Weight and Fertility

Weight is a core issue for our sex hormones and fertility, and a classic example of this is a girl’s menarche (her first period) has been stable to the weight of about 104.5lbs (47.5 +/- 0.5 Kg) over the last 120 years.  However, girls now reach that weight (and the menarche) at about 12½, while it was 16½ in 1900. This dramatic four-year age change is purely down to a girl’s weight altering her hormone balance, and the weight-hormone relationship will continue throughout her life.

The health of our weight is usually the “Body Mass Index” (BMI), which is a simple calculation between height and weight, and the ranges are:

• Under 18.5 is underweight
• 18.6 to 24.9 is normal
• Above 25 is overweight
• Over 30 is obese

In general, being a healthy weight coincides with good fertility, and fertility falls the further away we get from a normal BMI. The worst problem for fertility is that faced by underweight women, as they’re vulnerable to low hormone levels that disrupt or stop cycles. However, the most common weight-related fertility problem is excess weight, especially in the West:

• 35.7% of USA adults were obese in 2010 ⁱ
• Nearly a third (32%) of 20-39-year-old USA women were obese in 2011
• 86.3% of USA adults are expected to be overweight in 2030
• 51.1% of USA adults are expected to be obese in 2030

By 2030 it’s expected that 16-18% of the total US healthcare costs will be on obesity-related illnesses. ⁱⁱ

High BMI and health

Having a high BMI increases the risk of a range of health issues, including:

• Infertility
• Cardiovascular disease
• Hypertension
• Diabetes

The average weight has been rising since a rapid rise in childhood obesity rates in the 1970s because ⁱⁱⁱ

• More “empty calories” consumption in high-calorie foods and drinks rather than “proper meals”
• More food is eaten away from home or in convenience foods
• Children are burning fewer calories in activities like walking to school
• Kids spend more time watching television, using computers, and surfing the web

Female fertility and weight

Having an average weight maximises a woman’s fertility, and while obesity reduces a woman’s fertility, it’s not as bad as being too thin:

• Women with a BMI below 17 are 1.6x more likely to be infertile
• Underweight women are 1.3x more likely to have pre-term births
• Obese women take longer to get pregnant than normal BMI women ^iv
• Miscarriage rates are higher for obese women ^v
• Fertility treatment costs are 54% higher for “overweight non-ovulating” women than “normal weight non-ovulating women”
• Fertility treatment costs for “obese non-ovulating women” are 100% higher than “normal weight non-ovulating women” ^vi

Male fertility and weight

The rise in male infertility over the past 30 years has coincided with a three-fold increase in obesity in men of reproductive age. There’s evidence that obesity changes structures in the testes, lowers sperm quality and reduces a man’s potential to have children: ^vii

• An increase in BMI by as little as three units lowers male fertility ^viii
• Obese men are 3x more likely to have low semen quality than average-weight men ^ix
• Rises in BMI reduce sperm concentration and motility ^x
• Overweight men have more damage to their sperm DNA ^xi
• Obesity causes erectile dysfunction because a hormone (aromatase) in fat tissue converts testosterone to estrogen
• Male obesity affects the metabolic and reproductive health of their children, with evidence that paternal health cues pass to the next generation ^xii

There are some simple ways to assess and improve male fertility.

Childhood outcomes

Weight issues tend to run in families, and overweight parents increase the chances that their adult children will have:

• Type II diabetes ^xiii
• Obesity
• High cholesterol
• Hypertension ^xiv
• Stroke
• Heart attack ^xv
• Asthma
• Autism

Changing weight

Somewhat surprisingly, both under- and over-weight people face similar issues:

1. Their digestion is failing to nourish and support the body, which can cause body fluids to accumulate
2. Their microbiome is unbalanced and weakens digestive function, and it’s known faecal transplants of healthy microbiomes successfully treat both underweight and overweight conditions ^xvi–xvii
3. Poor diet choices fundamentally affect microbiome health
4. Unhealthy emotional relationships with food are complex and difficult to manage

Long-lasting weight change is impossible without lifestyle changes, or any weight lost or gained will revert to “what was normal” quickly as any weight change needs to be maintained for a year to become the “new norm”. Achieving a healthy weight has to focus on strengthening digestion in a gradual and sustained way.

Crash dieting

• Denies people their nourishment and leaves them feeling denied
• Weakens digestion
• It makes the situation worse in the long term and reduces fertility

Exercise helps promote digestive function by burning calories and improving fluid and hormone balance, but it needs to match Personal Fertility Profiles (PFPs). For many people losing (or gaining) weight is a vital way to raise their fertility, and when overweight or obese women:

• Lose 10% of their body weight their body fat falls by 30%
• Most obese women resume ovulating after a 10% weight loss
• Losing 10.2kg (22lb) results in 90% of obese women resuming ovulation ^xviii

There are simple rules on how to lose weight:

• It’s easier to succeed if you’re part of a group, so get some support!
• A routine is essential; put a structure in place to support yourself and avoid questioning what you should be doing all the time. You’ve made a choice; now, just follow it through
• Missing meals weakens digestion, and your diet should strengthen your digestion, not weaken it (see Energy)
• Avoid sugar (think of it as poison) as it gives people a quick “burst” and a very long “down”
• Try to avoid thinking you’re being denied food/sugar and focus on positive outcomes because no one will put up with their treats being taken away, so change the emotional language around food
• Changing food types and portion sizes alter energy levels and the palette in a surprisingly short time. Listen to your body and how it reacts to food, definitely eat more whole foods and vegetables and try cooking a bit more
• Reinforcing achievements is essential and heartening: be proud of what you can do, not focus on what you “should have done”

---