For Women Struggling to Conceive in the Face of Obesity and PCOS

The joys and fears of conceiving a baby and anticipating a pregnancy are often magnified for women who struggle with obesity and complications from polycystic ovarian syndrome (PCOS). Chief among the fears are difficulty conceiving, preterm labor, preeclampsia, fetal heart defects, gestational diabetes, spontaneous abortion, caesarean-section birth and others.

Establishing a personal connection between patient and clinician and identifying any potential comorbidities at the outset of fertility weight-loss programs can set women on the path to a successful and healthy pregnancy for both themselves and their future babies.

“Weight is such a delicate and sensitive issue that we decided to build a service to help women experience the pregnancy they want and deserve,” says Karen Cooper, DO, Director, Women’s Weight Management Program, Ob/Gyn & Women’s Health Institute.

The outcomes can offer so many rich rewards. In addition to a healthier lifestyle and newborn baby, “it is ultimately about empowering women and helping them break the false idea that their worth is tied to their weight.”

For the last four years, Dr. Cooper has helped women with body mass indexes in the range of overweight to morbidly obese improve their health status in preparation for conception.

It starts with a one-on-one conversation about goals and motivation and is followed by a personalized health inventory, including lipid and metabolic panel testing, insulin assay and HgA1C measurement.

Elevated cholesterol, for example, can increase the risk of heart defects in the developing fetus. Metabolic syndrome not only can contribute to obesity, it can cause irregular menstruation and increase insulin resistance.

“It is important to identify any comorbidities that may be contributing to decreased fertility,” says Dr. Cooper. “Once we determine that, then we can work on the psychosocial aspects of their treatment.”

Weight loss as fertility treatment

Dr. Cooper helps establish weight-loss and lifestyle management goals, in tandem with the treatment protocol of the infertility specialist, to enhance a successful outcome for the patient.

“When I talk to these women and we establish that safe and successful pregnancy is something they really want — often more than anything else — they are so much more motivated to lose weight and adhere to the dietary and exercise programs we discuss,” says Dr. Cooper.

Dr. Cooper’s recommendation for weight loss is based on her assessment of the patient, what the patient is ready for, and what will be most effective way to achieve her goals.

To ensure a healthy pregnancy for both mother and baby, Dr. Cooper recommends utilizing the American College of Obstetricians and Gynecologists (ACOG) guidelines for weight gain during pregnancy, under the supervision of a registered dietician. ACOG advises the following amount of weight to be gained during pregnancy, per the patient’s body mass index (BMI):

• < 18.5 (underweight), 28-40 pounds
• 5-24.9 (normal weight), 25-35 pounds
• 25-29.9 (overweight), 15-25 pounds
• >=30 (obese) 11-20 pounds

While shedding excess weight in anticipation of a pregnancy — only to gain some of it back when carrying a baby — might seem frustrating, Dr. Cooper’s take is that it is normal and, within the above guidelines, healthy for both mother and child.

“These women are highly motivated and are ready to do whatever it takes,” says Dr. Cooper.