“You MUST lose at least 20 kg, and then we will talk about that again!”. You might have been told this scornfully. “You have a sweet tooth, do you?” or “Madam, how much do you weigh? No, we don’t make any appointments here at the fertility center, you have to lose weight.” Nothing more mortifying, most of all, for those who have been struggling against their weight problems for years. You know that maternity is not for the slim ones- a lot of mums are overweight, so why have you been told that? Here, I would like to explain you something. Sometimes, doctor may be too direct and insensitive, but the topic has got its truth.
Let’s have a look at some figures: a woman with a body mass index over 32 (BMI >32) shows a rate of anovulation three times higher than a woman with an average BMI (BMI < 25). So, what happens?
First of all, adipose tissue is not just a static pocket full of fat, but it plays an important role in the production and metabolism of the sex hormones. A flattish or pot belly is always associated with a higher concentration of free hormones because SHBG– the protein that is produced by the liver and binds tightly the hormones, decreases significantly. This is the reason why women who have a flattish belly and generous hips, also show signs of hyperandrogenism- extra hair growth, or hair loss, for instance. Free hormones have considerably negative effects on the ovaries, as well.
Moreover, in overweight or obese women, the inversion of the ratio FSH/LH occurs– it means that the more your pituitary gland secretes LH, the more your ovaries will produce androgens in the ovarian theca- they will hinder the normal development of the follicles, and, the selection of the dominant one, as a result, your ovulation will be ineffective.
So, if you have some extra fat around the middle (it is not just a matter of weight) you may be likely to suffer from insulin resistance. It has got two negative effects: firstly, the increase in the production of FSH and LH will influence the normal equilibrium of the ovaries, and secondly, but not less important, the liver will release IGF 1 and 2, insulin like growth factors which favor the production of androgens in the ovarian theca. Then, insulin resistance prevents the body from producing those essential elements which guarantee a balanced oxidative and lipid metabolism in the muscles. So, the slower your metabolism is, the more easily you will gain weight. Yes, of course! It is a kind of vicious cycle- if you are obese, your weight is likely to increase. The responsible is the adipose tissue because it sends the brain a wrong message- it doesn’t say: “That’s ok, you are full, you have eaten enough, stop to eat,”. It makes the adipocytes produce leptin over and over again. More adipose tissue means more leptin which makes you feel hungrier and hungrier. Your hypothalamus will make you feel starving even if your body has enough energy. An excess of leptin does not only interfere with the glucidic metabolism (as it favors the production of insulin too), but it also has a negative effect on the production of the hormones because it inhibits the growth of the follicle and the selection of the dominant one.
You are still asking yourself why you are not even allowed to make an appointment at the fertility center, if your BMI is over 30? Because your uterus might be less prone to the implantation of the embryo and enhanced medical procedures and bigger dosages of medicines may be required- that means that the risks of side effects increase sharply.
You could have been told this truth impolitely, but your health has to be safeguarded.
Now, you have the right items of information, please don’t rush and don’t choose an eating plan among the many you can find everywhere nowadays! I know what you are thinking at the moment: big sacrifice=big result. No! Make an appointment with a dietitian or a nutritionist, they will evaluate your condition and your body to set the right targets. Very low-calorie diets work at the beginning, but then they can’t maintain the result in the long term. Motivation, sacrifice, deprivation have short life span; you can’t do without the pleasure of the food and its conviviality.
Opt for a balanced low-calorie food plan: low glycemic index, little fat, good proteins and a lot of fibers. Do regular and progressive exercise: don’t take up running if you have never done it before, and don’t go to the gym, if you feel too embarrassed. Try to do as much exercise as you can also in your everyday routine- when you do your housework, for instance.
Keep away from dangerous extreme plans, but get your chance to improve your lifestyle and lose weight because 10% decrease in your weight means:
- the insulin resistance decreases (your body and your metabolism will work better);
- the leptin level decreases and you will feel sated;
- SHBG production increases, as a consequence, you will suffer less from anodrogenism (less body hairs, and more hair);
- your ovaries will work better;
Good motivations, aren’t they? Think about it, shed some light on the issue, and when you are ready, take up something new and positive.
- AAVV. Infertilità umana. Edra Ed. 2014
- MIller WL., et al. “The molecular biology, biochemistry and physiology of human steroidogenesis and its disorders. Endocr Rev 2011; 32:81-151
- Rieder J., et al. Body shape and size and insulin resistance as easy clinical predictors of hyperandrogenic an ovulation in ethnic minority girls. J Adolesc Health 2008; 43:115-124
- Escobar-Morreale HF. Surgical management of metabolic dysfunction in PCOS. Steroids 2012; 77:312-316