Reproduction and care of off springs is one of the primal function for all living beings. Inability to reproduce, Infertility can be devastating to couples for it is perceived not only as medical problem but has social and psychological burden.
Obesity is defined as an abnormal accumulation of body fat, usually 20% or more over an individual’s ideal body weight.
According to WHO
Normal BMI: 18.5-24.9
Over weight : 25-29.9
Obesity : >30
1 in 4 women are suffering from obesity.
Obese women have 3 times more incidence of Infertility than ones with normal BMI.
Obesity affects Fertility, has pregnancy complications, adverse health effects
Obesity and Hormonal disturbances:
Fertility requires fine hormonal balance.
Leptin, product of Ob ( obese ) gene , serves as link between obesity and reproduction. Leptin acting on Hypothalamus reduces food intake and increases energy expenditure. In humans obesity is related to leptin resistance. Role of leptin present in pathogenesis of PCOS.
Polycystic ovarian syndrome makes it difficult for body to use insulin due to insulin resistance. Insulin helps to convert carbohydrates into energy. Due to insulin resistance sugar levels in blood stream increases. High insulin increases male hormones ( androgens) causing symptoms of acne, weight gain and menstrual irregularities.
34% of women suffering from infertility have obesity .
When it comes to menstrual disturbances and no ovulation 45% of females are found to be obese.
Insulin resistance is risk factor for future development of diabetes.
Obesity is also associated with thyroid disturbances which further can influence ovulation, egg quality and miscarriage rate.
Obesity affects conception:
Obesity makes it difficult to conceive in natural cycle or in treatment (IUI, IVF) cycles.
It is due to Hormonal disturbances, associated polycystic ovaries with inability to form eggs and ovulation or due to poor quality of eggs.
Dose of hormones required for growth of eggs is also high in obese women due to disturbed absorption and metabolism of drugs.
Obesity also increases risk of miscarriages… 38.1 % compared to 13.3% in normal BMI patients. It is postulated due to disturbed hormonal milieu like associated PCOS, hypothyroidism, insulin resistance, embryo quality or altered endometrial receptivity.
Obesity and fertility treatment:
Poor ART outcome is due to central obesity and PCOS, poor quality of embryos and need for higher hormonal doses. Endometrial receptivity may also be affected in obesity.
Obesity and pregnancy :
Obesity exposes mother and baby both to risk during pregnancy.
Chances of development of diabetes, increased BP are higher in obese females. Large baby, neonatal metabolic problems, requirement of operative delivery in case of fetal distress, malpresentation , neonatal morbidity, post partum endometritis is seen more often.
Obesity and male infertility:
Obesity can lead to decreased testosterone and quality of sperms in men. Ejaculatory dysfunctions is higher in obese males.
Health hazards of Obesity:
Other than Fertility problems obesity can affect other aspects of health in form of increased risk of
- High blood pressure
- Cardiovascular accidents
- Joint problems including osteoarthritis
- Sleep apnoea
- Cancers: increased risk of uterine, gall bladder, breast , colon cancer in females and high risk of colon and prostate cancer in males
Can loss of weight help?
Despite of array of problems caused by obesity, situation can be improved by just 5% of weight loss.
Positive effects seen on loss of 5% body weight
- Loss of abdominal fat by 11%
- Increased insulin sensitivity up to 71%
- Improved hormonal milieu of the body
- Regularisation of menses and ovulation
- Reduction in hormonal dosed in ART cycles
- Improved pregnancy rates
- Reduction in medication required for treatment of thyroid problems, diabetes and hypertension.
Life style modification programme:
Focuses on weight reduction by
- Nutritional intervention
- Increased physical activity by exercise programme as Gym, Yoga or walking
- Medications for menstrual regularisation in cases of PCO and thyroid management
- Behavioural modification to assist patient to change outlook towards life.