Your Questions Answered about Weight Loss and Fertility

Dr. Karen Maynard is an OB/GYN at Women’s Care of Nashua. Dr. Robert Catania is a bariatric surgeon at Southern NH Weight Management. What do these two physicians have in common? 

Dr. Maynard explains, “I see women every day in my practice who struggle with their weight and the adverse repercussions from obesity. Helping women achieve their reproductive goals is paramount in my practice, and referring those patients to the weight management program is a natural step forward.”  

Dr Catania agrees, “Close coordination between providers is important to make sure that patients achieve optimal weight loss and have healthy pregnancies. Women with obesity have higher rates of infertility and more difficulty with pregnancy. Achieving weight loss prior to starting a family is a great idea and benefits both mother and baby.” 

Drs. Maynard and Catania sat down with us to discuss the close relationship of weight and fertility.  

Question: Dr. Maynard, how does obesity impact fertility in both men and women?  

 In women, obesity can cause irregular menstrual cycles, which can lead to infertility. Higher body fat levels can cause insulin resistance, leading to higher insulin and androgen levels, disrupting normal hormone function and ovulation. We advise weight loss for infertile women with an elevated BMI. Multiple studies have shown that weight reduction will help in spontaneous conception and often reduce the need for fertility treatment. Weight loss also provides long-term benefits for overall health. 

For men, the effects of obesity on fertility are less clear, and more research is needed. Still, maintaining a healthy weight is beneficial for overall health.  

Question: Dr. Maynard, what are the most common fertility issues related to obesity that you encounter in your practice?  

Polycystic Ovarian Syndrome (PCOS) is what I see most commonly. PCOS has been associated with a miscarriage rate that is 20 to 40 percent higher than the baseline rate in the general obstetric population.  

Question: So, Dr. Maynard, how exactly can weight loss improve fertility outcomes? 

Obesity can affect the success of fertility treatments. Some studies show that obese women may have poorer outcomes, like less follicular development, fewer eggs, and lower fertilization rates. However, other studies find similar outcomes to non-obese women, but with a need for higher doses of ovulation-inducing medications.  

A higher BMI increases the risk of unsuccessful IVF treatment. A review of 33 studies involving nearly 48,000 IVF treatments found that overweight and obese women had slightly lower pregnancy and live birth rates and a higher miscarriage rate compared to women with normal weight. 

Question: Dr. Catania, what are the primary weight loss techniques you suggest for fertility?  

The techniques used depend upon the amount of weight loss the patient is hoping to achieve. We always begin with a discussion of lifestyle modification, including dietary choices, eating habits, and exercise. We frequently offer patients the option of using antiobesity medication or bariatric surgery. From a fertility perspective, we find that the greater the weight loss, the greater the improvement in fertility. 

Question: Dr. Catania, what criteria do you use to determine if a patient is a good candidate for bariatric surgery?  

Bariatric surgery is the most effective obesity treatment available for patients with a body mass index (BMI) over 35 who have obesity-related medical issues and for all patients with a BMI over 40. If the patient does not feel that surgery is appropriate, we offer antiobesity medication and lifestyle modification treatments.  

Question: Dr. Catania, what is the timeline of weight loss post-surgery?  

Typically, patients will lose between 50-70% of their excess body weight in the first 12-18 months after surgery. For women who are planning to have children, it is recommended that they wait 18-24 months after surgery before becoming pregnant. Women who become pregnant sooner than one year after surgery run a small risk of developing vitamin deficiencies or having small for gestational age babies. 

Question: Dr. Catania, are there specific guidelines for patients who become pregnant after bariatric surgery?  

Patients with a history of bariatric surgery before pregnancy are closely followed by their obstetrician and bariatric surgeon. Often, a nutritionist is also involved in their care. Close monitoring to ensure that the baby is growing normally and lab testing to evaluate and treat for vitamin deficiencies are part of the process. Importantly, it has been well established that pregnancy is often safer after bariatric surgery than without obesity treatment, particularly for women with severe obesity.  

Question: Dr. Catania and Dr. Maynard, what are some of the biggest challenges you face when managing weight loss and fertility issues?  

Dr. Catania: Time is the biggest challenge for most patients when managing weight loss and fertility issues. Many women with obesity who are trying to have children do not want to wait 1-3 years before pregnancy. I explain to patients that taking the time to achieve weight loss before starting a family often results in getting pregnant sooner, with less use of healthcare resources (and patient expense) and is more likely to have a positive outcome for the mother and child.  

Dr. Maynard: I agree. Also, patients with preexisting obesity followed by high gestational weight gain are at the highest risk of pregnancy complications. In addition, the offspring of pregnant people with obesity are at increased risk of developing obesity in childhood and as adults, so the child’s long-term health is at stake.  

Dr. Karen Maynard, MPH, FACOG of Women’s Care of Nashua, has been a practicing OB/GYN in southern New Hampshire for over 26 years. She studied medicine at Tufts Medical School, earned her master’s in public health at University of Michigan and completed a residency in obstetrics and gynecology at University of Arizona. As a generalist OB/GYN, she cares for women throughout their lives, practicing obstetrics as well as gynecologic surgery. She is a strong advocate for female reproductive rights and spends much of her time educating women how to be the healthiest they can be during pregnancy and beyond.  

Dr. Robert Catania of Southern NH Weight Management studied medicine at Temple University School of Medicine in Philadelphia, PA. He went on to complete his residency at Brown University Rhode Island Hospital in Providence, RI. Dr. Catania is fellowship-trained in minimally invasive and bariatric surgery from the University of Maryland School of Medicine in Baltimore, MD. He has been practicing bariatric surgery since 2007. Since then, he has performed over 1,500 bariatric procedures.