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Obesity and Infertility

Infertility

Dr. Suman

Sep 04, 2021

Obesity and Infertility are linked with each other in many ways. First we will study about obesity. The imbalance of calories inclines towards excessive fat in the body, which is commonly known as obesity. The state of obesity reaches when there are uncontrolled eating habits, irregular life routines, work-stress, and most importantly, an unhealthy diet. Being overweight is not an issue; the point is, are you healthy? If yes, then the weight is just not a matter. If No, then the problem rises right from here. It is hard to control weight gain, but maintaining our fat levels is absolutely in our control. It is essential to know that obesity is not an alone problem; instead, it brings many health issues. Obesity affects infertility, cardiac health, mental health, blood pressure, sugar level, and many other disorders. Also, physiological and psychological disorders are the result of high-risk obesity. 

People suffer from obesity due to many causes. There are specific environmental and genetic causes, including lifestyle and daily routine. Stigma and anxiety also play an essential role in causing obesity. Obesity is not limited to fat accumulation in a body; instead, it has many other harmful impacts on health. Food high in added sugar, salt, and oil raises the fat level in the body. 

To analyze obesity and overweight, BMI is a standard evaluation to measure weight-for-height in adults and children. (The total body weight in kilograms/square of height in meters). According to WHO, the BMI more than or equal to 25 consider overweight, whereas BMI more than 30 is obesity. 

BMI represents the standard of population-level measure of obesity for both genders of any age. Yet, it is true that this evaluation is not always the same for all individuals. Specifically, age is the basic standard while measuring the obesity rate in children. 

Global Impact of Obesity

Obesity categorizes into three types, namely low risk, moderate risk, and high-risk obesity. In the initial stage, obesity affects mental health, and later it starts affecting physical health too on a global scenario, obesity effect on productivity and life of human. Obesity harms abilities and health care. Diabetes, overweight, cardiac arrest, high blood pressure, cholesterol, asthma, sleeps disorders, and infertility. Infertility is one of the severe impacts of obesity that is becoming a hurdle in people worldwide. 

Obesity and Infertility

  • Obesity and infertility are interconnected, and it is one of the severe outcomes of obesity. Since obesity doesn’t hit directly, it still has unintended impacts on fertility. There is a fundamental cause of obesity and overweight. Below are some genuine causes of obesity:
  • Overconsumption of calories, greasy and energy-dense food result in high-risk obesity. Later it causes infertility and affects the reproductive system too. The severe effect of obesity increases female and male infertility issues. 
  • Obesity is a  factor that influences male and female sex hormones and reproductive health. Fat cells influence androstenedione and change it to male hormone (oestrone) in females. Far ahead, oestrone impacts the (metabolism) part of the female brain that controls the ovarian and the production of gametes. 
  • Not only females but also males experience the effects of obesity. As a result of obesity, the increase in testosterone levels impacts sperm factors and sexual activity. 
  • Overweight increases the hormonal imbalance and evokesPCOS in males and females. The hormonal imbalance leads to infertility, diabetes, cardiac diseases, and mental health problems. 

Can Obesity Cause Infertility in Females?

  • To the question, can obesity cause infertility in females the answer is yes? About 6% of female has infertility. According to WHO, the standard BMI of pregnant women ranges from 18.5 to 24.9 as a healthy weight. The BMI between the ranges indicates good chances of pregnancy and enhances physical health to sustain fertility for longer age. 
  • The women having obesity not only suffer from hormonal unbalance but also with poor egg quality. In women, ovulation reduces with aging and limits the chances of naturally conceiving. Even though overweight women ovulate but the production of eggs is affected adversely—the formation of eggs and their quality declines with the inverse effect of weight increase. 
  • Obesity increases the cause of gestational diabetes, stress, stillbirth, miscarriages that impacts female fertility. Women with higher obesity cause menstrual dysfunctions and anovulation. The increase in weight leads to poor reproductive health. 
  • Not only increase in weight affects female fertility, but also the menstrual cycle in females. The increase in estrogen makes periods fall irregular or can also stop it. Diseases like osteoarthritis, heart diseases, and endometriosis, breast & colon cancers are some health disorders that are outcomes of obesity.
  • In females, high and low estrogen levels increase weight gain and aggravate the cells that incite insulin in the female body. The effect of insulin raises the sugar level in the body. As per the study of ASRM, the increased level of fats prevents reproduction in females. Reducing weight by 5% by the present weight helps in natural conceiving than fat is the only reason for not getting pregnant.

Types of Infertility Factors in the Context of Insulin Responses

Obesity increases the level of leptin and insulin in females and negatively upsets female fertility. 

In obese women, the HPG axis declines, and types of gynecological effects arise in females.

The alterations of androgens to estrogens in the adipose tissue by inhibiting gonadotropin secretion affect female follicular development. As a result, all the adipokines influence reproduction by the cause of insulin resistance. 

The increase or decrease rate of adipokines may affect women’s reproduction in various ways. There are different types of effects for different types of adipokines. Also, adipokines have analyzed consequences on female bodies. 

Results of Adipokines on Female Reproduction

  1. An increase in leptins during obesity inhibits insulin-induced ovarian steroid genesis.
  2. A decrease in adiponectin  increases the plasma level of insulins
  3. An increase in resistin causes insulin resistance in obese women.
  4. An increase in vistafin affects insulin sensitivity in females.
  5. A decrease in omentin also creates insulin sensitivity in overweight women.
  6. An increase in chemerin negatively induces follicular steroidogenesis. 

Other than adipokines, obesity may also incur hyperandrogenemia and anovulation. Not all obese women suffer from hyperandrogenemia, where insulin stimulates ovarian estrogen, androgen, and progesterone productivity in females. 

Insulin binds the IGF receptors to their receptors and decreases the production of IGFBP-1and makes IGF-1 more active in the liver. By the actions of IGF-1, the theca cells and stromal cells secrete increased androgens. Thus, decreased level of SHBG from the liver increases androgens in fatty women.   

PCOS, a metabolic disorder, is a hyperandrogenic state which turns to infertility. Hyperadrogenic state refers to increased risk of impaired glucose intolerance, insulin resistance (IR), hyperinsulinism (HI), and obesity. 35%-60% of women having PCOS disorder are obese and exposed to infertility. 

The PCOS affects female fertility likely by:

  • Increased androgens on the endometrium
  • Developing oocytes
  • Increased level of leptin on the granulosa
  • Irregular menses
  • Continuation of anovulation 

Studies worldwide show a higher rate of miscarriages in obese women due to infertility. And obesity is an epidemic worldwide due to the luxury lifestyle and less physical work. To date, there is no perfect resolute for mechanisms of how obese women experience endometriosis caused by obesity. No doubt PCOS is a closed factor of obesity that resists pregnancy and affects female fertility.

Apart from frequent causes of infertility, obesity strikes fertility both in males and females. Due to infertility and not being able to conceive naturally, couples seek infertility treatments. Infertility treatment is initiated with diagnosis to detect the anomalies and causes of infertility. Later, when the patients are diagnosed with the exact inability, they are given proper treatment to overcome infertility. Not know how long the treatment will go and how fast it will work upon gaining normal fertility. 

Even though there is an advanced way of treatment IVF is available today, experts still say that chances of successful IVF are high with women with an average weight compared to obese women. ART is more supportive to females with correct BMI. Studies claim that women with obesity take a long time to for ovarian stimulation and gonadotropin treatment. 

As per studies, Women with high-risk obesity struggle higher during ART treatments. During IVF, the ovarian stimulation is deficient, and other significant responses also determine infertility during obesity.

  • Reduced level of oocyte retrieval
  • Poor quality of oocyte and embryo
  • Decreased intra-follicular human chorionic gonadotropins concentration
  • Decreased level of estradiol 
  • Decreased number of mature oocytes
  • Decreased incidence of embryo transfer
  • And a decreased number of transferred embryos 

Overweight or obese women had significantly reduced clinical pregnancy and live birth rates. And higher miscarriage rates in obese women than women with a normal BMI. The studies indicate that higher obesity has significant adverse effects on IVF and ART.

Obesity as a Disruptor of the Female Fertility

High overweight adversely affects the male/female reproductive functions. Besides, unbalance hormones and subfertility are the causes of PCOS. Furthermore, endometrial implantation and other reproductive functions are significant in women overweight. Significant complications like delayed conceptions, increased miscarriage rate, reduced outcomes in assisted conception treatments result from obesity.

Though to overcome fertility in males or females, both have to switch weight loss to reduce obesity. Losing weight also increases the chances of both natural and artificial conception. The impact obesity affects reproductive organs and is an attribute of the endocrine mechanism. Thus, the neuro-regulation HPO axis may be extremely unstable infertility and inclined to feeble fetal.

Effects of Abnormal Level of Bioactive Cytokines with Insulin Resistance

Leptin: amino acid protein 167 encode by the “ob” gene hormone important in food intake, body weight, and energy due to integrated serum levels of leptin in overweight women associates with higher levels of leptin in the follicular fluid. 

IVF studies show that leptin affects granulosa cells’ steroidogenic pathways and decreases estrogen and progesterone production. This negative effect of obesity on oocyte physiology could have downstream effects on endometrial receptivity and embryo implantation. So as adiponectin, insulin, and resistin have a different level of influence on female fertility.

Infertility Treatment During Obesity

It is challenging to treat high-risk obese women’s infertility. Women with obesity have lower chances of pregnancy during ART. Patients are given a high dose of gonadotropin, lower response ovarian stimulation, and increase miscarriages during the treatment. 

Not only women, even men having infertility issues with obesity. Most males with high-risk obesity find it challenging to make their partner conceive.  Obesity similarly affects fertility in both females and males and makes it difficult to get pregnant. 

Obesity and Infertility in Males

Usually, obesity is a common cause of infertility in both genders. 25-30% of males are having infertility. In past years semen quality is an essential factor for the inclination of fertility in males. Infertility raises in India and other parts of the world with the societal and economic change in lifestyle and eating trends. Obesity is one of the steadily growing health impact factors for infertility around the globe.

As a result of chemical calorie theory, endocrine disruptors are significantly responsible for infertility from past years. Men with higher BMI are more exposed to high-risk obesity compared to men with normal BMI. BMI less than 19 and more than 30 correlates with reduced men’s testicular volume and semen quality. 

Unfortunately, the bulges in the tummy are signs of an unhealthy lifestyle and obsolete illness. Being overweight incites health complications like type diabetes, blood pressure, high cholesterol, bone issues, sleep apnea, infertility, and cancer. Once you gain weight, it becomes very tough to get back to average weight. Also, weight gain impacts seriously on physical & mental health,emotional and social wellbeing in communities. 

Obesity Affects Male Sex-Hormone

The uncontrolled gain in body weight in men has considerably related to the testosterone level, sperm quality, and fertility. The infertility risk increases with every 9 kg extra weight to the average body weight. In males, obesity increases aromatase activity which changes the testosterone into estradiol. The reduced level of estrogen harms male reproduction. 

The impact of obesity on male fertility is multifactorial. Male fertility may be temper by genetic, endocrinal, and environmental effects. The rise in obesity has reached pandemic proportions, with 1.6 billion adults and 400 million adults categorized as obese. 7.5% of the total frailty of disease subjects to obesity. 

Paternal obesity increases the susceptibility to obesity. The vulnerability to obesity befalls diabetes in offspring and is a possible mechanism for amplifying chronic diseases. 

Obesity Affects Sperm Quality

The WHO studies indicate the impacts of obesity on traditional male semen parameters. The sperm concentration, sperm motility, and sperm morphology effect of obesity in male reproduction. Male obesity causes changes in semen parameters, especially sperm volume, total sperm count, total sperm motility, total progressive sperm, sperm morphology, and DNA fragmentation.

Different studies represent different factor-based results and outcomes of obesity in men. Every individual man with a specific weight may experience different impacts on their fertility. In simple terms, the effect of obesity may have a different impact on each male.

The inclination in testosterone and increase in estrogen impacts male fertility and reproduction. An increase in estrogen reduces the male sperm count and raises plasma concentration. Increased BMI decreases the FSH/LH ratios, inhibin B and SHBG levels in males, and affects the regulation of spermatogenesis and the function of cells(gametes).

Obesity Affects the Total Mechanism

  • Decrease in androgens
  • Reversible hypogonadotropic hypogonadism pathway
  • Increased estrogen and estradiol
  • Decrease in gonadotropin FSH and LH secretions. 
  • Increase in endogenous opioids 
  • Increase in HPG axis
  • Type 2 diabetes with central insulin resistance 
  • Pauses in breathing and sleep disorder
  • Decreased pituitary-gonadal function 
  • Morning testosterone concentrations 

Obesity and Sleep Apnea

Sleep apnea is a kind of sleep disorder interrupt nocturnal testosterone rhythm in male and affect fertility. Furthermore, the total testosterone is reduced consistently to the severity of the SA. It affects both testosterone levels independently and erectile function in male fertility organs.

Also, it negatively affects the male testosterone levels independent of BMI. Sleep apnea may also reduce the sexual quality of life. The combination of the multi-factors of sleep apnea results in a compound effect on male fertility.

Obesity and Spermatogenesis

The result of obesity hypothetically contributes to sperm production and results in scrotal adiposity (heating of gonadal). The natural process of spermatogenesis is sensitive to heat exposure. The optimum temperature of the scrotum is 34-35° in males. Overheating of the scrotum due to increased fat tissue hurts the sperm cells. And the toxic effect of heat harms sperm motility, incites sperm fragmentation and sperm oxidative stress. 

Alterations in testicular temperature cause obesity occur due to several mechanisms. The mechanisms of varicocele in sperm morphology are high in obese men. The causes of overheating can be due to:

  • Overuse of laptops placed in laps
  • prolonged immersion in sauna bath
  • Increased scrotum adiposity
  • Extra thigh fat around the public areas
  • Longer sitting duration, driving

All the causes described above contribute to reduced sperm function and subfertility. Obese men have increased sperm damage and high oxidative stress. Changes in reproductive hormones increase oxidative stress and increase BMI.  Furthermore, an increase in seminal macrophage activation leads to sperm motility, decreases acrosome reaction, and lowers embryo implantation rates. An increase in obesity and BMI fall in sperm concentration, serum testosterone, and increase the serum estradiol. 

Metabolic Syndrome and Aromatization 

The Mets syndrome disorder of energy utilization and storage detects through abdominal obesity, high blood pressure, plasma glucose, serum triglycerides and lowers the HDL (high-density cholesterol). The rise in metabolic syndrome increases the risk of cardiovascular diseases and diabetes. The Mets have inter-related hypogonadism and men’s erectile dysfunction. 

Most obese men suffer from Hyperinsulinemia and hyperglycemia and have an inhibitory effect on sperm quantity and reduce fertility.

Leptin and Toxins

Leptin is an intermediary hormone between body fat and the neuroendocrine axis that influences appetite and the reproductive axis. The leptin hormone secretes from fat cells and harms sperm cells and those cells that produce sperm cells.Adipose tissue has a dynamic role in whole-body energy homeostasis act as an endocrine organ.

Studies indicate solid neural influences and adipocytic expression and secretion of leptin. Leptin supplementssecretion of gonadotropin is an essential hormone for initiation and maintenance of male reproductive function. Also, it controls the hypothalamus to regulate GnRH that impacts neuronal activity and secretion. 

As a result, an increased level of leptin secretion significantly decreases testosterone production from Leydig cells. And the studies claim that raised level of leptin is ordinary in obese men. The high obesity sensitized high homocysteine and low vitamin D levels that primarily affect semen parameters. 

Anovulation % Obesity

The high conversion of androgens to estrogens in adipose tissues increases the free levels of estrogen and affects the HPG axis. Further, the adipose tissue is the largest endocrine organ that causes anovulation. Anovulation is a significant impact on overweight and high-risk obesity. 

In females, menstrual dysfunction and anovulation are the impacts of overweight. And uncontrolled weight gain brings women at high-risk reproductive health.  The risks include sub-fecundity, infertility, conception rates, miscarriage rates, and pregnancy complications in obese women.

Does Obesity Cause Infertility in Males?

The combined studies data represents that obese males have low sperm count and 39% of males have no sperms during ejaculation than the average male. Weight loss increases the total sperm count and semen volume. The weight loss incites testosterone and improves fertility in males.

The sperm-producing hormones inhibin b and androgen encounter the sperm count, sperm concentration, and the sperm’s ability to swim. Obese men have a poor quality of semen and sperm than men having average weight. Being underweight is also a factor of infertility in males. Also, being overweight causes hormonal changes and reduce fertility, and influence the male sex drive adversely.

Impact of Obesity on Female Fertility and Fertility Treatment

Obesity and overweight impact normal reproductive health and leads to infertility in both males and females. The number of infertile women due to obesity is gradually increasing worldwide. 

The obesity treatment in females refers to the reduction of abdominal fat and overall fat. The weight loss later increases the chances of getting pregnant, and normalize the regular menstrual cycle also helps restore ovulation. Infertility and obesity treatment suggest that weight loss will change insulin levels and later improve male/female reproductive growth. 

In men, the surgical removal of scrotal deficiency reports improving sperm parameters. By eating a healthy diet and following a fitness routine, they overcome infertility. The studies report that consistent weight loss15% increase the sperm concentration and initiate positive pregnancy outcome. Also, weight loss will improve the sperm DNA content and raise the fertility factor in males. 

Factors Reducing Obesity and Overweight

  • Diseases due to obesity and overweight will cure with the help of some change in diet and routine.  Best supportive environment and communities are the fundamental factor to help overcome obesity. Moving to a healthy diet and regular physical activity prevent gaining weight and obesity.
  • On a personal level, people can help themselves cure obesity by limiting energy intake, fats, and sugars. Putting yourself in the habit of a nutritious diet can help you fight to gain extra weight and keep your body fit and in shape. 

Treatment Procedures to Get Pregnant with Obesity

An increase in physical exercise or activity helps you to treat obesity problems. Many people have succeeded in maintaining their body weight by simply walking or doing regular exercise. Furthermore, if you want to improve your body mass index to get pregnant, you have to walk or exercise for at least 5 hours in one week. Simultaneously, you have to follow a healthy diet to shed extra body fat to conceive easily. 

Treatment Procedures to Conceive with Overweight Condition

Role of ART Techniques to Get Pregnant

ART is the acronym for Assisted Reproductive Technology. The procedure is useful for the treatment of infertility, which includes the sperm of a man and the egg of a woman. The technology works by removing eggs from the body of a woman. After this, doctors combine sperm and eggs to form embryos. Later, the formed embryos are put back in the body of a woman. 

Types of ART Techniques to Improve Your Fertility

In Vitro Fertilization

In vitro fertilization involves a series of treatment procedures to help people with fertility issues. IVF prevents most of the genetic problems and helps in the easy conception of any child. 

During the process of IVF, doctors collect mature eggs or retrieve from ovaries and fertilize them with the sperm in a laboratory setting. After this, the fertilized eggs or embryos enter the uterus of a woman. A complete IVF cycle requires three weeks approximately. However, in some cases, the steps take place in different parts, making the process relatively long. 

Intra-uterine Insemination 

IUI is the short form for intrauterine insemination. Doctors usually refer to IUI as artificial insemination. IUI performs its functions by placing sperm cells within the uterus directly at the time of ovulation. The treatment procedure allows the sperm to go close to the egg. The logic of IUI treatment is that direct placing of sperm cells reduces the total distance and time a sperm has to reach the egg.

To stimulate ovulation, both females and males have to take a few fertility medications before undergoing the insemination procedure. Your doctor will collect the semen from any sperm donor or your partner. Later, the sperm undergoes a sperm washing process to collect healthy sperm in concentrated amounts from the collected semen. Finally, the doctor places the sperm directly in the uterus. Pregnancy takes place whenever fertilization of your eggs occurs with the sperm. In other words, implantation of the fertilized egg takes place in your uterus lining. 

Intracytoplasmic Sperm Injection 

ICSI is the short form of Intracytoplasmic Sperm Injection, and it is a special type of IVF treatment. This type of treatment is recommendable in the case of severe infertility in males. The procedure involves injecting a single sperm directly into the matured eggs. In most cases, doctors perform ICSI during IVF treatment when the formed egg remains ready to retrieve. 

Sperm and Egg Retrieval Process

Any man has to produce his sperm sample by ejaculating in a cup, or doctors have to retrieve the sperm surgically. There are many ways to retrieve the sperm, and accordingly, IVF specialists conduct a few processes early and freeze other sperms. On the other side, IVF and ICSI experts harvest multiple eggs from a woman’s ovaries by using an ultrasound probe and a fine needle. The process may cause soreness and slight bruising. 

Injecting Sperm in Eggs 

Once your embryologist, IVF specialist, or other expert retrieve the collected semen sample, they isolate a single sperm to inject within the eggs using a hollow needle. As IVF specialists inject the sperm directly, it bypasses the requirement to swim from the cervical fluid. The sperm needs 1 day or 24 hours for the fertilization of an egg to form an embryo. 

Embryo Monitoring Process 

Embryologists place the fertilized embryos in a lab setting for a maximum of 6 days. During this period, they monitor them to identify the growth and development signs. However, doctors cannot transfer each of the fertilized embryos to the uterus of a woman. Hence, the embryo-monitoring process is very much essential to select the healthiest and viable embryos. 

Embryo Transfer 

Once the embryos approach a specific development stage, embryologists select a few embryos to transfer to the womb of a woman with the help of an ultrasound catheter. This step takes place after 2 days to 5 days of fertilization. 

Therefore, with various treatment procedures, you may easily get pregnant even when you have obesity problems. 

Conclusion

Infertility the cause of obesity mainly occurs due to high-risk obesity factors including less physical activity, overeating, irregular sleep, unhealthy lifestyle anxiety, and even overstress. The aforesaid details mention in the article explains the causes of obesity and fertility. Switching to a good lifestyle and healthy routine can help reduce the severity of obesity in both genders. The above post give a wider understanding of how obesity causes infertility. Hope it serves the best to understand the impacts of obesity and how it gradually affects the daily life of humans.

FAQs

How does obesity affect fertility?

Overweight women have a high level of leptin hormone release that secretes fatty tissues. The extreme secretion of leptin harms the fat level and leads to hormonal disorder and infertility.

Does obesity cause infertility in females?

Being overweight reduces the expectancy of getting pregnant and increases the rate of miscarriages, weak fetal, premature baby, conception, complications in childbearing. Not only natural but assisted fertilization in getting affected as a result of obesity.

Why does being overweight make it harder to get pregnant?

There is an autonomous (natural) correlation between hormones and ovulation, including hormones, estrogen, and progesterone levels during obesity.  The extreme secretion of hormone show an inverse reaction on body fat and limit the chances of conceiving.   

Can weight loss help infertility?

Medical studies refer to reducing weight as a positive factor that helps infertility.  An ideal weight during pregnancy does not help in conceiving but also results in healthy fetal growth.  

What is the minimum weight to get pregnant?

The weight during pregnancy depends upon the BMI. The standard BMI for getting healthy pregnancy ranges between 28 -40 pounds (BMI 18.5-24.9).

What is the fertility diet?

An ideal diet must contain unsaturated fat, green vegetables, fish, and whole grains to improve fertility. A fertility diet is affected by the high consumption of saturated fats and sugar. 

References 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4456969/

https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4408383/

https://blogs.imperial.ac.uk/imperial-medicine/2020/01/15/could-weight-loss-improve-male-infertility-in-obese-men/

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