0105" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Male obesity-related secondary hypogonadism - pathophysiology, clinical implications and management" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C.J. Fernandez" 1 => "E.C. Chacko" 2 => "J.M. Pappachan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.17925/EE.2019.15.2.83" "Revista" => array:6 [ "tituloSerie" => "Eur Endocrinol." "fecha" => "2019" "volumen" => "15" "paginaInicial" => "83" "paginaFinal" => "90" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31616498" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0110" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "ENDOCRINE OBESITY: pituitary dysfunction in obesity" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S. Ruiz" 1 => "F. Vázquez" 2 => "S. Pellitero" 3 => "M. Puig-Domingo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1530/EJE-21-0899" "Revista" => array:5 [ "tituloSerie" => "Eur J Endocrinol." "fecha" => "2022" "volumen" => "186" "paginaInicial" => "R79" "paginaFinal" => "R92" ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0115" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Associations between body mass index, waist circumference and erectile dysfunction: a systematic review and META-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D. Pizzol" 1 => "L. Smith" 2 => "L. Fontana" 3 => "M.G. Caruso" 4 => "A. Bertoldo" 5 => "J. Demurtas" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s11154-020-09541-0" "Revista" => array:6 [ "tituloSerie" => "Rev Endocr Metab Disord." "fecha" => "2020" "volumen" => "21" "paginaInicial" => "657" "paginaFinal" => "666" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32002782" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0120" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "BMI in relation to sperm count: an updated systematic review and collaborative meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N. Sermondade" 1 => "C. Faure" 2 => "L. Fezeu" 3 => "A.G. Shayeb" 4 => "J.P. Bonde" 5 => "T.K. Jensen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/humupd/dms050" "Revista" => array:6 [ "tituloSerie" => "Hum Reprod Update" "fecha" => "2013" "volumen" => "19" "paginaInicial" => "221" "paginaFinal" => "231" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23242914" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0125" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The impact of body mass index on semen parameters and reproductive hormones in human males: a systematic review with meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A.A. MacDonald" 1 => "G.P. Herbison" 2 => "M. Showell" 3 => "C.M. Farquhar" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/humupd/dmp047" "Revista" => array:6 [ "tituloSerie" => "Hum Reprod Update." "fecha" => "2010" "volumen" => "16" "paginaInicial" => "293" "paginaFinal" => "311" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19889752" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0130" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The relationship between male BMI and waist circumference on semen quality: data from the LIFE study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M.L. Eisenberg" 1 => "S. Kim" 2 => "Z. Chen" 3 => "R. Sundaram" 4 => "E.F. Schisterman" 5 => "G.M. BuckLouis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/humrep/det428" "Revista" => array:6 [ "tituloSerie" => "Hum Reprod" "fecha" => "2014" "volumen" => "29" "paginaInicial" => "193" "paginaFinal" => "200" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24306102" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0135" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Association between obesity and alteration of sperm DNA integrity and mitochondrial activity" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "R.M. Fariello" 1 => "J.R. Pariz" 2 => "D.M. Spaine" 3 => "A.P. Cedenho" 4 => "R.P. Bertolla" 5 => "R. Fraietta" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1464-410X.2011.10813.x" "Revista" => array:6 [ "tituloSerie" => "BJU Int" "fecha" => "2012" "volumen" => "110" "paginaInicial" => "863" "paginaFinal" => "867" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22300410" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0140" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Impact of body mass index on seminal oxidative stress" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "O. Tunc" 1 => "H.W. Bakos" 2 => "K. Tremellen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1439-0272.2009.01032.x" "Revista" => array:6 [ "tituloSerie" => "Andrologia" "fecha" => "2011" "volumen" => "43" "paginaInicial" => "121" "paginaFinal" => "128" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21382066" "web" => "Medline" ] ] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0145" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Obesity, a serious etiologic factor for male subfertility in modern society" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Y. Liu" 1 => "Z. Ding" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1530/REP-17-0161" "Revista" => array:6 [ "tituloSerie" => "Reproduction." "fecha" => "2017" "volumen" => "154" "paginaInicial" => "R123" "paginaFinal" => "R131" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28747541" "web" => "Medline" ] ] ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0150" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Weight loss in obese infertile women results in improvement in reproductive outcome for all forms of fertility treatment" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A.M. Clark" 1 => "B. Thornley" 2 => "L. Tomlinson" 3 => "C. Galletley" 4 => "R.J. Norman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/humrep/13.6.1502" "Revista" => array:6 [ "tituloSerie" => "Hum Reprod" "fecha" => "1998" "volumen" => "13" "paginaInicial" => "1502" "paginaFinal" => "1505" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9688382" "web" => "Medline" ] ] ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0155" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bariatric surgery on reproductive outcomes: the impact according to the diagnosis of polycystic ovarian syndrome and surgical procedures" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. Casals" 1 => "A. Andreu" 2 => "Y. Barral" 3 => "S. Ventosa" 4 => "M. Redondo" 5 => "F. Torres" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s11695-021-05297-x" "Revista" => array:6 [ "tituloSerie" => "Obes Surg." "fecha" => "2021" "volumen" => "31" "paginaInicial" => "2590" "paginaFinal" => "2598" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33629226" "web" => "Medline" ] ] ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib0160" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Incidence of successful pregnancy after weight loss interventions in infertile women: a systematic review and meta-analysis of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Milone" 1 => "G. De Placido" 2 => "M. Musella" 3 => "L.M. Sosa Fernandez" 4 => "L.V. SosaFernandez" 5 => "G. Campana" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s11695-015-1998-7" "Revista" => array:6 [ "tituloSerie" => "Obes Surg" "fecha" => "2016" "volumen" => "26" "paginaInicial" => "443" "paginaFinal" => "451" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26661108" "web" => "Medline" ] ] ] ] ] ] ] ] 32 => array:3 [ "identificador" => "bib0165" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "IVF outcomes in patients with a history of bariatric surgery: a multicenter retrospective cohort study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "V. Grzegorczyk-Martin" 1 => "T. Fréour" 2 => "A. De Bantel Finet" 3 => "E. Bonnet" 4 => "M. Merzouk" 5 => "J. Roset" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/humrep/deaa208" "Revista" => array:6 [ "tituloSerie" => "Hum Reprod." "fecha" => "2020" "volumen" => "35" "paginaInicial" => "2755" "paginaFinal" => "2762" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33083823" "web" => "Medline" ] ] ] ] ] ] ] ] 33 => array:3 [ "identificador" => "bib0170" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pharmacotherapy of obesity: available medications and drugs under investigation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Pilitsi" 1 => "O.M. Farr" 2 => "S.A. Polyzos" 3 => "N. Perakakis" 4 => "E. Nolen-Doerr" 5 => "A.E. Papathanasiou" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.metabol.2018.10.010" "Revista" => array:6 [ "tituloSerie" => "Metabolism." "fecha" => "2019" "volumen" => "92" "paginaInicial" => "170" "paginaFinal" => "192" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30391259" "web" => "Medline" ] ] ] ] ] ] ] ] 34 => array:3 [ "identificador" => "bib0175" "etiqueta" => "35" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Liraglutideincreases IVF pregnancy rates in obese PCOS women with poor response to first-line reproductive treatments: a pilot randomized study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "V. Salamun" 1 => "M. Jensterle" 2 => "A. Janez" 3 => "E. VrtacnikBokal" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1530/EJE-18-0175" "Revista" => array:6 [ "tituloSerie" => "Eur J Endocrinol." "fecha" => "2018" "volumen" => "179" "paginaInicial" => "1" "paginaFinal" => "11" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29703793" "web" => "Medline" ] ] ] ] ] ] ] ] 35 => array:3 [ "identificador" => "bib0180" "etiqueta" => "36" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of orlistat intervention on in vitro fertilization/intracytoplasmic sperm injection outcome in overweight/obese infertile women" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J. Tong" 1 => "L. Xiang" 2 => "Y. Niu" 3 => "T. Zhang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1080/09513590.2022.2028769" "Revista" => array:4 [ "tituloSerie" => "Gynecol Endocrinol." "fecha" => "2022" "paginaInicial" => "1" "paginaFinal" => "5" ] ] ] ] ] ] 36 => array:3 [ "identificador" => "bib0185" "etiqueta" => "37" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "How to manage weight loss in women with obesity and PCOS seeking fertility?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J.M. Hazlehurst" 1 => "P. Singh" 2 => "G. Bhogal" 3 => "S. Broughton" 4 => "A.A. Tahrani" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/cen.14726" "Revista" => array:3 [ "tituloSerie" => "Clin Endocrinol (Oxf)." "fecha" => "2022" "itemHostRev" => array:3 [ "pii" => "S1878875020310482" "estado" => "S300" "issn" => "18788750" ] ] ] ] ] ] ] 37 => array:3 [ "identificador" => "bib0190" "etiqueta" => "38" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hypogonadotropic hypogonadism in morbidly obese males is reversed after bariatric surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Pellitero" 1 => "I. Olaizola" 2 => "A. Alastrue" 3 => "E. Martínez" 4 => "M.L. Granada" 5 => "J.M. Balibrea" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s11695-012-0734-9" "Revista" => array:6 [ "tituloSerie" => "Obes Surg." "fecha" => "2012" "volumen" => "22" "paginaInicial" => "1835" "paginaFinal" => "1842" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22923309" "web" => "Medline" ] ] ] ] ] ] ] ] 38 => array:3 [ "identificador" => "bib0195" "etiqueta" => "39" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of’ obesity-associated gonadal dysfunction’ in severely obese men and women and its resolution after bariatric surgery: a systematic review and meta- analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "H.F. Escobar-Morreale" 1 => "E. Santacruz" 2 => "M. Luque-Ramírez" 3 => "J.I. Botella Carretero" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/humupd/dmx012" "Revista" => array:6 [ "tituloSerie" => "Hum Reprod Update." "fecha" => "2017" "volumen" => "23" "paginaInicial" => "390" "paginaFinal" => "408" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28486593" "web" => "Medline" ] ] ] ] ] ] ] ] 39 => array:3 [ "identificador" => "bib0200" "etiqueta" => "40" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Body weight loss reverts obesity- associated hypogonadotropic hypogonadism: a systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. Corona" 1 => "G. Rastrelli" 2 => "M. Monami" 3 => "F. Saad" 4 => "M. Luconi" 5 => "M. Lucchese" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1530/EJE-12-0955" "Revista" => array:6 [ "tituloSerie" => "Eur J Endocrinol." "fecha" => "2013" "volumen" => "168" "paginaInicial" => "829" "paginaFinal" => "843" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23482592" "web" => "Medline" ] ] ] ] ] ] ] ] 40 => array:3 [ "identificador" => "bib0205" "etiqueta" => "41" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment of functional hypogonadism besides pharmacological substitution" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. Corona" 1 => "G. Rastrelli" 2 => "A. Morelli" 3 => "E. Sarchielli" 4 => "S. Cipriani" 5 => "L. Vignozzi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.5534/wjmh.190061" "Revista" => array:6 [ "tituloSerie" => "World J Mens Health." "fecha" => "2020" "volumen" => "38" "paginaInicial" => "256" "paginaFinal" => "270" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31496147" "web" => "Medline" ] ] ] ] ] ] ] ] 41 => array:3 [ "identificador" => "bib0210" "etiqueta" => "42" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Weight loss is a major contributor to improved sexual function after bariatric surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. Mora" 1 => "G.B. Aranda" 2 => "A. de Hollanda" 3 => "L. Flores" 4 => "M. Puig-Domingo" 5 => "J. Vidal" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00464-013-2890-y" "Revista" => array:6 [ "tituloSerie" => "Surg Endosc." "fecha" => "2013" "volumen" => "27" "paginaInicial" => "3197" "paginaFinal" => "3204" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23612762" "web" => "Medline" ] ] ] ] ] ] ] ] 42 => array:3 [ "identificador" => "bib0215" "etiqueta" => "43" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "what is the impact of bariatric surgery on erectile function? A systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "F.P.A. Glina" 1 => "J.W. de Freitas Barboza" 2 => "V.M. Nunes" 3 => "S. Glina" 4 => "W.M. Bernardo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.sxmr.2017.03.008" "Revista" => array:6 [ "tituloSerie" => "Sex Med Rev." "fecha" => "2017" "volumen" => "5" "paginaInicial" => "393" "paginaFinal" => "402" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28526630" "web" => "Medline" ] ] ] ] ] ] ] ] 43 => array:3 [ "identificador" => "bib0220" "etiqueta" => "44" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Doesweight loss improve semen quality and reproductive hormones? Results from a cohort of severely obese men" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "L.B. Hakonsen" 1 => "A.M. Thulstrup" 2 => "A.S. Aggerholm" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/1742-4755-8-24" "Revista" => array:5 [ "tituloSerie" => "Reprod Health." "fecha" => "2011" "volumen" => "8" "paginaInicial" => "24" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21849026" "web" => "Medline" ] ] ] ] ] ] ] ] 44 => array:3 [ "identificador" => "bib0225" "etiqueta" => "45" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bariatric surgery does not improve semen quality: evidence from a meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Z. Gao" 1 => "Y. Liang" 2 => "S. Yang" 3 => "T. Zhang" 4 => "Z. Gong" 5 => "M. Li" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s11695-022-05901-8" "Revista" => array:7 [ "tituloSerie" => "Obes Surg." "fecha" => "2022" "volumen" => "32" "paginaInicial" => "1341" "paginaFinal" => "1350" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/35143010" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1878875018322484" "estado" => "S300" "issn" => "18788750" ] ] ] ] ] ] ] 45 => array:3 [ "identificador" => "bib0230" "etiqueta" => "46" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "How effective are weight-loss interventions for improving fertility in women and men who are overweight or obese? A systematic review and meta-analysis of the evidence" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D. Best" 1 => "A. Avenell" 2 => "S. Bhattacharya" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/humupd/dmx027" "Revista" => array:6 [ "tituloSerie" => "Hum Reprod Update" "fecha" => "2017" "volumen" => "23" "paginaInicial" => "681" "paginaFinal" => "705" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28961722" "web" => "Medline" ] ] ] ] ] ] ] ] 46 => array:3 [ "identificador" => "bib0235" "etiqueta" => "47" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Subfecundity in overweight and obese couples" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C.H. Ramlau-Hansen" 1 => "A.M. Thulstrup" 2 => "E.A. Nohr" 3 => "J.P. Bonde" 4 => "T.I. Sørensen" 5 => "J. Olsen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/humrep/dem035" "Revista" => array:6 [ "tituloSerie" => "Hum Reprod." "fecha" => "2007" "volumen" => "22" "paginaInicial" => "1634" "paginaFinal" => "1637" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17344224" "web" => "Medline" ] ] ] ] ] ] ] ] 47 => array:3 [ "identificador" => "bib0240" "etiqueta" => "48" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The influence of female and male body mass index on live births after assisted reproductive technology treatment: a nationwide register-based cohort study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "G.L. Petersen" 1 => "L. Schmidt" 2 => "A. Pinborg" 3 => "M. Kamper-Jørgensen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.fertnstert.2013.01.092" "Revista" => array:6 [ "tituloSerie" => "Fertil Steril." "fecha" => "2013" "volumen" => "99" "paginaInicial" => "1654" "paginaFinal" => "1662" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23394781" "web" => "Medline" ] ] ] ] ] ] ] ] 48 => array:3 [ "identificador" => "bib0245" "etiqueta" => "49" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Delayed child-bearing" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.A. Johnson" 1 => "S. Tough" 2 => "SOGC GENETICS COMMITTEE" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S1701-2163(16)35138-6" "Revista" => array:6 [ "tituloSerie" => "J Obstet Gynaecol Can." "fecha" => "2012" "volumen" => "34" "paginaInicial" => "80" "paginaFinal" => "93" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22260768" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/25300180/00000070000000S1/v2_202304211110/S2530018023000355/v2_202304211110/en/main.assets" "Apartado" => null "PDF" => "https://static.elsevier.es/multimedia/25300180/00000070000000S1/v2_202304211110/S2530018023000355/v2_202304211110/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2530018023000355?idApp=UINPBA00004N"]

Statistics

Consensus document

Obesity and fertility. Position statement

Obesidad y fertilidad. Documento de posicionamiento

I. Miñambresa,◊, A. de Hollandab,◊,

Corresponding author

amdehol@clinic.cat

Corresponding author.

, N. Vilarrasac, S. Pelliterod, M.A. Rubioe, L. Floresf, A. Caixàsg, S. Loboh, J.I. Martinez Salamancai, B. Acevedoj, V. Moizék, A. Andreul, J. Escaladam, on behalf of SEEN, SEEDO, SEF, AEU, SEGO, SEDYN ◊

a Servicio de Endocrinología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), CIBER de Diabetes y Enfermedades Metabólicas (CIBERDEM), Sociedad Española de Endocrinología y Nutrición (SEEN), Spain

b Servicio de Endocrinología, Hospital Clínic, Barcelona, Centro de Investigación Biomédica en red Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Sociedad Española de Endocrinología y Nutrición (SEEN), Spain

c Servicio de Endocrinología y Nutrición, Hospital Universitario de Bellvitge-IDIBELL, CIBER de Diabetes y Enfermedades Metabólicas (CIBERDEM), Sociedad Española de Endocrinología y Nutrición (SEEN), Spain

d Servicio de Endocrinología, Hospital Universitari Germans Trias i Pujol, Institut d'Investigació, Badalona, Sociedad Española de Endocrinología y Nutrición (SEEN), Spain

e Servicio de Endocrinología. Hospital Clínico San Carlos, Madrid, IDISSC, Facultad de Medicina, Universidad Complutense, Madrid, Sociedad Española de Endocrinología y Nutrición (SEEN), Spain

f Servicio de Endocrinología y Nutrición, Hospital Clínic, Barcelona, CIBER de Diabetes y Enfermedades Metabólicas (CIBERDEM), Sociedad Española para el Estudio de la Obesidad, SEEDO, Sociedad Española de Endocrinología y Nutrición (SEEN), Spain

g Servicio de Endocrinología y Nutrición, Hospital Universitari Parc Taulí, Institut d’Investigació i Innovació Parc Taulí (I3PT), Departamento de Medicina Universitat Autònoma de Barcelona, Sabadell, Sociedad Española de Endocrinología y Nutrición (SEEN), Sociedad Española para el Estudio de la Obesidad, SEEDO, Spain

h Servicio de Obstetricia y Ginecología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Grupo de Interés de Endocrinología Reproductiva, Sociedad Española de Fertilidad (SEF), Spain

i Servicio de Urología, Hospital Universitario Puerta de Hierro, Majadahonda, Lyx Instituto de Urología, Universidad Francisco de Vitoria, Asociación Española de Urología, Spain

j Servicio de Ginecología y Obstetricia, Unidad de Reproducción Asistida, Hospital Fundación Jiménez Díaz, Madrid, Profesor asociado de Medicina de la Universidad Autónoma de Madrid (UAM), Sociedad Española de Ginecología y Obstetricia (SEGO), Spain

k Servicio de Endocrinología y Nutrición, Hospital Clínic, Barcelona, Sociedad Española de Dietética y Nutrición (SEDYN), Spain

l Servicio de Endocrinología y Nutrición, Hospital Clínic, Barcelona, Sociedad Española de Dietética y Nutrición (SEDYN), Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Spain

m Departamento de Endocrinología y Nutrición, Clínica Universidad de Navarra, Pamplona, Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Sociedad Española de Endocrinología y Nutrición (SEEN), Spain

Read

657

Times
was read the article

204

Total PDF

453

Total HTML

Share statistics

 array:24 [
  "pii" => "S2530018023000355"
  "issn" => "25300180"
  "doi" => "10.1016/j.endien.2023.03.003"
  "estado" => "S300"
  "fechaPublicacion" => "2023-03-01"
  "aid" => "1360"
  "copyright" => "SEEN and SED"
  "copyrightAnyo" => "2022"
  "documento" => "simple-article"
  "crossmark" => 1
  "subdocumento" => "pgl"
  "cita" => "Endocrinol Diabetes Nutr. 2023;70 Supl 1:110-5"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:1 [
    "total" => 0
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S2530016422002385"
      "issn" => "25300164"
      "doi" => "10.1016/j.endinu.2022.10.002"
      "estado" => "S300"
      "fechaPublicacion" => "2023-03-01"
      "aid" => "1360"
      "copyright" => "SEEN y SED"
      "documento" => "article"
      "crossmark" => 1
      "subdocumento" => "pgl"
      "cita" => "Endocrinol Diabetes Nutr. 2023;70 Supl 1:110-5"
      "abierto" => array:3 [
        "ES" => false
        "ES2" => false
        "LATM" => false
      ]
      "gratuito" => false
      "lecturas" => array:1 [
        "total" => 0
      ]
      "es" => array:11 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">DOCUMENTO DE CONSENSO</span>"
        "titulo" => "Obesidad y fertilidad&#46; Documento de posicionamiento"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "110"
            "paginaFinal" => "115"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Obesity and fertility&#46; Position statement"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0005"
            "etiqueta" => "Figura 1"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr1.jpeg"
                "Alto" => 2133
                "Ancho" => 2925
                "Tamanyo" => 367436
              ]
            ]
            "descripcion" => array:1 [
              "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Esquema del abordaje la prevenci&#243;n y el tratamiento del sobrepeso u obesidad asociado a infertilidad&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "I&#46; Mi&#241;ambres, A&#46; de Hollanda, N&#46; Vilarrasa, S&#46; Pellitero, M&#46;A&#46; Rubio, L&#46; Flores, A&#46; Caix&#224;s, S&#46; Lobo, J&#46;I&#46; Martinez Salamanca, B&#46; Acevedo, V&#46; Moiz&#233;, A&#46; Andreu, J&#46; Escalada"
            "autores" => array:14 [
              0 => array:2 [
                "nombre" => "I&#46;"
                "apellidos" => "Mi&#241;ambres"
              ]
              1 => array:2 [
                "nombre" => "A&#46;"
                "apellidos" => "de Hollanda"
              ]
              2 => array:2 [
                "nombre" => "N&#46;"
                "apellidos" => "Vilarrasa"
              ]
              3 => array:2 [
                "nombre" => "S&#46;"
                "apellidos" => "Pellitero"
              ]
              4 => array:2 [
                "nombre" => "M&#46;A&#46;"
                "apellidos" => "Rubio"
              ]
              5 => array:2 [
                "nombre" => "L&#46;"
                "apellidos" => "Flores"
              ]
              6 => array:2 [
                "nombre" => "A&#46;"
                "apellidos" => "Caix&#224;s"
              ]
              7 => array:2 [
                "nombre" => "S&#46;"
                "apellidos" => "Lobo"
              ]
              8 => array:2 [
                "nombre" => "J&#46;I&#46;"
                "apellidos" => "Martinez Salamanca"
              ]
              9 => array:2 [
                "nombre" => "B&#46;"
                "apellidos" => "Acevedo"
              ]
              10 => array:2 [
                "nombre" => "V&#46;"
                "apellidos" => "Moiz&#233;"
              ]
              11 => array:2 [
                "nombre" => "A&#46;"
                "apellidos" => "Andreu"
              ]
              12 => array:2 [
                "nombre" => "J&#46;"
                "apellidos" => "Escalada"
              ]
              13 => array:1 [
                "colaborador" => "en representaci&#243;n SEEN&#44; SEEDO&#44; SEF&#44; AEU&#44; SEGO&#44; SEDYN"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2530018023000355"
          "doi" => "10.1016/j.endien.2023.03.003"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => false
            "ES2" => false
            "LATM" => false
          ]
          "gratuito" => false
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2530018023000355?idApp=UINPBA00004N"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2530016422002385?idApp=UINPBA00004N"
      "url" => "/25300164/00000070000000S1/v3_202306211155/S2530016422002385/v3_202306211155/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S2530018023000379"
    "issn" => "25300180"
    "doi" => "10.1016/j.endien.2023.01.001"
    "estado" => "S300"
    "fechaPublicacion" => "2023-03-01"
    "aid" => "1381"
    "copyright" => "SEEN and SED"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "pgl"
    "cita" => "Endocrinol Diabetes Nutr. 2023;70 Supl 1:116-25"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Consensus document</span>"
      "titulo" => "Executive summary of the consensus document on hypophysitis of the Neuroendocrinology Area of Knowledge of the Spanish Society of Endocrinology and Nutrition"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "116"
          "paginaFinal" => "125"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Resumen ejecutivo del documento de consenso sobre hipofisitis del &#193;rea de Conocimiento de Neuroendocrinolog&#237;a de la Sociedad Espa&#241;ola de Endocrinolog&#237;a y Nutrici&#243;n"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:8 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1894
              "Ancho" => 2007
              "Tamanyo" => 335859
            ]
          ]
          "detalles" => array:1 [
            0 => array:3 [
              "identificador" => "at0005"
              "detalle" => "Figure "
              "rol" => "short"
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Ipilimumab-induced hypophysitis&#46; Pituitary MRI with coronal T1 &#40;A&#41; and sagittal T1 &#40;B&#41; sequence with paramagnetic contrast in a 59-year-old man with uveal melanoma with liver metastases who developed ipilimumab-induced hypophysitis&#46; Coronal T1 &#40;C&#41; and sagittal T1 &#40;D&#41; pituitary MRI with paramagnetic contrast in a 46-year-old woman with uveal melanoma who developed ipilimumab-induced hypophysitis&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Pedro Iglesias, Betina Biagetti, Fernando Guerrero-P&#233;rez, Almudena Vicente, Fernando Cordido, Juan J&#46; D&#237;ez"
          "autores" => array:7 [
            0 => array:2 [
              "nombre" => "Pedro"
              "apellidos" => "Iglesias"
            ]
            1 => array:2 [
              "nombre" => "Betina"
              "apellidos" => "Biagetti"
            ]
            2 => array:2 [
              "nombre" => "Fernando"
              "apellidos" => "Guerrero-P&#233;rez"
            ]
            3 => array:2 [
              "nombre" => "Almudena"
              "apellidos" => "Vicente"
            ]
            4 => array:2 [
              "nombre" => "Fernando"
              "apellidos" => "Cordido"
            ]
            5 => array:2 [
              "nombre" => "Juan J&#46;"
              "apellidos" => "D&#237;ez"
            ]
            6 => array:1 [
              "colaborador" => "on behalf of the Neuroendocrinology Area of Knowledge of the Spanish Society of Endocrinology and Nutrition &#40;SEEN&#41;"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S2530016423000162"
        "doi" => "10.1016/j.endinu.2023.01.001"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2530016423000162?idApp=UINPBA00004N"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2530018023000379?idApp=UINPBA00004N"
    "url" => "/25300180/00000070000000S1/v2_202304211110/S2530018023000379/v2_202304211110/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S2530018023000367"
    "issn" => "25300180"
    "doi" => "10.1016/j.endien.2023.03.004"
    "estado" => "S300"
    "fechaPublicacion" => "2023-03-01"
    "aid" => "1371"
    "copyright" => "SEEN and SED"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "pgl"
    "cita" => "Endocrinol Diabetes Nutr. 2023;70 Supl 1:103-9"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Consensus document</span>"
      "titulo" => "Executive summary of the position statement of the Spanish Societies SEQC<span class="elsevierStyleSup">ML</span>&#47;SEEN&#47;SEEP&#46; Recommendations for the measurement of sex steroids in clinical practice"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "103"
          "paginaFinal" => "109"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Resumen ejecutivo del documento de posicionamiento SEQC<span class="elsevierStyleSup">ML</span>&#47;SEEN&#47;SEEP&#46; Recomendaciones para la medici&#243;n de esteroides sexuales en la pr&#225;ctica cl&#237;nica"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:8 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1429
              "Ancho" => 2508
              "Tamanyo" => 220982
            ]
          ]
          "detalles" => array:1 [
            0 => array:3 [
              "identificador" => "at0005"
              "detalle" => "Figure "
              "rol" => "short"
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Immunoassay &#40;A&#8211;C&#41;&#46; Example of competitive chemiluminescent immunoassay&#46; A&#41; The method is based on a specific antibody that recognises the analyte of interest&#46; B&#41; The antibody is incubated with the sample &#40;containing the analyte of interest and other molecules&#41; and with the labelled analyte&#46; Analyte and labelled analyte compete for binding to the antibody&#46; C&#41; The chemiluminescent signal from the labelled analyte bound to the antibody is recorded&#46; In the example&#44; the recorded signal will be inversely proportional to the amount of analyte originally present in the sample&#46;</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Mass spectrometry &#40;D&#8211;H&#41;&#46; Example of liquid chromatography with tandem mass spectrometry &#40;LC-MS&#47;MS&#41;&#46; D&#44;E&#41; Extraction of the serum sample with organic solvent&#46; This step cuts out possible interferers&#46; F&#41; Separation of sample components by liquid chromatography&#46; G&#41; Selection of the specific ions of the analytes&#46; H&#41; Representation of the results&#46; The area of the chromatographic peak is directly proportional to the amount of analyte originally present in the sample&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Gregori Casals, Roser Ferrer Costa, Eul&#224;lia Urgell Rull, H&#233;ctor F&#46; Escobar-Morreale, Jes&#250;s Argente, Gemma Sesmilo, Betina Biagetti"
          "autores" => array:7 [
            0 => array:2 [
              "nombre" => "Gregori"
              "apellidos" => "Casals"
            ]
            1 => array:2 [
              "nombre" => "Roser"
              "apellidos" => "Ferrer Costa"
            ]
            2 => array:2 [
              "nombre" => "Eul&#224;lia"
              "apellidos" => "Urgell Rull"
            ]
            3 => array:2 [
              "nombre" => "H&#233;ctor F&#46;"
              "apellidos" => "Escobar-Morreale"
            ]
            4 => array:2 [
              "nombre" => "Jes&#250;s"
              "apellidos" => "Argente"
            ]
            5 => array:2 [
              "nombre" => "Gemma"
              "apellidos" => "Sesmilo"
            ]
            6 => array:2 [
              "nombre" => "Betina"
              "apellidos" => "Biagetti"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S253001642200266X"
        "doi" => "10.1016/j.endinu.2022.11.004"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S253001642200266X?idApp=UINPBA00004N"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2530018023000367?idApp=UINPBA00004N"
    "url" => "/25300180/00000070000000S1/v2_202304211110/S2530018023000367/v2_202304211110/en/main.assets"
  ]
  "en" => array:15 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Consensus document</span>"
    "titulo" => "Obesity and fertility&#46; Position statement"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "110"
        "paginaFinal" => "115"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "I&#46; Mi&#241;ambres, A&#46; de Hollanda, N&#46; Vilarrasa, S&#46; Pellitero, M&#46;A&#46; Rubio, L&#46; Flores, A&#46; Caix&#224;s, S&#46; Lobo, J&#46;I&#46; Martinez Salamanca, B&#46; Acevedo, V&#46; Moiz&#233;, A&#46; Andreu, J&#46; Escalada"
        "autores" => array:14 [
          0 => array:3 [
            "nombre" => "I&#46;"
            "apellidos" => "Mi&#241;ambres"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#9674;</span>"
                "identificador" => "fn0005"
              ]
            ]
          ]
          1 => array:4 [
            "nombre" => "A&#46;"
            "apellidos" => "de Hollanda"
            "email" => array:1 [
              0 => "amdehol@clinic.cat"
            ]
            "referencia" => array:3 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#9674;</span>"
                "identificador" => "fn0005"
              ]
              2 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "N&#46;"
            "apellidos" => "Vilarrasa"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "S&#46;"
            "apellidos" => "Pellitero"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0020"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "M&#46;A&#46;"
            "apellidos" => "Rubio"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">e</span>"
                "identificador" => "aff0025"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "L&#46;"
            "apellidos" => "Flores"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">f</span>"
                "identificador" => "aff0030"
              ]
            ]
          ]
          6 => array:3 [
            "nombre" => "A&#46;"
            "apellidos" => "Caix&#224;s"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">g</span>"
                "identificador" => "aff0035"
              ]
            ]
          ]
          7 => array:3 [
            "nombre" => "S&#46;"
            "apellidos" => "Lobo"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">h</span>"
                "identificador" => "aff0040"
              ]
            ]
          ]
          8 => array:3 [
            "nombre" => "J&#46;I&#46;"
            "apellidos" => "Martinez Salamanca"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">i</span>"
                "identificador" => "aff0045"
              ]
            ]
          ]
          9 => array:3 [
            "nombre" => "B&#46;"
            "apellidos" => "Acevedo"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">j</span>"
                "identificador" => "aff0050"
              ]
            ]
          ]
          10 => array:3 [
            "nombre" => "V&#46;"
            "apellidos" => "Moiz&#233;"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">k</span>"
                "identificador" => "aff0055"
              ]
            ]
          ]
          11 => array:3 [
            "nombre" => "A&#46;"
            "apellidos" => "Andreu"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">l</span>"
                "identificador" => "aff0060"
              ]
            ]
          ]
          12 => array:3 [
            "nombre" => "J&#46;"
            "apellidos" => "Escalada"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">m</span>"
                "identificador" => "aff0065"
              ]
            ]
          ]
          13 => array:2 [
            "colaborador" => "on behalf of SEEN&#44; SEEDO&#44; SEF&#44; AEU&#44; SEGO&#44; SEDYN"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#9674;</span>"
                "identificador" => "fn0005"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:13 [
          0 => array:3 [
            "entidad" => "Servicio de Endocrinolog&#237;a&#44; Hospital de la Santa Creu i Sant Pau&#44; Universitat Aut&#242;noma de Barcelona &#40;UAB&#41;&#44; CIBER de Diabetes y Enfermedades Metab&#243;licas &#40;CIBERDEM&#41;&#44; Sociedad Espa&#241;ola de Endocrinolog&#237;a y Nutrici&#243;n &#40;SEEN&#41;&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Servicio de Endocrinolog&#237;a&#44; Hospital Cl&#237;nic&#44; Barcelona&#44; Centro de Investigaci&#243;n Biom&#233;dica en red Fisiopatolog&#237;a de la Obesidad y Nutrici&#243;n &#40;CIBEROBN&#41;&#44; Sociedad Espa&#241;ola de Endocrinolog&#237;a y Nutrici&#243;n &#40;SEEN&#41;&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Servicio de Endocrinolog&#237;a y Nutrici&#243;n&#44; Hospital Universitario de Bellvitge-IDIBELL&#44; CIBER de Diabetes y Enfermedades Metab&#243;licas &#40;CIBERDEM&#41;&#44; Sociedad Espa&#241;ola de Endocrinolog&#237;a y Nutrici&#243;n &#40;SEEN&#41;&#44; Spain"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
          3 => array:3 [
            "entidad" => "Servicio de Endocrinolog&#237;a&#44; Hospital Universitari Germans Trias i Pujol&#44; Institut d&#39;Investigaci&#243;&#44; Badalona&#44; Sociedad Espa&#241;ola de Endocrinolog&#237;a y Nutrici&#243;n &#40;SEEN&#41;&#44; Spain"
            "etiqueta" => "d"
            "identificador" => "aff0020"
          ]
          4 => array:3 [
            "entidad" => "Servicio de Endocrinolog&#237;a&#46; Hospital Cl&#237;nico San Carlos&#44; Madrid&#44; IDISSC&#44; Facultad de Medicina&#44; Universidad Complutense&#44; Madrid&#44; Sociedad Espa&#241;ola de Endocrinolog&#237;a y Nutrici&#243;n &#40;SEEN&#41;&#44; Spain"
            "etiqueta" => "e"
            "identificador" => "aff0025"
          ]
          5 => array:3 [
            "entidad" => "Servicio de Endocrinolog&#237;a y Nutrici&#243;n&#44; Hospital Cl&#237;nic&#44; Barcelona&#44; CIBER de Diabetes y Enfermedades Metab&#243;licas &#40;CIBERDEM&#41;&#44; Sociedad Espa&#241;ola para el Estudio de la Obesidad&#44; SEEDO&#44; Sociedad Espa&#241;ola de Endocrinolog&#237;a y Nutrici&#243;n &#40;SEEN&#41;&#44; Spain"
            "etiqueta" => "f"
            "identificador" => "aff0030"
          ]
          6 => array:3 [
            "entidad" => "Servicio de Endocrinolog&#237;a y Nutrici&#243;n&#44; Hospital Universitari Parc Taul&#237;&#44; Institut d&#8217;Investigaci&#243; i Innovaci&#243; Parc Taul&#237; &#40;I3PT&#41;&#44; Departamento de Medicina Universitat Aut&#242;noma de Barcelona&#44; Sabadell&#44; Sociedad Espa&#241;ola de Endocrinolog&#237;a y Nutrici&#243;n &#40;SEEN&#41;&#44; Sociedad Espa&#241;ola para el Estudio de la Obesidad&#44; SEEDO&#44; Spain"
            "etiqueta" => "g"
            "identificador" => "aff0035"
          ]
          7 => array:3 [
            "entidad" => "Servicio de Obstetricia y Ginecolog&#237;a&#44; Hospital Universitario La Paz&#44; Universidad Aut&#243;noma de Madrid&#44; Grupo de Inter&#233;s de Endocrinolog&#237;a Reproductiva&#44; Sociedad Espa&#241;ola de Fertilidad &#40;SEF&#41;&#44; Spain"
            "etiqueta" => "h"
            "identificador" => "aff0040"
          ]
          8 => array:3 [
            "entidad" => "Servicio de Urolog&#237;a&#44; Hospital Universitario Puerta de Hierro&#44; Majadahonda&#44; Lyx Instituto de Urolog&#237;a&#44; Universidad Francisco de Vitoria&#44; Asociaci&#243;n Espa&#241;ola de Urolog&#237;a&#44; Spain"
            "etiqueta" => "i"
            "identificador" => "aff0045"
          ]
          9 => array:3 [
            "entidad" => "Servicio de Ginecolog&#237;a y Obstetricia&#44; Unidad de Reproducci&#243;n Asistida&#44; Hospital Fundaci&#243;n Jim&#233;nez D&#237;az&#44; Madrid&#44; Profesor asociado de Medicina de la Universidad Aut&#243;noma de Madrid &#40;UAM&#41;&#44; Sociedad Espa&#241;ola de Ginecolog&#237;a y Obstetricia &#40;SEGO&#41;&#44; Spain"
            "etiqueta" => "j"
            "identificador" => "aff0050"
          ]
          10 => array:3 [
            "entidad" => "Servicio de Endocrinolog&#237;a y Nutrici&#243;n&#44; Hospital Cl&#237;nic&#44; Barcelona&#44; Sociedad Espa&#241;ola de Diet&#233;tica y Nutrici&#243;n &#40;SEDYN&#41;&#44; Spain"
            "etiqueta" => "k"
            "identificador" => "aff0055"
          ]
          11 => array:3 [
            "entidad" => "Servicio de Endocrinolog&#237;a y Nutrici&#243;n&#44; Hospital Cl&#237;nic&#44; Barcelona&#44; Sociedad Espa&#241;ola de Diet&#233;tica y Nutrici&#243;n &#40;SEDYN&#41;&#44; Centro de Investigaci&#243;n Biom&#233;dica en Red-Fisiopatolog&#237;a de la Obesidad y Nutrici&#243;n &#40;CIBEROBN&#41;&#44; Instituto de Salud Carlos III&#44; Spain"
            "etiqueta" => "l"
            "identificador" => "aff0060"
          ]
          12 => array:3 [
            "entidad" => "Departamento de Endocrinolog&#237;a y Nutrici&#243;n&#44; Cl&#237;nica Universidad de Navarra&#44; Pamplona&#44; Centro de Investigaci&#243;n Biom&#233;dica en Red-Fisiopatolog&#237;a de la Obesidad y Nutrici&#243;n &#40;CIBEROBN&#41;&#44; Instituto de Salud Carlos III&#44; Sociedad Espa&#241;ola de Endocrinolog&#237;a y Nutrici&#243;n &#40;SEEN&#41;&#44; Spain"
            "etiqueta" => "m"
            "identificador" => "aff0065"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Obesidad y fertilidad&#46; Documento de posicionamiento"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:8 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 2219
            "Ancho" => 2931
            "Tamanyo" => 341364
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0005"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Diagram of the approach to the prevention and treatment of overweight or obesity associated with infertility&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The position statement has been produced by the Sociedad Espa&#241;ola de Endocrinolog&#237;a y Nutrici&#243;n &#40;SEEN&#41; &#91;Spanish Society of Endocrinology and Nutrition&#93;&#44; through its Grupo de trabajo de Obesidad &#40;GOSEEN&#41; &#91;Working Group on Obesity&#93;&#44; to highlight the relationship between obesity and infertility and propose an approach and specific treatment based on scientific evidence&#44; but without attempting an in-depth review of obesity and infertility&#46; Other societies involved in the care of these patients have subscribed to this position&#58; Sociedad Espa&#241;ola para el Estudio de la Obesidad &#40;SEEDO&#41; &#91;Spanish Society for the Study of Obesity&#93;&#59; Sociedad Espa&#241;ola de Fertilidad &#40;SEF&#41; &#91;Spanish Fertility Society&#93;&#59; Asociaci&#243;n Espa&#241;ola de Urolog&#237;a &#40;AEU&#41; &#91;Spanish Association of Urology&#93;&#59; Sociedad Espa&#241;ola de Ginecolog&#237;a y Obstetricia &#40;SEGO&#41; &#91;Spanish Society of Obstetrics and Gynaecology&#93;&#59; and the Sociedad Espa&#241;ola de Diet&#233;tica y Nutrici&#243;n &#40;SEDYN&#41; &#91;Spanish Society of Dietetics and Nutrition&#93;&#46; Our aim is to show that people with obesity and infertility require specialised and multidisciplinary treatment and&#44; in the event of being candidates for bariatric surgery&#44; should be considered as a priority group when the likelihood of pregnancy is diminishing in the short term due to age&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Infertility as a disorder associated with obesity</span><p id="par0010" class="elsevierStylePara elsevierViewall">Obesity is a chronic disease of epidemic proportions in the western world and has become one of the most difficult challenges facing public health&#46; In Spain&#44; the estimated prevalence of overweight in the adult population &#40;aged 25&#8211;64&#41; is 39&#46;3&#37; and that of obesity&#44; 21&#46;6&#37; &#40;22&#46;8&#37; in males and 20&#46;5&#37; in females&#41;&#44; increasing with the age of the population&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> If the current rate of growth continues&#44; by 2030&#44; 29&#46;4&#37; of Spanish adults will suffer from obesity&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Obesity is associated with&#44; or is the direct cause of&#44; many other well-known disorders and diseases&#44; such as hypertension&#44; type 2 diabetes mellitus&#44; dyslipidaemia&#44; sleep apnoea-hypopnoea syndrome&#44; fatty liver disease&#44; bone and joint diseases and the risk of developing different cancers&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> This means that people with obesity have increased cardiovascular risk and morbidity and mortality rates&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Obesity is also the cause of lesser-known diseases&#44; such as both female and male infertility&#44; which can significantly compromise the health and quality of life of those affected&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> In Spain&#44; depending on the definition&#44; infertility attributable to the female can be as high as 17&#46;5&#37; in the 30&#8211;49 age group&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> About 23&#37; of women who undergo in-vitro fertilisation techniques are overweight or obese&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> The significance of obesity in the aetiology of infertility is difficult to determine due to the multifactorial contributions&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Female obesity and infertility</span><p id="par0020" class="elsevierStylePara elsevierViewall">Obese women are less likely to conceive spontaneously&#46; Excess weight is associated with anovulatory menstrual cycles&#44; with the likelihood of anovulatory infertility in women with a body mass index &#40;BMI&#41; &#8805;32 kg&#47;m<span class="elsevierStyleSup">2</span> estimated to be more than double that of women with normal weight &#40;RR 2&#46;7 &#91;2&#8211;3&#46;7&#93;&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;9</span></a> There is a common association between obesity and polycystic ovarian syndrome &#40;PCOS&#41;&#44; this being the most frequent cause of infertility due to anovulation&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Obesity exacerbates different reproductive and metabolic aspects of PCOS&#44; contributing to an increased likelihood of irregular menstruation and oligo-anovulation and having a negative impact on fertility in these patients&#46; In this context&#44; obesity can lead to changes&#44; including insulin resistance&#44; an increase in androgens&#44; a reduction in sex hormone binding globulin &#40;SHBG&#41; and increased peripheral conversion of androgens to oestrogens&#44; which in turn are the causes of altered secretion of gonadotropins by the hypothalamus and hinder the formation of follicles&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;12</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">However&#44; anovulation is not the only cause of subfertility associated with obesity&#46; It is estimated that for every point increase in BMI above 29 kg&#47;m<span class="elsevierStyleSup">2</span>&#44; the chances of spontaneous pregnancy are reduced by 5&#37; in women with ovulatory cycles&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> Possible causes of this phenomenon may be the impact of obesity on sexual desire and on the quality of the ova and their capacity to be fertilised&#44; and alterations in the endometrium which hinder implantation and contribute to a higher rate of abortions&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Obesity seems to have a negative impact on assisted reproductive technology &#40;ART&#41;&#46; Patients with obesity treated by controlled ovarian stimulation require higher hormone doses&#44; more days of stimulation&#44; and a higher rate of cancellation due to inadequate response&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> According to data from the Society for Assisted Reproductive Technology &#40;SART&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> a high BMI leads to a decrease in the number of oocytes retrieved and the quality of the embryos&#44; as well as a reduction in the rates of fertilisation and implantation and in the live birth rate&#44; which falls from 31&#46;4&#37; in women with BMI in the normal range to 21&#46;2&#37; in cases of BMI above 50 kg&#47;m<span class="elsevierStyleSup">2</span>&#46; The causes of less success in assisted reproduction in obese women are multiple but may include alterations in folliculogenesis&#44; implantation defects and alterations in embryonic development&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> However&#44; a recent systematic review concludes that the negative impact of obesity on clinical pregnancy&#44; live birth and spontaneous abortion rates after ART is weak in absolute terms and more consistent studies are needed on this subject&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Although not the focus of this statement&#44; pre-pregnancy obesity increases the risk of obstetric complications such as gestational diabetes&#44; pregnancy-induced hypertension&#44; caesarean section and macrosomia&#44; complicating the final part of the pregnancy&#44; in addition to increasing the risk of obesity in the offspring&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Male obesity and infertility</span><p id="par0040" class="elsevierStylePara elsevierViewall">The male factor accounts for 20&#8211;50&#37; of infertility cases in couples<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> and obesity may play a significant role&#46; Two systematic reviews substantiate that if the male partner is obese&#44; there is a greater risk of him being sterile &#40;OR&#58; 1&#46;66 &#91;95&#37; CI&#44; 1&#46;53&#8211;1&#46;79&#93;&#41; and poorer outcomes in ART&#46;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19&#44;20</span></a> The causes are multiple and are detailed below&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Firstly&#44; as in women&#44; obesity in men&#44; causes a cascade of hormonal changes&#44; which can lead to functional hypogonadotropic hypogonadism&#46; This is caused by the decrease in SHBG&#44; the aromatisation of androgens to oestrogens in adipose tissue&#44; which&#44; combined with other mechanisms&#44; including insulin resistance&#44; hyperleptinaemia and low-grade inflammatory state&#44; cause a decrease in the secretion of gonadotropins&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21&#44;22</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">In addition&#44; obesity in men is associated with a higher rate of erectile dysfunction&#44; which can occur in up to 75&#37; of men with grade 2 and 3 obesity&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> This association may be due to the hormonal changes described&#44; the presence of metabolic syndrome or treatments for that&#44; or secondary vascular damage&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">In terms of semen quality&#44; the data are less conclusive&#44; although some studies report a higher prevalence of oligozoospermia and asthenozoospermia&#44;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19&#44;24&#44;25</span></a> alterations in the DNA&#44; a reduction in mitochondrial activity and an increase in oxidative stress in the sperm in people with obesity&#46;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">26&#8211;28</span></a> It has been suggested that these changes could be secondary to functional hypogonadotropic hypogonadism itself&#44; to an increase in scrotal temperature secondary to increased adiposity&#44; or to the detrimental effect of the proinflammatory state and oxidative stress on spermatogenesis&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Impact of weight loss on fertility</span><p id="par0060" class="elsevierStylePara elsevierViewall">In women&#44; weight loss through lifestyle changes or bariatric surgery has been shown to restore ovulation&#44; regularise menstrual cycles and improve fertility&#46;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">30&#44;31</span></a> Although the impact of weight loss on the success of fertility treatments is less clear&#44; current evidence suggests that it could help achieve a greater number of spontaneous pregnancies&#44; in addition to reducing the necessary dose of gonadotropin treatment&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;32&#44;33</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Although pharmacological treatment of obesity offers proven health benefits&#44;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a> the information available on the improvement of fertility is limited and has only been studied in women&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">35&#8211;37</span></a> Studies are therefore needed to evaluate whether or not weight loss through anti-obesity drugs improves fertility results&#44; in addition to defining for each specific drug the precise moment it should be discontinued&#44; according to the pharmacokinetics and pharmacodynamics&#44; before planning the pregnancy&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">In men&#44; weight loss&#44; either through lifestyle changes or bariatric surgery&#44; leads to a clear improvement in the hormonal changes characteristic of functional hypogonadism secondary to obesity<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">38&#8211;42</span></a> and in erectile function&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">43</span></a> At present&#44; the data on sperm parameters are less clear&#46; Improvement in spermatogenesis after lifestyle intervention has been found in isolated studies&#44;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">44</span></a> but the effects of bariatric surgery do not seem to provide any benefit&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">45</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">The amount of weight loss necessary to see any benefits in parameters related to fertility is variable&#46; However&#44; with weight loss of 5&#8211;10&#37; achieved through diet and exercise&#44; there is an improvement in functional hypogonadism associated with obesity&#44; irregular menstruation and anovulation associated with PCOS&#44; and even in the pregnancy rate&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;40&#44;46</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Recommendations on the treatment of excess weight and obesity in people with infertility</span><p id="par0080" class="elsevierStylePara elsevierViewall">In view of the currently available evidence&#44; assessing for excess weight or obesity should be mandatory at Andrology or Gynaecology consultations for infertility&#46; To achieve this&#44; it will simply be necessary to measure weight&#44; height and waist circumference &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; In the presence of obesity and infertility&#44; treatment should focus primarily on achieving a healthy weight loss which is sustained over time through lifestyle changes&#44; including diet modification&#44; physical exercise and behavioural changes&#46; This first approach is the basis of any intervention aimed at weight loss and should be considered in all overweight and obese patients who come to the Gynaecology or Andrology clinic because of infertility&#46; As a negative synergistic effect on fertility has been observed when both partners are obese&#44;<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">47&#44;48</span></a> weight loss is recommended for both partners&#44; although the effect on male fertility is less conclusive&#46; It should also be noted that a preventive approach probably offers a wider window of action&#46; As a gynaecology appointment for routine check-up is often the only contact a woman of childbearing potential has with the healthcare system&#44; this consultation is a key point in the prevention of excess weight and obesity&#46; We therefore recommend the systematic assessment of patients in whom excess weight or obesity are identified&#44; and referral to the general practitioner or Endocrinology and Nutrition specialist in order to establish an agreed treatment plan&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">In people with BMI &#8805;27&#8239;kg&#47;m<span class="elsevierStyleSup">2</span> with associated complications&#44; or &#8805;30&#8239;kg&#47;m<span class="elsevierStyleSup">2</span>&#44; along with lifestyle modifications&#44; the addition of drugs to reduce body weight should be considered&#44; bearing in mind that the evidence regarding improvement in fertility is limited and any drug treatment should be stopped before attempts to become pregnant or starting fertility treatment&#44; in accordance with each drug&#39;s pharmacokinetics and summary of product characteristics&#46; In cases of grade 2 obesity &#40;BMI &#8805;35&#8239;kg&#47;m<span class="elsevierStyleSup">2</span>&#41; with obesity-associated disorders or grade 3 obesity &#40;BMI &#8805;40&#8239;kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&#44; the possibility of bariatric surgery should be considered&#44; bearing in mind that the resulting effects on fertility are clearer in women&#44; with less evidence in men&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> summarises the approach to the prevention and treatment of obesity associated with infertility&#46; We have to take into account&#44; however&#44; that despite the negative impact of obesity on fertility&#44; in women aged 38 or over the negative impact of age is much greater and&#44; in these cases&#44; achieving pregnancy should take priority over weight loss&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">49</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Areas for improvement in the treatment of obesity associated with infertility</span><p id="par0095" class="elsevierStylePara elsevierViewall">The approach to excess weight and obesity therefore has to be multidisciplinary&#44; including both the general practitioner&#44; endocrinologists&#44; dietitians&#47;nutritionists&#44; psychologists&#44; physical exercise specialists&#44; nurses&#44; gynaecologists and urologists&#46; Effective communication between the different healthcare professionals is key to agreeing on the best approach in each case&#46; Unfortunately&#44; such multidisciplinary programmes are few and far between and obesity units are limited to the treatment of severe obesity&#46; It is essential to promote the creation of these programmes in Primary Care in coordination with endocrinologists specialising in the treatment of obesity&#44; in order to respond to the growing demand&#44; and where patients with a lesser degree of obesity can receive care&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">In the case of drug treatment for excess weight and obesity&#44; as we are awaiting the approval of new agents which are more potent in terms of achieving weight loss&#44; studies will be needed to assess their impact on fertility&#44; and others on the pharmacoeconomics&#44; in order to obtain financing from the National Health System&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">The long and restrictive waiting lists for bariatric surgery represent another limitation in the treatment of obesity in the context of infertility&#46; In view of the already discussed impact of age on fertility&#44; this position paper specifically proposes prioritisation on bariatric surgery waiting lists for women aged over 35 with severe obesity and infertility&#44; bearing in mind that the recommendation is to wait at least 12 months after the bariatric intervention before becoming pregnant&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">This document also asserts that&#44; despite the huge repercussions it has on health&#44; obesity continues to be a stigmatised chronic disease with little recognition&#44; from the perspective of both society and healthcare&#46; There are currently very few units for the correct treatment of obesity&#44; there is a lack of funding by the National Health System for drug treatment&#44; and there are long waiting lists for bariatric surgery&#46; This situation contributes to the deterioration in the quality of life and life expectancy of people with obesity&#46; There is little recognition of the association between obesity and infertility and only through the training of healthcare professionals and increasing awareness among people with obesity and society in general&#44; including the health authorities&#44; will it be possible to promote new strategies to ensure proper assessment and the implementation of an effective treatment for improving both female and male fertility&#46; A multidisciplinary approach to this disease is key to improving the care of these patients&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Information for patients</span><p id="par0115" class="elsevierStylePara elsevierViewall">Obesity can be considered an epidemic disease throughout the world&#44; both in western and developing countries&#46; A chronic disease&#44; obesity is associated with&#44; or is the direct cause of&#44; many other well-known health problems and disorders&#44; such as high blood pressure&#44; type 2 diabetes&#44; dyslipidaemia&#44; respiratory disease and joint problems&#44; and even an increased risk of cancer&#46; This means that people with obesity have increased cardiovascular risk and morbidity and mortality rates&#46; Obesity is also the cause of lesser-known diseases&#44; such as both female and male infertility&#44; which can significantly compromise the health and quality of life of those affected&#46; The aim of this joint paper by the societies SEEN&#44; SEEDO&#44; SEGO&#44; SEF&#44; AEU and SEDYN is to draw attention to the impact of obesity on fertility&#44; both male and female&#44; and agree on a common approach&#46; Specifically&#44; it proposes prioritising severely obese women over 35 on the bariatric surgery waiting list&#46; Our aim is to draw attention to the need to allocate National Health System resources for the creation of multidisciplinary units to address obesity&#44; both at a hospital and Primary Care level&#44; and to the need to reduce waiting lists for obesity surgery&#44; assess the financing of anti-obesity drugs and develop strategies with the potential to impact on fertility in patients with obesity&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:8 [
        0 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Infertility as a disorder associated with obesity"
        ]
        1 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Female obesity and infertility"
        ]
        2 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Male obesity and infertility"
        ]
        3 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Impact of weight loss on fertility"
        ]
        4 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Recommendations on the treatment of excess weight and obesity in people with infertility"
        ]
        5 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Areas for improvement in the treatment of obesity associated with infertility"
        ]
        6 => array:2 [
          "identificador" => "sec0035"
          "titulo" => "Information for patients"
        ]
        7 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "NotaPie" => array:1 [
      0 => array:3 [
        "etiqueta" => "&#9674;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">They have similarly contributed to this manuscript&#46;</p>"
        "identificador" => "fn0005"
      ]
    ]
    "multimedia" => array:1 [
      0 => array:8 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 2219
            "Ancho" => 2931
            "Tamanyo" => 341364
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0005"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Diagram of the approach to the prevention and treatment of overweight or obesity associated with infertility&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:49 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence of general obesity and abdominal obesity in the Spanish Adult Population &#40;Aged 25&#8211;64 years&#41; 2014&#8211;2015&#58; the ENPE Study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46; Aranceta-Bartrina"
                            1 => "C&#46; P&#233;rez-Rodrigo"
                            2 => "G&#46; Alberdi-Aresti"
                            3 => "N&#46; Ramos-Carrera"
                            4 => "S&#46; L&#225;zaro-Masedo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.rec.2016.02.009"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Esp Cardiol &#40;Engl Ed&#41;"
                        "fecha" => "2016"
                        "volumen" => "69"
                        "paginaInicial" => "579"
                        "paginaFinal" => "587"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27133458"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "World Obesity Atlas 2022&#46; <a target="_blank" href="https://s3-eu-west-1.amazonaws.com/wof-files/World_Obesity_Atlas_2022.pdf">https&#58;&#47;&#47;s3-eu-west-1&#46;amazonaws&#46;com&#47;wof-files&#47;World&#95;Obesity&#95;Atlas&#95;2022&#46;pdf</a>&#46;"
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The SEEN comprehensive clinical survey of adult obesity&#58; Executive summary"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;D&#46; Ballesteros Pomar"
                            1 => "N&#46; Vilarrasa Garc&#237;a"
                            2 => "M&#46;&#193; Rubio Herrera"
                            3 => "M&#46;J&#46; Barahona"
                            4 => "M&#46; Bueno"
                            5 => "A&#46; Caix&#224;s"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.endinu.2020.05.003"
                      "Revista" => array:6 [
                        "tituloSerie" => "Endocrinol Diabetes Nutr &#40;Engl Ed&#41;"
                        "fecha" => "2021"
                        "volumen" => "68"
                        "paginaInicial" => "130"
                        "paginaFinal" => "136"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32933882"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Overweight&#44; obesity&#44; andmortality in a largeprospective cohort of persons 50&#8211;71 years old"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "K&#46;F&#46; Adams"
                            1 => "A&#46; Schatzkin"
                            2 => "T&#46;B&#46; Harris"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa055643"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med&#46;"
                        "fecha" => "2006"
                        "volumen" => "355"
                        "paginaInicial" => "763"
                        "paginaFinal" => "778"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16926275"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Obesity and reproduction&#58; a committee opinion"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Practice Committee of the American Society for Reproductive Medicine&#46; Electronic address&#58; asrm&#64;asrm&#46;org"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.fertnstert.2021.08.018"
                      "Revista" => array:6 [
                        "tituloSerie" => "Fertil Steril"
                        "fecha" => "2021"
                        "volumen" => "116"
                        "paginaInicial" => "1266"
                        "paginaFinal" => "1285"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34583840"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Calibrated prevalence of infertility in 30- to 49-year-old women according to diferent approaches&#58; a cross-sectional population-based study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "A&#46; Cabrera-Le&#243;n"
                            1 => "V&#46; Lopez-Villaverde"
                            2 => "M&#46; Rueda"
                            3 => "M&#46;N&#46; Moya-Garrido"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/humrep/dev226"
                      "Revista" => array:6 [
                        "tituloSerie" => "Hum Reprod&#46;"
                        "fecha" => "2015"
                        "volumen" => "30"
                        "paginaInicial" => "2677"
                        "paginaFinal" => "2685"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26370663"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Female obesity impairs in vitro fertilization outcome without affecting embryo quality"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46; Bellver"
                            1 => "Y&#46; Ayll&#243;n"
                            2 => "M&#46; Ferrando"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.fertnstert.2008.12.032"
                      "Revista" => array:6 [
                        "tituloSerie" => "Fertil Steril&#46;"
                        "fecha" => "2010"
                        "volumen" => "93"
                        "paginaInicial" => "447"
                        "paginaFinal" => "454"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19171335"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Adolescent body mass index and infertility caused by ovulatory disorder"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46;W&#46; Rich-Edwards"
                            1 => "M&#46;B&#46; Goldman"
                            2 => "W&#46;C&#46; Willett"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/0002-9378(94)90465-0"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Obstet Gynecol"
                        "fecha" => "1994"
                        "volumen" => "171"
                        "paginaInicial" => "171"
                        "paginaFinal" => "177"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8030695"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Body mass index and ovulatory infertility"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "F&#46; Grodstein"
                            1 => "M&#46;B&#46; Goldman"
                            2 => "D&#46;W&#46; Cramer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/00001648-199403000-00016"
                      "Revista" => array:6 [
                        "tituloSerie" => "Epidemiology"
                        "fecha" => "1994"
                        "volumen" => "5"
                        "paginaInicial" => "247"
                        "paginaFinal" => "250"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8173001"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pregnancy complications in women with polycystic ovary syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "S&#46; Palomba"
                            1 => "M&#46;A&#46; de Wilde"
                            2 => "A&#46; Falbo"
                            3 => "M&#46;P&#46; Koster"
                            4 => "G&#46;B&#46; La Sala"
                            5 => "B&#46;C&#46; Fauser"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/humupd/dmv029"
                      "Revista" => array:7 [
                        "tituloSerie" => "Hum Reprod Update&#46;"
                        "fecha" => "2015"
                        "volumen" => "21"
                        "numero" => "5"
                        "paginaInicial" => "575"
                        "paginaFinal" => "592"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26117684"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The adverse effects of obesity on reproduction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "J&#46;E&#46; Norman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1530/REP-10-0297"
                      "Revista" => array:7 [
                        "tituloSerie" => "Reproduction"
                        "fecha" => "2010"
                        "volumen" => "140"
                        "paginaInicial" => "343"
                        "paginaFinal" => "345"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20802106"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S187887501930227X"
                          "estado" => "S300"
                          "issn" => "18788750"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Metabolic effects of obesity on reproduction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "R&#46; Pasquali"
                            1 => "A&#46; Gambineri"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/s1472-6483(10)61179-0"
                      "Revista" => array:6 [
                        "tituloSerie" => "Reprod Biomed Online"
                        "fecha" => "2006"
                        "volumen" => "12"
                        "paginaInicial" => "542"
                        "paginaFinal" => "551"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16790096"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Obesity affects spontaneous pregnancy chances in subfertile&#44; ovulatory women"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46;W&#46; Van der Steeg"
                            1 => "P&#46; Steures"
                            2 => "M&#46;J&#46; Eijkemans"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/humrep/dem371"
                      "Revista" => array:6 [
                        "tituloSerie" => "Hum Reprod"
                        "fecha" => "2008"
                        "volumen" => "23"
                        "paginaInicial" => "324"
                        "paginaFinal" => "328"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18077317"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Obesity and Reproduction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "N&#46; Mahutte"
                            1 => "C&#46; Kamga-Ngande"
                            2 => "A&#46; Sharma"
                            3 => "C&#46; Sylvestre"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jogc.2018.04.030"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Obstet Gynaecol Can&#46;"
                        "fecha" => "2018"
                        "volumen" => "40"
                        "paginaInicial" => "950"
                        "paginaFinal" => "966"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29921431"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pregnancy outcomes decline with increasing body mass index&#58; analysis of 239&#44;127 fresh autologous in vitro fertilization cycles from the 2008&#8211;2010 Society for Assisted Reproductive Technology registry"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46;P&#46; Provost"
                            1 => "K&#46;S&#46; Acharya"
                            2 => "C&#46;R&#46; Acharya"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.fertnstert.2015.11.008"
                      "Revista" => array:6 [
                        "tituloSerie" => "Fertil Steril"
                        "fecha" => "2016"
                        "volumen" => "105"
                        "paginaInicial" => "663"
                        "paginaFinal" => "669"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26627120"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Overweight&#44; obesity and assisted reproduction&#58; a systematic review and meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46;M&#46; Ribeiro"
                            1 => "L&#46;M&#46;P&#46; Sasaki"
                            2 => "A&#46;A&#46; Silva"
                            3 => "E&#46;S&#46; Souza"
                            4 => "A&#46; Oliveira Lyrio"
                            5 => "C&#46;M&#46;G&#46; Figueiredo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ejogrb.2022.01.019"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Obstet Gynecol Reprod Biol&#46;"
                        "fecha" => "2022"
                        "volumen" => "271"
                        "paginaInicial" => "117"
                        "paginaFinal" => "127"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/35183001"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Maternal obesity in early pregnancy and risk of adverse outcomes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "I&#46; Bautista-Casta&#241;o"
                            1 => "P&#46; Henriquez-Sanchez"
                            2 => "N&#46; Alem&#225;n-Perez"
                            3 => "J&#46;J&#46; Garcia-Salvador"
                            4 => "A&#46; Gonzalez-Quesada"
                            5 => "J&#46;A&#46; Garc&#237;a-Hern&#225;ndez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1371/journal.pone.0080410"
                      "Revista" => array:3 [
                        "tituloSerie" => "PLoS One"
                        "fecha" => "2013"
                        "volumen" => "8"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Incidenceandmain causes of infertility in a resident population &#40;1&#44;850&#44;000&#41; of three French regions &#40;1988&#8211;1989&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46; Thonneau"
                            1 => "S&#46; Marchand"
                            2 => "A&#46; Tallec"
                            3 => "M&#46;L&#46; Ferial"
                            4 => "B&#46; Ducot"
                            5 => "J&#46; Lansac"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/oxfordjournals.humrep.a137433"
                      "Revista" => array:6 [
                        "tituloSerie" => "Hum Reprod"
                        "fecha" => "1991"
                        "volumen" => "6"
                        "paginaInicial" => "811"
                        "paginaFinal" => "816"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1757519"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Paternal obesity negatively affects male fertility and assisted reproduction outcomes&#58; a systematic review and meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46;M&#46; Campbell"
                            1 => "M&#46; Lane"
                            2 => "J&#46;A&#46; Owens"
                            3 => "H&#46;W&#46; Bakos"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.rbmo.2015.07.012"
                      "Revista" => array:5 [
                        "tituloSerie" => "Reprod Bio Med Online&#46;"
                        "fecha" => "2015"
                        "volumen" => "31"
                        "paginaInicial" => "593"
                        "paginaFinal" => "604"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effect of male body mass index on assisted reproduction treatment outcome&#58; an updated systematic review and meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "R&#46; Mushtaq"
                            1 => "J&#46; Pundir"
                            2 => "C&#46; Achilli"
                            3 => "O&#46; Naji"
                            4 => "Y&#46; Khalaf"
                            5 => "T&#46; El-Toukhy"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.rbmo.2018.01.002"
                      "Revista" => array:6 [
                        "tituloSerie" => "Reprod Biomed Online&#46;"
                        "fecha" => "2018"
                        "volumen" => "36"
                        "paginaInicial" => "459"
                        "paginaFinal" => "471"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29452915"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Male obesity-related secondary hypogonadism - pathophysiology&#44; clinical implications and management"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "C&#46;J&#46; Fernandez"
                            1 => "E&#46;C&#46; Chacko"
                            2 => "J&#46;M&#46; Pappachan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.17925/EE.2019.15.2.83"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Endocrinol&#46;"
                        "fecha" => "2019"
                        "volumen" => "15"
                        "paginaInicial" => "83"
                        "paginaFinal" => "90"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31616498"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "ENDOCRINE OBESITY&#58; pituitary dysfunction in obesity"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "S&#46; Ruiz"
                            1 => "F&#46; V&#225;zquez"
                            2 => "S&#46; Pellitero"
                            3 => "M&#46; Puig-Domingo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1530/EJE-21-0899"
                      "Revista" => array:5 [
                        "tituloSerie" => "Eur J Endocrinol&#46;"
                        "fecha" => "2022"
                        "volumen" => "186"
                        "paginaInicial" => "R79"
                        "paginaFinal" => "R92"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Associations between body mass index&#44; waist circumference and erectile dysfunction&#58; a systematic review and META-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46; Pizzol"
                            1 => "L&#46; Smith"
                            2 => "L&#46; Fontana"
                            3 => "M&#46;G&#46; Caruso"
                            4 => "A&#46; Bertoldo"
                            5 => "J&#46; Demurtas"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s11154-020-09541-0"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Endocr Metab Disord&#46;"
                        "fecha" => "2020"
                        "volumen" => "21"
                        "paginaInicial" => "657"
                        "paginaFinal" => "666"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32002782"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "BMI in relation to sperm count&#58; an updated systematic review and collaborative meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "N&#46; Sermondade"
                            1 => "C&#46; Faure"
                            2 => "L&#46; Fezeu"
                            3 => "A&#46;G&#46; Shayeb"
                            4 => "J&#46;P&#46; Bonde"
                            5 => "T&#46;K&#46; Jensen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/humupd/dms050"
                      "Revista" => array:6 [
                        "tituloSerie" => "Hum Reprod Update"
                        "fecha" => "2013"
                        "volumen" => "19"
                        "paginaInicial" => "221"
                        "paginaFinal" => "231"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23242914"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The impact of body mass index on semen parameters and reproductive hormones in human males&#58; a systematic review with meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "A&#46;A&#46; MacDonald"
                            1 => "G&#46;P&#46; Herbison"
                            2 => "M&#46; Showell"
                            3 => "C&#46;M&#46; Farquhar"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/humupd/dmp047"
                      "Revista" => array:6 [
                        "tituloSerie" => "Hum Reprod Update&#46;"
                        "fecha" => "2010"
                        "volumen" => "16"
                        "paginaInicial" => "293"
                        "paginaFinal" => "311"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19889752"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The relationship between male BMI and waist circumference on semen quality&#58; data from the LIFE study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46;L&#46; Eisenberg"
                            1 => "S&#46; Kim"
                            2 => "Z&#46; Chen"
                            3 => "R&#46; Sundaram"
                            4 => "E&#46;F&#46; Schisterman"
                            5 => "G&#46;M&#46; BuckLouis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/humrep/det428"
                      "Revista" => array:6 [
                        "tituloSerie" => "Hum Reprod"
                        "fecha" => "2014"
                        "volumen" => "29"
                        "paginaInicial" => "193"
                        "paginaFinal" => "200"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24306102"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Association between obesity and alteration of sperm DNA integrity and mitochondrial activity"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "R&#46;M&#46; Fariello"
                            1 => "J&#46;R&#46; Pariz"
                            2 => "D&#46;M&#46; Spaine"
                            3 => "A&#46;P&#46; Cedenho"
                            4 => "R&#46;P&#46; Bertolla"
                            5 => "R&#46; Fraietta"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1464-410X.2011.10813.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "BJU Int"
                        "fecha" => "2012"
                        "volumen" => "110"
                        "paginaInicial" => "863"
                        "paginaFinal" => "867"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22300410"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Impact of body mass index on seminal oxidative stress"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "O&#46; Tunc"
                            1 => "H&#46;W&#46; Bakos"
                            2 => "K&#46; Tremellen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1439-0272.2009.01032.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Andrologia"
                        "fecha" => "2011"
                        "volumen" => "43"
                        "paginaInicial" => "121"
                        "paginaFinal" => "128"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21382066"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Obesity&#44; a serious etiologic factor for male subfertility in modern society"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "Y&#46; Liu"
                            1 => "Z&#46; Ding"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1530/REP-17-0161"
                      "Revista" => array:6 [
                        "tituloSerie" => "Reproduction&#46;"
                        "fecha" => "2017"
                        "volumen" => "154"
                        "paginaInicial" => "R123"
                        "paginaFinal" => "R131"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28747541"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Weight loss in obese infertile women results in improvement in reproductive outcome for all forms of fertility treatment"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46;M&#46; Clark"
                            1 => "B&#46; Thornley"
                            2 => "L&#46; Tomlinson"
                            3 => "C&#46; Galletley"
                            4 => "R&#46;J&#46; Norman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/humrep/13.6.1502"
                      "Revista" => array:6 [
                        "tituloSerie" => "Hum Reprod"
                        "fecha" => "1998"
                        "volumen" => "13"
                        "paginaInicial" => "1502"
                        "paginaFinal" => "1505"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9688382"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Bariatric surgery on reproductive outcomes&#58; the impact according to the diagnosis of polycystic ovarian syndrome and surgical procedures"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46; Casals"
                            1 => "A&#46; Andreu"
                            2 => "Y&#46; Barral"
                            3 => "S&#46; Ventosa"
                            4 => "M&#46; Redondo"
                            5 => "F&#46; Torres"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s11695-021-05297-x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Obes Surg&#46;"
                        "fecha" => "2021"
                        "volumen" => "31"
                        "paginaInicial" => "2590"
                        "paginaFinal" => "2598"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33629226"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Incidence of successful pregnancy after weight loss interventions in infertile women&#58; a systematic review and meta-analysis of the literature"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Milone"
                            1 => "G&#46; De Placido"
                            2 => "M&#46; Musella"
                            3 => "L&#46;M&#46; Sosa Fernandez"
                            4 => "L&#46;V&#46; SosaFernandez"
                            5 => "G&#46; Campana"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s11695-015-1998-7"
                      "Revista" => array:6 [
                        "tituloSerie" => "Obes Surg"
                        "fecha" => "2016"
                        "volumen" => "26"
                        "paginaInicial" => "443"
                        "paginaFinal" => "451"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26661108"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "IVF outcomes in patients with a history of bariatric surgery&#58; a multicenter retrospective cohort study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "V&#46; Grzegorczyk-Martin"
                            1 => "T&#46; Fr&#233;our"
                            2 => "A&#46; De Bantel Finet"
                            3 => "E&#46; Bonnet"
                            4 => "M&#46; Merzouk"
                            5 => "J&#46; Roset"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/humrep/deaa208"
                      "Revista" => array:6 [
                        "tituloSerie" => "Hum Reprod&#46;"
                        "fecha" => "2020"
                        "volumen" => "35"
                        "paginaInicial" => "2755"
                        "paginaFinal" => "2762"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33083823"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pharmacotherapy of obesity&#58; available medications and drugs under investigation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46; Pilitsi"
                            1 => "O&#46;M&#46; Farr"
                            2 => "S&#46;A&#46; Polyzos"
                            3 => "N&#46; Perakakis"
                            4 => "E&#46; Nolen-Doerr"
                            5 => "A&#46;E&#46; Papathanasiou"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.metabol.2018.10.010"
                      "Revista" => array:6 [
                        "tituloSerie" => "Metabolism&#46;"
                        "fecha" => "2019"
                        "volumen" => "92"
                        "paginaInicial" => "170"
                        "paginaFinal" => "192"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30391259"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "35"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Liraglutideincreases IVF pregnancy rates in obese PCOS women with poor response to first-line reproductive treatments&#58; a pilot randomized study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "V&#46; Salamun"
                            1 => "M&#46; Jensterle"
                            2 => "A&#46; Janez"
                            3 => "E&#46; VrtacnikBokal"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1530/EJE-18-0175"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Endocrinol&#46;"
                        "fecha" => "2018"
                        "volumen" => "179"
                        "paginaInicial" => "1"
                        "paginaFinal" => "11"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29703793"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            35 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "36"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effect of orlistat intervention on in vitro fertilization&#47;intracytoplasmic sperm injection outcome in overweight&#47;obese infertile women"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46; Tong"
                            1 => "L&#46; Xiang"
                            2 => "Y&#46; Niu"
                            3 => "T&#46; Zhang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1080/09513590.2022.2028769"
                      "Revista" => array:4 [
                        "tituloSerie" => "Gynecol Endocrinol&#46;"
                        "fecha" => "2022"
                        "paginaInicial" => "1"
                        "paginaFinal" => "5"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            36 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "37"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "How to manage weight loss in women with obesity and PCOS seeking fertility&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46;M&#46; Hazlehurst"
                            1 => "P&#46; Singh"
                            2 => "G&#46; Bhogal"
                            3 => "S&#46; Broughton"
                            4 => "A&#46;A&#46; Tahrani"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/cen.14726"
                      "Revista" => array:3 [
                        "tituloSerie" => "Clin Endocrinol &#40;Oxf&#41;&#46;"
                        "fecha" => "2022"
                        "itemHostRev" => array:3 [
                          "pii" => "S1878875020310482"
                          "estado" => "S300"
                          "issn" => "18788750"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            37 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "38"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hypogonadotropic hypogonadism in morbidly obese males is reversed after bariatric surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; Pellitero"
                            1 => "I&#46; Olaizola"
                            2 => "A&#46; Alastrue"
                            3 => "E&#46; Mart&#237;nez"
                            4 => "M&#46;L&#46; Granada"
                            5 => "J&#46;M&#46; Balibrea"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s11695-012-0734-9"
                      "Revista" => array:6 [
                        "tituloSerie" => "Obes Surg&#46;"
                        "fecha" => "2012"
                        "volumen" => "22"
                        "paginaInicial" => "1835"
                        "paginaFinal" => "1842"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22923309"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            38 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "39"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence of&#8217; obesity-associated gonadal dysfunction&#8217; in severely obese men and women and its resolution after bariatric surgery&#58; a systematic review and meta- analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "H&#46;F&#46; Escobar-Morreale"
                            1 => "E&#46; Santacruz"
                            2 => "M&#46; Luque-Ram&#237;rez"
                            3 => "J&#46;I&#46; Botella Carretero"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/humupd/dmx012"
                      "Revista" => array:6 [
                        "tituloSerie" => "Hum Reprod Update&#46;"
                        "fecha" => "2017"
                        "volumen" => "23"
                        "paginaInicial" => "390"
                        "paginaFinal" => "408"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28486593"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            39 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "40"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Body weight loss reverts obesity- associated hypogonadotropic hypogonadism&#58; a systematic review and meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46; Corona"
                            1 => "G&#46; Rastrelli"
                            2 => "M&#46; Monami"
                            3 => "F&#46; Saad"
                            4 => "M&#46; Luconi"
                            5 => "M&#46; Lucchese"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1530/EJE-12-0955"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Endocrinol&#46;"
                        "fecha" => "2013"
                        "volumen" => "168"
                        "paginaInicial" => "829"
                        "paginaFinal" => "843"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23482592"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            40 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "41"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Treatment of functional hypogonadism besides pharmacological substitution"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46; Corona"
                            1 => "G&#46; Rastrelli"
                            2 => "A&#46; Morelli"
                            3 => "E&#46; Sarchielli"
                            4 => "S&#46; Cipriani"
                            5 => "L&#46; Vignozzi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.5534/wjmh.190061"
                      "Revista" => array:6 [
                        "tituloSerie" => "World J Mens Health&#46;"
                        "fecha" => "2020"
                        "volumen" => "38"
                        "paginaInicial" => "256"
                        "paginaFinal" => "270"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31496147"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            41 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "42"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Weight loss is a major contributor to improved sexual function after bariatric surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46; Mora"
                            1 => "G&#46;B&#46; Aranda"
                            2 => "A&#46; de Hollanda"
                            3 => "L&#46; Flores"
                            4 => "M&#46; Puig-Domingo"
                            5 => "J&#46; Vidal"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00464-013-2890-y"
                      "Revista" => array:6 [
                        "tituloSerie" => "Surg Endosc&#46;"
                        "fecha" => "2013"
                        "volumen" => "27"
                        "paginaInicial" => "3197"
                        "paginaFinal" => "3204"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23612762"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            42 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "43"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "what is the impact of bariatric surgery on erectile function&#63; A systematic review and meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "F&#46;P&#46;A&#46; Glina"
                            1 => "J&#46;W&#46; de Freitas Barboza"
                            2 => "V&#46;M&#46; Nunes"
                            3 => "S&#46; Glina"
                            4 => "W&#46;M&#46; Bernardo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.sxmr.2017.03.008"
                      "Revista" => array:6 [
                        "tituloSerie" => "Sex Med Rev&#46;"
                        "fecha" => "2017"
                        "volumen" => "5"
                        "paginaInicial" => "393"
                        "paginaFinal" => "402"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28526630"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            43 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "44"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Doesweight loss improve semen quality and reproductive hormones&#63; Results from a cohort of severely obese men"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "L&#46;B&#46; Hakonsen"
                            1 => "A&#46;M&#46; Thulstrup"
                            2 => "A&#46;S&#46; Aggerholm"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/1742-4755-8-24"
                      "Revista" => array:5 [
                        "tituloSerie" => "Reprod Health&#46;"
                        "fecha" => "2011"
                        "volumen" => "8"
                        "paginaInicial" => "24"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21849026"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            44 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "45"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Bariatric surgery does not improve semen quality&#58; evidence from a meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "Z&#46; Gao"
                            1 => "Y&#46; Liang"
                            2 => "S&#46; Yang"
                            3 => "T&#46; Zhang"
                            4 => "Z&#46; Gong"
                            5 => "M&#46; Li"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s11695-022-05901-8"
                      "Revista" => array:7 [
                        "tituloSerie" => "Obes Surg&#46;"
                        "fecha" => "2022"
                        "volumen" => "32"
                        "paginaInicial" => "1341"
                        "paginaFinal" => "1350"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/35143010"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S1878875018322484"
                          "estado" => "S300"
                          "issn" => "18788750"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            45 => array:3 [
              "identificador" => "bib0230"
              "etiqueta" => "46"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "How effective are weight-loss interventions for improving fertility in women and men who are overweight or obese&#63; A systematic review and meta-analysis of the evidence"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "D&#46; Best"
                            1 => "A&#46; Avenell"
                            2 => "S&#46; Bhattacharya"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/humupd/dmx027"
                      "Revista" => array:6 [
                        "tituloSerie" => "Hum Reprod Update"
                        "fecha" => "2017"
                        "volumen" => "23"
                        "paginaInicial" => "681"
                        "paginaFinal" => "705"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28961722"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            46 => array:3 [
              "identificador" => "bib0235"
              "etiqueta" => "47"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Subfecundity in overweight and obese couples"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "C&#46;H&#46; Ramlau-Hansen"
                            1 => "A&#46;M&#46; Thulstrup"
                            2 => "E&#46;A&#46; Nohr"
                            3 => "J&#46;P&#46; Bonde"
                            4 => "T&#46;I&#46; S&#248;rensen"
                            5 => "J&#46; Olsen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/humrep/dem035"
                      "Revista" => array:6 [
                        "tituloSerie" => "Hum Reprod&#46;"
                        "fecha" => "2007"
                        "volumen" => "22"
                        "paginaInicial" => "1634"
                        "paginaFinal" => "1637"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17344224"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            47 => array:3 [
              "identificador" => "bib0240"
              "etiqueta" => "48"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The influence of female and male body mass index on live births after assisted reproductive technology treatment&#58; a nationwide register-based cohort study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "G&#46;L&#46; Petersen"
                            1 => "L&#46; Schmidt"
                            2 => "A&#46; Pinborg"
                            3 => "M&#46; Kamper-J&#248;rgensen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.fertnstert.2013.01.092"
                      "Revista" => array:6 [
                        "tituloSerie" => "Fertil Steril&#46;"
                        "fecha" => "2013"
                        "volumen" => "99"
                        "paginaInicial" => "1654"
                        "paginaFinal" => "1662"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23394781"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            48 => array:3 [
              "identificador" => "bib0245"
              "etiqueta" => "49"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Delayed child-bearing"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46;A&#46; Johnson"
                            1 => "S&#46; Tough"
                            2 => "SOGC GENETICS COMMITTEE"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S1701-2163(16)35138-6"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Obstet Gynaecol Can&#46;"
                        "fecha" => "2012"
                        "volumen" => "34"
                        "paginaInicial" => "80"
                        "paginaFinal" => "93"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22260768"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/25300180/00000070000000S1/v2_202304211110/S2530018023000355/v2_202304211110/en/main.assets"
  "Apartado" => null
  "PDF" => "https://static.elsevier.es/multimedia/25300180/00000070000000S1/v2_202304211110/S2530018023000355/v2_202304211110/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2530018023000355?idApp=UINPBA00004N"
]

Article information

ISSN: 25300180
Original language: English

DOI:10.1016/j.endien.2023.03.003

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	28	2	30
2024 October	26	20	46
2024 September	65	34	99
2024 August	37	29	66
2024 July	24	10	34
2024 June	26	20	46
2024 May	23	13	36
2024 April	55	14	69
2024 March	72	16	88
2024 February	37	8	45
2024 January	11	6	17
2023 December	11	2	13
2023 November	17	5	22
2023 October	14	17	31
2023 September	5	4	9
2023 May	2	1	3
2023 April	0	3	3

Show all

Indexed in:

Follow us:

Subscribe:

Statistics

Indexed in:

Follow us:

Subscribe:

Statistics

Subscribe to our newsletter