6. Reproductive profile
One year
85 % will conceive
15 % need medical help
80 % during
investigation
20 %
20 % needs ART
needs ART i,e
i,e IVF
IVF
7. Obesity is the new
worldwide Epidemic
1. BMI > 30 kg / m2
- doubled
2. Morbid Obesity >
40 kg /m2
quadrupled
Super Obesity > 50 kg
/m2 –
five fold Increase
• These trends have
been noticed across
all races, age groups,
and nations
• Largest increase has
been seen in young
adolescents and
young women
8. OBESITY
“AN EMERGING MENACE”
1. > 1 Billion overweight
2. > 300 Million – Obese
3. 26% of non pregnant women
ages 20 – 39 are overweight /
obese
W
H
O
9. In India …..
Country Male Female
India 9 12 (2000)
12 16 (2001)
Punjab 30 37.5
Gujrat 15 17
UP 16 12
Haryana 14 17
11. An Obese Woman is about
Thrice as likely to be Infertile as
a normal woman
Yes
12. Obesity and Infertility
Chances of
pregnancy is
reduced by 5%
for every BMI
unit that
exceeds 29
kg/m2
13. MOST COMMONLY USED INDEX TO
QUANTIFY OBESITY IS BMI
SUBTRACT 2.5
in each category for INDIANS
14. High prevalence of Infertility in
Obese women
Obesity can be
• Main
• Secondary or
• Accompanying
infertility factor
The impact of obesity on A.R.T. outcomes is debatable
16. CENTRAL PLAYER ………
• Insulin resistance
• Hyperandrogenism
• Elevated leptin
• Leptin resistance
17. UNDERLYING MECHANISM both
regular or irregular cycle
• anovulation
• release of oocytes with reduced
fertilization potential
• endometrial abnormalities
“Both seed and soil defective”
18. British Fertility Society guidelines …
• Infertility treatment
should be deferred
until BMI<35 kg/m2
• preferably BMI<30
kg/m2 in young
women with good
ovarian reserve
19. Treatment Modalities
For Infertility in Obesity
Life – Style &
Nutrition
Changes
• Diet
• Exercise
• Psychological
Counseling
Surgical
Intervention
• Bariatric surgery
ART
• IUI
• IVF
• ICSI
Pharmacological intervention
Appetite suppressant, Weight Loss Drugs (Orlistat)
Drugs Increase sucidal tendency
21. OBESITY & ASSISTED
REPRODUCTION
Obese women : not only have a lower chance
of pregnancy following In Vitro Fertilization
They require higher doses of gonadotropins
and
Have an increased miscarriage rate
22. Facts……..
There are about 20 Million couples
in India who need advanced
Infertility treatment
only about 40,000 treatment cycles are
performed in India in approx 500 odd
registered IVF centres
Which is mere 0.2%
23. Under served infertility treatment
• Not enough
awareness about
various available
options
• Costly treatment
• Costly set-up
• No insurance /
governmental
support
24. Bellver et al, 2009:
the largest single
center study
(6500 IVF cycles)
25. Obesity and ovarian stimulation
Total dose of gonadotropins: Higher in obese
WMD: weighted mean difference
Maheshwari et al, 2007 : 37
26. Gonadotropin Resistance
Greater amount of body surface
Differences in absorption and metabolic
clearance
Altered peripheral steroid metabolism
Impaired absorption due to increased
subcutaneous fat
27. obesity and ovarian stimulation
Number of retrieved oocytes: Fewer in obese
Maheshwari et al, 2007
WMD: weighted mean difference
28. obesity and ovarian stimulation
Cycle cancellation rates: Higher in obese
Maheshwari et al, 2007
OR: odds ratio
29. obesity and pregnancy rates
BMI > 25 vs < 25 : Lower pregnancy rates
Maheshwari et al, 2007 : 37 papers for effects of obesity on ART- 12 papers actually included
31. obesity and pregnancy rates
Raising BMI by 1 unit: odds for pregnancy decrease by 0.98
Reducing BMI by 1 unit: odds for pregnancy increase by 1.19
Bellver et al, 2009
32. obesity and endometrium
Bellver et al, 2007 2656 first oocyte donation cycles
Lower implantation and pregnancy rates as BMI increases
•Higher miscarriage rate as BMI increases
•Lower ongoing pregnancy rate in OW and OB
ongoing PR
in BMI<25:
45.5%
in BMI>25:
38.3%
33. Complications of Obesity during
Pregnancy:
• Gestational HTN, Pre-Eclampsia, Eclampsia
• Gestational Diabetes
• Fetal Macrosomia
• Risk of medical and surgical complications
• Higher rate of C-Sections
• infection and PPH
• wound related complications
• Miscarriages
• Premature deliveries
• PROM
• IUGR, Intra-uterine fetal death
• Placenta Previa and abruption- placenta
34. Bariatric Surgery
A serious approach to serious problem
Safety of operation in
India
In Good Hands
is as Safe as
Lap Chole
35. Our Experience of Infertility and
Bariatric Surgery
Total cases – 17
All started having regular periods
2 had spontaneous pregnancy
4 had pregnancy with IUI &
6 had IVF ICSI pregnancy
12 Pregnancies
Hypertension, DM, Cholesterol has magical relief
40. Special Nutritional Consideration
• With malabsorption
there can be nutritional
deficiencies
• Decreased folate level
may cause neural tube
defects
• Poor caloric intake can
lead to ketosis and weight
loss
• Provide supplements &
consult with nutritionist
41. Post Bariatric surgery pregnancies
are generally safe
Work in
collaboration with
the Bariatric surgery
team to manage
42. Labor & Delivery
• H/o of Bariatric
surgery should
not change course
of labor &
delivery
• C-section rates
are slightly higher
in these patients
43. Practical Recommendations
Loose weight to
• Improve ovulation
• Reduce the risk of
miscarriage and
other complications
during pregnancy
• Look and
feel better
44. Weight loss is one of the corner stone to
achieve a healthy pregnancy and child birth
45. Success at lifecare IVF
• Overall conception rate 47 %
• Take home baby rate 35 %
• Blastocyst rate 50%
• Surrogacy 75 – 80 %
46. We should be able to slow down this trend.
We could do better.
