Obesity & Infertility

Obesity definitely has a negative impact on infertility. Overweight women have higher incidences of hormonal Imbalance, menstrual dysfunctions & imbalanced ovulation, 

Overweigh & obese women have low potential of fertility and high risk of miscarriages, plus increased complications during pregnancy & childbirth.

Definition of Obesity 

Body Mass Index (BMI) is the most common criteria to define obesity based on height, weight of a person. There are other indicators also which may consider more parameters like height, weight, age, measurements of waist etc. However, we will refer to BMI here, as this is the most commonly used index.

BMI = weight (kgs) / height (cm) x height (cm)

i.e. weight in kgs divided by square of height in cm. The result so obtained is classified as below:

Since the scope of this article is Obesity, we will cover BMI readings of 25 and above.

The formal definition of obesity is “abnormal accumulation of body fat usually 20% or more over an individual‘s Normal body weight”. According to above it would be described as a person having BMI over 30. as Obese & 25% or more as overweight.

In India, urban prevalence of obesity has increased alarmingly. 

50% of adult urban Indians & 29% of children, are in the category of overweight or obese. 

What are the factors causing obesity? 

 · Obesity is a mainly a result of nutritional disorder. In affluent & developing countries, due to rapid change in lifestyle, transition obesity is on the rise. 

· Increased consumption of energy dense foods like carbohydrates.

· Inactive sedentary lifestyle.

· Work related stress & irregular eating habits. 

· No time & dedication for exercise. 

· Increased consumption of alcohol & smoking. 

· Endocrinologic disorders mean hormones available in higher or lower quantity than required by organs. Key hormones pertaining to infertility are - androgens, Estrogen, Insulin, Glucose, Binding globulins, Prolactin, Growth Hormones, & Growth factor metabolism, Hormone leptin (produced & secreted by adipose tissue). These affect neuro endocrinal reproductive axis in two ways:

· Centrally – hormones not produced in right quantity 

· Peripherally – hormones produced in right quantity, but not reaching required organ

Impact of obesity on female fertility 

Obesity impacts couple’s ability to get pregnant. Around 6% of women infertility cases are due to obesity. 

· Obesity affects fertility by changing the way a woman’s body stores sex hormones. 

Fat cells convert a male hormone known as androstenedione to female hormone called estrone. Estrone affects the metabolism of the part of brain that regulates ovarian & testicular function.

· Obesity has substantial effect in manifestation of PCOS. 35-50% of women with PCOS are obese & 50% are overweight. 

· Obesity gives severe metabolic disorders which increases infertility, menstrual irregularities, chronic anovulation & lowered pregnancy rate. 

· Obesity also gives problems after conception, like miscarriages & obstetric complications.

Impact of obesity on male fertility

· Every excess of 10 kgs reduces a man’s fertility by 10 %. 

· Obesity is associated with altered spermatogenesis & erectile dysfunction. 

· There is direct correlation between increase BMI & sperm count & motility. 

· Obesity lowers testosterone levels which ultimately lowers sexual drive & effect into lowering sexual intercourse frequency giving infertility. 

· Obese males are more likely to have low sperm count or abnormalities in sperms due to high levels of oestrogen & low level of sperm producing hormones like Inhibin B & androgen. 

· Obesity in males raises the body temperature especially around the scrotum. This impacts sperm concentration, motility and ability to fertilize.

Management of Obesity 

Reducing obesity can have profound impact on infertility management. 

Woman are encouraged to lose weight before infertility treatment to improve outcome.

For overweight and obese patients between BMI 25-35, even a 7-10% reduction in body weight is effective in restoring fertility, resulting in spontaneous ovulation or increase sensitivity to drugs for ovulation. 

Obesity corrective measures 

· Behavioral – Self monitoring, social support, stress management. 

· Dietary intake—reducing calorie intake by 500-1000 per day. 

· Physical activity –moderate activity (brisk walking, jogging) 30-45 min /day 4-5 days a week.

· Adjunctive drugs & dietary supplements – like micronutrients, Vit D, zinc, liver enzymes. protein supplements with BMI > 27 with other medical co-morbidities 

· Surgery – BMI between 35-40 sometimes require bariatric surgery. 

Infertility treatment plan for obese patient 

· Weight loss plan is followed with other infertility treatments. This covers exercises as well as diet plans.

· Ovulation induction is first step. It is done with or without drugs to find out how obesity has impacted ovulation cycle. It also helps find out if there are male factors also impacting obesity.

· Routine Investigations done to uncover other issues if any like thyroid issues etc. Plus figure out what other medications / drugs / hormones will be required.

· Based on the output of above steps doctors suggest next course of action. 

· If infertility is due to male like symptoms of low sperm count & motility, treatment plan like IUI, IVF, ICSI are recommended.

Considerations for obese patients going for infertility treatments

Because of additional complications due to obesity:

 · Infertility treatments become more difficult to carry out, e.g. more difficulty in understanding sonography results, doing ovam pickups and embryo transfers. This is so because adipose tissue causes hindrance doing the procedures.

 ·  Likewise, cost of IVF, ICSI cycles also increases due to higher requirement of hormonal dosages for Ovulation induction. Also because of the added complexity, success rate goes down leading to additional cycle. 

Complications after conception due to Obesity 

· Early miscarriage 

· Recurrent abortions 

· Early foetal death – say around 20 weeks of pregnancy

· Preterm or premature baby

· Death of foetus at birth post delivery – still born baby

· Increase operative morbidity of mother during caesarean section

Conclusion

Obesity has a major impact on fertility of both male & female. Lifestyle changes & weight reduction should be priority before starting infertility treatment. Success rate of infertility treatment is inversely proportionate to BMI. Obesity gives lot of complications during infertility treatment & post conception. Obese female patients are always considered as high risk pregnancy. 

Akruti fertility centre runs a complete weight loss program which comprises of Psychological Counselling, diet plan & planning of physical activity to help obese patients improve chances of pregnancy & lowering child birth complications.

Mentioned below are couple of other related treatments:

· PCOS

· Hormonal imbalance

· IVF

· ICSI

· Andrology