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Weight is such a sensitive issue for many patients and often adds so much anxiety to the mix. I’ve had patients who were denied IVF due to being overweight. My understanding is that being overweight increases the need for gonadotropins, impacts egg quality and implantation, alters the HPG axis and leads to poor cycle outcomes. “The chance of spontaneous conception decreases by 5% for each unit increased in the BMI exceeding 29kg” (Fontana R, & Della Torre, S, 2015).
“To this regard, it has been reported that the time to conceive is longer in women with body mass index (BMI) superior to 25 kg/m2 or inferior to 19 kg/m2, and that both overweight and obesity are significantly related with reduced pregnancy rate, increased supplies of gonadotrophins and higher miscarriage rate. High BMI is also associated with adverse pregnancy outcomes such as gestational diabetes, hypertension and premature births and unbalanced diets with a prevalence of carbohydrates, fatty-acids, proteins or vitamins and micronutrients definitely exert a negative impact on ovulation. Moreover, nutritional factors may influence not only oocyte maturation, but also quality of embryos and efficiency of implantation” (Silvestris et al., 2019)
Research also shows that the follicular fluid of obese women contains higher levels of insulin, lactate, TGs, and C-reactive protein. Obese women have a 13.6% rate of miscarriage compared to normal weight women who have a 10.7% risk of MC. (Sharma et al., 2013).
I think that we have a wonderful advantage in that our practice is holistic and we can take the time to educate our patients. It’s not enough to tell someone to lose weight, they need to understand the reason why this impacts their fertility. I tell my patients that pregnancy is the goal, but ultimately welcoming a healthy child is the end goal. Maternal obesity impacts epigenetics and the long term health of the child. Healthy mother = healthy cells = healthy baby ☺️
I’d love to hear what resources others in the group recommend to patients — referrals to nutritionists, health coaches, others?