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Obesity and Infertility

The reasons for this blog are several. It will not be the first time that I need to deal with this sensitive topic of telling patients that I will suggest weight management, reduce carbohydrates, decrease portion size, exercise, even suggest medication or surgery. 

Fertility doctors, we do offer fertility treatment anyway and we do not refuse to start treatment just because of an elevated body mass index(BMI). Over the past 40 years, obesity (BMI>30kg/m2) has become epidemic over the western nations. Forty-two to forty-three percent of the American men and women were obese and 20% are severely obese (BMI>40kg/m2).

Obesity has detrimental consequeces in reproduction including anovulation, menstrual dysfunction, decrease in natural fertility, decrease in fertility treatment success and obstetrical outcome. 

Life style modifications, medical management and bariatric surgery are tools to improve obesity and infertility. Obesity is a disease of excess of body fat  and increases the risk for type 2 diabetes, hyperlipidemia, coronary heart diseases, hypertension, endometrial and post menopausal breast cancer, stroke, osteoarthritis and infertility.

It is well known the relation between excess weight and ovulatory dysfunctions, also many times it is likely confounded by the diagnosis of polysistic ovarian syndrome (PCOS). Central obesity can also result in insulin resistance and hyperinsulinemia.  The insulin resistance increases the level of the male hormones (hyperandrogenemia) due to a direct action in the ovary, and all this is affecting the regular menstrual cycle, lack of ovulation and abnormal bleeding.

Obesity also affects the outcome of invitro fertilitzation (IVF) related with the quality of the embryos. Obesity also affects male fertility, such as decreased sperm count or lack of sperm, and also may affect sperm function.

There are several options to manage your weight. They probably need to be discussed based on your own needs, that could be acheived by discussing it with your primary care  physiscian, nutritionist and with me as well. As I have mentioned earlier in essence the weight contributes to fertility issues, Does not mean you will not get pregnant and doctors do not need to postpone treatment due to obesity.

Daniel A Rostein MD FACOG, Fertility Specialist. Fertility Specialist . Minimal Invasive Surgery. Assistant Professor at Loyola Medical School

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