Obesity is on the rise. It is currently a global epidemic. Nearly 50% of women in the reproductive age group are overweight or obese. As per WHO, worldwide obesity has tripled since 1975. Obesity has become a big burden on the health sector as its adverse effects are plenty.
Obesity is measured as per the BMI, Body mass index, calculated as weight in kilograms over height in meter squared (kg/m2). Normal BMI being 18.5-24.9, overweight: 25-29.9, obese: 30-39.9 and morbid obese >40 kg/m2.
Obesity ruins life and most of the medical disorders are directly or indirectly related to it. It has a profound detrimental effect on reproduction and fertility. Women with high BMI have a myriad of gynecological problems and infertility in addition to medical co-morbidities like diabetes, hypertension, metabolic syndrome, neurological disorders, sleep disorders, etc. The abundant fat cell creates a hormonal dysregulation resulting in suboptimal production of eggs resulting in abnormal ovulation and irregular menstrual cycles ultimately leading to infertility. High BMI causes alteration in specific hormones like leptin and adiponectin which alters the micro hormonal milieu resulting in a state of androgen excess. These derails the egg development in the ovary thus, again contributing to infertility. Around 30-35% of women having PCOS are obese or overweight and this adds to the already compromised hormonal dysfunction. Getting pregnant becomes difficult and this state of subfertility becomes quite challenging not only for the patient but also for the physician. Obese men also have abnormal semen parameters and metabolic profile thus contributing equally to infertility.
Patients with high BMI respond poorly to ovulation inducing medications and usually require a high dose to generate mature eggs and during IVF, there is usually a compromise on the quality and quantity of eggs harvested. High BMI is inversely related to IVF outcome. Higher the BMI, the lesser is the quality and quantity of embryos generated and subsequently decreasing fertility outcomes.
In comparison to women with normal BMI during pregnancy these patients also have increased obstetric complications like miscarriage, hypertension in pregnancy, diabetes in pregnancy, preterm birth, stillbirths, high rates of operative and instrumental deliveries and major birth defects in the baby.
Management of obesity is best done in a multidisciplinary approach. Weight reduction and lifestyle modifications should be seriously considered by any person with high BMI and not restricted to only reproductive age group seeking fertility care.
Women in the reproductive age group desiring pregnancy should visit their physicians for a good health checkup. If checkup reveals increased BMI in the form of overweight or obese then conception should be deferred for at least 3-6 months to adopt lifestyle modification programs.
A lifestyle modification program should include dietary modifications, behavioral interventions, and psychological support and motivation. Physical activity in the form of regular exercise should be adopted. Yoga which is a time tested and an ancient form of physical workout not only aids in weight loss but also uplifts one’s mental wellbeing and mindfulness.
Lifestyle modification programs also help men to improve semen parameters and general wellbeing.
One should refrain from caloric intoxication and stick to the calorie intake as recommended by the dietician. Persistence is the key. Dedication, regular dietary habits and workout programs will eventually result in significant weight reduction.
Medical management of obesity are plenty but the use of these pharmacological agents and its effectiveness are still debatable and not proven otherwise for people desiring pregnancy.
Bariatric surgery otherwise called weight loss surgery can cause weight loss and also restore menstrual regularity, resume ovulation, and enhance fertility outcome. But fertility-enhancing procedures like IVF should be deferred for greater than one year post operatively. But, this could be an issue with women of advanced reproductive age where time is of the essence.
Every human being deserves to have a complete family and lifestyle diseases like obesity should not be a deterrent to this happiness. Obesity is preventable and reversible.
Dr Partha Das is a highly skilled fertility/IVF Physician specializing in Reproductive Endocrinology and Infertility. Dr Partha consults and manages patients presenting with complex gynecological, male and female infertility issues and management of recurrent miscarriage and IVF failures.