Pathophysiology White adipose tissue plays a role in metabolism and secretes cytokines; a subtype (adipokines) has been linked with subfertility by affecting cell function High levels of adipose tissue in women exacerbates polycystic ovary syndrome Adiponectin is associated with an increased risk of diabetes and has been linked to recurrent implantation failure The composition in follicular fluid is affected by increased adiposity and can lead to embryo fragmentation, poor blastomere score, and impaired folliculogenesis Oligospermia and azoospermia have been observed in obese males Psychosocial and economic implications People living with obesity face stigma and discrimination and can become outcasts in certain societies as childlessness can affect a person's burial rights, inheritance rights, and has been linked to witchcraft There is no clear established link between an increased BMI and higher costs associated with fertility treatments, although women with higher BMIs have a lower chance of live birth per cycle which may invariably affect cost