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Overweight and decreased pregnancy rates with fertility treatments

April 11, 2014

While this study is really not new news, it does reinforce ideas that we feel are paramount in our day-to-day fertility treatment world. For about 5 years now we have seen study after study at our national meetings pointing to the clear association of high BMI (body mass index – height to weight ratio) and decreased pregnancy rates with IVF treatments. The results are profound and always the same. One study showed over 36% pregnancy rates in the “normal” BMI (

This is why we are so adamant about changing the components of the diet in our patients undergoing any form of fertility therapy. It just never ceases to amaze me that people are writing about this problem and totally missing the underlying physiology and cause. In the above article, the paraphrased conclusion of the author is: “Though he noted that research has been pointing more and more toward a connection between extra weight and worse IVF outcomes, the reason is unclear. One explanation is that extra fat tissue releases estrogen, which fools the brain into thinking the ovaries are working when they really aren’t, so it doesn’t do its part to kick the ovaries into gear, Cooper said.”

Just amazing that nutrition is nowhere to be found in the discussion of what causes this problem?? It is clear. Are we the only ones that sees it so clearly? Simple physiology, which is completely outlined today, tells us carbohydrates stimulate insulin, that stimulates the ovary to make male hormones, that inhibits egg development. Very simple! Take away the carbohydrates, and thereby decrease the insulin and the ovarian environment normalizes. This allows for normal egg development, fertilization and pregnancy.

The conclusions of all of the studies addressing this issue are to lose weight. This does help but the studies recommend for example that a 45 BMI patient lose down to less than 38 BMI. That might be 50 to 80 lbs or so. While that is an admirable goal and will help the patient achieve pregnancy, the weight loss recommendations are almost universally wrong and don’t do well. In our program, we put patients on a strict low carbohydrate, high fat diet that immediately drops their insulin. In 6-8 weeks, we can achieve a metabolic transformation that provides a new healthy environment for ovulation and dramatically raises the pregnancy rates. This with only maybe a change from BMI 45 to BMI of 43 or so. A word of caution though: pregnancy itself is much more complicated, even from a metabolic standpoint with high start weight at the pregnancy outset. So, if possible and time permits, it is much more advantageous to actually lose as much weight as possible before starting treatment. This too because pregnancy happens very quickly in these patients once treatment cycles are started. If patients are already comfortable with the low carb approach, this can be more easily maintained in pregnancy which will dramatically reduce pregnancy associated weight gain, hypertension in pregnancy, seizures, abruption (separation of the placenta from the uterus) and gestational diabetes, all of which are at extremely high risk in these patients.

The above logic also leads us to recommend this diet approach for all fertility treatment patients and for patients at home trying on their own. This approach will dramatically increase pregnancy rates. For those contemplating pregnancy on their own, a pre-pregnancy consultation could result in significantly shorter time to pregnancy and much lower miscarriage rates and emotional distress. Other areas of importance in this setting are exercise and physiologic stress. It’s very difficult to sort through the enormous volumes of information out there on the internet regarding “how to get pregnant.” Much of it leads couples in the wrong directions. We are happy to provide this service which can be done via phone consult. For any questions, please don’t hestiate to contact our office at (904) 493-2229.

Dr. Michael Fox

Original Article: http://www.reuters.com/article/2011/08/25/us-fertility-idUSTRE77O0R520110825

   
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