Obesity Management

It is a known fact now that obesity in either male or female or both contributes directly or indirectly to Infertility. There have been many studies and research to prove that Obesity affects Fertilty potential of a couple. Being overweight is a precursor of obesity and may contribute to the fertility capacity.

How do we define Obesity/overweight’?
For adults, overweight and obesity ranges are determined by using weight and height to calculate a number called the “body mass index” (BMI). BMI is used because, for most people, it correlates with their amount of body fat.

  • An adult who has a BMI between 25 and 29.9 is considered overweight.
  • An adult who has a BMI of 30 or higher is considered obese.
  • An adult wo has a BMI between 20 and 25 is considered having an ideal BMI.

BMI is calculated by the following formula: BMI=Weight in kg/ (Height in meters)

We at Ankoor Fertility clinic directly calculate the fat percentage of a patient depending upon the height and weight with a relatively newer type of machine. This differentiates patients who are overweight because of their bone mass and patients who are overweight because of their fat. The interpretation is note on patients file and accordingly diet and exercise instructions are given.

Obesity

How does Obesity/Overweight affect female fertility?
Obesity has been linked with multiple medical problems including infertility. Infertility in Obese and overweight women is primarily related to ovulatory dysfunction (Growth and release of egg from ovary is hampered). This may lead to menstrual irregularities. Studies have shown that 30-47% of obese women have irregular menstrual cycles. Weight reduction often leads to resumption of normal menses and therefore fertility. New research has shown that obesity also contributes to infertility in women who ovulate normally and have normal menstrual cycles. Polycystic ovary syndrome (PCOS) is a specific medical condition associated with irregular menstrual cycles, anovulation, obesity and elevated levels of male hormones.

In addition to anovulation, there may be other mechanisms by which obesity interferes with the ability to achieve pregnancy. For example obesity is related to poor implantation rates(Egg going into the lining of uterus). It has been shown that obesity is associated with a longer duration of treatment, increased dosage of medication, and an increased risk of treatment cancellation due to poor response. Studies have also shown that pregnancy rates are approximately 30 percent lower in obese women undergoing IVF compared to women of normal weight. It has been proposed that the IVF is less successful for several reasons. Some of these include impaired absorption of medication due to increased fat stores, limited ability to visualize ovaries during ultrasound monitoring, and more challenging egg retrieval.

Ovulation disorders and obesity-associated infertility represent a group of infertile couples that are relatively simple to treat. The mainstay for treatment is weight loss, which improves both natural fertility and conception rates with ART. The most cost-effective treatment strategy for obese infertile women is weight reduction with a hypo-caloric diet.

 
What can women do?
First line treatment for obesity-related infertility is weight loss and lifestyle modification. While any amount of weight loss in obese women may improve fertility, a loss of 5 percent to 10 percent in overall body weight can result in spontaneous ovulation in 60 percent of patients. Efforts should be made to restrict calories to 1000 to 1200kcal/day, and to exercise at moderate intensity for at least 30 minutes, three times a week. Participation in a formal weight loss program can be very helpful.

Apart from weight loss, treatments for infertility in obese women do not differ substantially from treatments in non-obese women. For anovulation, first line treatment generally consists of ovulation induction with oral medications such as clomiphene citrate or anastrazole. Women who fail to achieve pregnancy with oral medications are often treated with injectable ovulation induction agents such as recombinant or urinary gonadotropins. In vitro fertilization is often performed if these treatments fail or if there are other factors contributing to infertility.

 
How does Obesity affect male fertility?
Recent studies have found a link between male fertility problems and obesity. A study found that men with a higher body mass index (BMI) had a significantly higher risk of being infertile compared with men considered to be normal weight. A separate study found that a link between obesity and sperm health. Deteriorated sperm quality increased significantly as BMI passed 25 and was severe in participants whose BMI was over 30. Poor sperm quality not only leads to infertility but also an increase incidence of abortion.

Also IUI and IVF done with sperms of obese men have high failure rate as compared to sperms of normal weight men. In addition, obesity can have a number of other effects on male fertility:

  • low sperm count and concentration
  • hormonal imbalance
  • increased scrotal temperature
  • decreased libido

As such, it is important to maintain good overall health in order to reduce the risk of male fertility problems and in order to maintain good reproductive health. Starting a healthy exercise regimen and a healthy diet plan can help to increase fertility.

 
How does obesity affect pregnancy?
Moreover, once pregnancy occurs, obese women have a higher rate of pregnancy loss. In fact, studies show they have up to a two-fold higher risk of abortion compared to normal weight women. In addition to abortion complications like preterm delivery, intrauterine growth retardation, low birth weight babies, hypertension and diabetes in pregnancy are increased. The incidence of cesarean section is also increased in obese women.

Achieving a normal weight prior to pregnancy can reduce the incidence of these complications significantly; which means that you are obese. It is better to loose as minimum of 10% of your body weight before attempting the invasive procedures like IUI and IVF.This will ensure adequate weight gain during pregnancy and will reduce complications like hypertension, diabetes in mothers and growth retardation in babies.

 
How does anybody manage Obesity or Overweight?
Its easy to calculate IBW. In males, height in cms minus 100 and in females height in cms minus 105, should be your ideal body weight. Body weight 20 % more than Ideal body weight is Obese and greater than two times ideal body weight is morbidly Obese.

Waist/ Hip ratio also can be measured; it should be within 0.7 range to have optimum levels of Estrogen.
Diet plays an important role in the genesis of Obesity. Personal choices, advertising, social customs and cultural influences, as well as food availability and pricing all play a role in determining what and how much we eat.

Weight loss occurs when energy expenditure exceeds energy intake. An energy deficit of 500–1,000 kcal/day will result in a loss of 1–2 pounds/week and an average total weight loss of about 8% after 6 months.

EAT RIGHT AND LESS BUT ,MORE FREQUENTLY.

  • Homemade Skim Milk
  • Brown bread 2 slices
  • Regular breakfast in small quantity & prepared in less oil
  • Egg whites , avoid yolk
  • Drink lot of water
  • No buscuits
  • Tea or milk with less sugar or sugarfreeEat
  • a whole fruit, no juice
  • Before Lunch or Dinner, Should eat lot of salads
  • Or buttermilk, or a veg soup
  • Or boiled vegetables or sprouted salad
  • Or boiled vegetables or sprouted salad
  • Should avoid all fried stuff

2 to 3 kg weight loss per month should be the goal to achieve and after 2 months of weight loss, even if not lost a single KG, maintainence of lost weight is more important.
For negative energy balance, one should start exercising 5 days a week. Should be slow and steady to start , so if not used to exercising then start from simple walks.

These changes in diet and exercises is Lifestyle modification. These all methods are advised and taught in Ankoor fertility clinic. So far , in our clinic Many overweight and Obese patients have lost 5 to 10 kgs easily over a period of time and achived a healthy motherhood.

 

DIET PLAN – Special tips not to forget.

Remember: Half a loaf of bread is better than no bread..Something is better than nothing.

That is, eat something more frequently than absolutely not eating anything…..which is a wrong myth. Rather eat less but more frequently. Don’t starve yourself for a long period as that will turn into fats.

  • Be slow and steady but persistently go on and don’t give up!
  • Take at least 2-3 litre of water daily. Half a litre between meals.
  • In a day try to have 5-6 meals with a gap of 3 hours.
  • Aim at having 3 fruits daily. Have a whole fruit but no juice. Avoid chikoo, papaya, mango, banana, custard apple.
  • Try to consume homemade skimmed milk and also curd made out of this milk. As this milk provide all goodness of milk except fats.
  • Eat all colourful vegetables, include green leafy too. Avoid potato, brinjal, sweet potato, peas.
  • Eat lot of salads before every meal. Make your salads interesting by adding pomegranate or apples or pineapple or raisins, sprouts or chicken slices.
  • Eat your meals very slowly and don’t watch TV or read book or talk on phone, just be with your food only.
  • Try and suffice 3 teaspoons of oil in the entire day food preparation. To use minimum oil, start using different methods like steaming, baking grilling, roasting and start using pressure cooker preparations.
  • Limit your daily sugar intake as excess turns easily into fats.
  • Add a variation to daily cereals intake in breakfast like can have rawa or dalia, oats, jowar, bajra , nachni preparations. Don’t follow” NO CARBS” diet plans…
  • Avoid legumes and whole pulses in night. Thin moong dals is a good option.Use plenty of sprouts and soy in your diet.
  • Exercise daily…..as negative energy balance is possible by only exercising….floor exercises are the best, like surya namaskars, skipping, climb up the stairs, make a conscious efforts to do stretchings.
  • Start saying NO to excess food
  • If there is a will, there is a way…don’t wait, lose excess weight happily and start feeling fresh all the time.