Overweight-related problems in childbearing are increasing

Even a small diet adjustment may help in getting pregnant.

An increasing number of individuals seeking infertility treatment are overweight.

“As it is becoming more common for people to be rounder, we are witnessing an increase in weight-related difficulties in conceiving,” says Päivi Joki-Korpela, specialist in obstetrics and gynaecology at the Helsinki University Hospital.

There is not a specific limit for clear weight or body mass index after which excess weight begins to make it more difficult to get pregnant. Instead, problems accumulate individually. Especially fat accruing around the midriff can disturb egg maturation and ovulation.

Clear excess weight makes both natural conception and infertility treatments more difficult. Problems accrue also during pregnancy. Women who are overweight are more prone to experiencing miscarriages as well as pre-eclampsia, hypertension, gestational diabetes and premature labour, and they have more caesarean sections and other delivery complications.

Shaming does not help

At the University Hospital, access to infertility treatment is limited to individuals whose body mass index is at or below 35. This is the limit that is officially defined as class II obesity. For women who are 165 centimetres tall, this would equal a weight of 96 kilograms.

When this limit is exceeded, a couple can be invited for a consultation. They are offered the help of a dietician, as well as the option of participating in one of the hospital’s digital weight-loss groups, Joki-Korpela explains.

“But this is a long road if the desire for a baby is already very strong.”

The topic is sensitive even among physicians. You should be able to state the facts but in a supportive way.

“Shaming doesn’t encourage positive change, and we don’t want to scare the patients.”

At the moment, Päivi Joki-Korpela and her colleague Maritta Pöyhönen-Alho are heading a pilot study on overweight pregnancies. In the study, couples seeking treatment are provided with lifestyle coaching for a maximum period of six months. The researchers follow the effect of nutrition, exercise, stress and sleep on the patients and treatment results.

Small changes can lead to big improvements

Despite the sensitivity of discussions about excess weight and the challenges of lifestyle reforms, many things speak of success.

“The wish for a baby offers the best possible motivation, and the lifestyle changes don’t necessarily have to be big. You shouldn’t strive for restrictive dieting – instead you should look for lifestyle changes that you can easily maintain,” Joki-Korpela advises.

If excess weight has already affected hormonal activity and broken the rhythm of the menstrual cycle, even a small loss of weight will return the cycle back to normal. Adjustments in food choices can help a couple to get pregnant even without actual weight loss,” says university researcher Tiina Jääskeläinen, who works as a nutrition specialist in Joki-Korpela’s research group.

“A healthier diet can significantly improve your ability to have children. Sometimes the results feel unbelievable, even for a researcher in the field,” Jääskeläinen says.

In an intervention study conducted by the Erasmus University Rotterdam, the results of infertility treatment improved by 65% with a six-month change of lifestyle. The study was headed by Professor Régine Steegers-Theunissen.

“The patients only needed to succeed in a single step towards a diet complying with nutritional recommendations,” Jääskeläinen summarises the research outcomes.

Fruitful advice

It is important to remember that the health and lifestyle choices of the parents have an impact on the next generation. Excess weight can result in abnormal metabolism, which leaves an imprint on the reproductive cells and on the foetus growing in the womb. Once born, the child will have an increased risk of developing certain diseases for the rest of their life. These include metabolic and cardiovascular diseases as well as some neurological diseases.

The first three months before and after conception are the most critical in terms of parent-child transmission of health risks.

Physicians and researchers do not recommend radical weight loss right before or during pregnancy. An intense diet regime stresses the body and may have an adverse effect on how the foetus programmes itself to assimilate nutrition.

“However, it’s never too late to improve your diet. It’s always beneficial,” Jääskeläinen points out.

Sometimes it can be problematic that dietary advice is already well-known. People are tired of receiving the same nutritional recommendations that are discussed in lifestyle campaigns.

“But you should listen anyway! The advice will also help with fertility issues,” Jääskeläinen assures.

“So, eat more fibre, vegetables, fruits and unsaturated fats – and replace red meat with fish.”

Men at a reproductive age should pay particular attention to good fatty acids.

“Sperms have a great deal of fat, and dietary fat has an impact on their mobility. This link is easy to prove, since sperms are relatively simple to study. Women’s eggs and female fertility are much more difficult.”

Excess weight in men is also linked with erectile dysfunction and low testosterone level. Fatty tissue produces the female hormone estrogen, so excess weight can slow down sperm production and weaken the quality of sperm.

Change can start from sleep

When both parties in the relationship wish to have a baby, in the best-case scenario also the positive lifestyle changes are made together.

“A couple seeking infertility treatment can provide important support to one another. There is ample evidence that lifestyle fixes are more often successful when the couple goes through them together,” Päivi Joki-Korpela says.

When it comes to habit change, there are various plans of action available. If starting out from food feels particularly daunting, there are other ways. Nutrition, exercise, sleep and stress all have an impact on weight, Joki-Korpela emphasises.

“An encouraging attitude from healthcare professionals is important, and advice should be tailored to meet the needs of the patients. Sometimes, for example, sleep is a good place to start the change. If the patient sleeps too little or is chronically tired, maintaining a healthy diet is difficult, and their hormonal status may be unbalanced.”

The article has been published in Finnish in the Y/07/19 issue of Yliopisto-lehti.

Problems in getting pregnant

Ovulatory disorders are the most common cause of infertility. These disorders are discovered in about one in four patients receiving infertility treatment at the Helsinki University Hospital. Overweight is a common background factor.

Excess weight makes getting pregnant more difficult through various mechanisms. The ovaries of an overweight woman may produce an excess of androgens, or male hormones, which prevents the egg from maturing and ovulation from occurring normally. The menstrual cycle may become irregular. Excess fatty tissue may also hinder fertilisation and the following embryonic development.

Other typical causes of infertility, in addition to ovulation disorders, are endometriosis, damage to the fallopian tubes, problems with semen and the age of the woman and, consequently, the eggs.

However, in about a third of the cases, the cause of infertility is never found.