Fertility Advice for Overweight and Obese Women

by Rebecca Smith Waddell

Here's What You'll Find Below:Most common weight-related reasons for infertility
Affects of weight on conception and pregnancy
Finding a weight-friendly health care provider
Test you can expect
Concerning medication
Improving the chance of getting pregnant
Controlling weight while making a baby

Does extra weight alone compromise fertility?

No, one should not assume weight alone is a problem. It can be, but it is not a given. In fact, weight is probably only a factor less than 10 percent of the time. The primary obstacle for overweight women is ovulation. If your physician suggests all your problems will be solved simply by losing weight, seek a second opinion because even if your weight is an issue, it is something medications can work around.

What are the most common weight-related reasons for infertility?

The two most common problems are excess estrogen and polycystic ovaries (PCOS). Along with both of these is a greater chance of a luteal phase defect (LPD).

Estrogen: Fat cells produce estrogen. The problem is that if you get too much estrogen your body reacts as if it is on birth control. Ovulation may not occur or it may be inadequate. An inadequate ovulation contributes to LPD, mentioned below.

PCOS: This is a endocrine disorder with any combination of several symptoms. These symptoms include irregular cycles, cysts in the ovaries, ovulatory pain, anovulation, acne, excess body hair (face, chest, below navel, toes), heavy and painful periods, as well as a high LH-FSH ratio (>3:1). Diagnosis involves both a physical exam, usually including an ultrasound to check ovaries, and blood work. Recommended blood tests will be addressed later in this document. See web sites and medical journal abstracts for more information.

LPD: The luteal phase in the time between ovulation and menses. The ideal length is 14 days, 12-16 being normal. There are a number of ways to diagnose the problem, including serum progesterone tests 7 days post-ovulation, endometrial biopsies, and the length of the luteal phase can be observed by charting basal body temperatures and/or being aware of when ovulation occurred. LPD can be caused by inadequate ovulation, so improving the quality and perhaps quantity of follicles produced will help straighten things out so that the lining is properly supported.

Does weight effect conception rates? What about body fat distribution?

There was a study published in the British Medical Journal that found that very lean women and very obese women (BMI >38) had lower conception rates. However, body fat distribution was found to have a greater impact. Women with a high waist-hip ratio had greater trouble conceiving -- so being shaped like an apple is not as good for conception as being shaped like a pear. PCOS women may be more likely to have the apple shape.

Does the extra weight put me at risk for pregnancy complications?

Extra weight can be related two pregnancy problems: gestational diabetes and pre-eclampsia. Generally speaking, gestational diabetes is very controllable. One thing that is very important to remember is that even though you may be at higher risk for something, it doesn't mean you are at a high risk. It also doesn't mean that you are not entitled to have a baby.