By: Lauren Cox for Fibroids1
With a third of Americans obese, public health advocates warn us adamantly about the risks for type 2 diabetes, heart disease, and osteoporosis. Yet rarely do pamphlets and news spots warn that obesity can also complicate fertility.
|The Mayo Clinic lists the following as its “Top 10 Healthy Foods:”|
Vegetable juice - low sodium - “an easy way to include vegetables in your diet”
Obesity may disrupt the fertility of any woman, and for women who have polycystic ovary syndrome (PCOS) – a condition found in 5 to 10 percent of the population – a difference of only a few pounds can determine whether they can conceive.
"If I go over a 30 BMI (Body Mass Index), I stop menstruating," said Lesa Childers, a PCOS patient and co-founder of activist group PCOStrategies. Internally, women with PCOS develop a resistance to insulin, higher levels of male hormones and problems ovulating. The residual effects put patients at higher risk for diabetes and uterine cancer.
Externally, women show PCOS symptoms of excess facial hair, acne and a tendency to gain weight. "I can point out a woman with PCOS on the street," said Childers.
Weight is a double-edged sword for women with PCOS. The condition exacerbates weight gain, and obesity exacerbates all other PCOS symptoms, including reproductive problems, said Leonid Poretsky, M.D., chief of endocrinology and metabolism at the Albert Einstein College of Medicine.
"In general, obesity is on the rise, so we're definitely seeing a PCOS increase," said Rinku Mehta, M.D., a reproductive endocrinologist in Fremont, Calif. PCOS cases make up the majority of her clients, and obesity alone causes about 10 percent of infertility cases in her clinic.
"There's something about being obese that complicates all fertility problems," said Drew Tortoriello, M.D., reproductive endocrinologist at Columbia University School of Medicine. In 1994, researchers discovered a hormone called leptin that may partially explain why. Leptin is manufactured in fat tissue and is one of many signals in your body that regulate energy, weight loss and reproduction. Elite athletes may stop menstruating because they don't have enough fat to produce significant amounts of leptin. Obese women have plenty of leptin, but their system can develop a resistance to it as they grow heavier, said Tortoriello. Without getting signals from leptin, a woman's reproductive cycle can go awry.
Though obesity can induce infertility in women who have PCOS and in women who don't, PCOS involves a unique and poorly understood problem of hormone balance and signals in the body. "Obesity can't trigger PCOS," said Poretsky. Weight loss drastically improves fertility outcomes in PCOS and non-PCOS cases. An obese woman with PCOS only needs to lose 5 to 10 percent of her body weight to regain her fertility, said Tortoriello. This means a 200 pound woman could conceive again if she dropped her weight to 190 or 180 pounds.
"Weight loss really helps all of the (PCOS) symptoms," said Poretsky. "But weight loss strategy is ineffective 95 percent of the time." Left with poor patient compliance, doctors often turn to drugs. Because doctors have yet to pinpoint the cause of PCOS, there's no cure-all prescription approved by the Food and Drug Administration, said Tortoriello. Instead, doctors judiciously treat PCOS by symptom. Insulin sensitizers like metformin can treat many of the PCOS symptoms. Hormones and fertility drugs can help, but they can get pricey. Mehta estimates that couples spend $1,000 for a round of hormone injections, or up to $12,000 to $15,000 for each try at in vitro fertilization.
Tortoriello pointed to a recent study in Australia that showed treating obese women with PCOS with drugs cost 10 times more than successfully treating them with weight loss and lifestyle programs. "I had always hoped that physicians would offer women lifestyle tools," said Tortoriello.
"We just recommend general caloric reduction and increased exercise," said Mehta. "They only need to lose about a pound a week. It's an emotional roller coaster for most couples," Many of her patients can't take the stress of trying fertility treatments again if they’ve failed once. "A lot of people say it's just too much emotionally to handle."