Obesity is a state of being too heavy and have accumulated fat , far beyond the normal proportion for your height , stature and desired weight.

•    There is almost a direct link between obesity and your fertility. This is more common with women than with men. In women, such obese women are prone to
•    reproductive disorders,
•    anovulation ,
•     hormonal imbalance,
•    premature pregnancy disorders,
•    coupled with certain diseases.

Obesity is increasing rapidly among women all over the world.  Obesity is a factor for sub fertility due to  anovulation, but it is unknown whether obesity also affects chances of spontaneous pregnancy in subfertile, ovulatory women.
The increased awareness and acceptance of assisted reproductive techniques, has helped in easing the otherwise difficult situation, arising for the effects of obesity
Obesity is increasing rapidly all over the world, affecting more than one billion people worldwide.

Qualification:
The World Health Organisation (WHO) considers a body mass index (BMI) as abnormal if BMI is over 25.0 kg/m2 and defines obesity as a BMI over 30.0 kg/m2. More women of reproductive age are becoming overweight and obese.

As measured by the BMI
– a 5-foot 6-inch woman who weighs 115 to 154 pounds is considered normal weight (BMI of 18.5 to 24.9).
– If she weighs between 155 to 185 pounds she is considered overweight (BMI of 25 to 29.9),
– And she would be considered obese at a weight of 186 or more (BMI of 30+).
For example, a woman with a BMI of 35 was found to be 26% less likely to achieve a spontaneous pregnancy than women who were normal weight or overweight but not obese.

A woman with a BMI of 40 or more was 43% less likely to get pregnant.

Women in the study who were severely obese were 43% less likely to achieve pregnancy, than normal-weight women or women who were considered overweight but not obese. The study is among the first to examine the relationship between body weight and infertility in women who ovulate. Obesity is an additional risk factor for infertility in women who have regular periods. This is important given the increase in obesity worldwide.

Hormonal and ovulatory problems: Disruptions in the hormone leptin, which regulates appetite and energy expenditure, may prevent successful fertilization.

Infertility in obese and overweight women is primarily related to ovulatory dysfunction. Anovulation often results in irregular menstrual cycles. Indeed, studies have shown that 30 per cent to 47 per cent of obese women will have irregular menstrual cycles. The likelihood of irregular menstrual cycles increases in direct proportion to increases in weight , and weight reduction often leads to resumption of normal menses and increased pregnancy rates.

Women who are obese, would need higher dosage of fertility drugs, that normal or overweight women. PCOS :  Polycystic ovary syndrome (PCOS) is a specific medical condition associated with irregular menstrual cycles, anovulation, obesity and elevated levels of male hormones. Some obese women have pcos.

Inseminations :
Obese women  undergoing intrauterine inseminations with donor sperm takes longer to conceive than normal weight women.

MEN : There is limited data that obesity negatively affects male fertility as well. Hormonal changes in obese men and increased scrotal temperature are potential underlying causes of impaired semen parameters.

IVF :Obese women have more infertility and are less successful at conceiving than women of normal weight. Once pregnant, obese women are more likely to have complicated pregnancies and are less likely to have a live born baby because of a higher rate of miscarriage, ectopic pregnancy and stillbirth. The babies born to obese women are more likely to die in the first month of life.
It is clear that women who are obese are at increased risk for infertility and other reproductive problems.  Obese woman are more likely to have ovulation problems that result in irregular or infrequent menstrual cycles and infertility. Women who are obese are also at increased risk for miscarriage though the reasons for this are as yet unclear. In the treatment of infertility, they are less successful.  This may be due in part to the fact that obese women do not respond to fertility medications as well and have a higher percentage of immature eggs.

Pregnancy Outcomes :
Ectopic Pregnancy : It is known that overweight women were 50% more likely to have an ectopic pregnancy
Obesity is a significant risk factor in adverse pregnancy outcomes. A recent study compared obese women (those with a body mass index of greater than 35) to normal weight women (those with a BMI less than 26). The obese women had a much greater likelihood of these problems.

PRE- ECLAMPSIA :
Pre-eclampsia, a problem with elevated blood pressure in pregnancy, was four to five times more likely to occur in the pregnancies of obese women.

Stillbirth :
Stillbirth was two to three times more likely to occur in the pregnancies of obese women.

Labour And Delivery :
During labour and delivery, there is a serious problem , which occurs when the shoulder of the baby gets caught in the mother’s pelvis. It is considered a medical emergency and can result in death or injury to the baby. This occurs during the deliveries of obese women two to three times more often.
Babies experience distress during labor two to three times more often in the pregnancies of obese women. As a result of the problems during delivery, obese women are delivered by cesarean section two to three times more often than women of normal weight.

Finally, the death of the babies born to obese women is two to four times more likely to die in the first 28 days of life (neonatal death).

Gestational Diabetes :
There is a higher risk of gestational diabetes in the pregnancies of obese women.

OBESE MEN —. Hormonal changes in obese men and increased scrotal temperature are potential underlying causes of impaired semen parameters.

Males who suffer from obesity also suffer from hormonal imbalances and irregularities that contribute to their fertility problems.
Obese males have lower testosterone, luteinising hormone and follicles stimulating hormone levels. Apart from these hormonal irregularities, obese males were also found to have lower libido levels and higher chances of suffering from erectile dysfunctions.

Treatment :
Weight Loss :
Controlled Diet :

First line treatment for obesity-related infertility is weight loss and lifestyle modification. While any amount of weight loss in obese women may improve fertility, a loss of 5 per cent to 10 per cent in overall body weight can result in spontaneous ovulation in 60 per cent of patients.

Moderate Exercise : exercise at moderate intensity for at least 30 minutes, three times a week. Participation in a formal weight loss program can be very helpful.

Medication : Weight loss medications and surgery (gastric bypass) may be recommended as well, if lifestyle modifications fail to result in sufficient weight loss.

Stimulatory Drugs :
Apart from weight loss, treatments for infertility in obese women do not differ substantially from treatments in non-obese women. For anovulation, first line treatment generally consists of ovulation induction with oral medications such as clomiphene citrate. Women who fail to achieve pregnancy with oral medications are often treated with fertility medication. In vitro fertilisation is often performed if these treatments fail or if there are other factors contributing to infertility.

It has been shown that obesity is associated with a longer duration of treatment, increased dosage of medication, and an increased risk of treatment cancellation due to poor response. Studies have also shown that pregnancy rates are approximately 30 per cent lower in obese women undergoing IVF compared to women of normal weight. It has been proposed that the IVF is less successful for several reasons. Some of these include impaired absorption of medication due to increased fat stores, limited ability to visualise ovaries during ultrasound monitoring, and more challenging egg retrieval.

Moreover, once pregnancy occurs, obese women have a higher rate of pregnancy loss. In fact, studies show they have up to a two-fold higher risk of miscarriage compared to normal weight women. It is not clear why this occurs. Nonetheless, weight loss can dramatically decrease the risk of miscarriage.

Weight Loss is The Key:
Obesity is a major health problem that is associated with infertility and miscarriage. Weight loss is extremely valuable in the management of such patients and can enhance fertility and decrease miscarriage rates.