Roughly
12 percent of all infertility cases can be traced to weight problems in
women—split pretty much evenly between weighing too little and weighing too
much, according to the ASRM.
Seriously overweight women suffer from infertility
at a rate approaching double that of normal weight women. Roughly the same is
true for underweight women. Men, too, face fertility problems related to being
overweight. Seriously overweight men are 50 percent more likely than normal
weight men to be infertile. And it turns out that couples in which both
partners are overweight are three times more likely not to be pregnant after a
year of trying than are couples of normal weight. Just 10 percent over or under
your ideal body weight is all it takes to make a difference in your fertility.
The
Harvard Nurses’ Health Study, a large, long-term research project on a variety
of health topics, found that overweight women took twice as long to get
pregnant as normal weight women. Underweight women experienced an even greater
gap compared to women of normal weight—it took them four times as long to get
pregnant. Being underweight or overweight increases the risk of miscarriage and
other risks of pregnancy as well.
None
of this bodes well for a nation such as ours: famously fat yet obsessed with
being thin, thin, thin. A tangle of factors connect weight and fertility, and
no one has teased them all apart yet. One important component is the estrogen
made in fat cells: the more fat cells, the more estrogen. Increasing estrogen
prevents ovulation (this is what birth control pills do). Seriously overweight
women often have irregular and/or infrequent periods, thanks in part to this
estrogen interference, as well as periods without ovulation or with inadequate
ovulation.
Being
overweight also increases androgens (“male” hormones) in women, impairing
ovulation. In addition, those estrogen-producing fat cells are throwing off
inflammatory substances that can reduce fertility. And excess weight comes with
an increase in insulin levels, yet another contributor to the fertility issues
overweight women have.
Women
who are underweight—who don’t have enough body fat—can’t produce enough
estrogen. The physical stress of being inadequately nourished lowers FSH and LH
levels, which creates low estrogen. This chain reaction results in irregular
cycles, follicles that can’t develop properly, and inadequate or nonexistent
ovulation.
Weight
matters for men who want to conceive, too. Many cases of low sperm count can be
blamed on excess weight. Overweight men have lower testosterone levels than men
of normal weight. As body weight goes up, so does the rate of conversion of
testosterone into a form of estrogen. An excess of estrogen results, which
impairs proper functioning of the testicles, including the development of
sperm.
In
addition, researchers theorize that excess body fat in the groin area and
thighs increases the temperature of the testicles, damaging sperm and impairing
fertility through excess heat, just the way a hot bath or tight leather pants
can. As body weight increases, the quality of sperm decreases (that is, the
rate of genetic abnormalities increases and motility decreases).
Couples in
which the man is overweight also have a greater risk of miscarriage, probably
because of sperm abnormalities.
Being
overweight lowers the success rate of fertility treatments. For example,
over-weight women have a higher rate of miscarriage with ART pregnancies than
do women of normal weight, and the higher the number of excess pounds, the
higher the risk. In addition, overweight women are less likely to respond well
to fertility drugs and so are less successful with IVF and other high-tech
fertility interventions. Being overweight also increases the risks associated
with surgery for infertility.
What You Can Do About It
The
vast majority (more than 75 percent) of women struggling with infertility
caused by being overweight will conceive naturally once their weight stabilizes
at a healthy point. Results are even more dramatic for underweight women: 90
percent of them can expect to conceive once they reach their ideal weight. If
you are overweight, the loss of 5 or 10 percent of your body weight, ideally
with the addition of some exercise, will significantly boost your chances of
pregnancy, even if it doesn’t bring you all the way to your “ideal” weight. If
you are underweight, putting on only a few pounds can make the difference. If
you are planning on IVF, losing any excess weight (or gaining a bit if
necessary) before you begin is one good way to increase your chances of
success. In fact, if you improve your weight, you might not even need IVF. Most
doctors don’t discuss weight with patients before proceeding with fertility
treatments; if you know you are not at your ideal weight, you should make it
your business to have that discussion before you sign up for any more invasive
approaches to getting pregnant.
You
are never going to have a stronger motivation to manage your weight than you do
right now. Wanting to wear a smaller-size wedding dress or impress an old boyfriend
at a high school reunion can’t hold a candle to your desire to conceive a
child. Not even your own health and well-being can. So take advantage! You know
what you need to do: eat well and move more. If you are underweight, add some
healthy fats and protein to your diet. Just a handful of nuts each day and half
an avocado on your lunch salad can do the trick (we’re not asking you to eat
chips and cream sauces). Whether you need to gain or lose, now is the time to
take action.
The
nutrition plan in this book can help you attain your desired weight. If you
need help with specifics such as portion control, you may want to consult any
of the myriad diet books out there or a doctor or nutritionist. Just steer
clear of fads, drastic dieting, and anything likely to produce only short-term
results, such as fasting or meal replacement. The only way to succeed with
weight control is to approach it as a lifestyle change, not a “diet,” and to
proceed at a healthy pace—a pound or two a week. (Losing weight too fast, like
other stressors, can affect the hormones and, as a result, fertility. Anorexia
and bulimia are the extreme examples, but even before you get that far, your
body could be off balance enough to stop ovulating, even if you are still
getting a period.) To maximize your fertility, find that healthy weight and
maintain it.
It’s
never easy to get a handle on your weight, but if you are like most of our
patients, ready and willing to do
anything to have a baby, why not start now? Managing your weight has to be easier
than undergoing surgery or enduring months and months of treatment with
powerful chemical hormones and toxic drugs, with all the attendant short- and
long-term side effects and risks. You’ll also enjoy a long list of benefits to
your general health, and if weight is the root cause of your fertility problem,
normalizing it is the thing that’s going to work best anyway.
Case Study: Morgan
Morgan had been a semipro
tennis player before taking up a-fast-paced job on Wall Street. She was now 28
and as driven and determined to get pregnant as she had been about her career.
But she hadn’t had a period in months, and it had always been erratic in any
case. I (Sami) suspected that Morgan’s estrogen level was too low, and testing
established that she was not ovulating.
Prescribing clomiphene (Clomid) to make
her ovulate was an obvious choice, but I felt that her body may have been
showing some wisdom in not allowing her to conceive. I feared that if I forced
ovulation with drugs, she might not be able to sustain a pregnancy. So I talked
with her about taking some time to get her body ready to conceive before
proceeding with any treatment. I recommended that she scale back on the amount
and intensity of her exercise (she hit the gym daily at 5:30 a.m. and was still
in close to competitive shape), and I talked with her about getting a little
more fat in her diet. She controlled her diet as she did everything else in her
life, and she paid particular attention to avoiding fat for health reasons.
But
in doing so, she was actually missing some of the nutrition her body needed.
Morgan applied the same determination that had made her so successful in other
areas of her life to changing her diet. She made sure to get some healthy fats
at every meal, adding flaxseed oil to her salads, snacking on almonds and
avocados, and eating salmon at least once a week. Morgan gained about four
pounds doing this, which she admitted she found a bit frightening. But it
brought her up to an appropriate weight for her height, so I knew that her body
would be much better able to regulate its hormones and was ready to support a
pregnancy.
At the same time, Morgan consulted Jill and began using an herbal
formula to help rebalance her system. After three months, she ovulated on her
own. But ovulation continued to be erratic, so Morgan decided she wanted some
pharmaceutical help. I gave her Clomid at a very low dose. She immediately
began to ovulate monthly and was soon pregnant.
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