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Infertility: Myths and facts related to obesity and reproductive health

ByZarafshan Shiraz, Delhi
Feb 15, 2023 08:26 AM IST

1 in every 15 couples is struggling with infertility. Since the struggle can be very challenging and stressful, both emotionally as well as physically, we got an expert to bust myths and spill facts related to obesity and reproductive health

Discussions around reproductive health and infertility are typically considered a taboo in the Indian sub-continent however, the reality is that today one in every fifteen couples are struggling with infertility. According to the Indian Society of Assisted Reproduction, India has approximately 27.5 million women and men with infertility.

Infertility: Myths and facts related to obesity and reproductive health (Photo by AllGo - An App For Plus Size People on Unsplash)
Infertility: Myths and facts related to obesity and reproductive health (Photo by AllGo - An App For Plus Size People on Unsplash)

The struggle with “infertility” can be very challenging and stressful, both emotionally as well as physically. There are multiple reasons for the rapidly rising rate of infertility and in the recent years, obesity has emerged as one of the important causes for fertility struggles in both women and men in addition to other factors.

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In an interview with HT Lifestyle, Dr Aparna Govil Bhasker, Consultant Bariatric and Laparoscopic Surgeon at Saifee, Namaha, Apollo Spectra and Currae Specialty Hospitals, highlighted the impact of obesity on reproductive health and said, “ The effect of obesity on reproductive health is complex. In women, obesity is associated with irregularity in periods which is usually a result of anovulatory cycles.”

She revealed, “Women with obesity tend to be insulin resistant which in turn promotes the development of polycystic ovarian syndrome or PCOS [PCOS is a condition in which the ovaries become enlarged and have multiple small collections of fluid]. Increased levels of multiple hormones such as luteinizing hormone, leptin, insulin, estrone, triglycerides and very low density lipo-proteins in turn have a negative impact on the hypopituitary gonadotrophic axis which in turn leads to infertility.”

The health expert cautioned, “Even after they conceive, women with obesity tend to have a higher chance of miscarriage or abortion. This is compounded by the fact that many times they tend to have irregular menses and miscarriages may go unnoticed. The other risks during pregnancy include high blood pressure, increased incidence of gestational diabetes, pre-eclampsia, infection and blood clotting (venous thrombo-embolism) and still-birth.”

Dr Aparna Govil Bhasker debunked the following myths and shared facts related to obesity and reproductive health:

· Myth 1# Obesity is only due to unhealthy diet and is self-induced.

People and especially women with obesity and infertility, battle with a double stigma. It has now been proven that obesity is not just about eating the wrong food. It is a result of complex interactions between genetic, developmental, behavioural, and environmental factors. Obesity is a disease just like diabetes, high blood pressure or heart disease and can affect anyone. Obesity is not self-inflicted and we need to work towards decreasing the stigma and bias against it.

· Myth 2# Eating less and moving more will lead to weight loss

Diet and lifestyle modification is an important aspect of the treatment for obesity. However, it is not the only treatment and neither can it be applicable in isolation for all stages of obesity. Only the people who are in the “overweight” category benefit from diet and lifestyle modification. As the weight and body mass index increase, the intensity of treatment needs to increase as well. Treatment modalities for obesity include pharmacotherapy, endoscopic therapies and bariatric surgery in isolation or in combination depending on the stage of the disease. Pushing patients with severe obesity into endless fad diets cannot produce effective outcomes in all patients.

· Myth 3# Obesity only impacts fertility in women

Obesity not only impacts fertility rates in women, it has a negative impact on fertility in men. It can lead to low sperm counts, erectile dysfunction and decreased interest in intercourse in men.

· Myth 4# Bariatric surgery can affect fertility in a negative manner.

Studies have now proven that weight loss subsequent to bariatric surgery has a positive impact on fertility in both women and men. Reproductive abnormalities induced by obesity tend to improve after weight loss. PCOS improves and period cycle tends to become more regularized and cycles become ovulatory from anovulatory. Bariatric surgery does wonders for women with obesity & infertility. The chances of natural conception increase greatly and even the outcomes after assisted reproduction techniques like IVF etc are much better after weight loss. One needs to wait for 12 to 18 months after surgery for weight loss and nutritional status to stabilize. After that, most women can go ahead with conception as per their doctor’s advice.

“Once other causes of infertility have been ruled out, it is essential that overweight and obese women attending infertility clinics be given necessary advice about weight loss. Reproductive abnormalities induced by obesity tend to improve after weight loss. Lifestyle modification forms the cornerstone of therapy and must be the first line of advice. Patients must be put on medically supervised diet and exercise programs. However, other treatment modalities for obesity like pharmaco-therapy, endoscopic therapies and bariatric surgery may be considered as per the stage and severity of obesity. A specialist must be consulted to recommend which treatment modality will be suitable for a particular patient as per their clinical profile,” Dr Aparna Govil Bhasker concluded.

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