Dr. Grace Couchman @ Carolina Conceptions

Patients often ask, “Is there anything I can do to improve my fertility”?

One of the hardest topics for patients and doctors to address is that of obesity. Fertility can be negatively impacted by obesity. Although we all know overweight women who conceive, the fact is that obesity contributes to infertility in a number of ways. A healthy BMI (Body Mass Index) calculated by height and weight, is between 18.5-24.9. Overweight is defined by a BMI of 25-29.9 and a BMI>30 is obese.

Women who are overweight and obese have higher body fat. Fat can increase the amount of estrogen in your body and this higher level of estrogen negatively affects the body’s desire to recruit and mature eggs, thus negatively affecting ovulation and menstrual cycles.

Women with polycystic ovarian syndrome (PCOS) may or may not be overweight, but PCOS is often linked with obesity and insulin resistance. Insulin resistance means that your body is forced to secrete high levels of insulin from the pancreas in an effort to always control your blood sugar so that you do not get diabetes. These high levels of insulin, however, circulate throughout your body, and impact the ovary by negatively affecting the development of eggs.

Foods that force particularly high levels of insulin to be secreted are sugars and carbohydrates (starchy foods). Therefore, the best diet for women with PCOS and obesity is a no sugar, low carb, high protein diet. Trying to eliminate sugar from your diet of course means eliminating the obvious sources of sugar: candy, cookies, sodas, and in the South, sweet tea!

You must also look closely at all the packaged food that you consume. If it has sugar, corn syrup, or sweetener as one of the ingredients, try to avoid it. The best way to eat is to eat whole foods that you are preparing and cooking at home. For example, grill or bake chicken with vegetables and small amounts of quinoa and you have an inexpensive and healthy meal. Make extra to use for lunch the next couple of days.

Lowering carbohydrates means cutting back on starchy foods and eating small amounts of potatoes, rice, grains and whole grain bread. Protein is ideal because it does not drive as much insulin secretion. Meat, chicken, and fish, along with nuts, eggs, and beans, are some of the best sources of protein.

Start your day with protein: eggs and leftover meat, chicken or fish from the night before. Do not start the day with bagels, pancakes, or cereal, as these carbohydrates will drive your pancreas to secrete too much extra insulin, again impacting your ovaries in a negative way. Fruits (including fruit juices), should also be eaten in moderate amounts as they too contain sugar, although natural and not refined.

Look on the web for low glycemic (or low sugar) foods. Fruits with a low glycemic index are apples and oranges whereas pineapple and watermelon have a high glycemic index- so don’t be fooled into eating a lot of high sugar fruits.

Supplements and medications that can help with insulin metabolism are pregnitude, inositol and glucophage (metformin). These supplement your healthy eating, but do not take the place of healthy eating.

Obesity not only causes anovulation but has also been linked to an increase in miscarriages particularly in BMIs over 30. Women often think that IVF is the final answer to their infertility, but studies show that women with higher BMIs have lower embryo implantation rates and therefore are less likely to conceive than a normal weight woman of the same age.

Losing weight is hard and there is no one way that works for every woman. Following some of the dietary suggestions above is just a start, but first, you must believe every day that what you are eating is affecting your ability to get pregnant. You don’t need sugar, nor does your baby when you are pregnant.

Some women lose weight by counting calories, others by keeping track on an app or in a journal, some by eating very small snacks and meals so that they never get desperately hungry, others by joining a weight loss group such as Weight Watchers and others with bariatric weight loss surgery. There are numerous other approaches, but there is no easy answer.

Even a loss of 5-15 pounds can improve your odds for conception. Being overweight puts women at risk for pregnancy complications such as high blood pressure, gestational diabetes and an abnormally large baby.

Partnering weight loss efforts with increased exercise can be particularly effective. If you do not exercise at all, start by walking and keeping track of how long or far you go. Of course, there is an app for all of this, or purchase a simple pedometer. You may increase your appetite with exercise so be conscious and plan your eating before you arrive home. Avoid all fast food and plan out your eating for the day.

You can do this!!! Start today. Start with small achievable goals: losing 3-5 pounds, walking 20-30 minutes a few days a week and drinking primarily water.

Encourage your partner to eat and exercise with you. Perhaps they can benefit from weight loss as well. If they can’t follow your eating goals, then insist that they do not bring sweets or unhealthy snacks into the house.

Reward yourself. If it’s a party or celebration, have a bite or two of cake and then throw it out! Buy a new water bottle, consider a personal trainer, and get a massage.

No one can lose the weight but you. It will not be easy, but it will be rewarding. You must decide and believe that weight loss will help you to reach your goals of becoming pregnant.

I have been taking care of women who want to be pregnant for over 25 years. In my experience, weight loss and a healthy lifestyle contribute greatly to successful conception and a successful pregnancy.

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