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Deborah: Going through fertility treatment is a very personal process for everyone involved. In this episode, we will deepen our understanding of how weight can be an important factor in the fertility process for women as well as men. Joining us today is Dr. Asima Ahmad, a reproductive endocrinologist at Fertility Centers of Illinois.

This is the Time To Talk Fertility podcast. I'm your host, Deborah Howell. Weight is a touchy subject for every woman without a doubt. Dr. Ahmad, why is it so important to discuss this topic when you're looking to grow a family?

Dr Asima Ahmad: It's very important. And I actually am very near and dear to this topic as someone who has polycystic ovary syndrome or PCOS herself. So it's important because just as an elevated or a very low weight affects your body in other ways, it also impacts your fertility. So when looking to build your family, it's important to try to optimize your overall health, including your weight, to not only increase the likelihood of pregnancy, you know, to increase your chances per attempt, but also to increase the chances of having a healthy pregnancy outcome for both you and the baby.

Deborah: Sure. Now, how does someone determine whether their weight is healthy or not?

Dr Asima Ahmad: So there's no perfect way to determine what the best weight is for everyone overall, because it's different for every individual. I think a good place to start is checking your body mass index or BMI, and you can usually do that through an app or a calculator. And you're looking for a BMI somewhere in the range between 18 to 25.

Deborah: Okay. And where do we stand as a country when it comes to weight?

Dr Asima Ahmad: When you compare to United States to over 150 other countries worldwide, we're in the top 15. So that means that over 35% of our adult population is obese. So we do tend to have a higher weight than the average population overall.

Deborah: Indeed. Now, how do you think the pandemic has factored into weight gain or maybe even weight loss?

Dr Asima Ahmad: I think it's made it much more difficult to stay fit. Our usual outlets like going to the gym or social outings and activities are so limited now with social distancing. And with that limited activity and easy access to food at home and increasing rates of depression worldwide, caloric intake has gone up for many as well.

Some people on the other hand have turned the other way by building at-home gyms or joining online forums and apps to continue being active. Though now they're doing it in front of the screen rather than with other individuals in a gym setting or outdoor setting, they've actually become more fit.

Deborah: Yeah, I have to say, because I have time now, I'm working from home, I get it in every single day. You know, when I was commuting, I just didn't have time every day. So there's that.

Dr Asima Ahmad: I'm in the same boat there.

Deborah: Happy for us. Now, you see patients every day. What weight trends are you seeing?

Dr Asima Ahmad: Well, most of my patients hit pretty hard by the pandemic when it comes to weight. They were already having high levels of stress from their diagnosis of infertility, recurrent pregnancy loss, polycystic ovary syndrome and other things. And this added more stress and isolation for many of them. Therefore, most of their activity levels tended to go down and their caloric intake went up, so they gained weight.

However, I do make it a point at every appointment to try to check in to see how they're doing. And if there's any indication that their weight has moved in the direction of unhealthy weight gain or weight loss, we discuss ways to improve it.

Deborah: That's fair enough. And what are the main ways a healthy weight boosts overall health?

Dr Asima Ahmad: The things that tend to run in line with healthy weight are lowered levels of fat tissue, insulin, and unhealthy cholesterol. This isn't perfectly true because we know there's also that, and then I quote, skinny-fat physique, but in general it tends to run in that direction. So when these three things, in addition to others, are at a lower level, it decreases the likelihood of health issues such as metabolic syndrome, diabetes, and cardiovascular disease.

Deborah: Now more specifically, how does a healthy weight boost fertility in women and even in men?

Dr Asima Ahmad: I think it's important to highlight that a healthy weight when looking at it from the lens of BMI or body mass index as mentioned previously is, you know, greater than 18, less than 25. This means that a healthy weight is when you are a neither underweight or overweight as both can cause increased issues with fertility, such as ovulation dysfunction. Ovulation dysfunction is when you're not releasing your egg.

Increased weight and fat content in our bodies can also lead to decreased egg quality. Increased fat content increases the insulin levels in the body, which can also increase androgen levels or male hormones that can, again, result in ovulation dysfunction, where the egg is not released.

Deborah: It's all connected. This one's for couples in treatment. How does a healthy weight increase their chances of success?

Dr Asima Ahmad: A healthy weight can improve the odds of more predictable ovulations in many individuals and will also help in those individuals doing timed intercourse or intrauterine insemination. It'll also improve the egg and sperm quality for not only these individuals, but also those undergoing in vitro fertilization.

Deborah: Now the fun part, once a couple becomes pregnant, how does a healthy weight improve pregnancy?

Dr Asima Ahmad: A healthy weight decreases certain risks during pregnancy. For example, someone with a very low weight is at increased risk for miscarriage, preterm delivery, and decreased weight for the baby. On the other hand, someone with an elevated weight is also at increased risk for miscarriage, preterm delivery, but also stillbirth, birth defects, gestational diabetes, preeclampsia, and even an increased chance of cesarean delivery. So having a healthy weight and continuing to maintain a healthy range of weight gain during pregnancy will reduce these risks.

Deborah: And now we're smack dab, of course, in the middle of a pandemic. So research has shown that extra weight can increase the illness if you get COVID-19. Can you tell us a little bit more about little bit more about that?

Dr Asima Ahmad: Yes. So obesity is linked with a few things that increase the risk of severe illness if you do happen to get the COVID-19 infection. For one, your lung capacity and reserve are decreased, and that can make ventilation more difficult. And also there's a link between obesity and decreased immune function.

So there was this meta-analysis study published in Obesity Reviews in August of last year that showed obese individuals are more likely to become hospitalized, 74% more likely to require ICU admissions and also have a higher risk of mortality.

Deborah: Maybe time to tell some patients to just take a breath. You've mentioned just a little weight loss can go a very long way. What should we know about that?

Dr Asima Ahmad: It definitely can. There are studies that have shown that even losing as little as 5% of your body weight can dramatically improve your fertility for both men and women,

Deborah: Can't beat that. Five percent is certainly a good place to start. Now, changing our lifestyle and making a weight goal is kind of overwhelming. Where should people start?

Dr Asima Ahmad: I think start off by setting smaller, more attainable goals. Weight loss is a combination of reducing caloric intake and increasing caloric expenditure. So one can start off by using a basal metabolic rate calculator. It takes into consideration your sex, your BMI, your age, and informs you of how many calories you're burning at rest. And with this information, you can determine how to adjust your diet and your activity to, one, decrease your calories and two, to burn more calories.

And in the beginning for some, this may just mean adjusting diet or activity at first, and then adding in the other later when they feel more comfortable. For best results though, it's good to introduce a combination of the two. Overtime, you can adjust these to continue with your weight loss. And this can be done with both extremely low body weight, but, for that, you would be trying to increase calories and then perhaps decrease activity levels.

And of course in the beginning, it seems overwhelming. It's hard, you know. Sometimes speaking to a nutritionist or a health professional can also help.

Deborah: Yeah, which actually leads to my next question. You know, there's calories on one hand and then there's nutrition on the other hand. When it comes to nutrition, what should people consider?

Dr Asima Ahmad: Well, first and foremost, food should not be seen as a bad thing. We need food to survive. I think it's about making smart choices on the types of food that we eat and the portions that we take in, and that can make a big difference. Sometimes it also helps when we do this with someone else, like a partner or a friend. It adds an accountability factor and keeps one motivated.

Deborah: Absolutely. Especially if that partner is somebody you're trying to be getting pregnant with. What's a good exercise goal to aim for as well?

Dr Asima Ahmad: This is different for everyone as everyone has a different level or activity at baseline, but a starting goal for someone who is primarily sedentary or is not moving too much on a daily basis is to have at least 30 minutes of activity, at least maybe three times per week. And this can be as easy as walking for those 30 minutes. And over time, what they can do is increase the amount of time that they're doing this and also change the type of activity to increase the heart rate more. For example, that walk can turn into a jog or a run

Deborah: Right. Walking really is exercise. A lot of people don't think that it is. They think they have to get out there jogging. But seriously, walking and then power walking is another great way to burn those calories. And, once you get started, you find it gets easier and easier and easier.

Now, we're coming to the end, but I have two more things for you, doctor. Do you have any anecdotal examples of patients who have achieved a healthy weight with the goal of boosting fertility and treatment success?

Dr Asima Ahmad: Absolutely. I've had many patients who have had difficulty conceiving and may have had an elevated BMI over 40 to 50. And while doing their workup, I also discuss weight loss and the impact of that on fertility. And for some of them, they were able to get pregnant even before their next consultation. Like for some of them they didn't show up and I called them and I'm like, "Hey, how are you doing? I haven't seen you in a few months." And like, "Oh, by the way, I got pregnant after losing weight." And that's the best news you can hear,

Deborah: Absolutely. Now, can you share some hope with our listeners?

Dr Asima Ahmad: Absolutely. I'm a woman in my late 30s with PCOS and, trust me, I know firsthand how weight can impact your fertility and also how it's harder to get to your ideal weight as you get older. And there are some days that seem like skipping a meal actually makes you gain five pounds rather than lose any weight, but you're not alone. There are so many individuals and so many resources out there that are available to help.

During the pandemic, the amount of resources you can access from home have gone up substantially. So please do not hesitate to reach for one of them. And sometimes, like I said, that resource is your partner or your friend, and you can take on this goal of achieving healthy weight together and you can make it fun.

And I'm also available. If you ever want to reach out, I can be found on Instagram or if you wanted to come to Fertility Centers of Illinois, I'm happy to sit down and talk to you about this further.

Deborah: Well, Dr. Ahmad, you are the perfect person to talk to about all of this and we can't thank you enough for being on with us today. It was very inspiring.

Dr Asima Ahmad: Thank you so much for having me.

Deborah: That was Dr. Asima Ahmad, a reproductive endocrinologist here at Fertility Centers of Illinois. Call (877) 324-4483 or visit us online at fcionline.com to schedule a telemedicine consultation with one of our wonderful physicians.

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This has been the Time To talk Fertility podcast. I'm your host. Deborah Howell. Have yourself a terrific day.