IVF

What is Obesity?

Obesity is a condition defined by an excess amount of body fat. The total body weight may come from muscle, bone, fat and/or body water. Being obese is different from being overweight, which means weighing too much. Obesity increases the risk of health problems such as high blood pressure, diabetes, heart diseases, arthritis and some cancers.

What is Body Mass Index (BMI)?

BMI, i.e. Body Mass Index is a measure used to define Obesity. It is calculated using the person′s measure body weight and height. The body mass index equals a person′s weight in kilograms (kg) divided by their height in meters (m²) squared.

Although it is considered to be a useful way to estimate healthy body weight, it does not help evaluate the body fat percentage. Using BMI, it is easier to determine whether a person is an underweight, healthy weight, overweight or clinically obese.

If an adult has a body mass index (BMI) of between 25 and 29.9, he or she is considered to be overweight. If the BMI is 30 or over, he or she is deemed to be obese.

Why do people become obese?

The balance between calories input and consumption differs for each person. Factors that might affect the weight include:

Consuming too many calories and overeating: Overeating leads to weight gain, especially if it is a fat rich diet.

Leading a sedentary lifestyle: Modern devices like television, computers, video games, remote control, washing machines, dishwashers, add convenience to routine activities, which leads to most people having an inactive or sedentary lifestyle. The less physical activity, the fewer calories will be burnt.

Psychological factor: Some people eat excessively in response to emotions such as boredom, sadness, stress or anger.

Lack of sleep: Periods of less sleep are found to be directly linked to an increased risk of Obesity. The hormone Ghrelin that simulates appetite is produced if the person is not getting enough sleep. Also, the production of the hormone Leptin, that suppresses appetite is reduced.

Genetics: Genes also affects hormones that are involved in fat regulation. Similarly, if one or both parents are obese, it is more likely that their child will develop obesity.

Slow metabolism with increasing age: As we age, we tend to lose muscle, and the metabolism slows down, therefore, we tend to gain weight particularly if we do not reduce our daily caloric intake.

Medications: There are various medications associated with weight gain like antidepressants (medication used in treating depression), anticonvulsants (medication used in controlling seizures), diabetes medications (medications used in lowering blood sugar such as insulin), oral contraceptives and most corticosteroids.

What are the health risks associated with obesity?

Obesity brings one closer to many diseases. It increases the risk of choric conditions like Osteoarthritis (degeneration of bone and cartilage), coronary heart disease, high blood pressure (hypertension), type-2 diabetes, sleep apnea and even respiratory problems. Obesity causes over-production of cholesterol, which may lead to gallbladder related disease.

The link between obesity, infertility and pregnancy complications

Obesity is linked to several health problems including infertility. Obesity in women lowers the chance for spontaneous pregnancy (the time to conception was increased more than two fold among overweight/obese women with BMI >25 kg/m2), can increase the risk of miscarriages and impairs the outcomes of assisted reproductive technologies and pregnancy especially when the body mass index exceeds 30kg/m².

The reason for this is due to insulin excess and insulin resistance. Studies have shown that the negative impact of obesity seems to be in the egg and the uterus/endometrium. Furthermore in obese women, there is an increasing amount of evidence that many complications of pregnancy for the mother (gestational diabetes, preeclampsia) and her baby (birth defects) are increased. Also obese women have an increased chance of a cesarean section for delivery.

In men, obesity is associated with low testosterone levels. In severely obese man, reduced sperm production (spermatogenesis) related with severe hypotestosteronemia (Low abnormal concentration of testosterone) may favor infertility. Moreover, the occurrence of erectile dysfunction increases with increasing body mass index.

What can be done to increase fertility in overweight men and women?

To increase the chance of conception, for a successful pregnancy and the birth of a healthy baby in overweight and obese women, they should first receive counseling on the potential medical, obstetric, and neonatal complications.

The foremost treatments for obesity and weight-loss are regular exercise and dieting. These help restore ovulatory function and reduce the rate of miscarriage in obese women who were infertile. When lifestyle modification does not help after a period of six months for women with a BMI 27 or 30 kg/m2 , then Pharmacology is recommended.

Apart from these, for women having a BMI 40 kg/m2 Bariatric Surgery is recommended. This procedure has shown significant improvement in obesity related co-morbidities that included irregular periods and infertility. However, it is advised not to try for pregnancy the first year after Bariatric surgery.

A multidisciplinary approach to weight management is important. This includes the initial assessment of infertility and body mass index, emphasis on the importance of lifestyle change, education about proper diet, exercise and behavior modification. A more holistic approach to obesity and reproductive health may help increase the chance of conception.

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