Obesity can lead to female infertility. To conceive successfully, lose weight first.

"5.11" World Obesity Day, the Bariatric and Metabolic Surgery Club of the First Affiliated Hospital of Jinan University was officially launched. Professor Wang Cunchuan, Vice President of the First Affiliated Hospital of Jinan University and Director of Bariatric and Metabolic Surgery, was interviewed by 39 Health Online on issues related to obesity and infertility.

With the relaxation of the two-child policy, many mothers, especially older ones, have been activated to desire a second child and have entered the pre-pregnancy phase. However, Professor Wang Cunchuan, Vice President of the First Affiliated Hospital of Jinan University and Director of Bariatric and Metabolic Surgery, reminds overweight expectant mothers that it is beneficial to lose weight before pregnancy. For some women with severe obesity, irregular menstruation, and polycystic ovary syndrome (PCOS), obesity itself can lead to difficulties in conception or even infertility.

What is considered obese?

According to international standards, the body mass index (BMI) is calculated as weight (kg) divided by the square of height (m). When BMI exceeds 30, it is considered obesity. Obesity is prone to complications such as diabetes, hypertension, hyperlipidemia, and coronary heart disease. When BMI ≥ 28 for Chinese people, the specificity of risk factors for hypertension, diabetes, and coronary heart disease detection is as high as 90% or more.

Obesity brings not only changes in body shape but more importantly, a series of health risks. Among the obese patients Professor Wang Cunchuan has treated, many have suffered from excessive stress on multiple joints and organs: commonly combined with diabetes, hypertension, gout, sleep apnea syndrome, knee and ankle joint swelling, deformation, osteoarthritis, and multiple cerebral infarctions.

Why does obesity make it difficult for women to conceive?

For women of childbearing age, obesity may also deprive them of the right to be mothers. The most common complications in the female reproductive system include polycystic ovary syndrome (PCOS), menstrual disorders, infertility, and miscarriage. Studies show that nearly 7% of women of childbearing age suffer from PCOS, and the incidence of obesity in women with PCOS fluctuates between 35% and 80%. It can be seen that most women with PCOS are obese. The symptoms of infertility in obese women include endocrine disorder infertility, ovulation disorder infertility, and reduced reproductive function due to excessive weight loss. For PCOS combined with obesity, weight loss surgery is one of the most effective treatments and should be the first-line treatment.

Professor Wang Cunchuan said that in recent years, many obese women have sought medical advice and have successfully lost excess body fat through surgery, achieving pregnancy and childbirth. However, many women with obesity and infertility are still unaware of the best treatment plan for weight loss. As long as they lose weight, the probability of successful conception will greatly increase.

Regarding how much weight needs to be lost to affect conception, Professor Wang Cunchuan said it depends on individual constitution, but generally speaking, controlling weight within the normal range before pregnancy not only helps conception but also improves the quality of fertility and reduces the risk of various complications during pregnancy.

It is understood that obese women before pregnancy are prone to pregnancy and medical complications, such as gestational diabetes, hypertension, preeclampsia, venous thrombosis, phlebitis, anemia, and nephritis. The likelihood of miscarriage during pregnancy and difficult labor during delivery is also high. Additionally, pre-pregnancy obesity has a significant impact on the fetus. According to research, if a mother is overweight, the mortality rate of the fetus during the perinatal period is relatively high. Pre-pregnancy obesity is also prone to causing defects after the baby is born, increasing the risk of macrosomia and hypoglycemia after birth.

How should obese expectant mothers lose weight scientifically?

For women who are overweight but have not reached the level of obesity (BMI below 30) and do not have metabolic syndromes such as diabetes or hypertension, as long as they identify the root cause of their obesity (mainly weight-promoting lifestyle) through active dietary management and increased exercise, they can effectively reduce their weight.

Which lifestyle habits are prone to obesity:

· Storing a large amount of snacks at home

· Eating fruits even after being full, treating fruits as unlimited snacks

· Excessively greasy family cooking methods

· Drinking too many various beverages——the calories in a small cup of coffee may require 30 minutes of exercise to burn off

· Taking a car everywhere, engaging in too little physical activity

· The extensive use of smart home products——various remote controls, dishwashers, vacuum cleaners, etc.

Of course, obesity is also a social problem. Taking the United States as an example, someone once proposed to forcibly reduce the sugar content in drinks, which resulted in strong protests and opposition from the entire sugar industry chain. Therefore, managing weight and preventing obesity largely depend on personal self-control and awareness.

In a previous obesity symposium, Professor Wang Cunchuan pointed out that eating slowly helps control food intake. Clinically, doctors at the First Affiliated Hospital of Jinan University have advised patients undergoing weight loss surgery to chew each bite 22 times before swallowing. Professor Wang Cunchuan believes that this habit of chewing 22 times per bite can be promoted to everyone.

Weight loss surgery can be considered for severe obesity with metabolic syndrome

Professor Wang Cunchuan said that for those with long-term severe obesity and metabolic syndrome, weight loss surgery is the best treatment option. Currently, there are two relatively mature and widely used surgical methods: "Laparoscopic Gastric Bypass" and "Laparoscopic Sleeve Gastrectomy."

These two surgical methods have their own advantages and disadvantages. Laparoscopic gastric bypass surgery is suitable for those with a higher BMI because it alters the intestinal structure, closes most of the stomach function, and reduces the stomach volume and length of the small intestine, resulting in more significant weight loss effects.

On the other hand, laparoscopic sleeve gastrectomy does not alter the physiological state of the gastrointestinal tract or interfere with the normal digestion and absorption of food. It reduces stomach volume and decreases the secretion of hunger-stimulating hormones. Therefore, it is suitable for those with a relatively lower BMI.

Indications for weight loss surgery:

2-type diabetes with a course of ≤15 years, and still some insulin secretion function in the pancreas, with fasting serum C-peptide level ≥1/2 of the lower limit of normal value;

BMI ≥ 27.5 kg/m²;

Male waist circumference ≥90 cm, female waist circumference ≥85 cm, may be considered for higher surgical recommendation levels;

Recommended age 16–65 years;

Patients with BMI between 25.0–27.4 kg/m² need to carefully consider surgery;

The above criteria, doctors also need to consider the components of metabolic syndrome or the presence of comorbidities in patients, please consult a doctor for details.

Click to view: Decoding Gastric Bypass Weight Loss Surgery

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