How does being overweight affect my fertility?

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A fine hormonal balance regulates the menstrual cycle. Overweight and obese women have higher levels of a hormone called leptin, which is produced in fatty tissue. This can disrupt the hormone balance and lead to reduced fertility.

The quantity and distribution of body fat affect the menstrual cycle through a range of hormonal mechanisms. The more excess weight and the more abdominal fat, the greater the risk of fertility difficulties.

Excess weight, particularly excess abdominal fat, is linked to insulin resistance (when the body has to produce more insulin to keep blood sugar levels normal) and decreased levels of sex hormone-binding globulin (SHBG), a protein that is involved in the regulation of the sex-hormones androgen and oestrogen.

This increases the risk of irregular menstrual cycles, which in turn reduces fertility. One study found women who were obese were much less likely to conceive within one year of stopping contraception than women in the normal weight range (66.4% of obese women conceive within 12 months, compared with 81.4% of women of normal weight).

Changes in the fine-tuned hormonal balance that regulates the menstrual cycle triggered by excess weight and obesity also increase the risk of anovulation (when no egg is released by the ovaries). Women with a body mass index (BMI) above 27 are three times more likely than women in the normal weight range to be unable to conceive because they don’t ovulate.

Women who are overweight or obese are much less likely to conceive.

Many women who carry excess weight still ovulate, but it appears the quality of the eggs they produce is reduced. The evidence for this is that among women who ovulate, each unit of BMI above 29 reduces the chance of achieving a pregnancy within 12 months by about 4%.

This means that for a woman with a BMI of 35, the likelihood of getting pregnant within a year is 26% lower, and for a woman with a BMI of 40 it is 43% lower compared with women with a BMI between 21 and 29.

And when couples use IVF to conceive, the chance of a live birth is lower for women who are overweight or obese than for women with normal BMI. On average, compared to women in the healthy weight range, the chance of a live birth with IVF is reduced by 9% in women who are overweight and 20% in women who are obese .



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