prospective parents should worry about their own weight when deciding to get pregnant
many women worry about how to take the weight off after a pregnancy, but according to many doctors, taking the weight off before a pregnancy might increase fertility, promote healthier pregnancies and healthier babies. men could also increase their fertility by losing weight.
a study recently published in the british medical journal found a link between obesity and sexual behavior and adverse sexual outcomes. obese men were more likely to report erectile dysfunction and less likely to report as many sexual partners as normal-weight men. obese women were less likely to seek healthcare services for contraceptives and more likely to report unintended pregnancies.
dr. joel batzofin, of batzofin fertility services in midtown, recognizes the gravity of conceiving when a mother's body mass index-a metric calculation of mass according to weight and height-is too high.
"getting a potential mother prepared for pregnancy is a big issue. if someone is too heavy, i don't like to help them get pregnant, until we help them get ready to be pregnant," said batzofin, who encourages patients to lose weight by referring them to counseling and weight-loss services, which he also offers in-house.
batzofin said pregnancy while obese can be plagued with a number of problems-including a high miscarriage rate, premature births, higher rate of neo-natal deaths, gestational diabetes, blood-clot formations and birth complications such as shoulder dystocia (when the baby's head passes through the vagina but the shoulders get stuck behind the mother's pubic bone). according to batzofin, the latter occurs because the babies are often too large.
batzofin said new studies show that children gestated in obese women may suffer metabolic syndrome in their adult life, an altered metabolic state which predisposes them to obesity and other conditions such as "diabesity," a new term that explains the strong association between diabetes and obesity.
overweight men also experience fertility challenges, including erectile dysfunction, low sperm count and low quality sperm due to hormonal imbalances or elevated scrotal temperatures that are not good for sperm production.
dr. carson liu, a ucla-trained bariatric surgeon, explained that obesity increases the production of an estrogen-like hormone, called estradiol, converted by peripheral fat in the body. in men, the change results in larger male breasts, loss of hair on the arms, legs and chest.
"they [men] basically have a lot more estrogen-like compounds circulating in their body that could decrease their libido and testosterone level," said liu. "testosterone allows men to handle more pain and be more aggressive. in that sense they cannot handle discomfort as well."
in women, a hormonal imbalance may trigger polycystic ovarian syndrome resulting in insulin resistance, a stop in ovulation and abnormal facial hair growth. "if the body is too thin or too heavy, it does not ovulate," explained liu.
obesity offers health challenges outside of fertility issues. liu said obese persons have a higher risk of co-morbidity, the presence of two or more disorders, often high blood pressure, diabetes and knee pain.
"it has been studied that the higher your body mass index is, the higher incidences of cancer and a lower rate of survival," said liu. "we think if you can treat the obesity you can prevent a lot of these medical illnesses."
batzofin said many obese people suffer from a number of mental challenges such as low self-esteem and depression, and focus all their energy on getting pregnant rather than becoming healthier. "a baby will make them feel better in a certain place, but a baby will not fix their weight problem," said batzofin, who acknowledges that addressing obesity is more than just telling a patient to slim down. "it requires treatment and working with professionals who are going to help them with their nutrition and their exercise, and maybe some people even need surgery to lose weight."
according to liu, people who diet only have less than a 1 percent chance of keeping the weight off. "all the randomized studies show the lap-band is more effective in getting weight off and keeping it off," said liu, referring to the adjustable gastric banding device that requires surgery.
but surgery is only the first step to reducing weight and increasing fertility. "the surgery takes 40 minutes, but if they don't change their lifestyle-diet and exercise-it is highly likely they will fail," said liu.
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