Every two of three women and three of four men in the United States are overweight or obese. Obese is defined as a body mass index (BMI) greater than or equal to 25 kg/m squared and a BMI greater than or equal to 30 kg/m squared, respectively. Approximately 50% of reproductive age women are obese. Obesity adversely affects reproduction in both women and men. IVF success rates are lower in obese women compared to normal weight women. Poor ovarian stimulation, oocyte quality and embryo development are adversely affected by obesity. Sperm parameters are also lower in men with obesity. Obesity in men is associated with poor fertilization and embryo development. Obesity in women can alter endometrial receptivity lowering implantation and increasing the chance of miscarriage. Obesity also increases the risk of obstetric and perinatal complications including gestational diabetes, hypertension, preeclampsia, preterm delivery, shoulder dystocia, fetal distress, early neonatal death, and both small and large for gestational age infants. The incidence of birth defects are also higher in women with obesity. Maternal obesity promotes obesity in their children and is associated with an increased risk of premature death in subsequent generations.
Obesity is a significant disease and is becoming a major factor in infertility and miscarriage. Life style modification remains the first line of therapy and includes calorie restriction and increased physical activity. Supervised medical therapy or bariatric surgery should also be considered. If bariatric surgery is performed pregnancy should be postponed for a year so that metabolic stability can be affirmed. Unfortunately, many because of advancing age may not be able to afford the time to wait until ideal body weight is achieved. For those morbidly obese (BMI greater than or equal to 40 kg/m squared), the goal should be to achieve a BMI at least less than 35 kg/m squared.
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