“Why do we always have to talk about this?”
This is a question that many patients ask when an infertility doctor brings up overweight and the need to lose weight at the surgery. It is an understandable and human reaction. Someone invades a patient’s privacy while the debate about the health risks associated with being overweight has been going on, ad nauseam, in the media and society.
“I already understand the risks,” many say impatiently.
This is partly true. For example, many people know that being overweight can cause hormonal changes and, consequently, possible absence of periods. However, not many people know that a high BMI (Body Mass Index) may also affect the success of infertility treatment (Kudesia et al., 2018; Rittenberg et al., 2011). Possible factors include reduced quality and number of eggs as well as problems implanting the embryo into the uterus. However, there is no consensus on the effect that being overweight has on the success of the treatment (Lan et al., 2017).
BMI = Body Mass Index, weight (kg)/height (m) x height (m)
“You and I, we’re on the same side.”
When assessing the effectiveness of treatments, weight is one of the factors that the doctor must take into account as part of the big picture. This also involves a number of other factors such as the woman’s age. If the doctor thinks that losing weight is necessary or would improve the likelihood of pregnancy, this must be communicated to the patient. In some cases a weight loss of 5-10% is sufficient (Clark et al., 1995; Pandey et al., 2010).
Issues related to weight are often personal, sensitive and difficult, and bringing up the topic may be unpleasant. But it would be worse not to talk about it as the patient might get an unrealistic idea of her chances of having a baby. It would put a mental strain on the patient and she might lose time in a situation in which losing weight might help. This would not be fair on the patient.
This is the reason that we as health care professionals need to talk about weight.
The good news is that in many cases being overweight is not a reason for not starting the treatments. It is the doctor’s duty to provide the best available information to support the patient’s decision-making. Here at Ovumia we listen to you and want to make it easier for you to find solutions, but we cannot ignore issues that people may find difficult. It is important to remember that you and I are on the same side and that we have a common goal: To create a new life.
References
- Clark AM, Ledger W, Galletly C, Tomlinson L, Blaney F, Wang X, Norman RJ. Weight loss results in significant improvement in pregnancy and ovulation rates in anovulatory obese women. Hum Reprod. 1995; 10: 2705–12.
- Kudesia R, Wu H, Hunter Cohn K, Tan L, Lee JA, Copperman AB, Yurttas Beim P. The effect of female body mass index on in vitro fertilization cycle outcomes: a multi-center analysis. J Assist Reprod Genet. 2018 Aug 21. doi: 10.1007/s10815-018-1290-6.
- Lan L, Harrison CL, Misso M, Hill B, Teede HJ, Mol BW, Moran LJ. Systematic review and meta-analysis of the impact of preconception lifestyle interventions on fertility, obstetric, fetal, anthropometric and metabolic outcomes in men and women. Hum Reprod. Vol. 32, No. 9 pp. 1925–1940, 2017.
- Pandey S, Pandey S, Maheshwari A, Bhattacharya S. The impact of female obesity on the outcome of fertility treatment. J Hum Reprod Sci. 2010 May-Aug; 3(2): 62–67. doi: 10.4103/0974-1208.69332.
- Rittenberg V, Seshadri S, Sunkara SK, Sobaleva S, Oteng-Ntim E, El-Toukhy T. Effect of body mass index on IVF treatment outcome: an updated systematic review and meta-analysis. Reprod Biomed Online. 2011 Oct; 23(4): 421-39. doi: 10.1016/j.rbmo.2011.06.018.
Text:
Anna Kivijärvi
Candido Tomás
Anna Pulkkinen
Hanna Paju
Anna-Maija Kakkonen
