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Weight and Unexplained Infertility

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a blog by David Kreiner, M.D., F.A.C.O.G., East Coast Fertility, December 21, 2010

Dear Fertilty Doc:

I have struggled for a few years now with the term "unexplained infertility." My husband and I have been trying to conceive for several YEARS now with no success. I have had every fertility test under the sun. I have been poked, injected, inseminated, dye tested, ovarian reserve looked at, both tubes perfect and finally told that I have "unexplained infertility."

I was told my only hope of conceiving would be through IVF, and then in the next breath I heard ''but your BMI is 44, and we need you to lose 30 pounds, and then we can help you.' This of course was after being told I have ''low ovarian reserve" as I approach the infamous age of 35. So, we need you to lose the 30 pounds before you turn 35 (talk about added pressure) or there won't be much any reproductive endocrinology and infertility clinic can do for you.

Really, I thought? I guess my question is why is this acceptable? My husband and I have worked hard to be able to afford IVF only to be told "good luck with that." I guess I can't understand if my ovarian reserve is such an issue, why is my weight a bigger issue? So, we did what anyone receiving this kind of news would do — we got a second and third opinion, but all the doctors echoed the same thing just in a different tone. I am trying to lose the weight (down 4 pounds already), but I wonder what your thoughts are on this and how you would feel if you were me. Thanks for reading!

Dear Ms Z:

You bring up three issues that are dear to me and many patients I have encountered over the years. The first is dealing with the diagnosis of "unexplained infertility," as if given the fact that fertility doctors cannot identify the cause of your inability to conceive a name makes dealing with the frustrations and disappointments any easier. It doesn't. Fortunately, our field has made much greater strides in the treatment arena than we have with diagnosis. Truly, "unexplained infertility" patients have a 60 percent pregnancy rate per cycle with IVF today. Presumably, the unexplained cause is related to sperm access to the egg or the fertilization process itself. Additionally, the IVF process can sometimes identify covert causes of infertility.

Second, I have always been offended by the prejudice openly expressed in the field of REI against the obese patient. Sometimes, treatments may be more difficult in these patients, but the excuse that they are more dangerous and pregnancy more hazardous needs to be examined and tested, and patients counseled regarding potentially greater risks, rather than simply delaying or denying therapy. I have found that IVF success is equivalent in the normal weight patient as it is to the obese and morbidly obese patient. Medical health to sustain IVF, anesthesia and pregnancy needs to be evaluated and patients counseled. Options of bariatric surgery could be offered.

The third issue is diminished ovarian reserve. Obesity does not cause this problem, nor will losing weight fix it. If this is identified in a woman, then that is a cause of infertility, and she does not have "unexplained infertility". AMH in addition to day 3 E2, and FSH as well as antral follicle counts should clear this up. If not, a letrizole challenge test or clomid challenge test will do so. In some cases pretreatment with DHEA may improve ovarian responsiveness, as may accupuncture.

I wish you a happy holiday and a better 2011!

Comments (1)

No woman likes it when you tell her to lose some pounds. Even though she looks very well just the way she is, if it's a matter of health or, in this case, reproduction, I'd do whatever it takes. But I can't really say how it is, I'm currently trying to gain some weight by taking sustanon and such.

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