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What happens when the fertility goddess can't fit in her jeans?
Whatever term you prefer — heavy, obese, plus-sized, husky, rubenesque, zaftig, fat, big-boned, overweight, queen-sized, curvy or full-figured — being too heavy can be an obstacle to getting (and staying) pregnant. According to Dr. Ronald Feinberg, the IVF medical director of the Reproductive Associates of Delaware and the author of
Healing Syndrome O: A Strategic Guide to Fertility, Polycystic Ovaries and Insulin Imbalance, many fertility specialists are concerned about a recent and dramatic increase in the impact of obesity and insulin resistance on fertility, miscarriage and healthy pregnancy.
A couple may have trouble getting or staying pregnant for many reasons, most of which have nothing to do with weight, but women of size may have special concerns about their fertility.
According to Dr. Feinberg, the most common fertility issues for overweight women involve problems with ovulation, especially polycystic ovarian syndrome (PCOS).
Women with PCOS do not respond properly to insulin, a hormone that helps you absorb energy from the food you eat. When your body doesn't respond to normal levels of insulin, the pancreas pumps out even more. This causes a cycle of hunger and overeating, which results in obesity. It also causes the ovaries to produce large amounts of male hormones, which can prevent the ovaries from releasing an egg each month. The result is irregular periods and infertility. Other symptoms may include skin problems (such as acne) and unwanted hair growth.
Should You Lose Weight?
There's no shortage of opinionated people telling plus-sized women to lose weight, but losing weight is not the only answer for PCOS or other fertility issues related to weight, and sometimes weight loss isn't even part of the solution. For example, many infertile women of size simply don't have enough time to lose a lot of weight. An overweight woman in her late 30s may not feel comfortable taking a year off from trying to conceive so she can lose weight.
Some women may choose not to lose weight for personal reasons, or they may have other medical issues that complicate the picture. And women who think they may be pregnant or who are actively trying to conceive should not follow a weight-loss plan without medical supervision.
With all that said, most overweight women can improve their health dramatically and improve their chances of getting pregnant by eating more nutritiously and raising their fitness level. In fact, recent studies have shown that if you're overweight, losing 5-10% of your body weight improves ovulation.
But there is so much more to the fertility story, including emotional health, overall fitness and stress management — your health is more complex than just a number on the scale. Experts today compare your weight to your height by using the "Body Mass Index," or BMI. If you're an adult who's 20 years or older, your BMI will fall into one of these categories: underweight, normal, overweight or obese. The Centers for Disease Control and Prevention (CDC) defines a BMI over 30 as obese, which applies to about one third of the American public. But the potential problems with infertility, treatment and pregnancy for a woman with a BMI of 30 versus a BMI of 48 are vastly different.
The easiest way to calculate your body mass index is to use one of the many BMI calculators on the Internet. You can find one by visiting
MyFreeDiet.com and clicking on "Body Calculators." If you don't have access to the Internet or prefer to do math the old fashioned way, do the following:
- Weigh yourself and record the number. (For example, 180 lbs.)
- Multiply your height (in inches) by itself. (For example, if you are 5' 4" tall, you are 64 inches tall. 64 x 64 = 4096.)
- Divide the answer to Step 1 by the answer to Step 2. (For example, 180 divided by 4096 is 0.044.)
- Multiply the result by 703, and this is your BMI. (For example, 0.044 times 703 = 30.93.)
BMIWeight Status Below 18.5Underweight18.5 – 24.9Normal25.0 – 29.9 Overweight0.0 and AboveObese
If you're overweight or obese, you might want to consider a weight-loss plan (under the guidance of your doctor, of course). According to Dr. Shahab S. Minassian, director of reproductive endocrinology and infertility at Hahnemann University Hospital in Philadelphia and co-director of the Center for Polycystic Ovarian Syndrome, losing weight is a primary treatment goal for many women with PCOS, but it's not the only answer. Weight loss results in lower insulin levels, and ovulation can occur much more regularly. But when weight loss isn't enough to restore fertility or when a woman can't or won't lose weight, fertility clinics can use insulin-lowering drugs such as glucophage to help patients ovulate.
Finding an Accepting Doctor
All women, regardless of health or body size, deserve an honest and caring doctor. If you are concerned about whether a doctor is open and compassionate toward obese women, call and ask if the clinic treats patients with a BMI over a certain amount. If they say no, don't argue the point. Save your energy for other battles (like getting pregnant) and find a better doctor.
If you're having trouble getting pregnant, it's best to see a reproductive endocrinologist (RE) rather than an Ob/Gyn. An RE specializes in hormone problems that affect repro- duction and, since most women with PCOS struggle to maintain a normal weight, an RE that is PCOS-friendly is, by definition, accepting of overweight women.
Dr. Jeffrey Rakoff, medical director of the Scripps Clinic Fertility Center in San Diego, CA, says an overweight woman and her partner can first expect the same fertility tests as any other couple: detailed questions about medical history, a thorough physical exam and ultrasound for the woman and a semen analysis for the man. Regardless of size, women who don't appear to be ovulating may have blood tests, plus a glucose tolerance test to rule out diabetes and to check for insulin resistance. Dr. Rakoff adds that if a woman is overweight, the RE should be careful about ruling out PCOS, since it may be causing the obesity as well as the infertility. If fertility drugs enter the picture, remember that one size does not fit all. Overweight women may need larger doses of medication (or sometimes smaller doses, in the case of women who are insulin resistant). There is also anecdotal evidence that very large women may need to use longer needles for injectable drugs, but according to Dr. Ron Feinberg, that's unusual.
Fertility treatments are no cakewalk, regardless of weight or size. But Dr. Feinberg says overweight women may also have the following problems:
- Blood draws, pelvic exams and ultrasounds are more uncomfortable, especially if it's hard for the doctor or nurse to see the ovaries.
- Surgical procedures like laparoscopy are riskier, particularly if they involve general anesthesia.
- During IVF, it may be harder for a caregiver to use abdominal ultrasound to see the uterus during embryo transfer in IVF.
- It's much more likely that any pregnancy will be high risk and may include miscarriage, premature labor and delivery, gestational diabetes, preeclampsia, fetal growth retardation and increased risk of delivery by Cesarean section.
- It's more difficult and riskier if you have a multiple pregnancy (which is not that rare for patients undergoing fertility treatment).\
- Any pregnancy is riskier if you have other obesity-related conditions such as hypertension, diabetes or heart disease.
If you think losing weight might be a good idea for you before trying to conceive or becoming pregnant, talk with your doctor or medical caregiver first. He or she can refer you to a nutritionist or other specialists if necessary, or can help you craft safe and realistic lifestyle changes, which is better than hurting yourself with a radical pro-gram. Steady, slow progress is much healthier than sudden weight loss and is more likely to help you achieve other goals… like parenthood.
About the author: Marjorie Osterhout is a freelance writer in Seattle.
Infertility article in e-pregnancy 
