Obesity is known to have significant effects on the reproductive health of women at all levels, affecting a woman’s ability to conceive naturally and posing adverse pregnancy outcomes such as higher risk of miscarriage and complications of gestational diabetes.

As the problem of infertility has been growing significantly in recent times, fertility experts now suggest that aggressive management of body weight should be a prerequisite for any woman who has trouble conceiving naturally.

Obesity creates fertility problems for both men and women, but more so for women as it can lead to irregular ovulation, high levels of insulin resistance and other metabolic problems.

At least 25-30 per cent of women requiring fertility treatment in the fertility clinic of SAT hospital here are either overweight or obese and over 60 per cent of them already have impaired glucose levels when they come for fertility treatment.

“It is a known fact that about 40 per cent of the infertility in women is contributed by polycystic ovarian syndrome or PCOS and the problem is rampant in Kerala. Several preliminary studies done in adolescent girls and young women show that over 10 per cent of the general population in Kerala have PCOS, which also explains the increasing spectrum of infertility issues here,” says Sheila Balakrishnan, Associate Professor of Obstetrics and Gynaecology, who also heads the fertility clinic at SAT Hospital.

Till about 10 years ago, PCOS was treated merely as a fertility issue, which was thought to be resolved when the woman finally conceived. All women who are obese do not have PCOS, but about 70 per cent of those with PCOS are obese.

Healthy body weight

“We now recognise PCOS to be a component of the metabolic syndrome, which has to be picked up and treated early, even at adolescence. In other words, care should be taken that adolescent girls are encouraged to maintain a healthy bodyweight to prevent the onset of metabolic issues, PCOS and infertility as they become young women,” says Dr. Balakrishnan.

In Kerala, 15-17 per cent of pregnant women have been known to develop gestational diabetes, which has huge health implications for the women and their babies in the long run. Doctors point out that even a five per cent reduction in body weight can have positive outcomes in women’s ovulation pattern.

In fact, a study conducted in the Academic Medical Centre, the Netherlands,(reported in the Journal of Human Reproduction in Dec. 2007) found that even women with normal ovulation cycles had difficulty conceiving spontaneously when their body weight went up. It reported that for every BMI unit over 29, the chance of pregnancy was reduced by four percent, when compared to women with BMI’s between 21 and 29. (A BMI over 25 is overweight and above 30 is obese)

Bariatric surgery

With the growth in the “obesity epidemic,” the number of women undergoing bariatric surgery – considered to be the last resort for the morbidly obese – with the hope of overcoming infertility issues has also been on the rise, doctors report.

“We advise them to adopt lifestyle modifications and to reduce their body weight as the first step towards aiding conception. But many women who had difficulty bringing down their weight through diet modifications and who opted for bariatric surgery have been able to conceive naturally afterwards,” says Mathew John, an endocrinologist in the city.

“Bariatric surgery is not for everyone and certainly it is not the answer to infertility issues. For some, the weight loss following the surgery has a positive impact on their ovulation pattern. We advise women to wait for at least an year after this surgery, before they try to conceive,” he points out.