We all know that obesity is a health condition characterized by a build-up of abnormal or excess accumulation of fat in the body that can worsen health. It is growing rapidly throughout the world. In people with obesity due to excessive adipose tissue deposition, various diseases are caused. Diseases of the coronary system, endocrine disorders, diseases of the respiratory tract (sleep apnea, chronic obstructive pulmonary disease), diseases of the digestive system (hepatic steatosis, gallbladder disease, reflux esophagitis) and diseases of the genitourinary system (erectile dysfunction, reproductive dysfunction) are common. Obese women have a higher risk of colorectal cancer, endometrial cancer and postmenopausal breast cancer than non-obese women.
Infertility is the inability to conceive for one year, even after sexual intercourse without birth control. Etiological studies have found an association between obesity and infertility is hormonal and epigenetic. If obesity treatment, starting with diet and exercise do not help, then the best choice is performing an obesity surgery, viz—Bariatric surgery. Bariatric operations have become one of the most common types of operations, especially in the last decade, in India. The purpose of this article is to assess the effects of obesity on male and female fertility and the effects of bariatric surgery in this regard.
Types of Bariatric Surgery:
To be eligible for weight loss surgery, you must have a body mass index of more than 35 or more than 30 with other conditions, such as diabetes or sleep apnea. People who stick to the nutritional diet with exercise strategy usually see an average weight loss of around 60 to 65 per cent of their excess weight in one year.
Bariatric surgery can be restrictive and aim to reduce calorie intake by reducing gastric capacity and malabsorption. Restrictive procedures include:
- Laparoscopic gastric banding (LAGB),
- Ring Silastic gastroplasty (SRG),
- Vertical band gastroplasty (VBG)
- Sleeve gastrectomy (SG).
Malabsorption bariatric procedures are:
- Biliopancreatic transfer (BPD
- Roux-en-Y (RYGB) gastric bypass
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Obesity and infertility:
How obesity affects fertility:
Obesity can be an essential factor in infertility for both women and men. Obesity makes it difficult for women to get pregnant. If you are pregnant, there is a higher risk of loss. Hormone levels also change in women who are overweight. Complications related to obesity in pregnancy (BMI> 35): preeclampsia (5 times), stillbirth after 28 weeks (3 times), premature death of newborns (3.5 times), infants with high gestational age (4-5 years) ) times), gestational diabetes (8 times). Treatment of infertility, including IVF, is also less successful in overweight people.
Being overweight, especially excess belly fat is associated with insulin resistance (when the body needs to produce more insulin to keep blood sugar levels normal) and low levels of sex-binding globulin (SHBG), a protein involved in the regulation of androgen and estrogen sex hormones. Studies show that obesity can affect hormones, cause irregular menstruation in women and reduce testosterone in men, as well as other adverse effects on hormones that regulate fertility and possible costs for infertility treatment. Unfortunately, overweight women may find it more challenging to accept through methods such as in vitro fertilization because of the lower success rate associated with obesity.
Many health professionals believe that achieving and maintaining a healthy weight can have a positive impact on fertility and pregnancy. If you try to lose weight to start a family, but you are not successful, you are not alone. Losing weight only through diet and exercise can be very challenging. The good news is that bariatric surgery can be a safe and effective way to lose weight and significantly increase fertility.
Obesity can affect a couple’s ability to get pregnant. According to the American Society for Reproductive Medicine (ASRM), obesity is the cause of the struggle against fertility in six per cent of women who have never been pregnant. Obesity affects infertility by changing the way a woman’s body stores sex hormones. This is like:
- Fat cells convert a male hormone called androstenedione into a female hormone called estrone.
- Estrogen affects the metabolism of the part of the brain that regulates ovarian and testicular function.
- Alters reproductive function.
- Hormonal changes
- Epigenetic changes
- Egg cells problems
- Growth of Embryo
- Abortion \ IVF and Obesity
And it’s not only women’s weight that affects fertility. Men who are overweight tend to have low or no sperm count. Reasons are:
- Being overweight can increase body temperature, especially around the scrotum.
- Hormonal imbalances. Obese men are more likely to have higher estrogen levels combined with lower levels of sperm-producing hormones such as inhibin B and androgens.
- Effects the sperm count, sperm concentration and sperm’s ability to swim well.
- Exacerbating fertility problems
- Hormonal changes
- Parameters for obesity and sperm
- DNA damage
- Male sexual health such as erectile dysfunction
How obesity makes Fertility issues worse:
Obesity and infertility can also have strange circular relationships. It’s hard to say which caused the others. For example, like couples who are on a long journey to fertility, stress can not only cause irregular periods but some women “eat stress,” which means that they eat junk food during stress.
Then there are health conditions such as polycystic ovary syndrome (PCOS), hormonal disorders that can cause ovarian cysts. Although the cause of PCOS is unknown, the side effect of PCOS is obesity. Doctors state that obesity is common in patients with PCOS and affects 50 to 60 per cent of women with the condition. The symptoms can be worse if a woman is obese.
When planning a family, you want to do everything possible to increase the chances of having a healthy baby with your partner. You must focus on your health first, especially if you are overweight. If you are overweight and plan to have a baby in the next few years, you may want to act now to lose weight.
Bringing your weight back to a healthy range before conception reduces the risk of complications during pregnancy and the risk of health problems for your baby.
Role of bariatric surgery in infertility:
Obesity is a leading cause of health complications and death during pregnancy for mothers and children. Benefits of treating obesity before bariatric surgery pregnancy include:
- Increase fertility
- Reducing the risk of miscarriage or stillbirth
- Reducing the risk of preterm birth
- Reduced risk of a mother experiencing preeclampsia, gestational diabetes, blood clots and high blood pressure due to pregnancy
- Reducing the risk of giving birth to babies that are far above average (more than 4 kg, which can endanger the health of the mother during childbirth and the baby after birth)
- Increased rates of successful vaginal deliveries, even after previous cesarean births
Less operative complications and infections
Babies born to healthy weight mothers tend to be obese compared to children and adults. In men, losing weight at least three months before trying a baby can increase the chances of conception and the baby’s health.
Benefits of weight loss surgery:
Following a healthy diet and exercise plan will significantly improve your health, but not always enough to lose weight. Some people still have problems with obesity regardless of the lifestyle changes they make. If you add surgery to the equation, you can finally get the results of all the hard work you do in diet and exercise.
Dr Venu Gopal Pareek Best best bariatric surgeon in Hyderabad, says to his patients about successes of surgery, with constant dietary changes and continuous exercise.
Outcomes with Bariatric surgery infertility:
Alternative strategies must be considered. For many private IVF clinics, this is only a higher or non-existent BMI limit. However, this approach leads to pregnancy in obese women with all maternal and perinatal complications. An alternative approach for obese, unhealthy women is a pre-conceptual bariatric surgery. It is clear that obese women need an increase in the dose of gonadotropin, produce fewer eggs and good quality embryos, and a higher risk of miscarriage, all of which contribute to a reduction in the likelihood of live births.
Regardless of the type of surgery, young women undergoing bariatric surgery experience great weight loss and many people experience normalization of their menstrual cycle, improved sexual function, increased metabolic profile, including diabetes and cardiovascular risk, and achieve pregnancy, and also with a reduced risk of miscarriage and pregnancy complications.
In addition to the hormonal problems associated with obesity, erectile dysfunction is more common in overweight men – which can cause an additional layer of stress in the conception process. When observing men who have had bariatric surgery, doctors see a significant increase in erection efficiency in men after surgery.
It is interesting to note that sperm traits which were also observed such as volume, concentration and mobility did seem to improve in men after bariatric surgery. Researchers have suggested that this could be the result of hormonal changes after this particular type of operation.
The relationship between bariatric surgery and male fertility seems to be correct. Obesity, in general, is a significant factor influencing partner fertility; both parties must try to lose the extra pounds they carry by surgery. This creates not only a healthy partner but also more living sperm and eggs.
Obesity is a factor that reduces the potential for fertility in men and women. Obesity must be countered by first regulating eating habits and increasing physical activity. The effects of obesity and related metabolic disorders on reproductive health are profound and affect both gender and all generations.
Of course, advice on how to achieve a healthy lifestyle after surgery must also be shared actively by all health professionals at every opportunity, including gynaecology clinics and prenatal and postpartum visits. For more details on the role of bariatric surgery in infertility and having a plan to undergo surgery contact Dr Venugopal Pareek for best bariatric surgery in Hyderabad, at +91 91-777-77715