Many women remain unaware that fatty liver is not merely a liver problem; it can significantly impair reproductive health and fertility. Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as non-alcoholic fatty liver disease (NAFLD), has emerged as a common metabolic disorder among women of reproductive age. Researchers are increasingly discussing the 'hepato-ovarian axis,' emphasizing the close connection between liver health and ovarian function. Women with insulin resistance or obesity often experience hormonal disturbances that can interfere with ovulation and reduce fertility.
Link Between Fatty Liver and PCOS
Women with polycystic ovary syndrome (PCOS) are particularly vulnerable. Numerous studies reveal a significantly higher prevalence of fatty liver disease in women with PCOS. Globally, fatty liver affects nearly one in four adults, with rising numbers among younger women, including in India. Studies indicate that in India, prevalence ranges from 9% to 32%, with higher rates in urban areas due to sedentary lifestyles and metabolic disorders.
How the Liver Affects Hormones
The liver plays a central role in regulating hormones, metabolism, and insulin balance—critical factors in women's reproductive health. It helps process estrogen and androgens. When fat accumulates in the liver, many of these key functions become disrupted, leading to hormonal imbalance.
Impact on Fertility and Pregnancy
Emerging research suggests that women with fatty liver disease may experience lower reproductive outcomes, as associated metabolic dysfunction can affect egg maturation, embryo quality, and implantation potential. This is particularly relevant for women planning assisted reproductive treatments such as IVF. Fatty liver disease has also been linked to a higher risk of gestational diabetes mellitus (GDM), hypertensive disorders like preeclampsia, and preterm birth, making preconception screening essential.
Silent but Reversible
Many women show no symptoms, earning fatty liver the label 'silent disease.' Others may experience unexplained fatigue, weight gain, or irregular periods. Fortunately, fatty liver is often preventable and reversible, especially when detected early. Key measures include:
- Weight management: Losing even five percent of body weight can reduce liver fat, improve insulin sensitivity, and restore ovulation.
- Nutrition: A diet rich in fruits, vegetables, and whole grains, while avoiding processed foods and saturated fats, is crucial.
- Physical activity: Consistent exercise improves hormonal balance and metabolic health.
- Sleep quality: Adequate sleep supports hormonal wellness.
- Early screening: Women with PCOS, obesity, or other risk factors should undergo liver function tests as advised.
As gynaecologists, we aim to address root causes beyond symptoms. Evaluating metabolic health, including liver function, may be an important first step for women struggling to conceive.
Dr. Nandita Palshetkar, Scientific Director & Head of the Bloom IVF Unit at Lilavati Hospital, Mumbai, and Medical Director of Bloom IVF Centres.
