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Lifestyle Factors & Infertility Treatment June 2006 Introduction Advances in sophisticated reproductive technology have certainly given hope to many experiencing infertility. However, this has perhaps led to an underestimation of the significance of the steps that can be taken at a primary health care level to dramatically improve fertility and, indeed, to enhance the outcomes of assisted reproductive technology should its use ultimately be recommended. This is demonstrated particularly with respect to body weight and fitness. Many studies have now shown that overweight women experiencing fertility difficulty who lose weight (5 - 10kg) through a combination of healthy diet and exercise, have an increase in pregnancy rates. The following is such a case.
Sue is 31 and Allen 32 years of age. Both have BMIs >35. Sue works as a care worker in a nursing home and frequently does shift work and works overtime. Alan is a staff nurse. They do not have regular meal times as time pressures force them to eat on the go. They both state that after returning home from work they feel too tired to do anything. Sue has a 30 to 35 day cycle with 6 days of bleeding and has not been able to observe any signs of ovulation. She has no other medical problems, takes no medications and has no allergies. On the advice of her GP she recently started taking folic acid. She remembers having had a laparoscopy 1 year ago for a cyst. The pelvis was reported as normal. Her parents are both obese and have high blood pressure. Allan has no significant medical or surgical history; he used to play soccer but gave up 5 years ago due to work commitments. He had a semen analysis done which was normal. The couple has intercourse twice a week but they say that timing is difficult due to problems in predicting ovulation.
Obesity (defined as BMI over 30) is increasing in Australian society. This couple leads a sedentary life style with no exercise and partakes of a chaotic diet. They both use cars to commute to work which requires them to walk only 2-3 km per day. Since they have been doing this for the last 5 years they are set in their patterns. This, together with Sues family history, indicates that urgent lifestyle adjustments are needed. Obesity can affect reproduction through fat cell metabolism, steroids and secretion of proteins such as leptin and adiponectin and through changes induced at the level of important homeostatic factors such as pancreatic secretion of insulin, androgen synthesis by the ovary and sex hormone-binding globulin (SHBG) production by the liver. Obesityassociated anovulation may lead to infertility and to a higher risk of miscarriage. Management of anovulation associated with obesity involves diet and exercise as well as standard approaches to ovulation induction. Many obese women conceive without assistance, but pregnancies in obese women have increased rates of pregnancyassociated hypertension, gestational diabetes, large babies, Caesarean section and perinatal mortality and morbidity
Women who are overweight and experiencing fertility difficulty are potentially feeling a double burden of expectation to conform to the social norms that strongly prevail both around body shape and control of fertility/having a family. The linking of the two can be an added blow to self esteem. Hence, in raising this respectfully, some space for conversation that acknowledges these pressures and the effects they may be having is important. However, women also repeatedly say that they feel disappointed and frustrated if the issues of excess weight and its potential effect on fertility have been avoided in their discussions with health care professionals, meaning that they have not been made aware early in their investigations that their weight could be a factor compromising their fertility. In a recent study of 100 women with polycystic ovary syndrome who attended a 4 month lifestyle modification group 38% conceived. Through the course of the group, 86% of these pregnant women had established regular menses and 75% were ovulating spontaneously. The pregnant women had reached a median weight loss of 3.2kg compared to 1.95kg in the non pregnant group.
References: 1. Norman, R, Noakes, M, Ruijin, W, Davies, MJ, Moran, L, and Wang, JX. 2. Nichols, JE, Crane, MM, Higdon, HL, Miller, PB, and Boone, WR, 3. Steele, K, Wickstead, R, Marks, J, Stern, K, McBain, J 4. The ESHRE Capri Workshop Group. Nutrition and Reproduction in Women. Human Reproduction  PRINT THIS PAGE
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