The Effects of Obesity on Female Reproductive Function – Asian Bariatrics

Reproduction-the enigma and mystery of human race bears the burden of weight like all other system but this is more significant for us as it directly has directly adverse effect on the future generations.

Obesity which has reached epidemic proportions is observed to be higher among women than men. Obesity affects all stages of women life.

The impact of obesity on reproductive function can be attributed primarily to endocrine mechanism. Let us understand how obesity changes the endocrine milieu making it unfavorable for reproduction. Abdominal obesity is associated with high level of insulin. Chronic hyperinsulinemia causes increased ovarian androgen production, increased LH secretion from pituitary and decreased sex hormones biding globulin (SHBG) production leading to increase in free circulating androgen. Fat aromatizes, these androgen to estrogen leading to chronic to chronic hyperestrogenic environment. Increased leptin and other inflammatory factors from adipocytes inhibit follicular development.

The imbalance in the estrogen and androgens cause irregular ovulation or an ovulation. Obesity accounts for 15-20% of all infertile patients. Poor quality of ova even in presence of ovulation leads to sub fertility . Obesity patients require higher doses of drugs and prolonged treatment and still do not respond to fertility treatment satisfactorily.

Even if the obese woman manages to get pregnant, she has a higher chance of abortion due to poor quality of ova. Abnormal hormonal milieu in form of increased insulin, estrogen, triglycerides , uric acid etc results in the increased incidence of congenital anomalies in fetus of obese mother , especially neural tube defects.Other associated medical problems like hypertension, diabetes, breathlessness, thrombosis can also complicate the pregnancy further leading to prematurity , IUGR, macrosomia and even still birth.

Even if she completes her pregnancy uneventfully, maternal obesity causes the infant to have increased degree of adipocytes predisposing the baby for childhood obesity. The abnormal milieu to which the child was exposed to in utero, leads to metabolic disease in children born to obese mothers.Various studies have shown the associated of childhood obesity and earlier onset of diabetes and cardiovascular diseases to maternal obesity.

Stringent anti obesity measures need to be implemented in women, due to detrimental effects of obesity on pregnancy and trans generational out comes. The prevention or treatment of obesity needs to be done before conception.

Even a 5 % decrease in weight, improves fertility in obese PCOS. British fertility society recommends that women who have BMI of 30 or above and less than 35 years of age should defer their infertility treatment. They should first be encouraged to lose weight to achieve a BMI <30 and then be given treatment for fertility to optimize the out come.

Nutritional education and behavioral modification can be tried for weight reduction, In women where these measures have failed bariatric surgery should be considered for women having BMI>35 without co-morbid disease or BMI >33 with disease. It is the only scientific method available today for surgical weight loss and long term management of weight loss.

ACOG (American college of obstetrician and gynecologist) has also endorsed that after bariatric surgery, there is a decrease in the risk preterm delivery along with the reduced risk of labour and delivery complications.

Thus we see that obesity has a profound negative influence on conception pregnancy, labor and even affects the unborn child.Timely correction obesity with conservative means or a bariatric surgery is hence advised before planning a pregnancy for a optional outcome.

Source –
Dr Sanjay Patolia is one of the most experienced and eminent obesity surgeon of India – the receipient of Surgeon of Excellence Award from SRC USA. He is also the co-founder and promoter of Asian Bariatrics, Asia’s largest Bariatrics and Metabolic Surgery Center.

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