Melanie Cole, MS (Host): Have you struggled with your weight and now you're thinking about trying for a baby? What is the relationship between weight and fertility? Well, we'll learn all about it on today's episode of Fertility Talk with RSCNJ, the Reproductive Science Center of New Jersey. I'm Melanie Cole and joining me today is Kelly Curtis. She is a Physician Assistant with the Reproductive Science Center of New Jersey.

Kelly, it's such a pleasure to have you with us today. I'd like you to start by telling us a little bit about that relationship. How does excess body fat affect hormone levels, affect our fertility? Tell us how all of this goes together.

Kelly Curtis, PA: Hi, Melanie thanks for having me. So, this is a very broad topic. We'll kind of touch on the big picture ideas. But the first thing to understand about excess weight or specifically obesity. So obesity is defined as a body mass index, which is the BMI is generated from a formula, involving your height and your weight.

A normal range BMI is 18.5 to 25, overweight is 25 to 30, and obesity is considered to be a BMI greater than 30. So with that, there are different classes of obesity as well. Class 2 starts at 35 and over, and class 3 is actually 40 and over for BMI. So what we found, is having excess adipose tissue, which is fat cells, can have a disruption in the way that the hormones of the body work. So if you have excess fat, these actually have trouble with estrogen production being converted to androgens, which is a male hormone. And having this male hormone circulating throughout the body at higher levels than what we need, throws off our system. So in a normal menstrual cycle, in fertility and with ovulation, normal ovulation, the brain talks directly to the ovaries.

So it's a closed loop. The hormones feed back and communicate with each other every month. It's a cyclical process. But it's kind of the A B conversation, see your way out. The fat cells are essentially the C and want to be involved in the conversation, which throws the whole process off.

So, that all being said, we know that having excess weight can cause issues with ovulation, it can cause issues with insulin resistance, which plays into that whole feedback system, regulation of menstrual cycles. So often times, being obese, you could have, very long periods, so that causes an issue with conceiving. And then, it also can have an effect on egg quality. So that is at any level, that is with trying to conceive on your own, or even with high fertility treatments such as IVF.

Host: Well, thank you for that. So is there an ideal weight? Is there an ideal range for optimal fertility? And I know talking about women here, but I'd like you to just touch a little bit on men and their weight issues as it pertains to fertility. But is there something optimal you're working, Kelly, with obese patients? Are you telling them sort of a range that you'd like them to try get to? Or if they're thinking about getting pregnant, something that they try for?

Kelly Curtis, PA: Yeah, so, a normal weight, which would be the BMI of 18.5 to 24.9, is ideal. And that's not only for fertility, but for everyday living. For heart disease risk, cancer risk, all the other things, that weight involves, being overweight involves, I should say. But for also similar things for the males, again, their closed loop. Their brain talks to the testicles, which produce testosterone and sperm. And when they have, again, excess fats, similar process where, they have higher androgen levels. Where it's an issue for the males is having what is not in the brain testes system; is the body is seeing more androgens that's not coming from the testicles, but the brain doesn't know otherwise.

So the impulses from the brain, are lower and you don't get as much of a response from the testicles. So that in turn leads to lower sperm counts, poor quality with the morphology, the motility, and even the body habitus. So the scrotum and testes are meant to sit away from the body to keep cooler, so the sperm can live. If your body habitus does not allow for that, then there can be issues with heating of the testicles, which can in turn have a poor effect on sperm.

Host: I know most people think about being overweight as being something that even could predispose you to high risk pregnancies. But what about being underweight, Kelly? Is that also an issue with fertility you've seen?

Kelly Curtis, PA: So or similar issues, not having enough fat, can actually cause issues as well where you're not having any periods and the body sees that as a stressor, and it's, again, disrupting the regulation of the impulses of the hormones from the brain talking to the ovaries. So being underweight is not a good thing either, and that's defined as a BMI less than 18.5.

Host: So tell then, someone comes to you and they're seeking fertility treatments and a couple comes and if this woman is obese, what do you tell her? How do you work with somebody? I mean, are they trying to lose weight? Are we going to recommend bariatric surgery before they start trying to pregnant? What do you do for somebody, Kelly, who is obese and trying to get pregnant where we do know that this excess body weight is affecting their fertility?

Kelly Curtis, PA: So, education is a huge thing when it comes to this. It's no secret that a healthy lifestyle and exercise is good for you. And it's something that is important to seek help if it's not something that you feel that you are capable of doing on your own. You know, it's very challenging to get motivated to lose weight. It's not an easy thing. So, we try to make sure that our patients have the resources they need, such as nutritionists, or a lot of the hospital systems now have, weight loss programs. So, if they're considering a lot of times to be even a candidate for bariatric surgery, you need to show that you are dedicated to losing weight.

But the big downfall with, you know, there's no quick fix with when it comes to weight loss. A lot of it is lifestyle changes. A lot of the medications that are available are not safe in pregnancy, and should be discontinued before trying to conceive. And for weight loss surgery, if you are a candidate for that, they do recommend waiting 18 to 24 months afterwards, to try to conceive because it's a big fluctuation in the vitamin levels and things like that, that could not be ideal for baby if you were to conceive after surgery.

Host: This is such a huge Kelly, but one of the things that we think about when you're trying to weight, and we've all been there. I don't know if you have, but I know I have, it's stressful. And also fertility treatments can take a lot of stress and emotional toll on the body. When you working with people, and you're such a kind hearted person, how do you work with them when got the possibly having obesity related issues to their fertility or even to their pregnancy itself. And then the stress of fertility and the stress of trying to eat healthy and lose weight, it all comes together. So it's, it can pretty hard. What do you do for people?

Kelly Curtis, PA: Yeah, it's a very challenging situation, and greater than 50 percent of women are overweight or obese at the time of conception, so you're not alone. It's a hard process to go through, and it's we do have recommendations for BMI cutoffs, and that is because of potential complications for anesthesia when we do egg retrievals for IVF, at poor obstetrical outcomes, you know, if you're a high risk we just want to make sure that you and baby are healthy, for a good, healthy pregnancy. But for fertility reasons, if you're overweight, you may have poor response to the medications. You may require more medications to get the desired effect.

And that's at any level. That could be an oral medication, either with IVF. And it can affect egg quality, like I said. So we may not be getting as many eggs as we would anticipate due to just being overweight. And the quality of eggs may not be ideal, or optimal if we could help it. And also just sometimes with the body habitus, it can make just ultrasounds a little bit more challenging too. We do transvaginal ultrasounds, um, or sometimes abdominal. And it just is sometimes a little bit more challenging, and if the BMI is very high or there's a lot of what we call truncal obesity, where you carry your weight around your belly; it can make things hard and potentially, it's much more challenging to do the normal things that we do with fertility.

Host: This is so interesting. And so Kelly, as we get ready to wrap up, when you're working with people every day and people are obese, women that are obese, that trying to get pregnant have these other issues. They may have blood They may have diabetes, these comorbid conditions that go with obesity, but they're also trying get pregnant. So I'd like you wrap it up with your best advice, what you would people to know that about relationship between weight and fertility, when they should come see the specialists at the Reproductive Science Center of New Jersey.

Kelly Curtis, PA: So it's something to focus on definitely, for not only reproduction, but overall health. And we try not to delay any cycles because time is always of the matter. We can't turn back time. So there may not be a lot of benefit from going through a bariatric surgery and waiting two years, because that's, you know, two years of potentially better quality eggs that we're missing out on. So, on top of everything, how you mentioned before with the stress of fertility treatment, stress of weight loss, stress of making sure you have a better diet. It is a lot, but it's something that you may see it pay off, as you're going through treatments.

So, depending on the level of excess fat that you have, and your body mass index, it's always something that can improve and even a little bit will go a long way. So, you know, if there's more motivation to get healthy or, a healthier weight, I should say, then having a child and then that's a good motivating factor we want you to roll with it.

Host: Thanks so much Kelly, for such an informative, educational episode. As always, you're really a great guest. Thank you again. for more information, visit FertilityNJ.com. That concludes episode of Fertility Talk with the Reproductive Science Center of New Jersey. I'm Melanie Cole. Thanks so for joining us today.