Obesity - A Very Sensitive Subject!
Everyday we meet with couples where one or both partners is significantly overweight and we know that even outside the world of "infertility" being overweight has significant health implications. Obese patients have an increased risk of diabetes, hypertension, heart disease, and even cancer! We tend to focus mostly on the female but obesity in the male certainly has an impact on hormonal regulation that has a direct impact on sperm production.
But lets focus on the female. Not only do we have to consider response to ovulation meds, whether for intrauterine insemination or super ovulation for in-vitro fertilization, but we have to consider the impact her weight may have on pregnancy should it occur. Did you know that if you are "obese" your chance if success in your age group could be reduced by as much as 65%?
We try to maintain a BMI cut-off of 39 prior to initiation of treatment but we do take individual patient situations into consideration. For example, we cannot expect a 41 year old female that is attempting pregnancy with her own eggs to take up to 6 months to lose the amount of weight needed to obtain a target BMI. She likely does not have 6 months due to diminished ovarian reserve. As long as the patient is willing to accept that success rates are decreased by as much as 65%, we may still move forward. If a patient's BMI is >40, this is considered too high and too much overall risk involved. After all, the first rule of medicine is "do no harm". Everything we do is elective therefore we must set and adhere to guidelines for patient safety.
Patients that are obese or extremely obese are subject to numerous complications. Those include:
- Decreased response to medications used to initiate follicular recruitment and maturation.
- More complicated IVF cycles because of greater difficulty retrieving eggs because of technical difficulties in being able to access ovaries.
- Increased anesthesia risks that include maintaining airway and possible aspiration.
- Fewer number of eggs retrieved because of decreased response to meds & difficult retrieval.
- Difficulty with embryo transfer because of difficulty in visualizing endometrial cavity under ultrasound guidance.
- Decreased embryo implantation/placentation.
- Lower IVF success rates even with genetically tested embryos.
Should pregnancy occur in the obese or extremely obese patient- more problems are ahead. Those include:
- Increased miscarriage rate.
- Increased risk of pregnancy induced hypertension, gestational diabetes, pre-eclampsia, and stillbirth.
- Increased probability of Cesarean Section which also carries an increased anesthesia risk (as stated above) plus surgical complications and post-operative complications such as pulmonary embolism.
Reproductive treatment is considered elective and we would be remiss in not providing patients with the above information. We can only do so much to help couples accomplish their dream of a baby. Patients MUST take control of their personal situation by making the necessary lifestyle changes with diet and exercise.