Obesity is a condition where there is excess body fat resulting in a much higher than ideal body weight. There are various grades of obesity. The commonly used measure of obesity is the Body Mass Index or BMI. The normal BMI for an Indian adult is 23-25. if the BMI is up to 30 the person is overweight. Higher than 30 BMI is obesity. A BMI over 37 is known as morbid obesity. It has been shown from various studies that a BMI over 30 is harmful to the health of the individual. As the BMI increases, so does the risk to an individual’s health. Once the BMI exceeds 37 the risk to health increases exponentially. Therefore weight loss becomes mandatory to prevent serious adverse events on the individual’s health.
The excessive fat in the body has negative effects on all organ systems including the reproductive system. The reproductive system both on the male and female are well controlled by the various hormones. The hypothalamus, pituitary and the end organs ovaries in the female and the testes in the male communicate with each other and maintain a balance to provide the optimal status to facilitate reproduction. This delicate balance is disturbed due to excess fat in the body. Normal metabolic processes are disturbed leading to either excess or reduction of the hormones. This seriously affects the reproductive potential of the individual.
Fortunately, these disturbances are reversible with weight loss. Estrogen is the female hormone and testosterone the male hormone. Both hormones are present in males and females but the levels are different. Obviously, testosterone levels are higher in the males and estrogen in the female. Due to the metabolic disturbances as a result of excess fat, the levels get altered. This can cause a reduction in sexual drive in the male and poor development of eggs in the female. Facial hair, acne and poly-cystic ovaries are commonly seen in these women. These are associated with infertility.
Resistance to Insulin is another important feature of severe obesity. Insulin plays a very important role in the release of the egg from the ovary. Insulin resistance, therefore, interferes with egg release, again leading to infertility.
Weight loss plays a very important role in improving the chances of pregnancy. This is true whether it is an attempt for natural conception or through any method of assisted reproduction. In countries where infertility treatment is state-funded, patients are refused IVF treatment id the female is over 35 BMI. They will be advised to lose weight before any treatment is initiated as studies have shown that the success rates in these patients are very low and IVF is a very expensive treatment. In India where patients are paying from their pocket, it is the responsibility of the doctor to make the patients aware of this fact. This would save the patients a lot of money and frustration of repeated IVF failure.
There are basically two approaches to weight loss. Surgical and non-surgical. In patients that are unable to lose weight through medically supervised weight loss programs and are morbidly obese, Bariatric surgery is offered as an option. Currently, this is the most effective treatment for weight loss in morbidly obese patients.
Gunasheela Fertility Centre & Hospital believes in a comprehensive approach in the treatment of infertile couples. We see a large number of obese infertile patients. If they are morbidly obese, they are advised for a medically supervised weight loss program. If unsuccessful or they have already tried many attempts at weight loss, Bariatric surgery is offered. We have till date performed Bariatric surgery on 26 obese infertile women that had come to the hospital asking for IVF. Out of these 14 have conceived spontaneously. This is comparable to the success rate of IVF in normal weight females. As a result of getting pregnant at a lower weight, their antenatal period has been uneventful. Pregnancy in obese females poses significant risks to both the mother and the fetus. Pregnancy-induced Diabetes, Blood pressure, Growth retardation in the foetus, premature delivery etc. are some of the problems in obese pregnant women.
Author: Dr. Rajshekhar Nayak, Bariatric Surgeon,
Contact: Gunasheela Hospital & Fertility Centre