Obesity and Fertility
What you need to know when trying to conceive
On my latest episode of multitasking mastery, I cleaning the kitchen and heated leftovers for dinner while I tuned into a panel discussion on one of the recent updates to the world of fertility. The paper, “Obesity and reproduction: A committee opinion” was released from Fertility and Sterility at the end of 2021. There were some interesting points from the discussion that I wanted to share with you. The following is a summary of what the panelist had to say as well as my own takeaways from the paper itself.
Background
The challenge of obesity has created a barrier to fertility treatments for many women. Depending on your own experience, I may be preaching to the choir right now. Most clinics and reproductive endocrinologist work within guidelines that set their cutoffs for the max BMI of their patients. Women who fall above that range are often told to reduce their BMI before they can start treatment. One possible exception may be for women who have a unique time restriction due to the timeline of cancer treatments.
So what about everyone else’s timeline? What about the women who have been trying to get pregnant and wanted their baby yesterday? How important is BMI and obesity to outcomes and what should full bodied mamas-in-the-making do to help their chances?
What’s the issue
Obesity is defined excess body weight starting at a BMI over 30 kg/m2. It is often associated with an increased risk for diabetes, hypertension, endometrial and breast cancer, as well as infertility. Of course. Most clinics have a BMI cut off of 45-50 kg/m2 limiting or even refusing care above that citing safety for the patient and limits of treatments.
Excess body fat can make egg retrieval difficult by interfering with the transvaginal ultrasound. If the ovaries can’t be easily monitored for hyperstimulation for example or even ultimate retrieval then the cycle can be lost. Managing the anesthesia for obese patients during retrievals can also be difficulty and add more risk. All of which go into designated practice standards and cutoffs.
Can you have a baby or not?
During the panel discussion, one key point was brought out that is worth restating. Fat women get pregnant all the time. Overweight women deliver babies to term every day. Fertility is not reduced in women simply because they are fat, it’s reduced because of all the other possible issues that are going on due to the fat cells and the way the body reacts. The BMI number itself is nearly meaningless, but no one has found a better (or bothered to find a better) screening criteria.
Obesity often happens concurrently with high inflammation, hormonal imbalance, insulin resistance, diabetes, weak immune system, gut imbalance....the list goes on. Furthermore, obesity often occurs alongside missing or weak ovulation, irregular cycles, high estrogen, low progesterone, missing cervical mucus...the list goes on. This is what disrupts fertility and the countless, intricate steps that need to happen from the day sperm meets egg until 40 weeks later when baby is born. Fat cells have their own metabolism, their own sending messages and signals to the rest of the body to support their growth. Fat cells make excess estrogen which contributes to the impact on cycles and fertility by estrogen dominance.
Another great point made during the discussion is that obese women are 2x more likely to have a partner that is obese as well. The male fertility factor is just as important, but is often neglected. He isn’t told to reduce his BMI in order to proceed with treatments. So it is not always clear if an overweight/obese woman can’t get or stay pregnant or if she can’t get or stay pregnant with her partner. Is it the effect of obesity to a woman’s eggs, hormones, or uterine lining that prevents pregnancy or the single or added issue of less than optimal sperm?
What should you focus on
So the better question for success of pregnancy and fertility status isn’t what is your BMI, the better question is how (un)healthy are your? How stable are your cycles? How likely is it that your body can safely sustain your health and the health of a growing baby bc both mama and baby are about to need an incredible amount of energy and nutrients? No matter if you are jumping into fertility treatments or trying the old fashion way, your whole body health needs to be your focus. Even if a clinic sets a BMI for you to aim for, is losing weight your only goal? Your eggs and your future baby both need to grown in your internal environment of your ovaries and uterus. How baby friendly are you making it? Tune into your habits to find what areas can you improve.
Wholebody checklist for fertility
Are you getting quality sleep consistently where you wake up feeling rested?
Do you poop everyday?
Do you hydrate yourself with non caffeinated beverages?
Is your cycle and bleeding regular with confirmed ovulation?
Do you have other signs of hormonal imbalance?
New measurements
If you really want to track a metric, look instead at waist circumference and waist-to-height ratio. Abdominal fat is very stressful on the body. The fat that you carry around your waist sits on and envelopes your vital organs. The higher your waist measurement the more likely that your fat cells are inhibiting the health of other systems. An average measurement of 35” is considered healthy. But even better than that is your waist-to-height ratio. This number tells more about your weight distribution. The inches of your waist divided by your height in inches should be 0.42-0.48 to be considered healthy. (In my own practice, I prefer to track measurement rather than the number on the scale because that thing is fickle). The BMI calculation itself is from the 19th century and it wasn’t made with the unique form and physique of black women’s bodies in mind. So it’s biased AF.
Should you lose weight or not?
Researches found no correlation with reducing BMI and increased live births following short term, recent weight loss. However, that is not to say that there is no benefit to shedding excess body fat. There is certainly a reduction to the risk to mom that is normally associated with higher BMI: preeclampsia, gestational diabetes, and labor complications, increased c-section rates, etc. As well as improvements for baby: long-term health, their likelihood of also being obese, size at birth, length of gestation and growing to term. I am not going to body shame anyone, but I do stress the idea of a “healthy weight” that is not based in fat phobia.
Furthermore, there is little research on the mama’s who are overweight and decide one day that they want to lose weight before they have a baby or if they have been trying already and think it will help. The data is mostly skewed towards outcomes of women who use assisted reproductive technology. This is where the research funding is, it doesn’t mean it’s the only rock worth looking under.
What does it all mean...
Weight is a factor. Just like age. But one thing that is abundantly clear is that it is the overall health of mama in the months leading up to and during pregnancy that really matter. Not her age, not the number on the scale. Yes, weight plays a role but it doesn’t stop everyone. So, for those women do find that your fertility is disrupted, it is worth asking why and begin focusing on other conditions and symptoms as well that what role they play. Weight is a side effect, a by product of both poor habits and poor health. It’s not that women don’t know they are overweight and don’t want to lose weight especially if it can help them get pregnant. Focusing on restoring whole body health and restoring healthy cycles should be focus. The weight will lose itself.
It is possible to get pregnant naturally. And the best way is to create fertility focused habits. Not an insane exercise routine. Tell your body that you are safe, nourished, and well taken care of. That it’s ok to support a pregnancy because from now on you will be taking care of yourself and the baby. Eventually, the internal stress can and will subside and implantation and pregnancy can happen. Naturally.
