OB-GYN (Obstetrician-Gynecologist) Questions Overweight

What is the connection between being overweight and the inability to conceive?

I am 32 years old and I am trying to conceive. The doctor thinks I am not able to conceive because I am overweight. Is there a connection between being overweight and not being able to conceive?

10 Answers

Yes. There is a connection. Some overweight women do not have regular ovulation, but not all. Polycystic ovarian syndrome can be connected to excess weight. Women who have that problem have irregular ovulation and increased insulin levels.
Your body forms three types of estrogen: estradiol, estriol, and estrone. The first two come from the ovaries. Estrone is created by fat in the body via conversion of androstendione produced by the adrenal glands. In a normal menstrual cycle, your body produces little to no estadiol and estriol while menstruating. Then, in the first two weeks after the beginning of your period, these to estrogens emitted from the ovary increase and produce the lining needed to support a pregnancy and encourage the development of an egg to be released at ovulation. A spike in estrogen occurs at approximately 14 days causing the release of the egg. At this point, the corpus luteum develops on the ovary and produces progesterone. Meanwhile body fat continues to produce a continuous and constant supply of the weaker estrogen, estrone. Progesterone secretion continues for the next 2 weeks in anticipation of a pregnancy. If pregnancy does not occur, then the body stops producing ovarian estrogens and progesterone. This lack of hormones causes the uterus to lose the lining needed for pregnancy and start the cycle all over. The problem with excess weight is that estrone,
produced by body fat, remains constant. This estrogen can become significant enough to prevent the withdrawal bleeding expected from the lack of ovarian produced estrogen and progesterone. In addition, this excess hormone can result in a much thicker uterine lining to shed each month. Therefore, many women with excess weight can find that they miss periods from the lack of hormone withdrawal or have much heavier periods from excess growth of uterine lining to shed.

W. David Stinson, MD
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Great question!

The comment made to you is very vague and not 100% accurate. There has been a link between being overweight and developing PCOS (polycystic ovarian syndrome). Patients with PCOS can often have a harder time conceiving. Traditionally, doctors always told patients to lose some weight and they should ovulate. Studies do show that a weight loss of even 10-15 pounds can return an anovulatory (no release of egg) female to an ovulatory (releasing eggs) state. That being said, I recommend an ultrasound of the uterus and ovaries to evaluate for PCOS and also some hormonal bloodwork to determine if you indeed have PCOS. If so, they are some medications that can be used to help you get pregnant. I hope this was helpful and if you are nearby, please feel free to come see for an appointment to discuss.

Richard T. Burke, MD
Yes, being overweight causes ovulation disruption by producing abnormal estrogen levels. It also causes an increase in male hormones that also affect ovulation.
Yes, being overweight can decrease the number of ovulatory cycles a woman has, thus decreasing conception rate. However, if your periods are regular, then you are ovulating fine and your weight is not a factor.
Please google "PCOS," or "polycystic ovaries," or "insulin resistance and infertility" - that being said, there are a lot of women who are severely overweight and conceive easily, so it seems very simplistic to blame it on your weight. You should get a 2nd opinion. Good Luck!
Fat converts some hormones into other hormones. This includes estrogen and progesterone which are part of the menstrual cycle. Increased production of these hormones can result in the ovary not producing eggs regularly. Some women can develop PCOS as a result of the hormone shifts. Fortunately, losing weight can reverse this situation.
If you are having regular predictable periods, that usually means you are ovulating. You can check this with over the counter ovulation tests (but don't use those to decide when to have sex - the egg is only viable for 12-18 hours and you may miss your window). If your periods are more than 32-34 days from start to start, you may also have difficulty conceiving.
Remember that the connection of ovulation to period is not from the start. Once ovulation occurs, the ovary produces progesterone for 12-14 days and then stops if there is no pregnancy. The drop is progesterone is what triggers the period. You can estimate when you are likely to ovulate if you are having regular periods. Back up 2 weeks from when you expect your next period, that is likely when you will ovulate. You want to spread your focus time at least 5 days before and after. During that time you want to have unprotected sex at least every other day but not more than once a day. If your periods are unpredictable, this is hard to do.
If you have been trying actively to have sex during your fertile time and have not conceived, it may be time to see a gynecologist who has experience in treating infertility or a reproductive endocrinologist (a specialist in fertility treatments). There are pills that can help some women ovulate before having to look at IVF.
It may be that you are not ovulating. The risk of early miscarriage is also possible.
Yes. Age, smoking, and obesity are all factors that can affect a woman' fertility, and success rates with fertility treatments.