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| Resources > Newsletters > Obesity and Infertility |
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| Obesity and Infertility |
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| The task of the reproductive specialist is not only to help a woman conceive, but also to make certain that her pregnancy has an optimum chance of being successfully completed, i.e. that delivery of a healthy infant at term will occur. Maintenance of body weight that is close to ideal is important for assuring this result. More than 50% of women in America are overweight or obese. Because obesity poses a particular obstacle to both the occurrence of pregnancy and the fetus that may result, addressing this problem warrants special consideration during the initial evaluation of infertility. |
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It is well known that obesity has been directly linked to serious diseases, including cardiovascular disease, high blood pressure and stroke. The livers of obese women produce increased amounts of cholesterol and triglycerides, both of which are known risk factors for heart disease. An increased strain on the back and legs from increased weight can lead to osteoarthritis. Increased insulin resistance can lead to Type II Diabetes as well as Polycystic Ovary Syndrome (PCOS). Aside from the physical and physiological consequences of obesity, there are also emotional and social consequences. |
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| More to our point, obesity has a major impact on a woman’s reproductive performance. Although there are many overweight women who are fertile and have children, studies have shown that the overall prevalence of reproductive disorders increases with increasing body mass index (BMI). These disorders include amenorrhea, oligomenorrhea, anovulation, infertility and poor response to ovulation inducing agents. |
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| Women with a high BMI who do conceive, moreover, are at increased risk for spontaneous miscarriage as well as pregnancy-related complications such as diabetes, pregnancy induced hypertension, pre-eclampsia and delivery of macrosomic infants, with attendant risks of operative delivery. Recent studies have also identified obesity with increased risks of stillbirth, neonatal death and even birth defects. |
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| Of course, the most common reproductive disorder associated with obesity – and one of the most difficult to treat! – is anovulation secondary to PCOS. But overweight and obese women whose failure to conceive is not related to anovulation, but to other factors such as tubal blockage or male factors, also benefit from weight loss. This is because the success rates of other fertility treatments increases as body weight approaches normal. |
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| Our policy at GENESIS is to encourage weight loss as the primary treatment of ovulatory disorders associated with obesity. Insulin sensitizing medications may be used, but mainly in patients who are at a significantly elevated risk because of obesity and where lifestyle modification has not resulted in sufficient weight loss. In general, we recommend weight loss to a BMI < 30 for all women trying to conceive. When BMI is > 30, we request a medical evaluation by an internist and/or Maternal Fetal Medicine specialist prior to initiating any therapy. Fertility therapy is generally not given to women whose BMI exceeds 40. Because of risks related to the induction of anesthesia, no patient can be accepted into the IVF program if her BMI exceeds 35. |
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| June 2005 |
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