Q I am 30 years old and have been married for three years. Recently, I have been trying to conceive. My menstruation is rather irregular, occurring once every six or eight weeks.
My gynaecologist thinks my menstrual irregularity is due to my being overweight as my BMI (body mass index) is 27. He has advised me to lose weight if I want to become pregnant.
How does obesity affect fertility? I have difficulty losing weight, even with appetite- suppressing drugs. Will surgery to reduce my stomach help?
A Normal menstruation essentially depends on the balance of two hormones (oestrogen and progesterone) produced by the ovaries. These hormones, in turn, are influenced by the pituitary gland (a small gland at the base of the brain) as well as other centres in the brain.
There are two sources of oestrogen in the body. The main source is the ovaries while an indirect and small source is the adrenal glands (a small gland on top of both kidneys).
The ovaries produce oestrogen directly and cyclically while the adrenal glands produce oestrogen indirectly through the fat cells.
In obese patients, the erratic inflow of oestrogen from the fat cells interferes with the cyclical oestrogen production of the ovaries. This ultimately results in disturbance in ovulation and infertility.
Another reason for obese patients being infertile is the association with a disorder called PCOS (polycystic ovarian syndrome) where there is excess of the male hormone (testosterone) and a diabetic-like state in the body. This deranged biochemistry makes the ovaries unlikely to ovulate or they produce poor quality eggs.
There is no easy and quick-fix way to lose weight. An approach involving lifestyle changes through proper diet, exercise, behaviour modification, stress reduction together with medication has been found to be most effective. The key to successful weight loss lies in your brain, not your stomach.
You may consider the following:
Joining a slimming group. Group work, with regular weigh-ins and sharing of experiences, can help motivation.
Learn your own weaknesses and food triggers ? look for ways to beat them.
Tell people you are dieting ? you might bore them, but it helps you to commit to the idea.
Do not be overambitious ? a gradual loss of 1kg maximum a week is the most you should expect.Medical research has shown that a reduction of 10 per cent of body weight in obese patients may correct the hormone and metabolic derangements. This will increase the chances of conception.
Stomach stapling is not advisable in your case as you are not extremely obese. It is an invasive procedure and carries surgical risks. It should be used as a last resort.
DR PETER CHEW, CONSULTANT OBSTETRICIAN AND GYNAECOLOGIST, GLENEAGLES HOSPITAL
If you have any questions, please e-mail them to sthealth@sph.com.sg
