Obesity Impacts Your Reproductive Health Goals

The topic of weight and fertility is a sensitive one: Years ago, I mentioned patient's concerns about “fat phobic” doctors in a newsletter on “Weight & Fertility”, in which I gave a quick description of how a woman's weight impacts her ability to get pregnant. Now, The Endocrine Society has made available a free, downloadable booklet with more information on the topic.

“Obesity, fertility, and contraception: Disparities Among Women – 3 Perspectives” covers the entire fertility spectrum, explaining how body weight is not just an issue for women trying to get pregnant. Those who are trying to avoid pregnancy are also at risk – for weight-related contraceptive failures.

The booklet is complex and thorough, and offers the professional opinions of a basic researcher, a clinical practitioner perspective, and a clinical researcher. A few interesting points in the publication:

• Higher prevalence of obesity in African American and Latina women is an important factor in racial and ethnic disparities in reproductive outcomes. 

• Obesity adversely alters egg quality, in addition to the endocrine system, and is associated with ovulatory dysfunction and higher risk of miscarriage.

• Donor egg recipients who are obese do not appear to have lowered IVF pregnancy rates.

• Hormonal contraception may fail more frequently in obese women.

Body weight is not merely a matter of fashion, and reproductive endocrinologists are specifically trained and experienced in applying the latest research-based knowledge to the related fertility needs of patients in the clinic.

The staff of Houston Fertility Center and I offer all fertility patients the opportunity to access helpful nutrition counseling, whether it is for weight-loss, maintenance, or weight-gain – whatever is healthiest for their situation and will promote the greatest fertility treatment success.

Another Infertility Cause: Fear Of the Unknown

One of the most distressing comments I hear regularly in my office: “Dr. Kristiansen, I cannot believe I waited so long to seek help getting pregnant. Now that so much time has passed, I hope I can still get pregnant!”

Why am I writing about this? Because we know from studies that a big percentage of men and women avoid seeking fertility treatment because they're afraid. If you've already taken that big first step of scheduling a fertility consultation, you know exactly what I mean. People who are starting to worry about why they haven't gotten pregnant scour the Internet for reasons and solutions, and what they see can scare them away from the very thing that could result in pregnancy.

Image(s): FreeDigitalPhotos.net

Here's what I want them to know: An initial consultation with a fertility specialist does not equate to treatment, but it can often add up to more informed women and men who go on to “get it right,” with or without treatment.

What are they afraid of?

Intimacy issues – Who wants an audience to be in on your private dreams of building a family? It's hard enough to discuss with loved ones, but talking to a professional can make you feel even more uncomfortable. Fortunately, I can tell you that my staff at Houston Fertility Center are all long-timers in this medical arena. We understand, in some cases from personal experience, the emotional discomfort that you're going through. Your concerns are treated with utmost dignity and discretion.

Medical procedures – Most fertility patients are of average health and have never gone through any kind of treatment process beyond an occasional round of antibiotics for infection. It's understandable that virtually any medical tests or treatments might seem scary. Many are under the mistaken impression that IVF is the only kind of treatment. Again, simply talking with a fertility specialist does not necessarily include any tests or procedures. That said, a lot of first-time patients do agree that scheduling their initial consultation on Day 3 of the woman's cycle, and undergoing a simple blood draw to determine levels of reproductive hormones, can save time and money in the getting-pregnant process. It's your choice.

Financial costs – It's true that once you decide to become a fertility patient, there will be some costs involved. The financial expenses will vary from patient to patient, depending on health care coverage (or not) and on the causes that are determined to be your own fertility obstacle. Treatment costs vary widely and, actually, most patients do not need IVF to get pregnant. The majority of patients can become pregnant with less costly forms of treatment, like IUI (intrauterine insemination). (I'll address the differences in an upcoming blogpost.) But no one can tell you what your costs will be until thorough diagnostics have been implemented, and you have had a chance to discuss the options.

The important point: There's no way that your research alone or even any online-only consultations can adequately review and assess your fertility status and sum up whatever issues might need to be addressed for you to get pregnant.

Don't let fear of the unknown be your own major obstacle to getting pregnant.

DIY Artificial Insemination Just Adds to Infertility Stress

Gone are the days of uninformed consumers and all-knowing experts. Now with just a flip of the webpage, you can find step-by-step instructions on everything from remodeling a bathroom to getting pregnant with artificial insemination. DIY conception used to be the only means available for people who couldn't get pregnant "the old fashioned way." It's a real good thing we've come a long way from those days.

But have we? It turns out there's an underground, online market for sperm, where women can access prospective biological fathers for their children without the intervention (and guidance, and screening, and medical and legal protections) of reproductive professionals.

Newsweek's Tony Dokoupil called one related website "a weird blend of Facebook, Match.com and a traditional sperm bank" in this article for ABC News.

"What's wrong with the DIY approach to getting pregnant, Dr. Kristiansen?"

Here's a quick list of why I think you and, more importantly, your potential children are far better off going the more conventional routes to accessing sperm for getting pregnant:

Without standard controls by the Food & Drug Administration and the policies and procedures of reputable clinics like the Houston Fertility Center, you risk transmission of infectious diseases and genetic conditions, to both the mother and child.

Engaging in activity within this level of intimacy, even if sexual intercourse isn't on the agenda, with people whom you've only "met" online is simply not as safe as using professional services.

Agreements made between individuals about level of parental responsibility and involvement in the child's life may not be binding without proper legal representation and execution.

If you've found the whole process of getting pregnant stressful, just imagine the additional burden that comes with using what amounts to be an unknown substance to conceive. Worry about the cost of artificial insemination? It just doesn't compare to worrying about your personal safety and your child's health and future.

Get Your OB On Board: Regular Menstruation Does NOT Equal Fertility

"Getting your period" is a big event for girls. And many a parent or counselor has tried to console young women's related worries by offering comments that equate menstruation with motherhood. It's understandable that so many of my patients at Houston Fertility Center grew up with the message that if you're menstruating, you can get pregnant.

Your OB/Gyn may even tell you something similar. After all, it's basically true for the average woman with average fertility. But if you're one of the many women who has regular menstrual periods but can't seem to get pregnant, you might be feeling dismissed by your primary care doctor's casually hopeful remarks.

Once you have reason to understand more than the average woman about menstruation, you'll find that the connection between periods and fertility is a bit more complicated. Your OB/Gyn might do a great job of providing you with that in-depth education about the reproductive details of menstruation -- but you'll probably first have to request more explanation. And never hesitate to ask! You definitely won't be the first patient in my office to say with great frustration, "But, Dr. Kristiansen, I have a period every month!"

Your body's menstrual and ovulatory cycles are absolutely linked, but they are also separate. Both cycles are the result of communication between several organs and glands which emit different levels of various hormones, producing a cascade effect that's supposed to be ongoing. There are so many different points along the path where something can go wrong. A small, seemingly insignificant glitch in one spot -- whether it's a gland that produces too much or too little of a hormone, or an organ that isn't responding to its cues -- winds up disrupting the whole fertility process.

Simply put, and as many Houston Fertility Center patients will attest, women can have regular periods and still be infertile, for many reasons -- some structural (as in blocked fallopian tubes), some hormonal (sometimes resulting in anovulatory bleeding, in which no eggs are being released).

It's pretty complicated. And if your OB/Gyn is more OB than Gyn (they're really not all the same!), then their focus in both training and, more importantly, experience may be on helping women manage their pregnancies and deliver their babies -- not on the many things that can go wrong when you're trying to get pregnant.

So if you've heard "If you're having a period, you have nothing to worry about" from your doctor, he or she may not be putting you off or ignoring your worries. It might just not be their area of expertise.

This is the 3rd post in a series called Is Your OB On Board With Baby-Making?
Also see: Get Your OB On Board: Time Is (Almost) Everything

~ Dr. Sonja Kristiansen M.D.