In the recent years, there’s one thing that is way too common in every household- Obesity and Stress. Today we uncover how obesity and stress is related to infertility. Obesity has become a global epidemic over the past four decades affecting an estimated 603.7 million adults, accounting 12% of the world’s population.
Prevalence of Obesity in India (Across different cities)
| Category | Female (%) | Male (%) |
| India | 24 | 22.9 |
| Punjab | 40.8 | 32.2 |
| Kerala | 38.1 | 36.4 |
| Delhi | 41.3 | 38.0 |
| Tamil Nadu | 28.4 | 20.6 |
| Andhra Pradesh | 36.3 | 31.1 |
| Karnataka | 30.1 | 30.9 |
A minimum fat mass of 22% of total body weight is required for the initiation and maintenance of reproductive function in both men and women.
Did you know?
1934 – Irving Stein and Michael Leventhal described the relation between obesity and infertility, who later described the triad of obesity, hirsutism, and infertility.
Obesity is derived from the latin word “Obesus” which means “One who has become plump through eating.”
Obesity impairs reproductive potential in the couple, leading to infertility and subsequent complications in pregnancy and the adverse effects of it on their offspring.
The distribution of fat is more important than the location of the fat:
- Type 1: Excess body fat without any particular distribution pattern – Global Obesity
- Type 2: Excess of subcutaneous fat, especially on the trunk and abdomen – android obesity – WHR greater than 0.8
- Type 3: Excess of fat in the abdominal viscera – Central Obesity
- Type 4: Excess of fat in the gluteofemoral region – gynecoid or pear shaped obesity – WHR is less than 0.8
Effect of obesity on Female Reproductive Health
Female obesity can cause alteration in fertility via menstrual and ovulatory disturbances. It can negatively affect the development and quality of oocyte and the endometrium. Obesity leads to insulin resistance probably due to down regulation of leptin receptor expression.
- Women with obesity for ovulation stimulation require higher doses of medication and produce lesser follicles.
- Obesity also appears to alter mitochondrial function and distribution in the oocyte, with clumping throughout ooplasm compared with controls.
- Elevated leptin levels in obese women may decrease the sensitivity of the trophoblastic to its effects.
But, it is only WOMEN? Absolutely NOT. MEN too have infertility issues when they are obese.
- Due to obesity, male infertility is adversely affected through endocrinological, thermal and genetic mechanisms.
- In obese men, more androgens are converted to estrogens via aromatization and of peripheral fat.
- Obese men have negative effect on the GnRH
- Obese men have a decreased leyding cell testosterone secretion, with testostesterone levels negatively correlated with fasting insulin and leptin levels.
The health benefits of postponing pregnancy to achieve weight loss must be balanced against the risk of declining fertility with advancing age of the couple. Lifestyle modification in women and men is the first line of treatment for obesity, followed by adjunctive medical therapy. Bariatric surgery in women and men is an important adjunctive to lifestyle modification and medical therapy for weight loss, but pregnancy in women should be deferred for 12-18 months postoperatively.
All of us experience stress to some degrees in our lives. Stress is a nonspecific response of the body to any circumstances or events that cause a change in one’s life, it involves changes affecting nearly every system of the body. Any stimulus able to trigger a change in one’s life is termed stressor.
5 Categories of Stressors:
- Acute time-limited stressors
- Brief Naturalistic stressors
- Stressful event sequences
- Chronic stressors
- Distant stressors
Stressful stimuli cause the activation of the hypothalamic pituitary adrenal (HPA) axis and the sympathetic adrenal medullary (SAM) axis. The stressful stimuli have its effects on the female adrenal and HPO axis in more than one psychological event of fertility including ovulation, fertilization and the implantation rate. Chronic stress was predictive of an increased chance of decreased ovarian reserve. In IVF cycles, lower concentrations of norephinephrine and cortisol in serum and follicular fluid at oocyte retrieval and at embryo transfer day were in women whose treatment was successful.
Again, it’s not always women. Studies have suggested that psychological stress could severely affect spermatogenesis and sperm quality, mainly as a result of varying luteinizing hormone pulsing and testosterone secretion. Coping for stress negatively impacts fertility, by increasing adrenergic activation leading to vasoconstriction. A review on the prevalence of psychological symptoms in infertility concluded that 25-60% of infertile individuals report psychiatric symptoms and that their levels of anxiety and depression are significantly higher than in fertile controls. Elevated levels of anxiety and depression are seen in infertile couples, so it is clear that infertility cause stress. However, there is still a debate on whether or not stress causes infertility.
More depression in infertile woman, the less likely she is to start infertility treatment and the more likely she is to drop out after one cycle. ART patients are at increased risk of experiencing psychiatric disorders, it is important to recognize and acknowledge psychological interventions that are likely to be associated decrease in depression and increase in pregnancy rates.
It may look so convincing to read and determine the impact of obesity and stress in infertility. However, the depth of this debatable topic is way larger than a single article or even the internet can hold. To a layman, this can be a solution, however, if you are looking to research and get an in-depth knowledge of this interesting topic, it’s time you look for a degree which gives you knowledge and recognition. Fellowship in Reproductive Medicine in India, a post-graduation course for medical students has been in the most demanded courses in the last decade. It is an important course which is indeed beneficial if you are planning to open your own IVF center. But, considering the time limitation every working professional has, it is difficult for them to leave their practice to enrol in a full-time fellowship program. And, basically due to the same reason, most of the practicing doctors are not able to continue their education.
In order to deal with this recurring issue which, the medical practitioners were facing since years, Medline Academics led by Padma Shri Prof. Dr. Kamini A Rao, has come up with it Hybrid Fellowship in Reproductive Medicine Program. With its inception in 2022, this institution has already generated more than 1000+ fellows successfully. Medline Academics’ curriculum is set in such a way that practicing doctors are able to finish their theory modules and live lectures online and the practical training thereafter as per their convenience. Due to its affiliation with the SSAHE, it conducts examinations twice in a year – February Session & July Session. With this Fellowship Program, it has made the life of medical students easier, giving them the absolute option of balancing clinical practice with continued medical education.
Dr. Kamini Rao Hospitals – The newest addition to our education institution. Think of the best IVF center in Bangalore, Come to Dr. Kamini Rao Hospitals. From Menarche to Menopause, our IVF center has every facility for a healthier you. Not just treatment, our hospital is also a learning center for the doctors enrolled for the fellowship in reproductive medicine. They get a chance to monitor multiple cases and enhance their clinical skills. First time consultation or a 2nd opinion, Dr. Kamini Rao Hospitals is always there to help you.