ACRM

Are You Overweight? How Your Weight May Be Impacting Your Fertility

By Paige Espenship, RD, ACRM

   Are you at a healthy weight?  If not, you may be decreasing your chances of becoming pregnant.  Women and men who are over or underweight are more likely to have hormone imbalances which can directly impact your fertility.  In addition to setting yourself up for a healthy pregnancy and creating a healthy environment for your children, a healthy weight can increase your chances of conceiving and carrying a child to full term.

   A healthy weight is not necessarily a normal weight.   Keep in mind that 60% of Americans are overweight or obese.  So the majority of our country is not anywhere close to their ideal weight.  In fact, when I tell patients what they should weigh, many of them balk in disbelief stating that they haven’t weighed that since their early high school years. 

   Body Mass Index (BMI) is the main tool that we use to determine a person’s ideal weight.   BMI is just a quick look at a person’s height and weight.  It started in the 1940’s with data collected by the Metropolitan Life Insurance Company’s tables which showed a very clear connection between  height, weight and death rates.  The BMI range that consistently shows the best health and the lowest death and illness rates is 18.5 to 24.9.  This also happens to be the Fertility Zone, the weight range for your height that promotes the healthiest hormonal environment.  For a woman who is 5’5” that translates to a weight range of about 111 lbs to 149 lbs, anything above or below that range is considered less healthy.  Like all great things in life, BMI charts do not come without some exceptions to the rule.  BMI does not work for athletes (people who are trained to compete in sports and possess physical strength, speed, agility and stamina).  It tends to overestimate an athlete’s fat mass.  Now, just because you go to the gym and do the elliptical and lift some weights for 45 minutes 4 or 5 times a week, you are not considered an athlete.  Athletes generally make exercise at least a part time job.  BMI is also not a good reflection of true health for the elderly population because it overestimates muscle mass.  But for the majority of us, BMI is an excellent indicator of our true health status as it relates to weight.   You can calculate your BMI by going to www.nhlbisupport.com/bmi

   So again, the majority of us in this country are overweight.  How does this impact fertility?  Too much body fat can dramatically alter your hormones, which can directly affect your chances of conceiving and sustaining a healthy pregnancy.  Extra body fat is associated with excess insulin and insulin like growth factor and a decrease in sex hormone binding globulin which leads to excessive testosterone production in women and excess estrogen production in men.  These equal problems for conception for both men and women.

  Fat tissue, also called adipose tissue, is not just a place to store fat.  Adipose tissue is very hormonally active and plays a major role in appetite, weight, activity, and reproduction.  Adipose cells make a very helpful protein called adiponectin which normally tells your body to burn extra fat and increases insulin sensitivity, however too much fat actually decreases the amount of adiponectin, which works to your disadvantage by decreasing insulin sensitivity  and slowing metabolism. 

   Too much body fat also increases levels of interleukin-6, leptin, plasminogen activator inhibitor-1, resistin, and tumor necrosis factor, all hormones that stimulates cell growth, communicate info about energy stores, inhibit blood clots, influence insulin sensitivity, and mediate inflammation.  This can mean problems with ovulation or interference with implantation of a fertilized egg. 

   The same may be true for men.  Even though there is not yet a good measure of a man’s ideal “fertility zone” for BMI.  The same hormonal factors may influence a man’s fertility by interfering with insulin, testosterone and estrogen balance.

   So, with all of that said, what if you are a long way off from your ideal weight range?  Don’t despair.  Moving in the right direction and losing 10 percent of your body weight may be enough to help eliminate some of these hormonal problems.  Weight loss should be slow and steady.  It is better to lose 4 to 8 pounds per month than it is to lose 20 pounds all at once.  The slower you take it off (as long as you keep taking it off), the more likely it is that you are burning the unhelpful fat cells while maintaining your muscle mass.

   Here’s a start.  Try these 10 tips to help you lose 10 pounds over the next couple of months.

1. Eat at least 4 cups of non-starchy vegetables everyday. The darker the color of the vegetable the better. 
2. Check labels for all of your dried packaged grains like cereal, bread, pasta, rice, crackers, popcorn, bakery items, etc.  Look for and buy foods that have more dietary fiber than sugar on the nutrition facts panel.
3. Cut out sweetened drinks and artificial (zero calorie) sweetners.  This will go a long way in saving you extra calories.   People who eat or drink artificial sweetners tend to eat more calories throughout the day.  They also interfere with insulin sensitivity.
4. Eat between two and four cups (or pieces) of fresh fruit per day.  Avoid drinking fruit juice, you get more nutrition and fewer calories from eating the fruit.
5. Choose lean meat almost always.  Five or six days a week don’t let skin on poultry, fatty cuts of pork, beef or fried anything near your lips.
6. Keep the amount of added fat in check.  This means ordering your salad dressing on the side and only add what you need for flavor.  Spread peanut butter, mayo or butter thin on your bread.  One handful of nuts is plenty as a snack.
7. Do something physically active for 30 minutes every day.
8. Drink enough water.  Generally speaking you need 1 liter of water for every 1000 calories you eat.  So if you are on a 1500 calorie diet, you need about 6 eight ounce glasses of water.  For every 30 minutes of exercise, drink another 8 ounces.
9. Earn or burn your extra luxury calories with extra exercise.  You know when you are indulging.  If you order that slice of chocolate cake after dinner, do some extra exercise that same week to afford those calories.  Think in 100 calorie increments.  For every 100 calories of junk (cake, cookies, milkshakes, candy) you eat, do another 20-30 minute workout to afford it. 
10. Keep a food record.  Write down everything you eat and drink.  This goes a long way in keeping you on track.

What is the Attain IVF Refund Program?

By: Irene Laschuk, Manager, Patient Financial Services, ACRM

The Attain IVF Refund Program is how you can take the financial risk out of trying.  It can take several attempts at IVF before realizing a successful outcome leaving some to wonder, “How do I pay for multiple cycles?”  “What if it doesn't work?”  “Will we have anything left to explore other options?”  The IntegraMed Attain IVF Refund program, offered exclusively through ACRM, has a way for you to put these concerns aside.

The Attain IVF Refund Program is a six-cycle treatment package with a refund guarantee.  Those who qualify pay approximately the cost of two IVF cycles upfront and get up to three IVF cycles and three frozen embryo cycles.  If you do not take a baby home from the hospital, you are entitled to a refund up to 70% of the program fee. 

Around 60% of patients under 35 will need more than one cycle to achieve success.  As patient age increases, so do the number of cycles. Patients who commit to multiple IVF cycles almost double their chance of having a baby. 

With the Attain IVF Refund Program, you're able to pay a fixed, discounted fee for multiple chances at success.  You can now concentrate on your treatment.  We have dedicated customer care groups at ACRM and IntegraMed that are happy to assist you with financial options, financing and work with you through the entire process.  For more information about the Attain IVF Refund Program please visit our website and select financial services.

Tubal Disease, Hydrosalpinges and Infertility

By: David L. Keenan, MD, FACOG, ACRM

Approximately 25% of female infertility is due to blockage of the fallopian tubes. The fallopian tubes are very delicate structures that are responsible for picking up the egg and providing the site for fertilization and early embryo development. The tube is narrowest at the inner portion that joins the uterus and then widens in the outer portion that has finger-like projection called fimbria. The fimbria are responsible for picking up the egg. The cells lining the tube produce secretions that nourish the egg and embryo. The tubes are frequently damaged by infections (e.g., chlamydia, gonorrhea) or other pelvic conditions such as endometriosis or even severe appendicitis.

Scar tissue and blockage can occur at either the inner or outer portion or in both of those regions of the tube. If blockage occurs at only the outer portion then the secretions of the tube will be unable to drain out of the end of the tube and swelling of the tube will occur. This is known as hydrosalpinx (literally water in the tube.)

There are two different approaches to treating infertility that results from tubal damage. If there is mild damage then surgical repair can be attempted. If there is severe damage then the results of surgery are poor and IVF (in vitro fertilization) is recommended to bypass the fallopian tubes.