Obesity and Infertility

December 14, 2007

Q & A: Can being overweight affect my chances of getting pregnant?

There are two sources of estrogen in the body: the ovary (directly) and the adrenal gland (indirectly). The ovary makes estrogen in phases--up and down--in what are part of the variations within the normal menstrual cycle. The adrenal glands, among other things (like adrenaline), make something called "androstenedione." All of these hormones are related to cholesterol, actually--even testosterone and progesterone, so it's common that hormones often are converted back and forth. In the case of the adrenal androstenedione, fat cells can convert it into an estrogen called estrone.

Besides causing increased risk of heart disease, hypertension, and diabetes, obesity can also cause biochemistry to gang up on your chances for decent ovulation. If you're significantly overweight, while your ovaries are trying to behave and cycle normally, the steady input of estrone from this other pathway will interfere. A steady supply of estrogen from the peripheral conversion of androstenedione to estrogen will blunt the peaks and valleys of the ovary's function, which ultimately interferes with ovulation and can cause infertility.

Also, all of this estrogen can even lead to pre-cancerous changes in the womb (uterus).These changes are usually reversible, but nevertheless any woman who is overweight and experiencing menstrual irregularities should be evaluated.

Knowing The Affect Of Weight

How can you tell whether you're a woman whose ovulations are affected by being overweight? If you're having regular periods, then you can assume you're probably having regular ovulations. But if the periods are sporadic ("dysfunctional uterine bleeding"), then probably so are your ovulations. If your periods are continuous or absent, then any expectation of ovulation will be unreliable.

Another point to remember is that if you walk into a gynecologist's office, he or she is likely to be prejudiced by gynecological thinking. In other words, certainly irregular menstrual cycles are because of hormone problems, right?

Not always. Thyroid problems can cause both irregular periods and obesity, so it isn't unreasonable to begin your infertility work-up with blood work to check for this. Thyroid problems are easy to diagnose and usually easy to fix, but if this  abnormality isn't even ruled out and you have this problem all of the hormonal manipulation in the world isn't going to help you. Prolactin the milk let-down hormone that's high in breast-feeding women¡Vis used to advantage when lactating women use the resulting interruption of their periods as birth control. It's not foolproof, but this property has been used somewhat successfully for thousands of years.

Being overweight affects everything. You can take lists of diseases from every specialty and find some obesity-related ones in each.  Hypertension, coronary artery disease, pulmonary problems, diabetes, skin health...the benefits of losing weight are significant.  One of them is becoming a regular ovulator.

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