Baby rates to suffer from battle of the bulge

Experts say that if women improve their fitness, their chances of getting pregnant radically improve. The New York Times Syndicate

The Lancet medical journal reports that the obesity epidemic will leave more couples struggling to conceive as women suffer more fertility-related problems.

One expert suggested the proportion of couples seeking infertility treatment could double to one in five within a decade.

"We're at the tip of the iceberg," says Bill Ledger, professor of obstetrics at the University of Sheffield. But he says the problem could be softened if women lose weight before resorting to medical interventions to get pregnant.

The Lancet study focuses on a common disorder - polycystic ovary syndrome (PCOS) - which affects one in 15 women worldwide. PCOS occurs when women have excess male hormones which cause little cysts to grow on the ovaries. Symptoms include irregular or missed periods, infertility, excess hair, acne and insulin resistance which can make them more prone to diabetes.

"Obesity has a substantial affect on the manifestation of polycystic ovary syndrome," the paper says. "Excess weight exacerbates metabolic and reproductive abnormalities in women with the syndrome, and family studies suggest that weight gain might promote polycystic ovary syndrome in a susceptible population."

Robert Norman, the lead author at the University of Adelaide, Australia, says: "Obesity doesn't cause PCOS but it exacerbates it ... it's argued that obesity will cause a crisis in infertility and I agree.

"Obesity has huge consequences for fertility but also when you treat someone who is obese and get them pregnant you have increased problems for the pregnancy." Problems include pregnancy-related diabetes, abnormalities and a decreased chance of a natural labor.

Adult obesity rates have nearly quadrupled in Britain over the past 25 years, and two-thirds of adults are overweight; of these, nearly a quarter are obese.

Prof Ledger says obesity is a big factor in predictions that the number of couples seeking fertility treatments would double in the next 10 years. "Given the rise in obesity incidence it's common sense to expect a rise in subfertility. Prescriptions for drugs which help women with PCOS get pregnant are going up."

Around 7 percent of women in the UK currently have PCOS. This is expected to rise to 10 percent in the next decade, he says. "It's a common problem, but the biggest thing is to tackle obesity. It's a problem that needs to be dealt with in lifestyle changes rather than through surgery. Losing weight will help women with PCOS get pregnant.

"The rising rates of STIs such as chlamydia, more male infertility, all these things are heading in the wrong directions just as rates of IVF are increasing. We're at the tip of the iceberg," he says.

Overweight women are denied some infertility treatments in the UK's health service (NHS). Women with a body mass index of over 30 -deemed obese - are usually not allowed IVF until they have lost weight. But most IVF cycles in the UK are paid for in private clinics which have less stringent rules.

The paper also reveals that if women lose even a little weight and, more importantly, improve their fitness, their chances of getting pregnant radically improve.

Geeta Nargund, a fertility expert and leading proponent of milder safer forms of IVF, says: "I would be very concerned if any clinic was offering IVF to overweight women without first advising them on how to lose weight. Fertility treatments aren't just about getting women pregnant but about healthy mothers and healthy children. IVF in women who are overweight has some very real risks."

Clare Brown, chief executive of Infertility Network UK, which supports people with fertility problems, says: "If a patient has made every effort to lose weight it would be nice to have a flexible approach."

The Guardian

(China Daily 08/29/2007 page19)