Obesity has become one of the main health problems of current society. The last two decades in particular have seen the prevalence of women in reproductive age with obesity has increased considerably. The World Health Organisation defines obesity as an abnormal or excessive accumulation of fat that can be harmful to health.
In clinical practice, the simplest way to estimate the degree of obesity is by using Body Mass Index (BMI), which is calculated by dividing a person’s weight in kilograms by the square of the size in meters. A person with a BMI between 18.5-25.9 Kg / m2 presents an adequate weight, between 25-29.9Kg / m1 is considered overweight and when the BMI is equal or over 30 they are considered obese.
Obesity has a significantly negative effect on reproduction; affecting both women who spontaneously seek pregnancy as well as those who undergo assisted reproduction techniques.
It is estimated that women with a BMI> 30Kg / m2 have three times more alterations in the menstrual cycle than those with an adequate weight. This is because obesity produces dysregulation in the hypothalamus-pituitary axis which alters the pulsatile secretion of GnRH and produces a preferential increase in LH in relation to FSH. This entails, on the one hand, the excessive secretion of testosterone and, on the other hand, follicular arrest, resulting finally in anovulation and amenorrhea. This clinical picture is usually typical of patients with
Polycystic ovarian syndrome (PCOS), present in 75% of women who are overweight.
Obesity not only produces anovulatory problems, but also has a direct, negative effect on oocytes, on the subsequent development of embryos and on the consequent implantation in the endometrium.
In assisted reproduction treatments this is translated into the need to apply a greater dose of gonadotropins, a higher percentage of cycles cancelled as a result of a poor response and, finally, a low success rate in treatments.
Despite certain discrepancies between studies regarding the relation of loss of weight-rate of live new-born, the loss of 5-10% of the weight causes a significant improvement at the endocrine level, thus achieving more regular menstrual cycles. Furthermore, we achieve a lower dose of medication required, a higher proportion of oocytes in Metaphase II, better quality of the embryos to be transferred, a lower rate of spontaneous miscarriage and preeclampsia and a lower number of necessary cycles.
Therefore, the loss of weight should be the first therapeutic measure to be considered in these patients. This should not only be applied to women, but also to men, since the few existing studies which exist indicate that obesity also affects spermatogenesis and hence the sperm parameters (volume, concentration, vitality, motility and morphology.
The etiology seems to be multifactorial in nature: excessive peripheral aromatization of testosterone to oestradiol, insulin resistance, increased temperature in the gonads, erectile dysfunction, accumulation of reactive oxygen species (ROS) and so on.
If, in addition to achieving an adequate BMI, a good diet will assist your fertility journey. Below there is a list of food rich in those nutrients that favour fertility.
Vitamin A – Milk, orange, carrot
Vitamin B – Egg, cereals, banana, lamb
Vitamin C – Kiwi, red pepper, broccoli
Vitamin E – Sunflower oil, hazelnuts, almonds
Folic Acid – Spinach, asparagus, broccoli, chard, lettuce
Polyunsaturated fatty acids (Omega 3) – Salmon, tuna, sardines
Monounsaturated fatty acids – Olive oil, avocado, olives
Proteins of vegetable origin – Lentils, chickpeas, beans, nuts
Carbohydrates with a slow absorption, rich in fibre – Wholemeal cereal/bread, strawberry, orange, pear, lentils, chickpeas
Calcium – Dairy products
Iron – Cockles, clams, lentils
Zinc – Oysters, celery, aubergine
On the other hand, the foods that should be avoided are:
– Proteins of animal origin (red meat)
– Saturated fats (pork, veal, bacon, yogurt, butter, chocolate)
– Carbohydrates of high glycaemic index / fast digestion (white bread, sweet sugary sodas, honey, potatoes)
– Alcoholic beverages
The relationship between food and fertility is a complex one but studies consistently show it is an important one. Choose your food and diet carefully and it will almost certainly have a positive effect on your chances of conceiving!
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