Infertility Due to Obesity

According to the International Obesity Task Force, around 1.1 billion adults worldwide are overweight. At the same time, around 312 million people are categorized as obese.

The World Health Organization (WHO) differentiates overweight and obese individuals based on their Body Mass Index (BMI). A BMI of greater than or equal to 25 is considered, while BMI greater than or equal to 30 is diagnosed as obese. Moreover, a BMI greater than or equal to 40 is already considered morbidly obese.

The increase in the prevalence of obesity and high-risk BMI also increases many people’s risk of developing chronic diseases. Being overweight or obese is associated with various comorbidities. Health problems such as diabetes mellitus, hypertension, coronary heart disease, osteoarthritis, and various types of cancers (including endometrium, breast, and colon) are linked to weight problems. A reason behind the relationship between our weight and health is because as the body accumulates fat, it surrounds our organs and hinders its normal function. Most overweight or obese people develop more than one health issue due to their weight.

As obesity rates climb up, so does the mortality rate among the population. Usually, health conditions caused by obesity are linked to one another. Developing one comorbidity may lead to a domino effect of developing more severe conditions. Sadly, the accumulation of these diseases may lead to death.

Furthermore, obesity can have different impacts on men and women. A person’s sex can direct what type of health condition they might develop, as men and women have different biological makeup. For women, one of the main health risks brought by obesity is infertility. However, it is not only women affected by this problem. Even men’s ability to reproduce may also be affected by their weight.

If you are looking to start your own family, you might want to keep your weight in check. To know more, this article will talk more about the relationship between obesity and infertility, and what you can do to avoid this issue. We will also look into alternative solutions for people who struggle to lose weight.

Relationship between Female Infertility and Obesity

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Aside from the common metabolic conditions, obesity may also affect one’s ability to reproduce offspring. If you are a woman and planning your pregnancy, your ob gyne might be reminding you to maintain a steady healthy weight. It does not mean that overweight or obese women automatically struggle in bearing a child. Some do not face any problems despite their weight, but some find it hard to produce a child because of weight problems.

Weight problems may lead to hormonal imbalances. Obesity changes the way how sex hormones are stored in a woman’s body. Even though it is considered a predominantly male hormone, women still have a level of testosterone in their body alongside oestrogen. It is important to keep the balance of these hormones, especially when it comes to reproduction.

Fat cells convert a male hormone called androstenedione (found in the ovaries and testes) into a female hormone known as estrone. Estrone then affects the part of the brain that is responsible for regulating ovarian and testicular function. As a result, it weakens the body’s ability to reproduce.

The issue of infertility among overweight and obese women are usually rooted in ovulation problems, specifically their body’s inability to release eggs from the ovaries. Obese women tend to have irregular menstrual cycles and ovulation.

A disorder that more specifically affects infertility in obese women is polycystic ovary syndrome (PCOS). PCOS is a hormonal disorder, where higher levels of a male hormone (androgen). This causes small collections of fluid or follicles to develop in the ovaries, hindering the regularity of egg cells. As a result, women have infrequent or prolonged menstrual periods and it’s harder for them to get pregnant.

With that said, obese women who do have normal ovulation cycles still have a hard conceiving compared to women with a normal weight. It might not be just because of weight problems; it can be due to other disorders such as thyroid disease, insulin resistance, and diabetes.

Again, weight problems do not automatically mean that you will have a hard time getting pregnant. In some cases, overweight and obese women get to conceive their children. However, doctors still consistently ask them to lose or maintain a normal weight. This is because excess weight does not only bring issues before pregnancy but also during those nine months. Sadly, this issue may also extend to your child.

Impact of Obesity During Pregnancy

Maintaining a high-risk BMI during pregnancy may lead to the following circumstances for you and your child:

Birth Defects

Birth defects are changes in any part of the body, including the heart, brain, foot, and more that are present from the child’s birth. Such defects may affect the child’s well-being, depending on what organ or body part is affected and how severe the condition is.

The latest researches state that babies born to mothers who are obese before and during pregnancy are more likely to develop major birth defects. Some common birth defects in these cases include heart defects and neural tube defects (NTDs).

Congenital heart defects are heart conditions that are present since birth. It is said that women who are overweight or obese have a higher risk of having a child with congenital heart defects. Even though the association between obesity and congenital heart defects remains unclear, numerous researches point to that fact. Severely obese women are twice as likely to have a child with congenital defects than women with a healthy weight.

Another common birth defect is neural tube defects (NTDs). NTDs affect the brain, spine, or spinal cord. It usually develops during the first month of pregnancy, even before the woman knows she is pregnant. Two of the most common NTDs are spina bifida and anencephaly.

Spina bifida happens when the foetal spinal column does not close completely, resulting in nerve damage that causes some paralysis on the legs. On the other hand, anencephaly happens when the brain and skull do not develop properly, which may lead to stillbirth or early child death. These defects may be caused by obesity or poorly controlled diabetes during pregnancy.

Foetal Macrosomia

Foetal macrosomia refers to a newborn that is much larger than an average baby. These are babies that weigh 8 pounds, 13 ounces (4,000 grams), no matter their gestational age. As a result, it complicates natural childbirth and increases the risk of injury during birth.

Maternal obesity increases the likelihood of this happening. It is because obesity may lead to maternal diabetes. If left uncontrolled, the baby tends to have larger shoulders and greater amounts of body fat than they need to be during their gestational age.

Childhood Asthma

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Weight gain and obesity during pregnancy are risk factors for your child to develop early childhood asthma. Studies show the relationship between maternal obesity and the increased instance of a child developing asthma during the first four years of their life.

Stillbirth

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Stillbirth refers to a foetus’ death during the 20th week- or onwards- of the mother's pregnancy. It may happen weeks or hours before labour. There are three classifications of stillbirth, depending on the number of weeks of pregnancy:

- Early stillbirth is between 20 and 27 weeks.
- Late stillbirth is between 28 and 36 weeks.
- Term stillbirth is on the 37th week or after.

The relationship between obesity and stillbirth is complex. Several other factors may contribute to the risk of stillbirth. However, an increasing BMI may also lead to an increased risk of stillbirth, especially during early and late-term gestation periods.

Preterm birth

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Preterm birth happens when the baby is born before the 37 weeks of pregnancy is completed. When it comes to a baby’s development during pregnancy, the final months and weeks are crucial. Having the child born earlier may lead to a lack of development in the brain, lungs, and liver.

Obese women may have the risk of undergoing extremely preterm delivery due to other issues brought by their weight. For instance, they might experience preeclampsia, which is characterised by high blood pressure and damage to other organs, often the liver and kidneys. This then results in a need for early delivery to get rid of the mother and the child of further risk.

Miscarriage

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Many studies have been focused on the association between maternal obesity and miscarriage. Weight problems increase the risk of miscarriage and recurrent miscarriage. It may be due to conditions such as preeclampsia or diabetes that increase the risk of complications during pregnancy. Furthermore, obesity may also affect women with PCOS, increasing the risk of miscarriage.

Though there’s a strong relationship, a majority of overweight women do not experience a miscarriage.

Relationship Between Male Infertility and Obesity

As mentioned earlier, infertility does not only concern women but also men. Obese men also run the risk of infertility.

Obesity may also cause hormonal changes among men. Obese men tend to have higher estrogen levels, creating an imbalance in the body’s hormonal levels. It also lowers the levels of testosterone and other sperm-producing hormones like inhibin b and androgen. As a result, obese men commonly have low sperm counts and low sperm motility compared to men with a healthy weight.

Medical Weight Loss Option

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As you are planning your pregnancy, there are more factors you need to consider when it comes to losing weight. To address your weight loss holistically, a great way to do so is through alternative medical approaches. One of the many people who decided to undergo medical weight loss is Ms Nur Shahida Suhaimi.

Shahida was a 35-year-old mother of two, who hopes to conceive a third child as a part of her dream of having a big family. However, weighing at 106kg and a BMI above 32.5, obesity hinders her plans. Her doctor advised her to lose weight, but this simple goal proved to be more difficult to achieve. She tried to shed off the excess weight through traditional diet and exercise, but to no avail.

A medical approach was opened to her. Bariatric surgery is a surgery that creates changes to the stomach and other parts of the digestive system, limiting the amount of food one can consume. However, Shahida refused to undergo the operation, as she is not looking to undergo another surgery after having two previous caesarean deliveries. She is not the only one. According to an article by the Singapore General Hospital (SGH), 50% of Obesity Centre’s patients refuse to undergo bariatric surgery despite being qualified candidates for the operation. A big part of the reason is that it is an invasive procedure.

Credits: Singapore General Hospital

So, Shahida opted for another medical weight loss approach, through the help of a swallowable gastric balloon. Gastric balloons take up space inside the stomach and allow smaller food consumption, thus leading to weight loss. The gastric balloon used for Shahida did not require surgery, endoscopy, or anaesthesia. Rather, the balloon is placed by swallowing a capsule (containing the inflated balloon) with a glass of water. She was fully awake throughout the procedure, which only took 20 minutes.

Initially, Shahida could only drink water for the first two to three days after the balloon placement. After a week she was fully recovered and was able to consume small portions of food. She also made changes to her lifestyle like cutting out carbs from her diet, consuming more protein, and exercising for at least 10 minutes a day.

With the help of the gastric balloon, Shahida reportedly lost nearly 15kg after 4 weeks. With the additional lifestyle changes, she further lost another 5kg to 10kg.

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Many people wish to fulfil their dream of having a family, but their weight sets a hindrance from achieving it. While some might see great results through mere diet and diet exercise, others find it hard to do so. It is because their body is already used to having excess weight, and it takes targeted diet and exercise to shed them off.

Undergoing medical weight loss can be a big help. If you are like Shahida and concerned that pregnancy may affect your outlook on surgery, there are more options out there aside from bariatric operations. Treatments like gastric balloons, usually come under a program that helps you find the right diet and exercise regimen that assists you in losing and sustaining your weight.

With that said, it is not advised to have a balloon placed during pregnancy as it can threaten the growth of your baby. It is best to do it before or after having a child to achieve great and safe results.

Go forward in your dreams of having your own family by taking the first step in your fitness journey! Please seek advice from a qualified doctor to assess eligibility for this program.