Impact of Obesity on Infertility in Women & Men
Every woman dreams about cradling a baby in her arms. It is a wish, a longing, a prayer and all of us wait for that beautiful day when we can cuddle our baby. While having a baby is one of the most wonderful experiences in this world, inability to conceive causes a heartache that is incomparable. Inability to procreate leads to the most distressing feelings like anger, grief, depression, loss of self-esteem and confidence and added anxiety. Infertility or inability to conceive naturally is still considered as a taboo in our society and even today, women who cannot conceive, feel outcast from the society.
Research has shown that infertility levels have increased by 20 to 30% over last 5 years in India. Infertility is now neither limited only to cities nor to women alone. Lot of men also face issues that hamper conception and women in rural areas are equally susceptible. While there are many reasons that lead to infertility, obesity has become one of the leading causes for failure to conceive.
In my day to day practice, as a weight loss expert and a bariatric surgeon, I see a lot of young obese women who are struggling with infertility and it is a major concern for them. Most of them come to me after multiple failed attempts at conceiving naturally and then a fair number of trials of assisted fertilization through IUI, IVF etc. Commonly, there is no objective medical cause to explain infertility in these women. The entire process is extremely frustrating and most of the times they do not realize that obesity itself is causing a negative impact on fertility and is leading to multiple adverse reproductive outcomes. With rising levels of obesity in women of reproductive age group, as doctors we are dealing with an increasing number of patients who are battling infertility.
Obese women have a lower implantation rate, a higher miscarriage rate and increased chances of complications during pregnancy. They are also known to have a higher failure rate with assisted reproductive techniques like in vitro fertilization. They are also more prone to have a cesarean section as compared to normal vaginal delivery. Worst of all they have a lower chance of giving birth to a healthy newborn as compared to normal weight women. Children born to obese mothers are at a higher risk of becoming obese and developing type 2 diabetes in future.
The effect of obesity on reproductive health is complex. Obesity is associated with irregularity in periods which is usually a result of anovulatory cycles. Obese women tend to be insulin resistant which in turn promotes the development of polycystic ovarian syndrome or PCOS. PCOS is a condition in which the ovaries become enlarged and have multiple small collections of fluid. Increased levels of multiple hormones such as luteinizing hormone, leptin, insulin, estrone, triglycerides and very low density lipo-proteins in turn have a negative impact on the hypopituitary gonadotrophic axis which in turn leads to infertility.
Even after they conceive, obese women tend to have a higher chance of miscarriage or abortion. The exact incidence of miscarriages among obese women remains unknown. This is compounded by the fact that many times obese women tend to have irregular menses and miscarriages may go unnoticed. The other risks during pregnancy include high blood pressure, increased incidence of gestational diabetes, pre-eclampsia, infection and blood clotting (venous thrombo-embolism). Rates of still born babies are also higher among obese women.
Does the father’s weight affect a couple’s chances of conceiving?
Obesity has a negative impact on male fertility as well. Some overweight and obese men may have a poorer sperm quality than normal weight men. Obese men may also have a higher incidence of erectile dysfunction and they tend to be less interested in sex.
Once other causes of infertility have been ruled out, it is essential that overweight and obese women attending infertility clinics be given necessary advice about weight loss. Lifestyle modification forms the cornerstone of therapy and must be the first line of advice. Patients must be put on medically supervised diet and exercise programs. Reproductive abnormalities induced by obesity tend to improve after weight loss. Period cycle tends to become more regularized and cycles become ovulatory from anovulatory. Women suffering from PCOD must see an endocrinologist to seek treatment for the same.
In case of severely obese women with a BMI more than 37.5 kg/m2, bariatric surgery can be recommended for weight loss. One of my patients, Akansha Sharma, a 38 year old lady had been married for ten years. At 134 kg she was battling not only with weight issues but also infertility. Multiple miscarriages and subsequent multiple attempts at assisted reproduction through IVF had taken a toll on her physical and psychological health. She also suffered from uncontrolled diabetes and had recently been started on medications for depression which in turn led to more weight gain. After many failed attempts at weight loss she finally underwent a Laparoscopic Roux en Y gastric bypass in 2012. She lost 45 kg in one year and conceived naturally after 18 months. Today she is a proud mother to a beautiful baby girl. Bariatric surgery does wonders for morbidly obese women suffering from infertility and there are many such success stories of women who have conceived after losing weight.
Preconception counselling must be mandatory and one must target to achieve normal weight, before natural or assisted conception. You “must” lose those extra kilograms before you get onto the journey of becoming a “yummy-mummy”.