Obesity and Infertility
Many obese (BMI > 30) and/or diabetic women wish to conceive but are afraid of the risks. Their doctors have probably warned them of the multiple complications that can occur during pregnancy, which are exaggerated by high insulin and blood pressure levels. The more immediate problem, however, is these women’s difficulty to conceive in the first place.
Excess weight increases androgens (e.g., testosterone and other “male” hormones) in the body, negatively impacting ovulation. Polycystic ovary syndrome (PCOS), for example, is a hormonal disorder that is frequently linked to obesity. It is a common cause of irregular periods and infertility, and the treatment for it includes making lifestyle changes such as reducing one’s calorie intake and engaging in regular exercise in order to normalize one’s weight.
Research, however, has shown that unhealthy diet not only hinders ovulation but can also lead to infertility in women who ovulate normally. As reported by WebMD, a study conducted by scientists in the Amsterdam’s Academic Medical Center revealed that from a group of women who had regular menstrual cycles and ovulated, severely obese females were roughly 50% less likely to conceive than overweight or normal-weight women.
Male obesity can also contribute to infertility due to factors such as reduced sexual drive, increased temperature at the scrotum, lower testosterone levels, and other hormonal imbalances in the regulation of sperm production. Thus, obese men are more likely to be sterile or have low sperm quantity and quality than their normal-weight counterparts.
Obesity and In Vitro Fertilization (IVF)
In general, obese women have poorer response to fertility treatments. In many cases, either few eggs are retrieved during an IVF cycle or the eggs are of lower quality. In addition, studies have reported difficulties with embryo transfers as well as lower implantation rates of embryos after transfer. These finding indicate that IVF success rates for obese women (especially those using their own eggs) are also lower compared with the rates for women of normal BMI.
Excess Weight During Pregnancy
Although many overweight or obese women do manage to get pregnant, high maternal weight significantly increases the risk for developing serious conditions such as gestational diabetes mellitus (GDM) and preeclampsia.
Gestational Diabetes Mellitus
GDM is diabetes with onset during pregnancy. Although it often disappears after childbirth, women who develop GDM face an increased risk of developing type 2 diabetes later in life.
Poorly controlled gestational diabetes can also have a harmful effect on the baby, leading to respiratory difficulties, jaundice, hypoglycemia, predisposition to obesity and type 2 diabetes, or other complications. One of the treatments is controlling blood sugar via healthy diet and exercise.
Preeclampsia
Preeclampsia is characterized by high blood pressure and damage to an organ system (e.g., the kidneys). Left untreated, it can lead to major, even life threatening, complications for both the mother and the baby. Currently, the only treatment for the mother is delivery of the baby.
According to the Preeclampsia Foundation, possible effects on the baby include
- Acidosis
- Blindness
- Cerebral palsy
- Deafness
- Epilepsy
- Learning disorders
- Neonatal death
- Stillbirth
Other Complications
Other possible complications of pregnancy in obese women include
- Greater chance of miscarriage
- Greater chance of surgical complications during dilation and curettage (D&C)
- Stillbirth (chances are twice as high in obese patients than in normal-weight patients)
- Greater chance of caesarean section delivery and postoperative complications
Low BMI and Infertility
Like their obese counterparts, some underweight women (BMI < 18.5) face infertility problems due to hormonal imbalance. Their menstrual cycles are typically irregular, and their ovulation is impaired due to insufficient amounts of estrogen (linked to low fat storage). Typically, the solution is simple: consuming more fat can often restore ovulation, eliminating the need for hormonal therapy.
Underweight men are also at an increased risk of suffering from infertility. They often have lower sperm counts and reduced sperm quality compared with normal-weight men.
Low Weight During Pregnancy
A 2007 study conducted at the London School of Hygiene & Tropical Medicine revealed that underweight women were 72% more likely to miscarry in the first trimester than normal-weight women. Those who took vitamin supplements (especially prenatal multivitamins rich on folic acid) reduced their risk of miscarriage by around 50%.
In addition, studies have reported that being underweight at the onset of pregnancy increases the risk of premature birth and delivery of a small-size baby. These effects can lead to long-term health problems in children, such as
- Anemia
- Apnea
- Bleeding in the brain
- Feeding difficulties
- Heart failure
- Infection (e.g., lung, blood)
- Jaundice
- Respiratory problems
- Retinopathy
Normal BMI and Infertility
Normal BMI is not a guarantee for fertility. Though the reasons can vary, including age, genetics, and certain medical conditions, recent research points to unbalanced diet as a major contributor to infertility in women of normal weight. More specifically, excess consumption of carbohydrates and insufficient intake of protein have been implicated as potential causes of hormonal imbalance and poor quality embryos.
To read about the special dietary restrictions my reproductive endocrinologist suggested, please visit my post “Special Fertility Diet.”
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