Obesity, in 2013 was considered to be a disease by the American Medical Association.

And now in 2022 we consider obesity to be another on-going pandemic.

Yes, you read that right, an on-going Global Pandemic.With this article, we’re trying to understand what is obesity and its relationship with pregnancy, fertility and IVF.

What is Obesity?

 Obesity is excess fat deposition in the body and it is assessed by calculating the Body Mass Index or the BMI.

 The BMI is the weight in kilograms by the height in meters squared.

·      And, a BMI of less than 18 is considered to be underweight

·      18 to 24.9 is considered to be ideal weight

·      25 to 29.9 is considered to be overweight

·      30 to 34.9 is considered to be Grade1 obesity

·      35 to 39.9 is Grade 2 obesity

·      And 40 and above is morbid or Grade3 obesity

Can a person who has a normal BMI still be considered obese?

BMI does not take into account muscle mass. It does not take into account body fat distribution and thus has its limitations. We know very well that central obesity of fat accumulation around the tummy area can increase a person's risk of developing hypertension, diabetes, and heart disease. All these put together is called the Metabolic Syndrome.

 The better measure would be to calculate the Waist-Hip ratio. And if the Waist-Hip ratio is higher than 0.9 in men and 0.8 in women then despite of a normal BMI this particular individual could be at increased risk of developing metabolic syndrome. Hence, normal BMI persons could also be classed as obese based on their Waist-Hip ratio.

How does obesity affect reproduction?

In a fertility clinic, most of these women that come for treatment are found to have Polycystic ovaries but not all of them.

And we know that polycystic ovarian syndrome is associated with irregular periods, and failure to ovulate regularly, and hence they have delayed conception. However nowadays, even women, who do not have polycystic ovaries and are obese can have hormone disturbances and, a delay in conception.

Also, we know very well that these women have an increased risk of miscarriage and they also have an increased risk of recurrent miscarriages. Hence, repeated pregnancy losses.

Also in pregnancy, women who are obese are more likely to have diabetes, hypertension, as well as Caesarean delivery and there is also a chance that they could have a decreased live birth.

Are there any special tests required for obese women?

The first check done for a woman who is looking to get pregnant is to check whether she is ovulating properly. Then, if the fallopian tubes are open and normal and also to see if the semen analysis, the husband's semen analysis is normal. In addition, we always check the ovarian reserve to make sure the woman has sufficient number of eggs.

If a lady is obese, then additionally we need to screen for hypertension and make sure she's not a diabetic by doing aglucose tolerance test. And also, ensure that her cholesterol levels and triglyceride levels are normal.

What is the impact of obesity on IVF?

Obese women actually are less responsive to medication and they take a longer time to stimulate and they usually require larger doses of medication.

Also, the eggs tend to be of poorer quality and the embryos may also be of poorer quality.

However, Aneuploidy, that is chromosome abnormalities in the eggs and embryos are more likely as a result of older age than increased weight.

What are the recommendations to lose weight?

These are recommendations by the AmericanSociety of Reproductive Medicine.

The goal should be to lose at least 5 to 10% of the existing weight over a period of 4 to 6 months. This can improve fertility considerably. Also, a calorie restriction to about 1000-1200 kCals per day is advised. About 150 minutes per week of moderate aerobic activity or 10,000 steps a day in terms of exercise is also advised. It’s also best to get the advice of a dietician as they can provide with personalized solutions basis your body condition.

Now, newer diets like Keto, Paleo, intermittent fasting, vegan, etc, can cause micronutrient deficiency.

Micronutrients meaning, Iron, Calcium, Zinc,Choline Omega-3 Fatty acids, Folic Acid, Vitamin B-12 and Iodine, etc. can all reduce considerably.

And these are important in the periconception period. So going on these newer diets

may not be such a good idea.

Is it important to lose weight before IVF?

So many women come up with this question. And it is our belief that it’s good to lose weight. But you need to give yourself a reasonable amount of time.Now, if you're 25 or 26 years old and you needIVF for whatever reason, and you have a good ovarian reserve, then, you can take your time and lose weight.

But if you're 35 or 36 years old with reduced ovarian reserve, you need to be very prudent and give yourself a limited amount of time and if you fail to lose weight, then it's best to get on with IVF because, age will have a worse effect on egg quality and embryo quality than excess fat.

What is the role for Bariatric surgery for weight loss in women trying to conceive?

There certainly is a role for Bariatric surgery because it's the most definite way one can lose weight and it is usually advised in women with a BMI above 40 or a BMI or above 35 with co-morbidities like hypertension, diabetes, etc.

But the flip side is one has to wait for atleast one year after surgery to plan a conception because pregnancies within one year have been associated with an increased risk of miscarriages, small babies, pre-term deliveries and also micronutrient and Vitamin deficiencies in the mother.

In young women, Bariatric surgery could be ideal if the ovarian reserve is excellent so they have plenty of time to get pregnant, but it may not be suitable in older women who are planning to conceive.

Can male obesity affect reproduction?

Obese males have reduced fertility and this is because of various reasons.

They tend to have to increased Oestrogen in their body and testicular temperature will be raised because of plenty of scrotal fat and also these men tend to have erectile dysfunction more commonly as well as diabetes. And all these factors can impair sperm production, sperm concentration, sperm motility as well as an increase in sperm DNA fragmentation. And sperm DNA fragmentation means when the DNA inside the sperm is broken in various places, and all this could lead to infertility.

Takeaway

If you’re looking to pregnant, losing weight is ideal. It’s important to give yourself time when you’re attempting this.

However, your weight is only secondary to your age. If you’re getting older and you don’t see any results in your weight loss attempts, it’s best to start with IVF.

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