Many women with PCOS struggle with their weight and their fertility. High levels of testosterone and other androgens can cause weight gain and irregular ovulation, amongst other related complications.
Ovulation, the release of a mature egg from the ovary, is a key component to getting pregnant. Knowing when that egg is released is crucial to timing intercourse or other fertility treatments. Proper timing ensures that the sperm is able to encounter the egg within 24 hours after its release. If you aren’t sure when ovulation is occurring, it can be difficult to make sure that you are trying at the optimal time.
Irregular ovulation is usually the result of hormonal changes. In women with PCOS, this often results from high levels of circulating androgens, such as testosterone. The high androgen level interferes with your menstrual cycle and can prevent ovulation. Being overweight, also common with PCOS, contributes to anovulation (complete lack of ovulation) or oligoovulation (irregular ovulation).
It is known that being overweight or obese can significantly reduce your fertility and even the success rate of infertility treatments. In fact, more and more clinics are reporting policies where patients must be under a certain body mass index (BMI) in order to be treated. This may sound mean and discriminatory, and can definitely hurt when the doctor tells you that you’ll need to lose weight first, but I promise that there’s a good reason.
While, yes, women of all shapes and sizes have been getting pregnant throughout time, getting pregnant while very overweight can put you and the baby at risk for severe complications. In addition to being at higher risk for infertility and miscarriage, an obese woman who gets pregnant is at higher risk for developing gestational diabetes, pre-eclampsia (high blood pressure in pregnancy that can lead to seizures), and even stillbirth. Labor and delivery can be significantly more difficult, as can your recovery.
Another thing to keep in mind is that if you are undergoing IVF, a surgical procedure under general anesthesia is required at the end of the cycle. Since many of these procedures take place in small office procedure rooms (as opposed to the hospital), the facility may not be equipped or able to deal with potential surgical complications associated with obesity. Obese patients are much more likely to develop adverse reactions to the anesthesia, including issues with breathing and your airway, that can be dangerous if not managed immediately with advanced equipment. If such an emergency were to occur, your life would be at risk and no responsible physician would knowingly take that chance.
Researchers have done several studies looking at the effect of weight loss with or without certain drugs, known as insulin sensitizing agents, to see their effect on normalizing ovulation, fertility and pregnancy. Insulin sensitizing agents are drugs that increase a woman’s response to insulin, which is one of the hormones that is altered in women with PCOS. Many physicians who treat women with PCOS are now using these drugs because they seem to help manage symptoms and prevent some complications.
In addition to lifestyle changes and medication, bariatric surgery is one option for women who have a significant amount of weight to lose. According to a position statement published by the Androgen Excess and Polycystic Ovary Syndrome Society of the American Society of Reproductive Medicine states that “in another study examining gastric bypass in overweight women with PCOS, a 56.7% weight loss over 1 year improved menstrual cyclicity, hirsutism, and natural conception.” (Moran 2009).
Weight loss surgery, however, is a big step and not all women are candidates for the surgery. Make sure to do your research and carefully select a surgeon who has worked with women with PCOS before. You’ll also want to work with someone who provides ongoing support after your surgery to minimize the chance that you will gain weight back.
X.L. Smith, R.W. Ke, A.M. Page, W.H. Kutteh. Effect of weight and insulin-sensitization agents on polycystic ovarian syndrome (PCOS)-associated infertility. Fertility and Sterility - September 2007 (Vol. 88Supplement 1, Pages S178-S179, DOI: 10.1016/j.fertnstert.2007.07.617).
Lisa J. Moran, Renato Pasquali, Helena J. Teede, Kathleen M. Hoeger, Robert J. Norman. Treatment of obesity in polycystic ovary syndrome: a position statement of the Androgen Excess and Polycystic Ovary Syndrome Society. Fertility and Sterility - December 2009 (Vol. 92, Issue 6, Pages 1966-1982.