Being healthy is essential for having a normal reproductive potential. Any chronic or long-term health disorder can reduce this reproductive potential of a couple. However, many people think that the mere absence of a health challenge such as hypertension (HTN), diabetes mellitus (DM), thyroid disorders, and so on amounts to being healthy. It’s not so. Being obese is enough to say that we are unhealthy. Here is how obesity effects fertility in men and women:
Medical complications of obesity are many. Being obese is like inviting many health problems such as HTN, DM, cardiovascular disorders, thyroid problems, fertility issues and even certain cancers. In other words, we can say that obesity is the mother of many diseases.
Obesity prevalence is rapidly increasing and has become a worldwide epidemic.
What is Obesity
Based on the body mass index (BMI), obesity of three orders is widely recognised. They are Obese, Overweight and Morbid Obesity.
Calculate your BMI by dividing your weight in kilograms by the square of your height in metres.
- A healthy BMI is considered to be between 18.5 and 24.9.
- Having a BMI between 25 and 29.9 is considered ‘overweight’.
- A BMI over 30 is considered ‘obese’.
- If it is more than 40, it is said to be ‘severe’ or ‘morbid obesity’.
Causes of Obesity
Nowadays, the foremost cause of obesity is an unhealthy lifestyle, that is, a sedentary or inactive lifestyle along with bad eating habits, worsened by lack of sleep and too much stress.
Other causes of obesity are hormonal (uncorrected hypothyroidism, insulin resistance, Polycystic ovary syndrome [PCOS]), certain medications (like antipsychotics, antidepressants, steroids which may alter body’s calorie-burning mechanisms) and genetic predisposition.
Is Obesity Hereditary
No. Children of obese parents do not always become obese. However, they are at a high risk to develop obesity if they don’t follow a healthy lifestyle, that is good food habits and physical activity.
Complications of Obesity and Its Effects on Female Fertility
Many don’t realise that the complications of obesity include the significant impact on fertility in both men and women. The link between obesity and infertility is known. Research says that it may be because of hormones, free radicles and chronic inflammation.
Chances of Pregnancy are Lower in Obese Women
When BMI is >35, a woman has 26% fewer chances for spontaneous conception, and if BMI > 40 she has 43% fewer chances for natural conception.
High BMI also will give suboptimal pregnancy rates even with fertility treatments.
Obesity in women can cause problems both before conception and even after getting pregnant.
- Obese women will have ovulatory problems as it is mostly associated with PCOS and other hormonal issues.
- Even when a woman is regularly ovulating the chances for conception are less in obese woman, and they take a longer time to conceive as the quality of the egg is low in these women.
- After conception, these women have more chances to develop complications like miscarriages, HTN, Gestational diabetes mellitus (GDM), thyroid problems, preterm deliveries, difficulty in having a normal delivery and complications during a caesarean procedure.
- The baby may have growth issues and may develop long term problems such as childhood obesity, HTN, DM, and so on in early life due to alteration of genes in intrauterine life due to maternal obesity.
So, losing weight is not only important to improve the chances of conception but also to improve pregnancy outcomes and to give birth to an offspring without long term consequences.
Effects of Obesity on Male Fertility and Sexuality
Until recently, it was thought that the age and health of a woman were important in determining the genetic makeup of the offspring. But recent research says that paternal age and health status also has an impact on offspring at birth and with long term consequences.
- Obesity in men also affects their fertility. Several mechanisms might account for the effect of obesity on male infertility, both directly and indirectly, inducing sleep apnea, alterations in hormonal profiles and increased scrotal temperatures. The effects of obesity in men ultimately manifest as impaired semen parameters such as decreased total sperm count, concentration and motility; increased DNA fragmentation index).
- Men may develop sexual dysfunctions such as erectile and ejaculatory challenges.
How Does Obesity Management Help Fertility in Men and Women
Available data indicates that obesity management is a necessity.
Obesity management can be achieved through weight loss. Weight loss of at least 5-10% will improve fertility potential in spontaneous cycles and also in treatment cycles.
Weight reduction or obesity management should be achieved through healthy ways, i.e., proper diet, physical activity along with good sleep and proper stress management. And this healthy lifestyle should be followed even after attaining the ideal weight.
For those who are overweight and obese, a balanced diet with complex carbohydrates, instead of simple sugars, with good protein and energy deficiency of 500-750kcal/day is good enough to achieve sufficient weight loss.
Similarly, any kind of physical activity can be chosen as no specific activity is proven to be better than others. Vigorous- to moderate-activity of 150-250min/week is found to be effective in achieving weight loss.
For young couples where there are no other obvious reasons for immediate treatment are advised to have lifestyle corrections and weight loss before conception.
For aged women or for women who have serious issues where fertility treatments can’t be delayed, lifestyle corrections and weight loss are advised along with treatment protocols to improve the outcome.
Our Experience with Obese Couples
Many obese couples who visit our clinics say that they are ready to do anything to conceive. But when we advise weight reduction, they neglect it.
Couples often don’t realise the importance of weight loss even after explaining its importance in several sessions. They are ready to pop up as many pills as possible and just sit without any physical activity. They even want pills to lose weight.
No fancy diets or drinks or belts can give healthy and long-term benefits. Instead, they spoil the internal environment, which then becomes unfavourable for conception even after weight loss.
There is no shortcut for weight loss.
If conception is important, couples need to lose weight in a healthy way such that their internal environment becomes conducive to conception and conception happens naturally.
To conclude, lifestyle corrections are essential or critical part of fertility treatments without which any treatment is incomplete and will give suboptimal results.
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