Over the past few years, there has been a growing body of evidence linking excessive body weight to infertility

East/West
Is Your Weight Affecting Your Fertility?
By Michael A. Feinman, MD, FACOG, & Denise Noyer-Erez LAc, FABORM Did you know that what - and how much - you eat can affect your fertility? For centuries, the Chinese have viewed nutritious food as the foundation for health and longevity. Creating the optimum environment for a baby is also dependent on proper nutrition, and as new research shows, your weight. Excessive body weight may play a role in infertility, building on the established relationship between
obesity and ovulation disorders.
PCOS
One reason could be connected to Polycystic Ovarian Syndrome (PCOS), a condition marked by
infrequent or no ovulation, some degree of obesity and increased male hormone levels. For many years,
a well-documented relationship between PCOS and insulin resistance has shown that insulin-like growth
factors help regulate ovulation at the ovarian level. Women with insulin resistance have elevated levels
of insulin, with normal glucose levels. The increased insulin may stimulate the ovaries to produce excess
testosterone, interfering with ovulation and sometimes causing increased hair growth.
Despite an explosion of research on this subject, the significance of insulin resistance in treating PCOS
remains controversial. Many physicians recommend the use of insulin receptor-enhancing drugs like
Metformin to treat the insulin resistance and induce ovulation. Metformin causes several gastrointestinal
side effects in many people, nor does any compelling evidence exist that Metformin is better than the
more conventional clomiphene citrate (Clomid or Serophene). However, evidence shows obese women
with PCOS glean long-term health benefits from a combination of weight loss and Metformin. Although
the evidence is less compelling, this approach may allow some women with PCOS to eventually
conceive without using clomiphene or other ovulation drugs. Obviously, this approach takes many
months or years to achieve and requires a high degree of faith and commitment.
Weighty Issues
Until recently, physicians and patients have been reluctant to accept the notion that body composition
alone, absent ovulatory problems, could affect fertility. These skeptics received a loud wake-up call with
a Newsweek cover story featuring the so-called "Fertility Diet." Bottom line: The link between body
composition and infertility for both anovulatory (the ovaries fail to release an oocyte) and normally
ovulating women is supported by medical evidence.
Increasing evidence shows that aside from interfering with ovulation, body composition adversely
affects reproductive outcome. Consider these findings:
 A large Scandinavian study found that significantly obese women experienced a 50 percent  A recent study showed that for overweight couples, it took extra days per kg of excess weight to conceive spontaneously. This finding included the men!  Another recent study showed that for women with high BMI, IVF pregnancy rates were unaffected, but the miscarriage rate was higher, compared to leaner controls (Human Reproduction, 23;4: 878-884).
The first question that arises is "Why?" Fat tissue is well-known to secrete estrogen. The tissue also
exudes inflammatory molecules. It is possible that any or all of these interfere with implantation or the
ability to carry a pregnancy.
A second frequent response is, "I see heavy women with babies all the time. If weight plays a role in
fertility, how can this be?" As mentioned above, excess weight may not be an absolute cause of
infertility, but it may delay conceiving, cause a woman to require more procedures to conceive, and
cause miscarriages.
The Endometrial Function Test (EFT) may help determine if weight is playing a role in a woman's
infertility. Created by Dr. Kliman at Yale, the EFT analyzes an endometrial biopsy taken on a certain
day of a woman's cycle for the presence of specific complex molecules that should be absent or present
on that day. Several studies show the predictive value of this test on IVF success rates.
One potential cause of an abnormal EFT is inadequate or excessive weight. We have seen several cases
where weight loss led to an improved EFT, and eventual successful treatment, after several failed
attempts.
A common concern for women in their late 30s is the delay required to lose weight and the effect this
delay would have on egg quality. It may prove cost-effective for heavy women with abnormal EFT
results to freeze embryos and use them when their body composition is more optimal.
Everybody knows that obesity is an overall health risk. Pregnancy exacerbates many of the well-known
complications associated with excess weight: hypertension, gestational diabetes, thrombosis, wound
infections, etc. Hopefully, the growing awareness that abnormal body composition may also affect the
ability to conceive will further encourage couples to improve their health before embarking on the often
long and expensive road of infertility care. The potential health benefits will extend far beyond the
ultimate pregnancy.
Food: Fertility's Friend or Foe?
It takes about three months for your body to recruit the eggs it is going to ovulate. This means whatever
you were doing three months ago affects the egg that is being ovulated this month. It also takes three
months for sperm to regenerate, so it is important for men to also be healthy!
When on the path to fertility, being in the recommended range for the amount of weight and body fat for
your particular bone structure is very important. Using the Body Mass Index (BMI) scale is a good guide
to see what range you are in.
It is essential that your body be in balance. Too little body fat can be just as detrimental as too much.
Some 12 percent of infertility results from abnormal body weight: 6 percent from being overweight and
6 percent from being underweight). The good news is that 70 percent of women not conceiving because
of their body weight can become pregnant naturally once their weight disorder is corrected.

Can nutritious eating increase your fertility potential?
Whether you need to lose weight, gain weight or maintain your weight, a wholesome diet that supports
your fertility is most important.
What to Eat
Local and seasonal foods. It is thought that we are healthier when our bodies are in tune with the cycles
of nature. Eating foods that are grown in your geographical area and that are in season provides you with
the necessary nutrients nature intended. For example, winter vegetables and fruits tend to be warming
and denser in nutrition while summer produce is cooling and lighter.
Organic produce, dairy, poultry, eggs and meat. Meats and eggs have essential fatty acids and are a
valuable source of protein which can make a significant contribution to a healthy reproductive system.
Choose organic because consuming pesticides, hormones and antibiotics in food will interfere with your
reproductive and endocrine system. Eat lean, grass-fed, organic meat and eggs. Red meat and lamb
nourish and build blood. In the Chinese philosophy like cures like, it is suggested to eat eggs to nourish
your eggs.
Folate. Green leafy vegetables, fruits, beans, beets, avocados, peas and potatoes contain large amounts
of folate, a nutrient that helps the body make and maintain new cells and helps to prevent anemia,
especially around the time of conception and pregnancy. Most importantly folate lowers the risk of
spinal and neuro tube defects, and contributes to brain development in the fetus. Folic acid must be
obtained before getting pregnant and during the first few weeks of pregnancy, often before a woman
even knows she is pregnant.
Fish in limited quantity and low in mercury. Eating fish can be very beneficial for the Omega 3 essential
fatty acids, which help improve blood flow in the reproductive system, balance triglycerides and reduce
heart risk. Choose wild salmon, trout, sole, halibut and shell fish. One to two times a week is safe!
Warming foods. Digestion is a warm process. Lightly cooked vegetables are better for our overall health
than raw vegetables. By slightly cooking the vegetables the body does not have to work as hard to digest
your food, allowing your body to ultimately receive more nutrients than from raw cold vegetables. This
pertains to ice-cold beverages as well. Don't worry - you can still have your salad, and the occasional
ice cream, just not EVERY day.
Hydration. Drink plenty of room temperature water. Avoid alcohol, coffee and caffeine. Coffee
(decaffeinated too) has been shown to have detrimental affects on fertility and pregnancy. Caffeine is a
vasoconstrictor, so it decreases blood flow; during pregnancy, increased blood flow to the reproductive
organs is essential for optimum health.
Fiber. The recommended daily intake of fiber is 25grams. Vegetables and whole grains are excellent sources of fiber. Mindful Eating
How you eat is almost as important as what you eat. Eating regular meals and snacking every two to
four hours will help keep your blood sugar under control. Do not skip meals.
Relax, eat slowly, chew your food well and enjoy it. According to the Chinese, from 7 to 9 p.m. is the
time the stomach rests, so eat most of your meals before 7 p.m.
Working with a professional nutritionist is the best way to design a diet and control calories and insulin
levels, and ultimately create a healthy baby. Acupuncture and traditional Chinese medicine can also help
couples achieve and maintain the optimum conditions for conception.
Michael A. Feinman, MD, FACOG, is a physician at the Huntington Reproductive Center Medical Group, with locations in Westlake Village and Encino. He can be reached at 866.HRC.4IVF (472.4483). Denise Noyer-Erez is a licensed acupuncturist and a fellow of the American Board of Oriental Reproductive Medicine. Her practice, Acupuncture and Oriental Medicine, at 1220 LaVenta Drive, Suite 205A in Westlake Village, and in Encino at 15503 Ventura Blvd, Suite 200, is committed to the wellness of women, with a focus on reproductive health, fertility and menopause relief. Contact her at 805.497.2625 or online at www.ineedleu.com.

Source: http://www.ineedleu.com/downloads/pdf/resources/practice-articles/weight-fertility.pdf