Your Pregnancy - - Q&A Fertility -

Q: I’ve been try­ing to con­ceive for a year now, but my doc­tor just tells me to lose weight and then it will hap­pen. Surely it can’t be that sim­ple – my pe­riod isn’t reg­u­lar so I think the cause of my in­abil­ity to con­ceive must be some­thing else, not the ex­tra 15kg I’m car­ry­ing! Could it be PCOS? A: Dr Nedic answers: Obe­sity af­fects fer­til­ity by caus­ing hor­monal im­bal­ances and prob­lems with ovu­la­tion. In­sulin re­sis­tance, which usu­ally presents with stub­born belly fat, is associated with poly­cys­tic ovary syn­drome (PCOS), a com­plex hor­monal dis­or­der af­fect­ing young women at a re­pro­duc­tive age. While obe­sity, hy­per­ten­sion and in­sulin re­sis­tance are a few of the symp­toms of PCOS, it is also the lead­ing cause of in­fer­til­ity. In an ar­ti­cle pub­lished over 10 years ago in the BMJ (for­merly known as the Bri­tish Med­i­cal Jour­nal) it was al­ready found that PCOS was ac­count­ing for 90-95% of women who at­tend in­fer­til­ity clin­ics with anovu­la­tion. In some men­strual cy­cles, an egg does not ma­ture, and a woman does not ovu­late, which is re­ferred to as anovu­la­tion. A weight loss of as lit­tle as five to 10 per­cent can im­prove a woman’s chance of fall­ing preg­nant. In fact, in the world’s first com­pre­hen­sive study on weight and its ef­fect on fer­til­ity, re­searchers found that los­ing even five per­cent can have a sig­nif­i­cant ef­fect on a woman’s chances of con­ceiv­ing. The study in­volved 23 fer­til­ity cen­tres, and was car­ried out by the Univer­sity Med­i­cal Cen­tre in Gronin­gen in the Nether­lands. The study found that weight loss fol­low­ing a life­style in­ter­ven­tion im­proved con­cep­tion rates among obese in­fer­tile women who ex­pe­ri­enced ir­reg­u­lar men­strual cy­cles. More specif­i­cally, obese in­fer­tile women who had just com­pleted a six­month life­style in­ter­ven­tion were more than four times as likely to nat­u­rally con­ceive com­pared with women who were given fer­til­ity treat­ment alone. Stud­ies have also shown that over­weight and obese women with PCOS may have a greater chance of be­com­ing preg­nant if they lose weight be­fore be­gin­ning fer­til­ity treat­ment. A hor­monal im­bal­ance is the main dif­fi­culty with PCOS. In women with PCOS, the body man­u­fac­tures more an­dro­gens than nor­mal. An­dro­gens are male hor­mones which fe­males also pro­duce. High lev­els of these hor­mones af­fect the devel­op­ment and the re­lease of eggs dur­ing ovu­la­tion. In­creased lev­els of an­dro­gens in a woman’s body are re­spon­si­ble for the ma­jor­ity of symp­toms, how­ever many symp­toms are com­ing from an un­der­ly­ing in­sulin re­sis­tance. In fact, in­sulin re­sis­tance seems to be par­tic­u­larly detri­men­tal for modern PCOS epi­demics. PCOS has a va­ri­ety of signs and symp­toms, which do not nec­es­sar­ily in­clude hav­ing iden­ti­fied cysts in the ovaries in or­der to di­ag­nose this dis­ease.

PCOS symp­toms and signs

• Ir­reg­u­lar or ab­sent men­strual cy­cles • In­fer­til­ity or re­cur­rent mis­car­riage • Hir­sutism (ex­ces­sive fa­cial hair and body hair) • Oily skin/acne • Obe­sity/ab­dom­i­nal fat • Male pat­tern bald­ness • In­sulin re­sis­tance • Dys­lip­i­daemia (un­healthy lev­els of one or more kinds of lipid – or fat – in the blood) • Hy­per­ten­sion • De­pres­sion and/or anx­i­ety • Sleep ap­noea Sta­tis­tics show that half of these women, if left un­treated, can de­velop type 2 di­a­betes by the age of 40. Mean­while, their chances of suf­fer­ing from a car­dio-meta­bolic syn­drome, heart at­tack or cere­brovas­cu­lar in­sult is 5 to 7 times higher, while the risk of con­tract­ing en­dome­trial can­cer is also in­creased three­fold. In one study, 187 obese and over­weight women with PCOS were im­me­di­ately treated with a drug that in­duces ovu­la­tion. In the other study, 142 women with PCOS be­gan a weight-loss pro­gramme, which con­sisted of a lower calo­rie in­take, ex­er­cise, and anti-obe­sity med­i­ca­tion be­fore start­ing the fer­til­ity treat­ment. Women who were treated with the treat­ment alone had an ovu­la­tion rate of 44.7 per­cent and a live birth rate of 10.2 per­cent. The women who re­ceived the treat­ment af­ter the weight-loss pro­gramme had a 62 per­cent ovu­la­tion rate and a 25 per­cent live birth rate. Med­i­cal re­search has shown that there is strong and con­sis­tent ev­i­dence that over­weight and obese pa­tients in wellde­signed pro­grammes can achieve weight loss as much as 10 per­cent of their base­line weight. Pre­scrip­tion med­i­ca­tion, to­gether with a healthy eat­ing and ex­er­cise plan, can help kick start a weight-loss jour­ney, or can help some­one get back on track. Speak to your doc­tor or go to ilivelite.co.za or 8thsense.co.za for more info.

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