According to statistics, women who are overweight are more likely to face the problem of infertility than those with normal body mass index values. It's all about the hormonal activity of adipose tissue. It produces many hormone-like substances that act at the systemic level and affect the reproductive system. And as a result - hormonal imbalance and problems with ovulation.
If pregnancy occurs, being overweight significantly increases the risk of miscarriage.
To eliminate these problems with conception and pregnancy, a woman needs to normalize her body weight as much as possible already at the stage of pregnancy planning.
How to determine if a woman is overweight
The most objective indicator for calculating body mass index (BMI) is bioimpedance measurement or body composition analysis. With the help of such a quick and safe diagnosis, you can find out the level of metabolism, the amount of adipose tissue and its distribution in the body, calculate physical activity and, together with your doctor, draw up an effective plan for normalizing parameters.
You can calculate your body mass index yourself. It is determined by the formula: mass in kilograms divided by the square of height in meters. A BMI of 18 to 25 is normal, a BMI of 25 to 29 is overweight, and a BMI of 30 or higher indicates obesity.
Reproductive dysfunction begins already with a BMI of 25-26, and as the numbers increase, the risk of developing infertility also increases. At the same time, excess weight is an obstacle not only to natural conception, but also to successful IVF and to further pregnancy.
There are also a number of cases when women who do not appear to be overweight actually have a metabolic disorder; correction of this disorder must also be carried out before planning a pregnancy.
Why is it so important to lose weight before IVF?
During the IVF protocol, eggs are collected and, after fertilization, embryos are created. When metabolic disorders occur, the quality of oocytes suffers, which negatively affects the condition of the embryos obtained from them. To avoid such negative consequences, an overweight woman needs to lose weight before the IVF protocol.
Of course, with very high rates of obesity, it will not be possible to quickly lose a large number of kilograms; in addition, rapid weight loss can harm your health. However, even a slight weight loss under the strict supervision of a doctor can significantly improve metabolism, and therefore the quality of eggs. The patient must strictly adhere to the individual weight loss program developed by the specialist, and then a positive result will not be long in coming.
Before planning a pregnancy, an overweight woman undergoes diagnostics, which includes:
- measurement of body weight, height;
- calculation of body mass index;
- waist circumference measurement;
- blood pressure control;
- identifying disorders of carbohydrate metabolism - they conduct a test for glucose tolerance, insulin level, and find out other necessary indicators;
- blood chemistry;
- Ultrasound of the abdominal cavity;
- hormone test;
- determination of vitamin D levels.
The effect of excess weight on reproductive function
Excess weight provokes hormonal imbalance.
In the adipose tissue of the female body, male hormones androgens are converted into female hormones - estrogens. When it is in excess, the amount of estrogen exceeds the norm. As a result, an imbalance is formed, which manifests itself in the form of various problems, one of them is related to childbirth and problems at the conception stage. The more excess weight you have, the higher the risk of difficulty conceiving.
Excess weight, especially excess abdominal fat, is associated with insulin resistance (when the body has to produce more insulin to keep blood sugar at normal levels) and decreased levels of sex hormone binding globulin, a protein that is involved in regulating the sex hormones androgens and estrogens. This increases the risk of irregular menstrual cycles, which in turn reduces fertility.
Changes in hormonal balance due to obesity also increase the risk of anovulation. This menstrual cycle disorder is characterized by the absence of ovulation. Many overweight women still ovulate, but the egg quality is significantly lower than in women of normal weight.
With IVF, the likelihood of a normal course and completion of pregnancy in women with overweight or obesity is lower than in women with a normal BMI. On average, the likelihood of having a healthy baby with IVF is reduced by 9% in overweight women and by 20% in obese women.
Women
Excess weight is known to reduce pregnancy rates. To understand whether you have it, you need to find out your body mass index. The normal indicator lies between 18.5 and 25. “It is believed that with a BMI of up to 27.5 there is no effect on the pregnancy rate, that is, a slight excess is still acceptable,” says endocrinologist at the MAMA clinic Elena Ivanovna Eltsova. But the higher the body mass index, the less chance a woman has of getting pregnant both in IVF programs and when trying to conceive naturally. “Nowadays, much attention is paid to the nature of the distribution of fatty tissue. If a woman’s waist circumference is more than 80 cm, then we are talking about abdominal obesity, that is, excessive deposition of fatty tissue in the abdominal area,” comments Elena Ivanovna Eltsova.
How does excess weight affect these processes? Often, obese women have a tendency to type 2 diabetes mellitus (insulin resistance, burdened by heredity); menstrual cycles pass without ovulation; the egg does not fully mature. If you are overweight, difficulties arise with embryo implantation: the endometrium in obese women is less prepared. Carrying a baby in this case also has risks: miscarriages and spontaneous early births occur more often. Obese women have a significantly higher risk of developing gestational diabetes - diabetes mellitus in pregnant women, which also increases the risk of complications during pregnancy
To choose the right treatment tactics, it is very important to understand the cause of excess weight. For example, the issue may be endocrine disorders - in particular, dysfunction of the thyroid gland. In this case, the speed of biochemical processes in the body slows down. “Women with this diagnosis often have a low pulse, a tendency to be overweight, and fat and carbohydrate metabolism is disrupted: the body is in a kind of semi-hibernation,” says Elena Ivanovna Eltsova. If you bring the level of thyroid hormones back to normal, the speed of biochemical processes will increase, metabolic processes will be restored and the woman will lose weight.
It happens that excess weight is a symptom of adrenal dysfunction. In particular, the adrenal glands can produce too much of the hormone cortisol, which will manifest itself in the deposition of fatty tissue mainly in the abdomen and upper shoulder girdle, increased blood pressure, and huge purplish or bright pink wide stretch marks will appear on the skin, especially in the abdominal area (stretch marks). But with such a vivid clinical picture, of course, doctors immediately recognize this disease and the woman comes to the reproductologist with a diagnosis already made.
If the cause is not an endocrine disorder, you can most likely lose 10 to 15 percent of your body weight through diet and exercise. This result is enough to increase your chances of success. Usually the doctor gives the following simple recommendations: daily caloric intake should be reduced to 1200–1600 kcal and physical activity should be added (fitness, swimming, walking - from 11–12 thousand steps per day).
Pharmaceuticals can also be used, but with great caution and only on the recommendation of a doctor. There are not many medicines that have proven effectiveness and safety. In particular, there is a group of drugs that block lipase, an enzyme that breaks down fats in the intestines to the smallest droplets so that they are better absorbed. Thanks to these drugs, absorption of about 30–40 percent of fat can be avoided.
The second type of medication is prescribed if a woman is overweight and has insulin resistance—a partial failure of the body’s cells to recognize their own insulin. This is metformin. What is it for? “Insulin, connecting to the cell wall, opens a gate for glucose. It passes inside and provides all processes with energy,” explains Elena Ivanovna Eltsova. Metformin helps tissues be more sensitive to insulin. And since these processes in a woman’s body are normalized, it becomes easier for her to get pregnant. Metformin is not indicated during pregnancy; it is used only in preparation for pregnancy.
Solving the problem of excess weight
As mentioned above, this problem must be solved at the pregnancy planning stage.
Losing weight increases your chances of getting pregnant - studies have shown that 80% of women who have lost at least 10% of weight have improved reproductive function without additional treatment. It also reduces the risk of complications during pregnancy and childbirth.
If your BMI is significantly higher than 25 and you are unable to get pregnant, it is better to contact a reproductive specialist in Krasnodar at the OXY-center, and also undergo additional diagnostics from an endocrinologist and nutritionist. Doctors will prescribe the necessary examination and, based on its results, draw up a treatment plan, give recommendations on lifestyle changes, nutrition, and adjust hormonal function with subsequent monitoring of ovulation.
Excess weight and hormones in women
How are excess weight and hormones related in women? There are three main hormones that influence weight gain.
Leptin is a regulator of fat content in cells. When the volume of fat in cells decreases, the level of liptin also decreases, which immediately increases appetite and metabolic rate. There is also a reverse process - when there is a lot of fat, leptin tells the brain to stop. But the way we are designed is that with constant overeating, other processes occur in the brain that prevent leptin from stopping the feeling of hunger. Moreover, in healthy people, leptin is a reliable regulator of hunger.
Insulin - the pancreas is responsible for its production. Insulin suppresses the work of enzymes that break down fat, promotes the transformation of excess sugar into fat and, accordingly, the accumulation of fat in cells. When we eat a lot of sweets, insulin levels immediately increase sharply and convert sugar into fat even more actively. Insulin is responsible for fat storage in all parts of the body.
Thyroid hormones. The thyroid gland is responsible for their production. If these hormones are not enough, hypothyroidism appears, in which fat deposition increases sharply, and a person gains weight strongly and unevenly. With an excess of hormones, hyperthyroidism occurs (Graves' disease), and “incorrect” weight loss occurs.
How to avoid gaining excess weight during pregnancy
Everything is simple and not very simple here))
If you carefully monitor your diet, eat a balanced diet, adhering to the above recommendations, include minimal physical activity (in this state, I recommend walking if there are no contraindications).
This is all simplicity. But the difficulty is that sometimes it is difficult to control appetite, not skip meal times, limit portion sizes, refuse strange temptations (a piece of cake with smoked sausage
