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Obese Britain Summer 2015.pdf

A magazine about Healthy Living, Weight Loss, Exercise and Dieting. Distributed with the Guardian on the 27th June 2015 www.obesebritain.com

OBESITY AND REPRODUCTION

OBESITY AND REPRODUCTION Photograph: iStock 28 Fertility and body weight: Being overweight may double your wait for a pregnancy Being overweight may affect the fertility of both men and women. Professor Adam Balen, who is Professor of Reproductive Medicine in Leeds and Chair of the British Fertility Society, has been studying the links between body weight and fertility for many years. We have known for many years that female fertility is very sensitive to changes in weight whilst this is a relatively new discovery in men. For this reason we understand less about why overweight men have a tendency to produce less fertile sperm and where both environmental and hormonal factors play a role. Women who are underweight stop having periods as they do not have the nutrition to sustain a pregnancy. It therefore seems logical to assume that women with more body fat should be fertile and many are. Going back to ancient times, fertility symbols were of overweight women and until a few years ago the healthy female form was considered to be curvaceous rather than slim. Nonetheless we are now living in an age of sedentary lifestyles and increased calorie intake that this certainly can impede natural fertility but also lead to significant risks during pregnancy. The mother could face diabetes, high blood pressure, problems during delivery and even death, whilst the baby could see an increased risk of miscarriage, congenital abnormalities (heart defects, spina bifida), still birth, prematurity and neonatal problems. We also know that the environment within the ovary that the egg cell develops in can be significantly affected by the mother being overweight – for example, eggs from obese women are more likely to be abnormal and less likely to fertilise. Furthermore the resulting embryos then have to be “incubated” during pregnancy in the safety of a healthy womb. Here again, if the mother is overweight this may lead to long term problems for the baby that may follow him or her through to adulthood. A person’s body mass index (BMI) is calculated by assessing body weight in relation to height, normal being between 20-25 kg/ m2. A person is obese if his or her BMI is more than 30 kg/m2. There are also degrees of obesity: class 1 (30.0–34.9 kg/m2), class 2 (35.0–39.9 kg/m2) and class 3 (> 40 kg/m2). Rates of obesity vary around the world and in the UK more than 60% of the entire adult population are overweight or obese, with rates increasing with age. A recent survey of women attending our clinic for the first time in Leeds, with a mean age of 33, found 31% to be overweight and 17% obese. The mechanism which links obesity to reduced fertility remains to be fully understood. Obese women, particularly those with central obesity (that is fat within the abdomen that increases waist circumference, are less likely to conceive per cycle. Even being slightly overweight (BMI > 27) has a negative effect, but if your BMI is more than 30 your chance of infertility is increased by two to three fold. We also appreciate that ethnicity plays a role in influencing the effect of body weight on fertility. For example in the UK people who originated from South Asia have worse fertility and other health problems (such as diabetes) at a lower BMI than the Caucasian population. This may be because historically some populations have a genetic make up that protects them from the effects of food deprivation in times of famine, but in times of plenty being overweight has a greater impact. Overweight women experience menstrual cycle disturbance and are up to three times more likely not to ovulate than women of normal weight. Obesity not only impairs ovulation but has also been

observed to detrimentally effect endometrial development – the development of the womb lining - and implantation of the embryo, thereby also leading to an increased risk of miscarriage. The commonest hormonal problem experienced by women is polycystic ovary syndrome (PCOS), an area that has been the main focus of my research over the years. The expression of PCOS is regulated, in part, by weight and so obese women with PCOS often have more severe symptoms and experience more sub-fertility. Obesity also impairs the response of women to all fertility treatments, which is why the National Institute of Care Excellence (NICE) advises that NHS funding for fertility treatment should not be offered to women with a BMI of more than 30. Weight loss through lifestyle modification or bariatric surgery has been demonstrated to restore menstrual regularity, ovulation and improve the likelihood of conception and a healthy pregnancy, both naturally and with treatment. CASE STUDY Lucy (not her real name) attended our clinic eighteen months ago at the age of 29 and with a BMI of 36, she had irregular periods but otherwise she and her husband were healthy. Since puberty she had struggled with her weight and found it difficult to exercise. When we explained the impact this was having on her fertility she enrolled in a weight management programme, was careful with her diet and started to swim and then started running once her weight started to fall. She came back to clinic after 6 months with a BMI of 32, by which time she didn’t need further encouragement as she was enjoying feeling fitter. After a further three months her periods were regular and she conceived naturally without the need for treatment. FACTFILE: BODY WEIGHT AND FERTILITY • Fertility is most likely in people with a normal weight • Women who are underweight stop having periods • Women who are overweight and obese have a 2-3 fold reduction in their fertility • Being overweight increases risks during pregnancy and also may adversely effect the long term health of children • Fertility treatments are less likely to work in people who are overweight • Weight loss is best achieved by a combination of diet and exercise ABOUT THE AUTHOR ADAM BALEN Professor Adam Balen MB, BS, MD, DSc, FRCOG is a full time Consultant in Reproductive Medicine at Leeds Teaching Hospitals NHS Trust. 29

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