It is well known that obesity, defined as a BMI >30, is a disease of hormonal imbalance that wreaks havoc on most, if not all, aspects of one’s body.  Many people are aware of the deleterious effects of obesity as it increases the incidence of heart disease, diabetes, sleep apnea, and even certain cancers. Another body system that is not immune to the negative impacts of obesity is the reproductive system in both men and women. Some of my most fulfilling days at work have been when a woman excitedly tells me she is pregnant after years of suffering from infertility, or when a couple shares with me that their relationship is better than ever because of improvements in their sex life.  Reproductive health should not be ignored.  Its dysfunction can lead to emotional turmoil and a resultant poor quality of life.    

Below we discuss how obesity leads to increased infertility in both women and men, and how this disease also contributes to poor sexual health in both genders.  But do not despair...it is also well-known that weight loss, sometimes as little as 5-10% of one’s body weight, can lead to dramatic improvements in fertility and sexual health.  At New Jersey Bariatric Center, we are excited to help you achieve your weight loss goals while also improving many other aspects of your lives, including the important areas of reproductive health and sexual well-being.

Obesity and Infertility

Obesity often causes infertility in women.  In fact, some studies show that the risk of infertility is threefold higher in women whose BMI is > 30 compared to women with a healthy BMI.  There are different causes of infertility, depending on whether the problem is with the woman becoming pregnant or sustaining her pregnancy.  Obesity has negative impacts on all aspects of pregnancy, from conception, to implantation (ability of the embryo to attach to the uterus), to the ability of a woman to carry to term and have a safe delivery.

PCOS and Obesity

Many women who suffer from obesity have Polycystic Ovarian Syndrome (PCOS), a condition in which the patient has two or more of the following:  irregular menstrual cycles, increased testosterone levels, and and/or ovarian cysts seen on Ultrasound.  In addition, most of these women suffer from insulin resistance, a condition in which our bodies need to produce more Insulin in order to regulate blood sugar (see “Treating Type 2 Diabetes with bariatric Surgery” blog for a more detailed explanation).  More than 50% of women with PCOS suffer from obesity.

IVF and Obesity

Studies have also demonstrated that women with obesity who are undergoing  in-vitro-fertilization (IVF) treatments have a lower chance of conceiving.  This can be due to poor egg quality or unfavorable conditions in the uterus preventing implantation of the embryo.  It is recommended by many fertility experts that a woman with BMI >30 lose weight prior to beginning the process of IVF in order to improve their chances of a successful pregnancy.  Advanced maternal age can also lessen the likelihood of successful IVF cycles. Given this, patients should ask their fertility doctors for advice about the best timing for IVF treatments while trying to lose weight.

Becoming pregnant is not the only obstacle for many women suffering from obesity.  The miscarriage rate in women with BMI > 30 has been reported to be as high as 40%, compared to much lower rates in women with healthy weights.  Other obesity-related risks of pregnancy include preeclampsia, gestational diabetes, higher likelihood of c-section, impaired fetal well-being, and increased risk of diabetes for the child in the future.  

Obesity in Men and Infertility

Obesity does not discriminate based on gender when it comes to fertility problems.  Men with a BMI > 30 may suffer from infertility secondary to low testosterone,(“low-T”), and abnormally elevated estrogen levels, leading to poor sperm quality.  This condition can be seen in up to 40% of men with obesity.  Erectile dysfunction and decreased libido are also prevalent among men with obesity.  

How Losing Weight Can Help

The good news is that weight loss, oftentimes only 5-10% of one’s weight, can drastically improve infertility and sexual dysfunction in both women and men.  For women, we know that those with PCOS face an up-hill battle, since losing weight with diet and exercise alone is extremely difficult because of the hormonal imbalances they face.  Bariatric surgery ( in those who qualify), can successfully combat these hormonal imbalances in many patients allowing ovulation to occur normally, and improve fertility while allowing for dramatic weight loss. In men, sperm quality and sex drive improve significantly after weight loss, and bariatric surgery can lead to dramatic and sustainable weight loss for those with a BMI > 40 or a BMI > 35 with obesity -related comorbidities.  For male or female patients whose BMI is < 35, medical weight loss with nutritional counseling and certain weight loss medications can oftentimes lead to 10% body weight loss, which has been proven to be enough for improvements in reproductive and sexual health.  

References

1. “Obesity as a Disruptor of the Female Fertility”  Erica Silvestris, et al Reprod Biol Endocrinol. 2018; 16:22

2. “Bariatric Surgery, Polycystic Ovary Syndrome, and Infertility”  James Butterworth, et al. Journal of Obesity Volume 2016. Article ID 1871594
3. Endocrine Implications of Bariatric Surgery: a Review on the Intersection Between Incretins, Bone, and Sex Hormones.” Isabel Casimiro.  Physiological Reports 7(10), 2019, e14111