- August 20, 2015
- Comments: 0
- Posted by: admin
Obesity and Infertility
Fertility can be negatively affected by obesity.
In women, early onset of obesity favours the development of menstrual irregularities, decrease in release of eggs from ovary and infertility in the adult age.
Obesity in women can also increase risk of miscarriages and impair the outcomes of assisted reproductive technologies and pregnancy, when the body mass index exceeds 30 kg/m2.
The main factors implicated in the association may be insulin excess and insulin resistance. These adverse effects of obesity are specifically evident in polycystic ovary disease(PCOD)
In men, obesity is associated with low testosterone levels. In massively obese individuals, reduced production of sperms associated with low testosterone hormone levels may favour infertility. Moreover, the frequency of erectile dysfunction increases with increasing body mass index.
How does it happen?
Adipose tissue is an active endocrine organ. In obese women, leptin is increased and adiponectin is decreased.This results in the body not utilizing insulin present in blood. Androgen levels may also be increased. Because of these changes the eggs does not get released from the ovary.
Adverse outcomes are often attributed to the increased prevalence of diabetes in obese women, however, glucose tolerant obese women are also at greater risk of adverse outcome; therefore, other pathways are likely to play a role.
The pathogenesis of some adverse outcomes may be adipose tissue-related dysregulation of metabolic, vascular, and inflammatory pathways, which can affect many organ systems.
For example, insulin resistance and abnormalities in inflammatory pathways have been linked to development of hypertension during pregnancy.The risk of some pregnancy complications rises with increasing obesity, which supports this hypothesis.
IT’S WISE TO KNOW THE FACTS:
Studies have shown that 71 % of PCOD females will get their normal menstruation after bariatric surgery.
The levels of testosterone and other male hormones causing hirsuitism and infertility in PCOD females will come down significantly after weight loss following bariatric surgery.
Pts with PCOD will experience a boost in their fertility after bariatric surgery.
Results of bariatric surgery are better than IVF in obese patients with infertility.
WHAT OUR STUDY SAY:
- In our experience, there were 21 patients who conceived after bariatric procedure during the past two years and all were natural pregnancies.
- 18 pregnancies were after Sleeve Gastrectomy and 3 were after Roux–en–Y Gastric bypass.
- They conceived between 4 months to 2 years after surgery.
- The mean age of the patients was 29 years.
- Mean BMI was 43 at the time of surgery and 29 at pregnancy.
- The mean weight loss before pregnancy was 46 kgs and the mean weight gain in pregnancy was 7 kgs.
- None of them had Gestational hypertension or diabetes mellitus.
- Nobody had nutritional deficiencies.
- There was no antenatal, intranatal and postnatal complications.
- 4 had Caeserian Section in view of obstetric indications and the rest had normal vaginal deliveries.
- The mean birth weight of the babies was 2.8 kgs.
- Other fertility outcomes we observed in our study were resumption of normal menstrual cycle in 80% of individuals within 4 months of bariatric procedure, ease of intercourse and increased spontaneous conception rates.
- We advise the patients to delay pregnancy for 12-18 months (rapid wt loss phase)
- E. Sheiner, “Effect of bariatric surgery on pregnancy outcome,” International Journal of Gynecology and Obstetrics, vol. 103, no. 3, pp. 246–251, 2008.
2. A. C. Wittgrove, L. Jester, P. Wittgrove, and G. W. Clark,”Pregnancy following gastric bypass for morbid obesity,” Obesity Surgery, vol. 8, no. 4, pp. 461–464.