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Archive for the ‘weight and fertility’ tag

Overweight and Infertile

By Dr. David Kreiner and Tracey Minella

January 3rd, 2014 at 1:41 pm

 

image courtesy of OhMega 1982/free digital photos.net

Raise your hand if you made a resolution to lose weight this year…again. C’mon, get that hand up, sister.

To a woman TTC, nothing is worse than being told you can’t have a baby without medical intervention…unless you’re then told you’re too overweight to have the treatments.

Fortunately, there are compassionate RE’s out there who are willing to give overweight patients the respect and the treatment they deserve.

Dr. Kreiner brings this prejudice and injustice to the forefront in his thoughtful, compassionate post:

The most shocking thing I’ve experienced in my 30+ year career in Reproductive Endocrinology has been the consistent “resistance” among specialists to treat women with obesity. This “resistance” has felt at times to both me and many patients to be more like a prejudice. I have heard other REI specialists say that it is harder for women to conceive until they shed their excess weight. “Come back to my office when you have lost 20, 30 or more pounds,” is a typical remark heard by many at their REI’s office. “It’s not healthy to be pregnant at your weight and you risk your health and the health of the baby.” Closing the door to fertility treatment is what most women in this condition experience.

An article in Medical News Today, “Obese Women Undergoing Infertility Treatment Advised Not To Attempt Rapid Weight Loss”, suggested that weight loss just prior to conception may have adverse effects on the pregnancy, either by disrupting normal physiology or by releasing environmental pollutants stored in the fat. The article points out what is obvious to many who share the lifelong struggle to maintain a reasonable Body Mass Index (BMI): Weight loss is difficult to achieve. Few people adhere to lifestyle intervention and diets which may have no benefit in improving pregnancy in subfertile obese women.

The bias in the field is so strong that when I submitted a research paper demonstrating equivalent IVF pregnancy rates for women with excessive BMIs greater than 35 to the ASRM for presentation, it was rejected based on the notion that there was clear evidence to the contrary. Here’s the point I was trying to prove: IVF care must be customized to optimize the potential for this group.

Women with high BMI need a higher dose of medication. Those with PCOS benefit from treatment with Metformin. Their ultrasounds and retrievals need to be performed by the most experienced personnel. Often their follicles will be larger than in women of lower weight. Strategies to retrieve follicles in high BMI women include using a suture in the cervix to manipulate the uterus and an abdominal hand to push the ovaries into view.

Most importantly, a two-stage embryo transfer with the cervical suture can insure in utero placement of the transfer catheter and embryos without contamination caused by inadvertent touching of the catheter to the vaginal wall before insertion through the cervical canal. Visualization of the cervix is facilitated by pulling on the cervical suture, straightening the canal and allowing for easier passage of the catheter. The technique calls for placement of one catheter into the cervix through which a separate catheter, loaded with the patient’s embryo, is inserted.

Using this strategy, IVF with high BMI patients is extremely successful. With regard to the health of the high BMI woman and her fetus, it’s critical to counsel patients just as it is when dealing with women who live with diabetes or any other chronic situation that adds risk.

We refuse to share in the prejudice that is nearly universal in this field. It’s horrible and hypocritical to refuse these patients treatment. Clearly, with close attention to the needs of this population, their success is like any others.

Women who have time and motivation to lose significant weight prior to fertility therapy are encouraged to do so and I try to support their efforts. Unfortunately, many have tried and are unable to significantly reduce prior to conception.

What right do we have to deny these women the right to build their families?

It can be hard to deal with obesity and even more so when combined with infertility. If you are feeling sad or depressed, it may help to talk to a counselor or to others who have the condition. I advise you to ask your doctor about support groups and for treatment that can help you including fertility treatment.

Remember, though this condition can be annoying, aggravating and even depressing, seek an REI who is interested in supporting you and helping you build your family and reject those who simply tell you to return after you have lost sufficient weight.

* * * * * * ** * * ** **

Have you been turned away from an RE because you’re overweight or obese? Do you think that’s fair?

 

Photo credit: Ohmega 1982 http://www.freedigitalphotos.net/images/agree-terms.php?id=10073481

 

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Infertility and Body Weight

By Tracey Minella

January 25th, 2013 at 9:31 pm

credit: stock images/free digital photos.net

What better time than Healthy Weight Week to examine whether your weight may be affecting your fertility?

January is synonymous with New Year’s resolutions of weight loss or getting healthier. As we approach the end of the month, some will be on their way to a fitter, healthier self. Others may be struggling to follow through with their plan.

Here’s reason to forge ahead on the path to a healthier, fertility-friendly weight.

While being just a couple of pounds over the ideal weight for your height and bone structure should not derail your baby-making plan, being grossly overweight…or even significantly underweight… can stop your plan in its tracks. Why?

Weight issues can cause imbalances in hormone levels which play a part in pregnancy, including estrogen. Very heavy women may produce too much estrogen; very thin women may produce too little. Sometimes, being very overweight or underweight can interfere with ovulation and cause women to have irregular or absent periods. These hormonal and/or ovulatory problems can be barriers to conceiving without either medical intervention or a correction of the underlying weight issue. Sometimes, an overweight woman may be suffering from PCOS, or Polycystic Ovarian Syndrome, a common cause of infertility. http://bit.ly/WWA7xL.

Long Island IVF physicians sympathize with and make every effort to provide treatment to overweight patients, so long as it is medically advisable. Many reproductive endocrinologists refuse to even consider grossly overweight patients for IVF until they lose a recommended amount of weight. Perhaps they fear their IVF success rates/stats will suffer.

Having a healthy BMI, or body-mass index, is important in maintaining optimum fertility. If you feel your weight could be a factor in your inability to conceive, ask your doctor for an evaluation. Consider a nutritionist and/or a personal trainer to help you gain or lose the recommended amount of weight and to get your body in top fertility shape.

Sometimes, a moderate weight adjustment may be all you need to conceive naturally. And even if you still need some medical assistance to get pregnant, each pound you did conquer can only increase your chances for a healthier pregnancy.

* * * * * * * * * * * *

Is your weight a factor in your infertility? What tips do you have to get in fighting reproductive shape?

 

photo credit: http://www.freedigitalphotos.net/images/Healthy_Living_g284-African_Lady_Holding_Weighing_Scale_p92773.html

 

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Overweight and Infertile

By Dr. David Kreiner and Tracey Minella

January 15th, 2013 at 10:23 pm

credit: imagerymajestic/freedigitalphotos.net

To a woman TTC, nothing is worse than being told you can’t have a baby without medical intervention…unless you’re then told you’re too overweight to have the treatments.

For some, infertility and depression go hand-in-hand with overeating. And the longer the infertility journey takes, the bigger the gap can get in the back of one’s hospital gown.

In a perfect world, we’d all be a healthy weight. None of us would be infertile, or have thyroid issues or diabetes, or PCOS, or just plain-old, depression-induced obesity to fill the void where our baby is supposed to be.

But the world is not perfect.

Fortunately, there are compassionate Reproductive Endocrinologists out there who are willing to give overweight patients the respect and the treatment they deserve. They’re just not easy to find. Maybe they even felt the sting of the public’s disdain for the obese on a personal level. Whatever their motivation, it’s worth the extra effort to find this kind of support on your infertility journey.

You need a doctor who is willing to potentially sacrifice his program’s IVF stats to make you a mom, because he believes he can do it…today…not after sending you home to lose loads of weight first. Today.

Dr. Kreiner brings this prejudice and injustice to the forefront in his thoughtful, compassionate post:

The most shocking thing I’ve experienced in my 30 year career in Reproductive Endocrinology has been the consistent “resistance” among specialists to treat women with obesity. This “resistance” has felt at times to both me and many patients to be more like a prejudice. I have heard other REI specialists say that it is harder for women to conceive until they shed their excess weight. “Come back to my office when you have lost 20, 30 or more pounds,” is a typical remark heard by many at their REI’s office. “It’s not healthy to be pregnant at your weight and you risk your health and the health of the baby.” Closing the door to fertility treatment is what most women in this condition experience.

An article in Medical News Today, “Obese Women Undergoing Infertility Treatment Advised Not To Attempt Rapid Weight Loss”, suggested that weight loss just prior to conception may have adverse effects on the pregnancy, either by disrupting normal physiology or by releasing environmental pollutants stored in the fat. The article points out what is obvious to many who share the lifelong struggle to maintain a reasonable Body Mass Index (BMI): Weight loss is difficult to achieve. Few people adhere to lifestyle intervention and diets which may have no benefit in improving pregnancy in subfertile obese women.

The bias in the field is so strong that when I submitted a research paper demonstrating equivalent IVF pregnancy rates for women with excessive BMIs greater than 35 to the ASRM for presentation, it was rejected based on the notion that there was clear evidence to the contrary. Here’s the point I was trying to prove: IVF care must be customized to optimize the potential for this group.

Women with high BMI need a higher dose of medication. Those with PCOS benefit from treatment with Metformin. Their ultrasounds and retrievals need to be performed by the most experienced personnel. Often their follicles will be larger than in women of lower weight. Strategies to retrieve follicles in high BMI women include using a suture in the cervix to manipulate the uterus and an abdominal hand to push the ovaries into view.

Most importantly, a two-stage embryo transfer with the cervical suture can insure in utero placement of the transfer catheter and embryos without contamination caused by inadvertent touching of the catheter to the vaginal wall before insertion through the cervical canal. Visualization of the cervix is facilitated by pulling on the cervical suture, straightening the canal and allowing for easier passage of the catheter. The technique calls for placement of one catheter into the cervix through which a separate catheter, loaded with the patient’s embryo, is inserted.

Using this strategy, IVF with high BMI patients is extremely successful. With regard to the health of the high BMI woman and her fetus, it’s critical to counsel patients just as it is when dealing with women who live with diabetes or any other chronic situation that adds risk.

We refuse to share in the prejudice that is nearly universal in this field. It’s horrible and hypocritical to refuse these patients treatment. Clearly, with close attention to the needs of this population, their success is like any others.

Women who have time and motivation to lose significant weight prior to fertility therapy are encouraged to do so and I try to support their efforts. Unfortunately, many have tried and are unable to significantly reduce prior to conception.

What right do we have to deny these women the right to build their families?

It can be hard to deal with obesity and even more so when combined with infertility. If you are feeling sad or depressed, it may help to talk to a counselor or to others who have the condition. I advise you to ask your doctor about support groups and for treatment that can help you including fertility treatment.

Remember, though this condition can be annoying, aggravating and even depressing, seek an REI who is interested in supporting you and helping you build your family and reject those who simply tell you to return after you have lost sufficient weight.

* * * * * * * ** * * * *

Have you been told you’re too overweight for infertility treatment? What did you do? If you have a success story, please share it to support others.

 

Photo credit: http://www.freedigitalphotos.net/images/search.php?search=obese+woman&cat=&page=4&gid_search=&photogid=0

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