Obesity in India Reaching Epidemic Proportions

When people think of one of the most pervasive and chronic illness that is affecting almost every age group, obesity easily tops the charts, to an extent that it has reached epidemic proportions in the 21st century, with morbid obesity affecting 5% of the country’s population. Contrary to popular belief, obesity is not just a condition of putting on some extra weight; it is the root cause of many other serious conditions – from cancer to cardiovascular disease and even infertility.

In India, as it is the case in other countries, infertility is becoming a grave concern for many young couples who want to witness the joy of parenthood. Research suggests that it has gone up by 20-30 per cent in the past five years. Men and women may each have certain risk factors that can contribute to infertility which can be genetic, environmental or related to lifestyle. One of the most common risk factors for infertility in both men and women is obesity. A person who is healthy will usually have a BMI (Body Mass Index) between 18.5 and 24.9. A BMI between 25 and 29.9 is considered ‘overweight’ and a BMI over 30 is considered ‘obese’

Obesity Linked Infertility in Women and Men
Obesity is linked to a plethora of health issues, difficulties in conceiving is one of them. Being obese can trigger a lot of hormonal imbalances in a woman’s body, making it difficult to conceive. It is also associated with polycystic ovary syndrome (PCOS), a common cause for infertility in women. However, it is just one of the adverse effects of obesity-induced infertility. Women who are obese are also at a greater risk for other pregnancy complications like having a C-section, giving birth to a large baby or even developing gestational diabetes and hypertension. Obesity has also been observed to affect the endometrial development and implantation. These unfavorable conditions also impair the response of women to assisted conception treatments.

Obesity is known to decrease the rate of successful pregnancy in natural conception cycles and also cause insulin resistance that is linked to anovulation or failure of a woman to produce the egg from each ovary each month.

Most often than not, it is assumed that infertility can affect only women, however, it is not surprising that  overweight and obese men have worse sperm quality than men of healthy weight. Being overweight or obese can also cause hormonal changes in men. A male’s weight problem can play an equal factor in preventing conception; obese men may see a decrease in their sperm production due to hormone irregularities. Excess fat can also harm the testicles, further reducing the overall sperm count. Obese men may also suffer from higher than normal levels of estrogen which can change the makeup of the sperm and lead to low testosterone levels.

Obesity, IVF and Related Risks
The link between obesity and IVF and the impact it has on assisted reproduction cannot be ignored and needs to be taken seriously. However one needs to shed close to 15% of body weight before undergoing the procedure. It is not always necessary to achieve a perfect BMI to undergo IVF. There are risks involved if IVF is performed on obese woman due to few of the following factors.

One of the concerns of IVF involves the use of powerful, super-ovulating drugs called gonadotropins that stimulate a woman’s ovaries to produce multiple eggs for fertilization. Some studies have found that obese women require significantly higher doses of the drugs, increasing the risk of ovarian hyper stimulation syndrome, which, in rare cases, can lead to blood clots, kidney failure or death.

The risk of pre-eclampsia that is a condition of high blood pressure and large amount of protein in the urine usually in the third trimester of pregnancy, doubles in overweight women and triples in obese women. Fat deposition in the abdomen of a woman is known to produce male hormones that prevent follicular maturation and results in anovulation (decreased ovulation) and high chances of miscarriages.

Another problem is that the ultrasound images become very “fuzzy” from the extra tissue between the probe and the ovary. Therefore, it is often difficult to clearly visualize the ovaries and the egg-containing follicles.

Conclusion
Obesity cannot be a deterrent always for conception as it can be handled with modification in lifestyle, any form of exercise and complete guidance by IVF specialist and nutritionist. As a last resort woman can also undergo weight loss surgeries like bariatric and gastric band to improve symptoms of PCOS and thus may even sometimes conceive naturally or with IVF. As a result the pregnancy is safer and the baby is healthier.

However weight loss surgery should always be the last option as carries its own risk of complications, takes time to recover from and requires a significant change in your lifestyle afterwards. You may be advised to wait several months or even up to a year before trying to get pregnant after surgery, so that you have time to build up stores of the nutrients you need to grow a baby. Even so, babies conceived this long after weight loss surgery may still be at risk of being small-for-dates.

By Dr. Nikhil Shetty, Consultant, Reproductive Medicine, Manipal Fertility, Mangaluru