Ask Our Doctors – Archive
Our Medical Directors are outstanding physicians that you will find to be very personable and compassionate, who take care to ensure that you have the most cutting-edge fertility treatments at your disposal. This is your outlet to ask your questions to the doctors.
Hello Dr. Sher,
I would really appreciate your expert opinion with regards to the following issue:
How much does being overweight impact fetal health? By how much does the risk increase?
I am overweight (current BMI of 26). I have read that there is a negative impact on the fetus not just with being obese, but anytime the BMI is over 25 at conception. Under adverse effects I have seen anything from cardiac malformations to autism spectrum disease.
It would seem I will ovulate tomorrow, and in light of this new information I don’t know if I should go ahead and try to conceive, or wait until I lose at least some weight first.
( I am 34 years old, and my BMI has usually been between 22-23, until I gained weight over the last few years). I am not looking for any guarantees or definitive answers, but it would be very helpful to know some more tangible percentages, in order to better evaluate this increased risk and to make a more informed decision.
Many thanks,
Joanna
A BMI of 26 is by no means being Obese. However, bear in mind the following:
The prevalence of obesity in Western societies is on the rise. This has a profound effect on the reproductive performance of women who are trying to have a baby. Recent evidence suggests obesity in women of the reproductive age is associated with decreased birth rates, increased miscarriage rates, higher rates of premature delivery and a marked increase in pregnancy complications. We use two parameters to measure height-weight relationship. The first is Body Mass Index (BMI) (the ratio of height to weight that is calculated by taking body weight in kg and dividing this by the square of height in meters. The second is the percentage contribution made by fat to overall body mass
BMI: A BMI of <20 is regarded as underweight; 20 - 25 is ideal/normal. A BMI of >30 is definitively indicative of being overweight. A BMI of 30-40 is obese and > 40 is morbidly (dangerously) obese. The “ideal BMI” for fertility is 20-25. A BMI of<20 increases the risk of miscarriage. Women with a BMI of > 30 fertility often have a reduction in response to ovarian stimulation. BMI significantly impacts male fertility as well. Men with an increased BMI often experience significant sperm dysfunction.
Percentage Fat: The contribution of fat to body weight is also important. The normal contribution of fat to body mass in adult women is about 28%. Anything under 22% can result in dysfunctional or absent ovulation. Both diet and exercise modification can help regulate the percentage of body fat and BMI.
Simply stated, being overweight with a significantly elevated BMI and or having a high percentage of body fat has a decidedly adverse effect on overall reproductive performance. And when it comes to IVF in specific, while the results of several studies have in some cases have been discordant the general trend strongly suggests that women who are moderately overweight (BMI>25-30) and those who are obese (BMI>30) have poorer IVF outcomes than do controls with a BMI <25. As alluded to above, it would appear that women with a BMI of >25 and especially those with a BMI of >30 exhibit a poorer ovarian response to fertility drugs (impaired follicle and embryo development with fewer blastocysts becoming available for transfer). They also tend to have a reduced ability to implant transferred embryos into their uterine linings (perhaps due to reduced endometrial receptivity).
Women with polycystic ovary syndrome (PCOS) often usually have BMI’s of >30. In such women, the hormonal environment in the ovaries is known to adversely affect follicle and egg development. Given that there is often no clear cut distinction between PCOS and other overweight women, it is possible that many of the factors that are believed to affect egg/embryo quality in PCOS might similarly affect egg development and endometrial receptivity in overweight women. Such factors could include increased production of luteinizing hormone (LH), hyperinsulinemia and increased production of ovarian male hormones (androgens such as testosterone). The link between increased LH and resulting increased production of ovarian androgens (mainly testosterone) and poor follicle and egg development is well established. It is also well known that such hormonal changes can be transmitted to the adjacent uterus thereby adversely affecting endometrial development.
Clearly the question arises as to whether the negative effect of an elevated BMI (>25) on general fertility potential and IVF outcome is due to compromised egg development, endometrial receptivity to the implanting embryo or both. In my opinion, while a direct ovarian influence probably predominates, there is also likely to be an adverse influence on endometrial development. This endometrial affect is commonly seen in PCOS women who, when they develop severe ovarian hyperstimulation on fertility drugs often have a very thin (< 8mm endometrium). Then there is the reality that it is often technically more difficult to perform a “smooth” and “flawless) embryo transfer in women who are overweight. This is especially true when it comes to those with a BMI of >30. Visualizing the cervix is much more difficult and the introduction of the embryo transfer catheter through the cervix, often difficult. Given that the efficiency by which ET is conducted, represents a rate-limiting determinant of IVF outcome, kit follows that obese women tend to have poorer overall IVF outcomes.
Finally, it is important to emphasize that overweight women are at far greater risk during pregnancy than are women of normal body weight. As previously mentioned, the miscarriage rate is much higher. So is the incidence of diabetes, high blood pressure, preeclampsia, premature labor, surgically assisted deliveries, stillbirth and neonatal death. Maternal complications that occur after birth of the baby (i.e., infection, uterine post partum hemorrhage, etc. are also much more common. Babies born to such mothers, are also at great risk of developing respiratory distress syndrome (RDS). This condition which ordinarily only occurs in preterm babies can also occur in the absence of prematurity in such cases. RDS is the commonest reason for the newborn having to be admitted to a neonatal intensive care unit and also the commonest cause of death in the first week of life.
The clinical significance of a growing population of overweight women is enormous because not only can this compromise their overall reproductive performance but it also compounds the risk of chronic medical conditions such as diabetes, coronary/cerebral/peripheral vascular disease and thus compromises life expectancy as well as the quality of life. As such, being overweight represents an overall life hazard that should be addressed by the medical profession as well as by society as a whole. The answer is surely not a simple one but the solution does not lie in dieting alone (which rarely is of sustained benefit). Instead it requires an overall modification in lifestyle.
I strongly recommend that you visit http://www.DrGeoffreySherIVF.com. Then go to my Blog and access the “search bar”. Type in the titles of any/all of the articles listed below, one by one. “Click” and you will immediately be taken to those you select. Please also take the time to post any questions or comments with the full expectation that I will (as always) respond promptly.
•Controlled Ovarian Stimulation (COS) for IVF: Selecting the ideal protocol
•IVF: Factors Affecting Egg/Embryo “competency” during Controlled Ovarian Stimulation(COS)
•The Fundamental Requirements For Achieving Optimal IVF Success
•Ovarian Stimulation for IVF using GnRH Antagonists: Comparing the Agonist/Antagonist Conversion Protocol.(A/ACP) With the“Conventional” Antagonist Aproach
•Ovarian Stimulation in Women Who have Diminished Ovarian Reserve (DOR): Introducing the Agonist/Antagonist Conversion protocol
•Anti Mullerian Hormone (AMH) Measurement to Assess Ovarian Reserve and Design the Optimal Protocol for Controlled Ovarian Stimulation (COS) in IVF.
•Human Growth Hormone Administration in IVF: Does it Enhances Egg/Embryo Quality and Outcome?
•The BCP: Does Launching a Cycle of Controlled Ovarian Stimulation (COS). Coming off the BCP Compromise Response?
Please call or email Julie Dahan, my patient concierge. She will guide you on how to set up an in-person or Skype consultation with me. You can reach Julie at on her cell phone or via email at any time:
Julie Dahan
•Email: Julied@sherivf.com
•Phone: 702-533-2691
?800-780-7437
Geoff Sher
I also suggest that you access the 4th edition of my book ,”In Vitro Fertilization, the ART of Making Babies”. It is available as a down-load through http://www.Amazon.com or from most bookstores and public libraries.
Hi Dr. Sher!
My husband have been confirming ovulation with OPK’s, temping, and timing intercourse right for 7 months straight and have not conceived. I have a slow rising temp after ovulation and I also spot new and old blood for 5 days before CD1. I had my progesterone tested 7 DPO and it was 10.4. Should I be concerned or continue trying until we hit the 1 year mark before intervening?
A I stated in my earlier response to this post, With 7 months of failing to conceive, you are as yet not eligible for a full evaluation. If you wish to keep trying while hubby is away, you can have his sperm collected, frozen and have this inseminated monthly with the LH surge while he is away.
Geoff Sher
Dear Dr. Sher,
1) If an embryo reaches early blastocyst with 100 cells on day 5, can we freeze it? Is this considered to be expanded blastocyst stage with 100 cells?
2) For DOR women, is it better to freeze the embryo on day 3 to optimize their chance to be pregnant since they have one or two follicles and reaching the expanded blastocyst stage means also that the good grade embryo might be arrested on day 6 or 7 as they are too long outside in the dish instead of in the uterine?
Thanks for advise.
Kindest regards.
1) If an embryo reaches early blastocyst with 100 cells on day 5, can we freeze it? Is this considered to be expanded blastocyst stage with 100 cells?
A: An expanded blastocyst has a central collection of fluid inside with cells arranged around this…much like a blister.
2) For DOR women, is it better to freeze the embryo on day 3 to optimize their chance to be pregnant since they have one or two follicles and reaching the expanded blastocyst stage means also that the good grade embryo might be arrested on day 6 or 7 as they are too long outside in the dish instead of in the uterine?
A: Virtually without exception, I advocate freezing embryos only once they have reached the blastocyst stage of development. Embryos that cannot reach this stage within 5-6 days of being fertilized are almost invariably non-viable anyway. They would not have had a better chance at viability had they been frozen or even transferred earlier…anyway. So what is the point in doing so unless they reach blastocyst?
Good luck!
Geoff Sher
Hi doctor Geoffrey u was wondering could u help me in 33 yrs old im trying for a baby and I’m starting Ivf soon but I’v been told I can conceive naturally IV been trying for 5yrs but think my app is wrong it tells me I’m fertile 8dayd after the 1st day of my period my cycle is 28 days but when I google it says day 14 im fertile could u clear this up for me please
Ovulation usually occurs 14 days prior to menstruation. Pregnancy is most likely to occur when intercourse or insemination happens just prior to ovulation. It is unlikely to occur if exposure is after ovulation has taken place. The use of a home ovulation test can help predict that ovulation is about to occur within 6-30h hours of the 1st sign of a color change in the urine, using home ovulation testing.
Good luck!
Geoff Sher
Hello Dr Sher,
Tomorrow I will be having my first scan for a pregnancy following a day 5 blastocyst FET. I will be 6w6d tomorrow on scan day. Should I expect to see a heart beat, and if so what is the number I should be looking for to indicate a viable pregnancy?
Congratulations!
You should be able to see a distinct sac of appropriate size, containing an appropriately grown conceptus with a heart beat of 110-180 beats per minute and a yolk sac.
Good luck!
Geoff Sher.