Heavy obstacles
For many, obesity becomes a contributing factor to infertility.

By Kathleen Kernicky
South Florida Sun-Sentinel
November 26, 2004

Lucy Zuel had tried for seven years to get pregnant. She'd lived with
obesity most of her life. The two collided a few years ago when she sought
treatment for infertility.

"The doctor told me my weight would be a problem," says Zuel, 37, who
weighed 280 pounds when her doctor told her she had polycystic ovarian
syndrome, an ovulation disorder of which weight gain or obesity is a
symptom.

Ovulation disorders are the No. 1 factor in female infertility, creating
hormonal imbalances, disrupting menstrual cycles and blocking efforts to
conceive. About 15 percent of these cases are linked to weight disorders,
most often being overweight or obese.

"We don't beat up our patients about it, but we strongly encourage them to
lose weight," says Dr. Ellen Wood, a reproductive endocrinologist who
treated Zuel at the South Florida Institute for Reproductive Medicine. "We
have a fair amount of patients who are 100 to 150 pounds overweight."

Wood estimates that 10 percent to 15 percent of her patients have
weight-related infertility and weight is a contributing factor in others.
Obesity affects a man's fertility as well, resulting in lower levels of the
hormone testosterone, a diminished sex drive and less ability to produce
sperm.

Dr. David Hoffman, reproductive endocrinologist at IVF Florida Reproductive
Associates and past president of the Society for Assisted Reproductive
Technology, encourages patients to start a weight-loss and exercise program
before they try to get pregnant.

"Losing weight is going to improve their odds of conceiving naturally, or
if they don't, getting a better response to ovulatory drugs. It's going to
make it easier to get pregnant, easier to carry, and they're going to have
less complications."

Doctors say overweight patients have a poorer response and a weaker
absorption of fertility drugs. As a result, they may need higher doses, and
they're more likely to require intramuscular rather than subcutaneous
injections.

"If you're going to spend $12,000 on infertility treatments and your body
is not going to absorb the medications properly, it can potentially be a
waste of money," Wood says.

Infertility doctors factor in a patient's weight with her age.

"If a woman in her 20s is overweight and trying to conceive, we might tell
her to take six months to a year and lose weight," says Wood. "When a woman
is in her mid-30s or older, we have to weigh the difficulties of losing
weight with her age. You have the concern that her eggs are going to be a
year older."

After seeking help from Wood, Zuel had surgery for the ovarian disorder.
She and her husband, Jim, 48, made three attempts at intrauterine
insemination. All failed. She hit her low point when Wood told her that her
weight exceeded the limit for patients trying a new fertility drug.

"The more weight you have to lose, the more overwhelmed you get," says
Zuel, who was 140 pounds overweight at the time.

Forced to confront the obesity, Zuel stopped fertility treatments. "I
didn't believe I would ever get pregnant," she says.

In April 2002, she had gastric bypass surgery, a procedure that involves
sectioning off a small pouch from the stomach that is surgically attached
to the small intestine. That results in a drastic reduction of food that is
eaten and absorbed.

During the next year, she lost more than 100 pounds and started having
regular menstrual cycles. But the surgery put her pregnancy plans on hold.
Because of the rapid weight loss that follows surgery, women are told to
use contraception and wait at least one year before they try to get
pregnant.

In June 2003, Zuel returned to Wood after missing two menstrual cycles. She
thought it was the stress of her mother's death from cancer the month
before. Wood did an ultrasound. Zuel was 14 weeks pregnant.