Discussing body weight with patients as part of the infertility consultation can be embarrassing.  Some women even express feeling insulted.  However, many articles in the literature show that increased body mass index (BMI) adversely affects fertility.  Even for the men!  A recent article showed that for every extra pound over ideal BMI in either partner, they could calculate how many DAYS extra per pound it took to conceive.

Increased BMI affects both ovulation and implantation.  Most people so not appreciate that fat tissue produces a form of estrogen that is not measured in the blood.  This can contribute to suppressing ovulation.  The classic presentation of this situation is Polycystic Ovarian Syndrome (PCOS).  This condition is typified by increased BMI, cystic appearing ovaries, and irregular or absent periods.  The efficacy of ovulation inducing agents, like Clomid, are reduced by increased weight.  Thus, even if weight loss does not improve the ovulation pattern, the response to treatment will likely improve.

Women with high BMI also experience lower implantation rates with IVF, and higher miscarriage rates when they conceive.  This may be due to the production of estrogen, and other molecules by fat tissue.

Finally, everyone knows it is unhealthy to be significantly overweight.  There is an obesity epidemic in America, and the infertility experience can be a good inspiration to lose weight.  Appropriate diets, supervised by a nutritionist are most effective.  For some women over 300ib. bariatric surgery might be more effective.

In general, low-glycemic diets are considered best for fertility.  This entails reducing carbohydrate intake, especially, “White Foods,” like white bread, rice, and potatoes.  Whole grain carbs are better, and, ironically, sweet potatoes are better than white ones.  Carbohydrates can be assessed by the fiber content.  Foods with 5gm or more of fiber are best.  Avoid fruit juices and tropical fruits, including bananas and pineapple. .  Surprisingly, mangos are OK.

Delaying fertility treatment until a more ideal weight is achieved sounds frustrating, but may prove more effective in the long run.