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Obesity and Infertility – Does obesity affect pregnancy?

Obesity and Infertility: Obesity is a life-long, progressive, life-threatening, genetically-related, multi-factorial disease of excess fat storage. BMI (Body Mass Index) = Weight in Kg / Height in M2. For Asian populations, classifications remain the same as the international classification, but public health action points for interventions are set at 23, 27.5, 32.5 and 37.517. Obesity has reached epidemic proportions in India in the 21st century, affecting 10% of the country’s population and another 12% being overweight. 1.5 million deaths are reported due to obesity in 2000 and 20 million deaths due to obesity in 2010.

What is Metabolic syndrome?

Metabolic Syndrome is a condition in which excess body fat is accumulated to such an extent that health may be negatively affected and the life span is shortened. It is a group of diseases where increased abdominal girth more than 90 cm in males and more than 80 cm in females generally associated with increased BMI, diabetes, dyslipidemia, hypertension, polycystic ovarian disease, sleep apnea and non-alcoholic steatohepatitis.

Obesity and Infertility:

How is Obesity related to Infertility? Obesity makes it difficult for women to get pregnant. If they get pregnant, then there is higher risk of losing it. Hormonal levels are also altered in obese women. Obesity related complications in pregnancy (BMI >35): Preeclampsia (5 times), stillbirths after 28 weeks gestation (3 times), early neonatal death (3.5 times), large-for-gestational-age infants (4 times), gestational diabetes (8 times). The infertility treatment including IVF also has lesser success in obese people.

Management of Obesity:

By lifestyle and medical methods weight loss is modest and rarely sustained. We had only few medicines to take care of Obesity. Leucine 2.25 gm with B6 30 mg per day increases fatty oxidation by 30 percent which may help to lose weight to some extent.

Obesity and Infertility – Treatment Options

Non-Surgical treatment: Intragastric Balloon (IGB):

Intragastric balloon for Weight Loss.

It is placing a deflated balloon in the stomach using endoscope and then filling it to decrease the amount of intragastric space. It can be left in the stomach for a maximum period of six months. It results in average weight loss of 10 to 15 kg. It may be used in patients with overweight who are not suitable for Metabolic Surgery

Surgical Treatment (Metabolic Surgery):

The term “bariatric” surgery is derived from the Greek word baros for weight; defines surgical procedures designed to produce substantial weight loss. Metabolic Surgery – Metabolic changes occurring cannot be explained completely by their effects on body weight alone; hence procedures which induce metabolic improvements come under the category of metabolic surgery.

Laparoscopic Sleeve Gastrectomy (more than 30 BMI patients) :

The portion of stomach which secretes Ghrelin and acid in excess is removed. This leads to reduction in food intake and also alteration in hormonal milieu which leads to usage of stored fat for caloric requirement. This has got very good results without significant nutritional deficiency and hence most preferred.

Modified Sleeve Gastrectomy with Ileal Interposition (BMI 25 – 30):

In this after a modified sleeve gastrectomy ileum is brought near the stomach by interposing proximally. The jejunum is connected after ileum. This ensures early entry of food to ileum but jejunum is not kept out of its route. There is significant increase in GLP1 hormone and resultant increase in timely secretion of insulin. There is no dumping or vitamin deficiency in contrast to bypass procedures.

Patients will be initially on liquid diet and later on changed to semi solids, gradually changed to solid diet in a month’s time. Patients will be on vitamins for a month or so, Pantoprazole for 2 months; Calcium will be optional. Biotin is advised if patient has significant hair loss. There is no need for long term vitamins.

RESULTS:

Around 85 to 90 % of diabetes patients treated by these surgeries get complete resolution of diabetes. Whereas, the rest of them get significant control of diabetes with reduced dose of medication. In addition to diabetic control the other benefits are loss of excess weight and control of triglyceride levels. Sleep apnea, arthritis, cardiac episodes, kidney disorders and cancers are also reduced significantly. Studies show that metabolic surgery is cost-effective and safe. IFSO Global Registry studied more than 1 lakh bariatric surgeries over 18 countries and has reported a mortality of 0.03%. SOS – Swedish Obese Subject Study (prospective matched cohort study with 15 years follow up) showed excellent results of metabolic syndrome resolution which is sustained even after many years.

When can pregnancy be planned?

Patients can conceive after 6 months of Bariatric Surgery. Generally, there is no need for any special nutrition or vitamin supplementation to these patients other than what is recommended for a pregnant lady routinely. Bariatric surgery might be effective in young infertile obese women who wish to become pregnant. Weight-Loss surgery resolves PCOS. Most of the improvement in PCOS symptoms occurred during the first 12 months after bariatric surgery.

Conclusion:

Metabolic surgery has emerged as the most preferred, highly effective, and safer means to achieve long term resolution of type 2 diabetes and excellent improvement in fertility status.

Video Talks on Bariatric Surgery

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Diabetes and Obesity - Malayalam
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Video Testimonials

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Best Bariatric Surgeon India

Bariatric Surgeon India – Dr R Padmakumar at VPS Lakeshore

Bariatric Surgeon - Dr R Padmakumar is Sr Consultant Laparoscopic and Obesity Surgeon - Department of MIS and Head of Department, General & Lap Surgery at VPS Lakeshore Hospital and also Managing Director of Keyhole Clinic – Center for Obesity...

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Contact Details

Dr. R. Padmakumar
MBBS, DNB, MNAMS, DipALS, FAIS, FIMSA, FCLS, FRCS (GL)
Senior Consultant Laparoscopic and Metabolic Surgeon &
Director - Verwandeln Institute (Transforming Lives)
(Specialist in Laparoscopy, Hernia, Cancer, Obesity Surgery or Bariatric Surgery, Diabetes Surgery, Endoscopic Thyroid Surgery, Thoracoscopy, Intragastric Balloon)
Keyhole Clinic, Thammanam Road, Plarivattom, Kochi, Kerala, India
VPS Lakeshore Hospital, Maradu, Kochi, Kerala, India
Chairman - Association of Surgeons of India, Kerala Chapter

Address

Keyhole Clinic - Center for Obesity and Laparoscopy

Palarivattom, Kochi, Kerala

VPS Lakeshore Hospital

Maradu, Kochi, Kerala


Mobile: +919447230370, +919846320370
Email: drrpadmakumar@gmail.com

Website:
www.drrpadmakumar.com

Chairman, Association of Surgeons of India - Kerala Chapter
National President - Indian Hernia Society (2016)
GC Member, Association of Surgeons of India (2013 - 2018)
Vice President- Society of Endoscopic and Laparoscopic Surgeons of India
Jt. Secretary - Indian Association of Endocrine Surgeons (2016)
Founder Member, Obesity and Metabolic Surgery Society Of India
Founder Member, Association of Minimal Access Surgeons of India
International Faculty of IASGO on Hernia and Diabetic Surgery
International Faculty of IFSO on Diabetic Surgery
Associate Editor : Diabetes and Obesity International Journal