WEIGHING IN ON AN INFERTILITY BIAS
Weigh the Facts
John S. Rinehart, MD, PhD, JD and President of Reproductive Medicine Institute in Chicago (www.reproductivemedicineinstitute.com) cautions the public to ‘weigh the facts’. “The first thing to remember about obesity and fertility is that most obese women are not infertile,” says Rinehart. “For those who are, the cause of their infertility may be an ovulatory dysfunction related to their weight. But a 44 year old obese patient who thinks her primary problem for not achieving a pregnancy is her weight, is ignoring an even greater statistic in that her odds of achieving pregnancy are @ 4%, regardless of her body size.
Weight does negatively impact a woman’s chance to conceive if she is infertile. If a patient is using IVF, there is a direct correlation between the Body Mass Index (BMI) and pregnancy success rate. There is a direct and measurable effect on pregnancy success rates as BMI increases.
Males can also have fertility related issues. Increased BMI in males results in increasing incidence of male factor infertility. These can arise due to hormonal alterations, temperature effects, and performance issues. Weight loss corrects for most of these issues and time is less of a factor as male infertility has a much slower decrease than that of females.
Balancing the Scales
So, what is a reasonable ‘compromise’ for those seeking treatment despite ‘weight-y issues’? “It’s crucial to properly evaluate the patient, not just in regards to weight, but to age, structural issues, ovarian reserve and overall health,” says Rinehart. While an optimal weight certainly produces the best outcome, not only in achieving pregnancy but maintaining it (preeclampsia, gestational diabetes, prematurity et al); at what point, does the time spent on weight loss management result in creating problems of its own?”
Rinehart points out that our current ‘methods for treating obesity’ are largely unsuccessful, with 60-86% of weight loss regained in 3 years and 75- 121% regained in 5 years.
“Prior to undertaking a weight loss regimen whose minimal benefits might be outweighed with the passing of time and ooycte aging, we are better off to offer patients all forms of fertility treatment that correct their problems even if they are overweight. Simultaneously, it must be communicated that obesity will reduce their success rates, but if they understand this, then they should be free to proceed with their treatment."