But What About the Children? part 2

From WorldMakerMedia.com

And now, after an appropriately pregnant pause...

Part 2 of another way obesity effects 'the children'.  The ones that are waiting to be born.

I had a nice discussion with a OB-GYN MD the other day, one who specializes in infertility, about the role of obesity in infertility. We also discussed the issue of deciding when is it appropriate to discuss female weight and BMI with a prospective couple - after or before the typical infertility workup?

The typical infertility workup is as follows, after we define some terms.

An infertility evaluation is usually indicated after one year of regular unprotected intercourse in women under age 35, and after six months of unprotected intercourse in women aged 35 and older.  An earlier evaluation may be performed in women with irregular menstrual cycles, or known risk factors for infertility, such as PCOS, endometriosis, a Hx of PID, or reproductive tract malformations.

The initial basic workup obviously includes both partners.  It is also common to have multiple factors resulting in infertility.  Male testing includes semen analysis.  Female testing starts with documentation of normal ovulatory function, and then imaging to r/o tubal occlusion, usually via an hystersalpingogram (HSG).

Should all these come back normal, but the patient is overweight, there is evidence that initiating basic lifestyle modification to lose as little as 10% of their body weight can significantly improve fertility.

However, with a female that is overweight, there are known direct associations between obesity and infertility.  Women with evidence of anovulatory cycles and hirsutism was positively correlated with weight, and being overweight was directly proportional to the percentage of that finding, making it increasingly likely as weight increased beyond 30# overweight.

Weight loss after Bariatric surgery is usually more than that 10%, with the vast majority occurring in the first year.  That is not the time to conceive, as we mandate our patients to sign a contract to wait until 2 years after surgery.  The risk is that rapid weight loss, and a potentially tenuous nutritional state at that time may result in miscarriage or significant fetal abnormalities.

Reproductive aberrations induced by obesity do improve after surgery, usually by improvements in menstrual cyclicity.  PCOS is also shown to improve, by demonstrating marked improvement in both clinical and biochemical hyperandrogenism.

Of additional note, once pregnancy is established, obstetric complications (Gestational DM,  macrosomia and hypertensive disorders) are greatly reduced compared to morbidly obese women.

So, another reason to keep bariatric surgery in mind for a patient unable to make changes in their lifestyle that could result in durable weight loss resulting in comorbidity reduction or resolution.

And, for those of you trying to convince that patient that may otherwise not be interested in surgery, this may prove to be your trump card to get them thinking...

From Gagaoverbabies.blogspot.com