In a normal weight person, the amount of estrogen produced is adequate. In an obese person, there will be extra deposits of fat which will be secreting excess estrogen. This estrogen excess interferes with ovulation and causes irregular menstrual cycles. In women who are severely obese (with BMIs ranging from 35-40), the hormonal imbalance becomes so severe that it can cause problems with conception leading to infertility.

List of problems related to obesity and fertility:

1. Problems with ovulation
2. PCOD Polycystic Ovarian Disease
3. PCOS Polycystic Ovarian Syndrome
4. Irregular menstrual cycles
5. Primary infertility
6. Secondary infertility
7. Lower success rates for fertility treatments
8. Increased risk of miscarriage
9. Increased risk of birth defects in babies
10. Insulin Resistance
11. Acanthosis nigricans
12. Increased risk of gestational diabetes
13. Increased risk of preeclampsia
14. Hirsutism

Obese men have lower circulating testosterone which affects sperm production known as spermatogenesis. This affects the quantity and quality of a man’s sperm. Obese men have increased the risk of oligozoospermia, having fewer than 15 million sperm per milliliter of semen, and far fewer motile sperm than a man of healthy weight. Sperm with high amounts of damaged DNA is significantly more common in obese men than in normal-weight men. Ejaculate volume is also affected. Altered male hormones can also give erectile dysfunction which is the major cause of infertility in obese men.

Bariatric surgery – Experience it to believe it

If Obesity is the root cause of infertility in males or females, losing weight is the first step in increasing the chances of fertility. Loss of significant weight leads to a gamete of changes in the hormones, thus resetting the balance as before.
In my practice, I have seen the impossible become possible in just a matter of 6 to 12 months after significant weight loss. Couples who have been knocking doors of fertility centers ranging from 3years of married life to 17 years of married life have yielded excellent results after weight loss surgery/ bariatric surgery.

However, I have been very choosy in selecting my cases. By this I mean to choose cases in whom the only reason not to conceive is morbid obesity, wherein all other causes of infertility have been ruled out. Loss of the first 15 to 20 kgs. sets the periods back to regularity. In fact, now we must ask the couples to please take precautions to avoid pregnancy until the mother is able to take in adequate quantities of food intake (as it takes few months for the stomach to stretch after bariatric surgery.

My practice has witnessed gratifying results after bariatric surgery in Bangalore in terms of both primary infertility as well as secondary infertility due to Obesity—Be it the sleeve gastrectomy or the gastric bypass. It is a myth that one can’t get pregnant after bariatric surgery. The other myth is that bariatric surgery affects the intrauterine growth of the baby. For obese mothers who are infertile and have diabetes, bariatric surgery offers a triple benefit — freedom from Obesity, Infertility as well as diabetes.