Dr. Meldrum, in his position as an editorial editor for Fertility and Sterility, has organized a series of “Views and Reviews” in the April 2017 issue of the journal on the impact of obesity on reproduction. Dr. Meldrum writes that he was struck by the observation that women bear the predominant burden of the obesity pandemic and are responsible for the large majority of the direct health care costs of obesity, recently estimated to be $427 billion yearly in the U.S.
Obstetricians and gynecologists and reproductive endocrinology/infertility specialists have a unique opportunity to encourage healthy lifestyle measures for their obese patients and to take measures to reduce the large health care costs that can occur in achieving a successful pregnancy with IVF.
In this series the causes, consequences and solutions of the obesity pandemic are discussed in detail. An argument is raised that there is no evidence that weight loss per se reduces the most serious pregnancy complications nor does it improve the pregnancy rate with IVF. In fact marked weight loss, such as following obesity surgery, can adversely affect the pregnancy and contribute to poor fetal growth. Rather, there is gathering evidence that introducing healthy lifestyle measures such as regular exercise and a healthy diet can markedly improve outcomes (see www.lifechoicesandfertility.com). In one study, obese women who exercised regularly had an IVF success rate over three-fold higher than obese women who were sedentary. In that study, the women who exercised regularly likely also made more prudent food choices (diet was not assessed).
Because the follicles that result in mature eggs for an IVF cycle develop over three to six months, regular exercise and a healthy diet should be followed throughout that crucial period and should be continued during the IVF cycle and pregnancy when the developing embryo and fetus require an optimal maternal environment. As a lifelong measure, a healthy lifestyle will contribute to gradual and sustainable weight loss, improved general health, and a reduction of serious lifelong illnesses and disabilities that can otherwise occur in obese individuals. Those consequences of obesity are also discussed, together with 12 simple guidelines a person can take every day to avoid unwanted weight gain.
Dr. Meldrum also suggested that obesity should be a very strong, if not an absolute indication, for single embryo transfer. Both multiple pregnancy and obesity markedly increase premature delivery. At Reproductive Partners San Diego, over 90% of our transfers are with a single embryo. Because Preimplantation Genetic Diagnosis (PGS) is crucial in promoting a high rate of success with transfer of a single embryo, women who are obese should be fully advised of the benefits of PGS.
We live in a health-hostile environment with an overabundance of calorie dense foods, devices that reduce or eliminate physical exertion, and cheap, nonphysical entertainment, which have led to obesity in many of our patients. The physicians and staff at Reproductive Partners are committed to achieve as successful and safe an outcome as possible for our obese patients, while at the same time encouraging lifestyle measures that will promote long-term health.