Tuesday, June 8, 2010

What the Scale Isn't Telling You About Your Fertility

Someone recently asked about the correlation between weight and infertility. I thought that was a really good question and one that is not discussed nearly enough. When going through infertility (IF) we are so focused on what's going on in that mysterious region south of our belly button that we neglect to see what's going on right before our eyes. In thinking about my friend's question, I saw two possible ways to tackle this topic: on the one hand, the effect of weight on one's fertility; on the other is how infertility affects our weight. Today I'm going to focus on the former and provide you with some topline information for your to discuss with your doctor.

Being too thin or too fat can affect your fertility. In fact, an estimated 1 in 5 is coping with IF has an underlying issue with an eating disorder. You do not have to be dealing with a clinical eating disorder to be struggling with weight and IF. People with an eating disorder just happen to be at each extreme of the spectrum, but there are many gray areas before you can achieve a healthy middle.

In a culture where you can't bee too thin, it's very difficult to feel sorry for women who are barely filling a size 0. But in truth, an unhealthy thinness can have a huge effect on your fertility. When you are just 10-15% below your healthy weight (for your height), that corresponds to a third of body fat loss, which consequently leads of menstrual dysfunction (this is called the "Critical Weight Hypothesis"), a common cause of IF. So imagine what someone dealing with anorexia is doing to her body. Living with a very distorted sense of body imagine, people with this eating disorder starve themselves to a point where their organs and reproductive systems are affected. Sadly, in some cases, even after recovery, women who have dealt with anorexia for years may have caused permanent damage to their body. Another group that I would include under "too thin to ovulate" are over exercisers -- those women who spend hours at the gym, running miles and miles on the treadmill and then jumping into a aerobics class, to eventually treat themselves to a mini-smoothie. While the scale might indicate a "healthy weight," the lack of body fat affects them in similar ways as a someone who is overly thin. Behind those perfectly defined abs are women who have very little body fat and therefore have trouble ovulating and hence, conceiving. Whether you are dealing with anorexia, over exercising or are simply too thin, you are very likely to suffer from amenorrhea (no ovulation or menstrual cycles), irregular menstrual cycles, PCOS and reduced egg quality. While it is important to feel good about yourself, especially during a time when everything has come into question as a result of your IF, I urge you to focus on increasing your food intake. Include more good fats (avocados, nuts), lots of protein (chicken, milk) and Omega-3 rich foods (wild salmon). Avoid artificial sugars, especially if you're struggling with PCOS. And don't over exercise. Trust me, your baby isn't going to care if you have a six-pack.

On the other end of the spectrum are women who are overweight. Some women are genetically predisposed to being overweight, others have grown from being an overweight child to an overweight or obese woman, and lastly you have your compulsive eaters -- this overlooked eating disorder involves bingeing on food without purging. To be considered overweight you need to be in the 25-30 BMI, and anything over 30 is considered obese. Above I talked about the importance of some body fat, excessive body fat can have similar effects to your reproductive system as someone who is too thin. Some overweight and obese women suffer from amenorrhea, PCOS with insulin resistance (an inability to process sugars), which ironically can be both the cause for the extra pounds and the result of them. Studies have shown that overweight women aren't as much affected by IF as overly thin women, but the pregnancy risks associated with the excessive weight increases your chances of gestational diabetes and pre-eclampsia. Following a lean diet high in protein, whole grains, fruits and veggies, combined with regular exercise still remains the best way to manage your weight. Recently, women who are overweight and PCOS have found some success when taking Metformin, which has helped with more regular and higher quality ovulation, and yes, weight loss.

If you have been experiencing unexplained weight gain or weight loss, your first step should be to check your thyroid function. Hyper and hypothyroidism can affect your weight and as a result your reproductive system.

Discuss any concerns you have about your weight with your doctor and don't be afraid to meet with a nutritionist who can guide you in the right direction.

Stay tuned for my next entry where I will discuss how IF affects your relationship with food, your body and your mind.


B said...

'Most overweight and obese women suffer from amenorrhea'

Is that really true? I can believe most obese women do, but I find it hard to believe that most women with a BMI over 25 aren't having periods.

My BMI was under 25 (just!) before I was pregnant. After a miscarriage at 17 weeks it's now close to 27. I've decided I need to do something about that to help me conceive again, so this post is timely. THank you.

The Infertility Doula said...

Hi B,

Unfortunately my statement is true, While a certain level of fat cells are essential for regular ovulation, women who are overweight (25-30 BMI) tend to experience amenorrhea or oligomenorrhea (infrequent menses), in part due to the high correlation between being overweight and having PCOS. A 2002 study showed that obese women (BMI over 30) were 30% more likely to experience amenorrhea (vs. 4.7% in normal weight women).

Additionally, women who are overweight can also be dealing with high levels of prolactin, which inhibits ovulation, as a result of hypothyroidism.

So losing the weight might not always be enough as there might be an underlying hormonal or pituitary issue. Even if you are not experiencing amenorrhea, you might have an egg quality issue for instance. You should probably go in for a full physical to make sure your hormones are all at sufficient levels.

Most importantly, I am very sorry for your loss. I can't imagine what a difficult period this must have been for you. I think your doctor would recommend that you lose some weight in order to optimize your reproductive system. And I sincerely hope you will be pregnant again soon. Best of luck.

B said...

I do take your point that this is a serious problem, but you state that 'most' overweight and obese women suffer from amenorrhea and i just don't believe that more than 50% of overweight/obese women haven't had a period for over 6 months (the definition in the UK where I am) :) I'm pretty sure that that would be seen as a public health crisis! From the figures you state from 2002 that would still only be 34.7% of obese women, which is a long way from 'most' in my mind.

Anyway, thank you for your kind words. It's been a horrendous experience and I find it really hard to accept everything that happened :( The weight gain is due to the absolute disinterest I've had in being healthy for the last six months. Of course, I'm now suffering from anxiety and depression as well, and taking antidepressants, and I *know* that antidepressant use is ALSO linked with a higher risk of miscarriage...... however, so is depression, so you just can't win can you? I feel caught in a serious of vicious (sp?) circles. And as far as my reproductive system goes, I don't seem to produce fertile cm. I was surprised I got pregnant at all, even though I'm ovulating regularly :s If I'm not pregnant this month I'm going to ask my doctor to refer us on for testing. I'm not 35, so really she shouldn't, but seeing as I'm 34 I really really want to be referred on. Keep your fingers crossed for me that she is supportive???? Thank you :)

The Infertility Doula said...


I'll change it to "Some." ;)

I do hope your doctor is supportive. I don't see the point of waisting precious time when it comes to your fertility. I guess it's different in the UK. Here you see a specialist when you want, regardless of your age. I can't imagine how many years I would have waisted had there been an age limit.

Anyways, good luck. And keep me posted.

B said...

Thank you. It's swings and roundabouts - we don't have to rely in insurance cover so everyone can get the same treatment on the NHS (theoretically!) but it does mean they have to draw a line somewhere. I'm just glad that IVF is offered up to the age of 39 where I live - in other places they have a cut-off of 35 after a year of unexplained infertility, and I wouldn't have met that criteria in time. I'm still hoping this rossed...

(and I am very pedantic at times, thank you for taking it in good humour! i do find this site really interestinmonth might be the one anyway. Fingers cg and helpful. thank you for writing it)

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