Infertility is defined as an inability to produce offspring after 12 months of unprotected consistent sexual intercourse. According to the CDC 13% of women ages 15-49 are impacted by infertility. One in seven couples struggles with fertility. It is well established that weight loss yields several health benefits such as improved energy, increased longevity, and improved overall health. Excess fat loss also greatly improves fertility for both men and women. There are several causes of infertility ranging from anatomical to hormonal, the good news is that excess weight is a factor that can be potentially cured with the correct weight management plan.
Excess weight and female fertility
Women who are overweight or obese can take up to twice as long to become pregnant when compared to women of normal weight. In addition, women who are overweight are at higher risk of pregnancy and post pregnancy related complications such as pre-eclampsia and/or eclampsia (a common cause of bedrest, emergency c-section, and pregnancy induced seizures), gestational diabetes, hypertension, and large weight babies. Other risks include a higher risk of miscarriage and still birth. Studies show that although the still birth rate is low, this rate doubles for women with BMIs over 30.
The menstruation cycle involves a host of hormones such as estrogen and progesterone and when these hormones are circulating at abnormal levels it impairs ovulation and therefore, interferes with the ability to become pregnant. Obesity greatly impairs normal reproductive hormones as well.
Excess weight and male fertility
For men, excess weight reduces libido (interest in sex), lowers sperm count, impairs sperm quality, and reduces sperm motility. Excess body fat increases body temperature and this is particularly harmful for sperm encapsulated in the scrotum, which is intended to provide a slightly cooler climate in order to support healthy sperm function. Poor sperm quality and quantity directly reduces the chances for pregnancy. In addition, overweight men are more likely to have low testosterone levels. Testosterone is an important male hormone that is responsible for male sexual development, lean muscle and bone mass, mood, and the storage and utilization of body fat.
Polycystic Ovarian Syndrome (PCOS) and Infertility
Polycystic ovarian syndrome or PCOS is one the most common endocrine conditions impacting women. It is a leading cause of infertility due to the imbalance of female reproductive hormones. There are different types of PCOS but in the most traditional type women experience abnormal menstrual cycles, androgen (male hormone) excess, and ovaries with multiple cysts. Hormone irregularity makes it difficult to become pregnant due to interfering with key processes required for successful conception. There are other features of PCOS that interfere with overall health as well such as high levels of insulin caused by elevated testosterone and high estrogen levels due to increased fat production. PCOS does not have a cure; however, it is significantly improved with weight loss, proper nutrition, and lifestyle changes. Weight loss is the primary recommended treatment for PCOS even before starting medications. The good news is that women with PCOS who lose weight, even an amount as small as 3-5%, increase their chances of pregnancy.
How does normal pregnancy work?
A woman's ability to become "fertilized" is based on many factors such as age, genetics, the reproductive system, overall health, and just plain luck. The luck part is due to ideal timing. A well-intentioned sperm has a small window of time to reach the egg before it disintegrates. Once the window of opportunity is missed it will be another 28 days before a mature egg is available for fertilization. For child-bearing age women the monthly cycle coincides with the journey of the egg from the ovary through the reproductive tract to the uterus. The egg is first expelled by the ovary into the fallopian tubes to start the journey (a process known as ovulation). The egg has 24 hours to either team up with sperm to create a future baby or dissolve forever. Despite the sperm's ability to survive inside the female reproductive tract for 3-5 days, the timing for fertilization must be exactly right in order to lead to pregnancy.
Obesity and Fertility Treatment
Fertility specialists are doctors who help women struggling to naturally conceive by using medical treatment to aid in pregnancy. Most fertility doctors will ask that weight and overall health are addressed before starting fertility treatments. Although excess weight can negatively impact fertility it is not the only factor.
Even with fertility treatment, excess weight creates barriers such as poor quality embryos, difficult egg retrieval, risks for less viable embryos, poor uterus implantation, and the same pregnancy related risks mentioned previously, including higher risk of respiratory complications if intubation or emergency surgery is needed.
Fertility doctors use the following treatments for infertility:
- Medications and hormones to stimulate ovulation
- In vitro fertilization
- Intrauterine insemination
- Intravaginal insemination
- Referral to weight loss doctor for medical management of obesity
In vitro fertilization (IVF) is a scientific method for overcoming the anatomical or physiological barriers to pregnancy. IVF is a form of Assisted Reproductive Technologies (ART) which accounts for 1-3% of live births and over 7 million births since the late 1970s. A woman undergoing IVF will take medication to stimulate the ovarian follicles then have these stimulated eggs retrieved and fertilized by sperm in a laboratory. The fertilized egg (or several eggs) are then implanted directly into the uterus.
In intrauterine insemination (IUI) motile concentrated sperm are directly inserted into the uterus. In intravaginal insemination, similar to IUI but in some instances a cheaper alternative, highly motile sperm are directly inserted into the vagina. These alternatives are useful for couples hoping to increase the chances of pregnancy or couples with barriers to sexual intercourse. Ovulation tracking devices are often used to predict the best time for insemination based on maximum fertility.
At Abundant Health & Vitality Associates, we not only help women with Polycystic Ovarian Syndrome (PCOS) and infertility accomplish their goals through weight loss but we promote long term weight management that will keep both mom and future generations healthy for a lifetime.
If you are a woman interested in weight management to increase your chances of pregnancy
Please call our office at 704-997-9661 or complete appointment request on the home page
Clark AM1, Ledger W, Galletly C, Tomlinson L, Blaney F, Wang X, Norman RJ.Hum Reprod. 1995. Weight loss results in significant improvement in pregnancy and ovulation rates in anovulatory obese women. Oct;10(10):2705-12.
Veronica Sarais, Luca Pagliardini, Giorgia Rebonato,Enrico Papaleo, Massimo Candiani, and Paola Viganò.23 February 2016. A Comprehensive Analysis of Body Mass Index Effect on in Vitro Fertilization Outcomes.