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Does obesity or overweight without PCOS affect fertility?

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JOCELYN HAS BEEN FEATURED ON:

Weight is a sensitive issue during fertility and pregnancy, but a subject that is tremendously important for health care providers to broach with their patients.

In my online fertility program, I talk a lot about optimal and healthy weight for fertility and pregnancy, including the impacts on fertility of being underweight, where the body can de-prioritize ovulation/fertility.

Being overweight has also been linked to infertility, but almost always in association with PCOS (polycystic ovarian syndrome). However, a new joint study from the Universities of Goiás and Jataí in Brazil has looked at whether overweight (excess body weight with a BMI between 25-30) affects fertility in women who do not have PCOS, are not obese (BMI over 30), and do have regular menstrual cycles (25-35 days).

A common misconception amongst fertility patients is that if menstrual cycles are regular, they must be ovulatory. However, I have seen time and again that this assumption can be false. Ovulation can be confirmed medically with a day-21 progesterone test (a level above 18 nmol/L confirms ovulation), or ultrasound monitoring of ovarian follicles. Functionally, this can also be monitored by tracking basal body temperature and confirming a temperature jump that is sustained in the second half of the cycle (more on this here).

The Brazilian study found that overweight increases the chance of anovulation by more than two times among infertile women with regular menstrual cycles, with no previous diagnosis of polycystic ovary syndrome. The theory is that excessive body weight contributes to infertility by affecting ovulation via endocrine (hormonal) actions – inducing high levels of insulin, high LH, abnormal FSL:LH ratios, lowered progesterone, and low levels of SHBG.

Obtaining a healthy weight for conception requires holistic support, including nutrition and exercise review and guidance; hormonal testing including thyroid hormones to determine metabolic factors; and support for factors like disordered or emotional eating that may be implicated. Cycle tracking and day-21 progesterone tracking are also integral components to identify how the menstrual cycles is changing through a weight-loss support program, and to identify if and when ovulation is occurring.

Exploring weight as a potential issue in fertility is certainly worth the discussion.

I hope you have found this helpful, and do let me know if you have any questions!

If you are hungry for more evidence-based information for your fertility or pregnancy journey, visit www.myhealthypregnancyplan.com for free webinars and complete programs.

And if you are a care-provider looking for evidence-based resources for your fertility or pregnancy patients, please get in touch with us at support@myhealthypregnancyplan.com.

In health,

Dr Jocelyn Land-Murphy, ND

Terra Life

Disclaimer: The information and content provided is for general educational and informational purposes only and is not professional medical advice, nor is it intended to be a substitute therefore. Please consult the Disclaimer and Terms of Use for full details.

References:

Giviziez, C. et al. (2021). Association of Overweight and Consistent Anovulation among Infertile Women with Regular Menstrual Cycle: A Case-control Study. Rev Bras Ginecol Obstet,  43(11): 834-839.

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