Weight loss in obese infertile women results in improvement in reproductive outcome for all forms of fertility treatment

Department of Obstetrics and Gynaecology, The Queen Elizabeth Hospital, University of Adelaide, Woodville, SA, Australia.
Human Reproduction (Impact Factor: 4.57). 07/1998; 13(6):1502-5. DOI: 10.1093/humrep/13.6.1502
Source: PubMed


Obesity affects ovulation, response to fertility treatment, pregnancy rates and outcome. In this prospective study, a weight loss programme was assessed to determine whether it could help obese infertile women, irrespective of their infertility diagnosis, to achieve a viable pregnancy, ideally without further medical intervention. The subjects underwent a weekly programme aimed at lifestyle changes in relation to exercise and diet for 6 months; those that did not complete the 6 months were treated as a comparison group. Women in the study lost an average of 10.2 kg/m2, with 60 of the 67 anovulatory subjects resuming spontaneous ovulation, 52 achieving a pregnancy (18 spontaneously) and 45 a live birth. The miscarriage rate was 18%, compared to 75% for the same women prior to the programme. Psychometric measurements also improved. None of these changes occurred in the comparison group. The cost savings of the programme were considerable. Prior to the programme, the 67 women had had treatment costing a total of A$550,000 for two live births, a cost of A$275,000 per baby. After the programme, the same women had treatment costing a total of A$210,000 for 45 babies, a cost of A$4600 per baby. Thus weight loss should be considered as a first option for women who are infertile and overweight.

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    • "Physical activity has a protective effect on fertility along with weight loss. In infertile obese women who experienced weight loss (about 10 kg/m 2 ) through diet and exercise intervention, resumed spontaneous ovulation , achieved spontaneous pregnancy, had lower miscarriage rates, and increased live birth [66] . Obese, infertile women (BMI > 30) who previously could not achieve conception and were engaged in a diet and exercise regime for at least 6 months (reduction in BMI of about 9.6) had improved spontaneous conception rate and with ovulation induction therapy had improved pregnancy outcome [67] . "
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    ABSTRACT: Human fertility is influenced by multiple factors, some more strongly than others. While not all factors are under our control, certainly most lifestyle factors are amenable to change to some extent, in order to minimize its adverse effects on fertility. Factors, such as couple's age during conception, body weight, smoking tobacco, alcohol and caffeine consumption, diet and exercise, use of illicit drugs, and sexually transmitted infections, can influence the couple's fertility potential. Adopting a healthier lifestyle contributes toward optimal fertility, which will enhance natural conception, promote a safer pregnancy leading to the live birth of a healthy baby. This chapter reviews studies on these individual lifestyle factors and discusses their findings. Knowledge on how these factors can impair fertility is essential to create awareness among couples who are planning to start a family or those who are already pregnant, in order to maximize their natural fertility potential and outcome.
    Handbook of Fertility: Nutrition, Diet, Lifestyle and Reproductive Health, Edited by Ronald Watson, 04/2015: chapter 13: pages 145-157; Academic Press.
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    • "Physical activity has been shown to confer a protective effect on fertility when coupled with weight loss in obese women [46]. However, excessive exercise can negatively alter energy balance in the body and affect the reproductive system [56]. "
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    ABSTRACT: Approximately 10 to 15% of couples are impacted by infertility. Recently, the pivotal role that lifestyle factors play in the development of infertility has generated a considerable amount of interest. Lifestyle factors are the modifiable habits and ways of life that can greatly influence overall health and well-being, including fertility. Many lifestyle factors such as the age at which to start a family, nutrition, weight, exercise, psychological stress, environmental and occupational exposures, and others can have substantial effects on fertility; lifestyle factors such as cigarette smoking, illicit drug use, and alcohol and caffeine consumption can negatively influence fertility while others such as preventative care may be beneficial. The present literature review encompasses multiple lifestyle factors and places infertility in context for the couple by focusing on both males and females; it aims to identify the roles that lifestyle factors play in determining reproductive status. The growing interest and amount of research in this field have made it evident that lifestyle factors have a significant impact on fertility.
    Reproductive Biology and Endocrinology 07/2013; 11(1):66. DOI:10.1186/1477-7827-11-66 · 2.23 Impact Factor
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    • "demonstrated that lifestyle modification led to increased insulin sensitivity and resulted in improved ovulation and fertility in obese women with PCOS. This approach of lifestyle modification, which includes weight-reducing diet and exercise, should be the first step in the management of them [16]. Increase in physical activity and loss of at least 10 % of body weight are given in the form of lifestyle modification. "
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    ABSTRACT: Polycystic ovary syndrome (PCOS) is the most frequent endocrine disorder in women of reproductive age. In 2006 the Japanese Society of Obstetrics and Gynecology (JSOG) proposed new, revised diagnostic criteria that in the future could also be valued internationally. Based on the new diagnostic criteria, the JSOG has also proposed the revised treatment criteria in 2008. In PCOS obese patients desiring children, weight loss and exercise is recommended. Nonobese patients, or those obese women who do not ovulate after lifestyle changes, are submitted to ovulation-induction therapy with clomiphene citrate (CC). Obese CC-resistant patients who have impaired glucose tolerance or insulin resistance are treated with a combination of metformin and CC. If these treatments options are unsuccessful, ovulation induction with exogenous gonadotropin therapy or laparoscopic ovarian drilling (LOD) is recommended. A low-dose step-up regimen is recommended with careful monitoring in order to reduce the risk of ovarian hyperstimulation syndrome (OHSS) and multiple pregnancies. Alternatively, with LOD high successful pregnancy rates of around 60 % are expected with a low risk of multiple pregnancies. If ovulation induction is unsuccessful, IVF-ET treatment is indicated. In high OHSS-risk patients, systematic embryo freezing and subsequent frozen embryo transfer cycles are recommended. In nonobese, anovulatory PCOS patients not desiring children, pharmacological treatments such as Holmström, Kaufmann regimens or low-dose oral anticonceptives are used to induce regular withdrawal bleeding. These treatments are especially important for preventing endometrial hyperplasia and endometrial cancer. These new diagnostic and treatment criteria hopefully will contribute to an improved care of PCOS patients in Japan.
    Reproductive Medicine and Biology 07/2013; 12(3):71-77. DOI:10.1007/s12522-013-0145-1
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