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Fertility Fitness - the impact of increased weight on fertility

Written by Mystic on Sunday, September 28, 2008

Thirty seven percent of Australians are overweight or obese according to recent Australian Bureau of Statistics data and the number is rising. In addition to the association with cardiovascular disease, diabetes and some cancers, increased weight has now been shown to have an adverse effect on fertility and also increases the risk of miscarriage.

This association was first noted in studies in the 1950's but received little attention until the last decade. Most of the work to date has concentrated on fertility issues in women. As a woman's weight increases she requires higher levels of insulin to maintain a normal blood glucose level. These increased levels impact on the ovary, stopping ovulation and leading to increased male hormone levels. The result is irregular menstrual cycles and fertility problems. Women who have been diagnosed as having polycystic ovaries (PCO) are particularly at risk. Some studies have shown that even women at the higher end of the normal weight range can have their fertility affected.

Increased weight can also impact on the effectiveness of fertility treatments. As a woman's weight increases, she will require more drugs to get the desired response, and in up to 30% of cases, will still not respond well enough for treatment to occur. In addition, despite the increased stimulation, her chance of pregnancy is significantly reduced as a consequence of the effects of the increased weight.

If a pregnancy does occur the risk of miscarriage is increased, with once again women with PCO being particularly at risk.

The good news is that a small amount of weight loss can reverse these problems. An Australian study, which was a world first, has shown that a group programme of exercise and dietary advice, without an emphasis on low calories, can restore menstrual regularity and therefore ovulation and pregnancy for up to 90% of the women involved. Even women with causes of infertility unrelated to producing an egg each month (anovulation), such as tubal blockage or male sperm problems, showed a dramatic improvement in their chance of pregnancy on treatment. In addition, the risk of miscarriage was significantly improved. The women lost a maximum of seven to ten kilograms over six months so it was not necessary to get back to the normal weight range to get the beneficial effects. Even a 2-5% weight change was effective in restoring ovulation.

The study found that lifestyle changes are much easier for women to achieve if they were part of a group of women with the same fertility aims as themselves. Conversely, individual dietary advice and lifestyle management has not been shown to be particularly effective. The advantage of the group programme is that it appears that the weight loss is sustained and therefore it is likely that long-term health benefits will also result.

The programme is currently available to women who live in Sydney, Melbourne or Adelaide. Contact details can be obtained through ACCESS. (link to about Access)

Very little is known as yet about the effects of increased weight on male fertility. We do know that as a man's weight increases his testosterone levels can drop and in extreme situations there is an alteration in the semen profile. A study is now underway to explore this issue further. It is being run in association with the Gutbusters programme. Any overweight men interested in seeing the effects of weight loss on their sperm and hormonal profile can contact Wendy on (02) 9586 3214.

In summary, for women in particular, weight loss should be considered as part of the initial treatment of any woman above her 'weight for height' average, who requires fertility management, irrespective of whether it is as simple as ovulation induction or as complicated as IVF. As anyone who has tried to lose weight knows, getting the bit of your brain that wants to lose weight to connect to the bit that has to do it, is very difficult. However, making use of group dynamics, either with a specific programme associated with a fertility clinic or some other means, has been shown to be most effective in achieving the aims of weight loss, pregnancy and a healthy outcome.

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Trying to Conceive: Infertility

Written by Mystic on Saturday, September 27, 2008

A couple is regarded as infertile when they have not conceived after 12 months of regular, unprotected intercourse. About 15% of couples of reproductive age have a fertility problem. Find that hard to believe? That's because most don't talk about it. Three out of five couples conceive within six months of trying, one in four takes between six months and one year. For the rest, conception takes more than a year, which means that there may be a problem of infertility.

The causes of infertility are many and varied and can be related to male or female issues. They include problems with production of sperm or eggs, problems of the fallopian tubes or uterus; endometriosis, frequent miscarriage; and hormonal and autoimmune (antibody) disorders in both men and women.

In about 40% of infertile couples, the problem is a male factor and in about 40% it is due to a female factor. For the remaining 20%, both partners have an infertility problem, or the cause is unknown ("idiopathic").

There is no evidence that stress causes infertility. There is plenty of evidence, however, that infertility causes stress.

Treatments for infertility include surgery to fix blockages of the fallopian tubes, hormone treatments for either partner, insemination of the woman with the sperm of her partner or a donor, IVF (In Vitro Fertilisation) and related treatments such as GIFT (Gamete Intra Fallopian Transfer). Some people try natural treatments, such as herbs, acupuncture and meditation.

If you are trying to get pregnant , and have not succeeded after a year of trying, you may have a fertility problem, and it is worth seeking medical help.

If you are over 35, and have been trying to fall pregnant without success, it may be a good idea to start checking things out even earlier. Infertility investigations can sometimes take a long time, and if you put off seeking help, you could be leaving it too late.

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Stress Cause Infertility

Written by Mystic on Wednesday, September 24, 2008

Stress and infertility are intricately linked. There is little evidence that stress causes infertility but it is well known that infertility causes stress.

Stress is a normal part of life - but many would argue that dealing with infertility isn't normal. Finding ways of dealing with the stresses of infertility help a person cope both with the physical treatments and outcomes that occur.

Many see that management of stress is one of the major roles of infertility counsellors. Counselling is not only for those who aren't coping but talking with the unit counsellor can be a positive way of taking back control of the emotional side of infertility.

Counselling is important when someone is in crisis and maybe needs more therapeutic options. It is also useful and sensible to discuss options, outcomes and ways of managing stress as a way of avoiding situations getting too difficult or out of control.

Obtaining information is also a way of taking control. It is easier to cope if you have as much clear accurate information as you feel you need to make your own decisions. The counsellor isn't a clairvoyant who can predict what is going to happen, but by looking at options and thinking about possible outcomes it will be easier to manage feelings at that time. Thus seeking counselling can be proactive.

All Australian infertility clinics provide access to trained counsellors (social workers or psychologists). Some clinics see counselling as more integral to their service than others. In some states counselling is mandatory and in others it is variable. But however it is offered, counselling is of most benefit when it is client motivated ... when people are doing something for themselves and getting what they want from that service.

As everyone who has been there knows, infertility is more than a medical diagnosis. A diagnosis of infertility brings a range of emotions which can be hard to handle at times happens in the midst of and often linked to a lot of other social pressures such as tense work environment, elderly relatives or pregnant friends.

Most people cope with infertility most of the time, but reactions can be surprisingly strong and unexpected when they do hit. Many a person has seen a counsellor to find out if their emotional responses are normal, to get reassurance that others have similar reactions, and to work on coping techniques. This can also be part of the information gathering - finding out how others have coped and what has helped them.

It can be particularly difficult for people who are used to being able to organise their lives to suddenly come to this big problem - infertility. The usual methods of setting goals and steps to achieve them don't work and even more frustration occurs.

Frustration is one of the most common words used to describe infertility. People get annoyed at not being able to achieve what they want and the usual coping mechanisms aren't being effective. However the very nature of infertility often means that all the annoyances, disappointments and fears are bottled up and it helps to let them out by being able to talk.

The private and sensitive nature of infertility means that a person's usual sources of support may be inappropriate or hard to use at this time. Partners who are usually very supportive may be having their own responses to this crisis and aren't able to help each other. Or it maybe too hard to talk because both are too close to the situation.

Likewise it may be difficult to talk with friends and relatives because they don't really understand or their social circumstances are very different. Sometimes because of their very concern and closeness it may be hard to talk for fear of upsetting them as well.

It may be better to talk with someone who is not personally involved, who understands both the technology and the range of emotions, and who has professional training and experience in this area. This may be useful in untangling confused fears and looking realistically at the situation.

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