Obesity and infertility

Dr. Kiran Rukadikar
Wednesday, 13 March 2019

Dr Kiran Rukadikar, bariatric physician and obesity consultant, talks about how weight-related issues can lead to infertility

What is infertility? Infertility means not being able to conceive after a year of trying (or six months if a woman is 35 or older). Women who can get pregnant but are unable to stay pregnant may also be infertile.
Pregnancy is the result of a process that has many steps. To get pregnant, a woman’s body must release an egg from one of her ovaries (ovulation), then the egg must go through a fallopian tube towards the uterus (womb). A man’s sperm must join with (fertilise) the egg along the way, then the fertilised egg must attach to the inside of the uterus (implantation).
Infertility can happen if there are problems with any of these steps like tuberculosis of uterus, hypoplasia or malformed uterus, blockages of fallopian tubes and peritubal adhesions etc. Another major problem, which is common nowadays, is PCOD Polycystic ovarian disease or Polycystic Ovarian Syndrome PCOS. In short, it means many number of small cysts in the ovaries. It is also the most common cause of infertility in females. 

However, in today’s time obesity or excess fat (weight) and even underweight are some of the most common and significant causes for infertility. That said, not all infertile females are obese and at the same time not all obese females are infertile. There are many women who are underweight and infertile. Having normal weight and fat, highly increases the chances of conception.  

Have a balanced meal
For obese women and men, fat loss by balanced meal and walking has a positive effect on fertility. Eating low calorie but balanced meal for a longer period of time will definitely help in reducing the fat.
Low calorie food certainly doesn’t mean only fruits or salads. Just reducing high-calorie items like fried food, sweets and desserts, dry fruits (including coconut and groundnuts) will itself help a lot. 
Eating frequently that is at least 8 times a day (3 major meals — breakfast, lunch, dinner, 3 times serving of fruits and twice tea / coffee or milk) will help in distributing the energy intake. How much to eat it depends upon your age, height, sleeping hours, work related activities. For proper guidance, you should consult a dietician. 

Avoid excessive exercise
Excessive high-intensity exercise has actually been associated with decreased fertility in certain women. Excessive exercise may change the energy balance in the body, and negatively affect the reproductive system.
Obesity is associated with high testosterone levels; with increased physical exercise, particularly in females the chances of increasing it more are high leading to more complications in conceiving or pregnancy. One large observational study found that the risk of infertility was 3.2 times greater for women who exercised intensely every day, compared to inactive women.
But walking helps tremendously — it will never increase your appetite and also will not make any major hormonal change. So if you are into rigorous exercising, it is time you gave it a break and started walking. And see how wonderfully you make yourself ready for pregnancy.   

Be sexually active
Obese couples who are married for more than 3 years and have not been blessed with a child become more sexually inactive (I have a female patient who did not conceive in 7 years, out of which in the last 3 years she did not have sex). There are many reasons for the same. Prominent of them are inferiority complex of not being able to conceive, self image, one partner is obese and hence the other is not interested, the sheer pressure of having sex just to have a baby is itself a very disturbing job ( yes, job — patients say that they don’t enjoy having sex; they just want the baby). My answer to all these situations is — just enjoy it, have frequent intercourse. Don’t just think of doing it during the ovulation phase, do it outside that phase as well. Sex itself will change your hormones and entire physiology to help you conceive. 

Research from Indiana University has found that sexual activity triggers physiological changes in the body that increase a woman’s chances of getting pregnant, even outside the window of ovulation. “The sexually active women’s immune systems were preparing in advance to the mere possibility of pregnancy,” says Tierney Lorenz , a research scientist. 

Infertility in men
Problems like called varicocele, oligospermia (low sperm count) or azoospermia (no sperm), problem in motility of sperms or sometimes injuries or other damage to the reproductive system may block the sperm. The problems that affect the sperm may start later in life due to illness or injury. 

The Solution 
Before you consult an infertility specialist try this sincerely for 1 year. 
Fat loss or weight loss. 
Only walking and stop exercising. 
Have enough intercourse 

(The writer is a bariatric physician and obesity consultant at www.livenhealthcare.com

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