Obesity complicating pregnancy hit the front page of the New York Times today!

We have also seen a rise in obesity related cases of infertility. In a recent medical journal article, being overweight and obesity negatively affect the outcomes of ovarian stimulation and in vitro fertilisation, by D. Zhang, obese women required significantly higher dose fertility medicine and days of stimulation, but exhibited less oocytes retrieved and had a significantly lower fertilisation rate than normal weight women. There were also less high-grade and cryopreserved embryos. This translates into high medication costs, more shots and the need for more fresh cycles of IVF!!!

So how to deal with this….weight loss drugs? Surgery? Boot camps?

These are tough issues because we don’t always know what effect these new drugs or surgery will have on pregnancy but we do know that obesity causes infertility. When obese patients are made aware of the significant impact obesity has on their success rates in conceiving, especially with fertility treatment, they often ask if they should undergo bariatric surgery.

At first it seems a double-edged sword–they need to lose weight to get pregnant, but that means more time spent NOT getting pregnant while their fertility clocks keep ticking. Recent studies indicate that they experience a 25 percent reduction in pregnancy rates if BMI (a measure of height and weight) is in the overweight to obese category. So while they are pouring money into fertility treatments, it makes sense to see if they can increase the chance of success by losing weight first. My recommendation is to check their fertility markers first–FSH level, AMH level, antral follicle count. If these are not showing signs of concern already, then efficient weight loss is the key.

Again, studies prove that weight loss programs, under physician guidance, tend to have the best staying power. This also includes support groups and exercise buddies. I often refer patient to Jump Start, Sunrise Health Medical Group, and The John Muir Weight Loss Clinic as well as individual nutritionists. A recent study publishing in April 2010 showed that bariatric surgery for patients that are obese (BMI >35) before pregnancy reduced high blood pressure to only 10 percent of women (compared to 31 percent), preeclampsia at 2.5 percent (compared to 15 percent). So here’s to low carb, exercise, and maybe even getting more aggressive with medical and surgical means!