Periodical press

Obesity and infertility everything you need to know

The P.O.Y. announced in 2008 that 1 in 2 people on our planet are overweight or obese.


It is widely known that it is the cause of many diseases such as arterial hypertension, diabetes mellitus, coronary heart disease, hyperlipidemia, stroke, infertility etc. but also another part of the problem that no one gives perhaps as much importance to is the low self-esteem of the obese, depression social stigmatization, and the list is endless!


Overweight is defined as a patient whose body mass index BMI is 25-29.9 Kg/m2 and obese as a patient whose BMI is greater than 30 Kg/m2. One example is a woman with a height of 160 cm and a weight of 79 kg is considered obese, while a man of 180 cm and 82 kg is considered overweight! So we understand that there are many who will wonder about the fact that it doesn't matter what we think about ourselves but what the numbers say!


And if the serious diseases that coexist with overweight-obesity appear gradually, perhaps what can immediately change our eating behavior is the need to have a child.


Fertility and obesity are two diametrically opposed definitions. Starting with the man, we would say that more specifically, scientific studies have shown that reduced mobility and low sperm volume are the most common findings in overweight men.


In addition, it has been observed that obesity may be associated with changes in the levels of testosterone as well as other hormones that play an important role in reproduction, while it may cause erectile dysfunction and reduced desire for sex.


Studies have shown that obese men have lower levels of total testosterone in their blood as well as lower levels of the gonadotropins LH and FSH, which are essential for reproduction, compared to men of normal weight. Low levels of gonadotropins are indicative of hypogonadism, a condition in which the testicles do not function normally.


Conversely, obesity is associated with increased estrogen levels and a decrease in free testosterone. Excess body fat can increase the conversion of testosterone to estrogen in a man's blood. The consequence of this is the negative feedback of the secretion of gonadotropins in obese men and thus the hypofunction of the testicles.


Obesity also significantly affects sperm in terms of motility, quantity and morphology. Several studies prove that sperm motility is inhibited in obese men and especially in those with abdominal obesity.


Finally, studies have shown that an increase in men's BMI by 3 units increased couples' infertility, and even a 10 Kg increase in men's weight reduced male fertility by 12%!



For women, things are not significantly different.


In the female body there are two organs that produce estrogen: the ovaries and the adrenal glands.
The ovaries produce estrogen in a cyclical fashion during the 28 days of the cycle, half of the days showing increased production and half of the days very low.


The adrenal glands produce a hormone called androstenedione. This hormone is converted in fat cells into an estrogen called estrone. The more body fat, the greater the production of this estrogen.


Consequently, in obese women there is an increased production of estrone, which affects the normal cycle of estrogen production from the ovary, thus preventing ovulation and causing infertility or even infertility.


As a result, women with obesity ovulate less often, while the eggs that will manage to be produced due to the continuous effect of estrogen will be of poor quality, with the result that the probability of normal or even assisted fertilization is low.


The most common cause of obesity-related infertility is polycystic ovary syndrome (PCOS) which affects approximately 10% of women of reproductive age. Increased body weight is not a necessary condition for the diagnosis of the syndrome but is found in approximately 40% of women with PCOS and significantly burdens the symptoms. One factor that seems to play an important role in this is insulin resistance, due to increased fat, which results in increased insulin levels (hyperinsulinemia). Hyperinsulinemia is an independent factor that can cause both period disorders and fertility disorders.


The point is that even if the woman wants to undergo IVF, obesity is a huge obstacle not only from a hormonal point of view but also from a technical point of view, i.e. the carrying out of embryo transfer egg retrieval as well as simple gynecological checks.
What is certain is that weight loss not only improves fertility rates but in most cases is the solution to the couple's problem.


Treatment of obesity focuses primarily on 4 goals: diet, exercise, behavior modification, and surgical management. Currently, bariatric surgery is the most effective treatment, with the best long-term results, in maintaining weight loss and reversing diabetes mellitus, two diseases that go hand in hand but is a surgical treatment with all that entails.


Many diets have been described but what is certain is that the greatest weight loss is achieved when dieting is combined with behavior modification and exercise.


Reproductive gynecologists must explain to the couple that it is important to enter a weight loss program and that obesity is above all a disease with serious consequences on fertility.


There are some medicinal preparations that help in weight loss. Most of them have to do with pills, but in recent years we have also had an injectable treatment with liraglutide that reduces the feeling of hunger with immediate weight loss and significant results.


In essence what matters is having a child and the health of the couple. The effort must be done collectively and counseling must be done only by the experts.