Welcome to my blog, discover acupuncture with Dr Maggie Ju

Qualified as a medical doctor in Western medicine in China with a Medical degree from Beijing, China and a PhD degree from the UK. Many year research and clinical experiences. This blog is for information only.

Monday, 15 August 2022

How overweight affects fertility and how can acupuncture help?

Obesity increasingly affects people’s health. It is well studied and extensively agreed that obesity has negative impact on fertility. Women with obesity are three times more likely to suffer from infertility than women with body normal weight. The impaired fertility has been seen in obese women naturally and obese women with assisted conception. Obesity reduced fertility by affecting ovulation, egg development, embryo development, endometrial development implantation and pregnancy loss.

Obesity affects ovulation and period cycles. Obesity has effect on hypothalamus-pituitary-ovarian axis which is important in regulation of sexual hormone production. If this axis is disturbed, normal hormone production is impaired leading to abnormal period cycle and anovulation. This causes infertility. Women with obesity respond poorly to ovulation induction. Weight loss only could restore normal period cycle and ovulation; it increased response to ovulation induction.

Obesity affects egg quality and egg quality is likely to be poor in women with obesity

Obesity has great impact on reproductive health. Women with obesity are nearly three times more likely than women without obesity to have difficulty to conceive and may take longer to conceive. Women with obesity also have an increased risk of miscarriage, pregnancy complications and congenital defects in offspring, if they do get pregnant. Obesity may affect egg competence and maturation caused by alterations in steroid hormone balance, particularly those hormones that trigger follicle maturation. This is because fat tissue is an important site for steroid hormone production and metabolism and excessive fat in obesity may alter steroid hormone levels. Also metabolic alterations in obesity occur in the serum which is reflected in the follicular fluid and some changes in this micro environment may affect egg quality. For example, serum insulin concentrations and resistance to insulin action in cells are increased in obesity. In women with obesity has increased C-reactive protein which is an inflammatory marker in follicular fluid. When undergoing IVF, women with obesity have less quality eggs collected. This is caused by reduced human chorionic gonadotrophin (hCG) concentration impairing egg maturation. Many studies showed that obese women undergoing IVF have lower fertilization rate than women with normal weight. Impaired egg development could lead to impaired embryo development and following impaired implantation.

Obesity reduces uterine receptivity

How obesity affects women’s fertility? Recent research suggested that obesity reduces uterine receptivity in overweight women. Bellver J et al analysed the reproductive outcome of recipients of donated ova according to their body mass index (BMI). These data were from 9587 first cycles of ovum donation from normal weight donors. Recipients received in vitro fertilization (IVF) were divided into four groups according to their BMI: group A lean BMI<20 kg/m2, group B normoweight BMI 20-24.9 kg/m2, group C overweight BMI 25-29.9 kg/m2 and group D obese BMI ≥30 kg/m2. There was no difference among the groups in IVF parameter. However, implantation, biochemical pregnancy, clinical pregnancy, twin pregnancy, and live-birth rates were significantly decreased as BMI increased. In the lean, normoweight, overweight and obese groups, the implantation rate was 40.4%, 39.9%, 38.5% and 30.9%. Clinical pregnancy rate was 56.9%, 55.9%, 54.3% and 45.3% and live-birth rate was 38.6%, 37.9%, 34.9% and 27.7% respectively. Clinical miscarriage rates were similar in all groups. They suggested that female obesity impairs the reproductive outcome of donated ovum because of reduced uterine receptivity. To make uterus more acceptable for pregnancy, it is time to lose weight for those overweight women.

Women with obesity are more likely to have early pregnancy loss once they are pregnant. Increased miscarriage rates were observed in pregnancy from natural conception, ovulation induction and assisted conception. This suggests that endometrium may play a part in early pregnancy loss.

Obesity affects assisted conception treatments. Many studies have shown that obese women undergoing assisted conception such as IVF have lower live birth rates. This is accumulated effect of lower implantation and pregnancy rate, higher miscarriage rates and increased pregnancy complications.

Weight loss improves fertility greatly no matter what weight loss methods were used. The first method used should be life style changes including diet and exercises. Many evidences showed improvement of ovulation frequency and pregnancy rates after good weight loss.

Acupuncture helps regulate metabolism of the body. Acupuncture helps increase ovarian and uterine blood flow to improve egg quality and uterine lining for conceiving and implantation and supporting pregnancy.

References

Bellver J et al Fertil Steril (2013) Jul 3

Yao H et al Zhen Ci Yan Jiu (2012) 37:497-501

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