Expert advice – Monica Moore on weight loss and infertility

By Monica Moore, founder of Fertility Health

I was asked this question by one of my patients, Mary on weight loss.

“I am trying to lose weight prior to my trying for a second IVF pregnancy…it’s a challenge, especially having Polycystic Ovarian Syndrome, but I know it will be worth it. Any tips for weight loss would be appreciated.”

I’m ashamed to say that my answer to this would have been completely different a few years ago: ‘Lose five to ten percent of body weight’ or ‘move more and eat less’.

How vague and unhelpful

Although obesity is associated with many factors that can negatively affect your ability to get pregnant, there is no research that proves that quick, short-term weight loss can help. There are exceptions, in certain situations, such as an extreme in BMI and if you don’t ovulate due to excess weight. So, quickly losing weight in order to undergo an IVF cycle is not only stressful but probably not helpful. Why, then, do we say things like ‘lose five to ten percent of body weight?’

Let’s start with how the existing studies are set up: the negative effect on reproductive outcomes is based on comparing women in certain BMI categories to other women in other BMI categories, so those in ‘normal’ BMI categories did better on certain measures than those in very low or high BMI categories. The important concept is that these women were not compared to themselves once they lost weight.

Recently, a few studies have looked at this and found that quick weight loss didn’t help achieve a pregnancy when undergoing fertility treatments. Why? It is thought that detrimental processes going on inside the person (metabolic factors, like glucose control and insulin resistance) either are not improved by quick weight loss or there was not enough time to improve them.

So, now what?

My advice is simple: improve your inside and the outside will likely follow. And if it doesn’t right away, don’t rush it. Better to improve health than just lose weight at the risk of your health.

It is incredibly difficult to lose weight and not regain it. The body has compensatory mechanisms in place to keep you at your current weight. Studies have proven this time and time again. In fact, a study by Weight Watchers found that after about two years, only 20 percent maintain their goal weight, by five years, that number goes down to 16 percent. Not very promising for clients (but a good business model for WW). With PCOS, we (yes, I have it too) enjoy the added complexity of insulin resistance, which favors weight storage, confuses hunger and satiety signals, and amplifies your body’s production of androgens.

So, how do you improve your inside?

It starts with rearranging your thought process and maybe inhabiting a space that is uncomfortable for you. But there is an added benefit to employing these methods, they can also help you deal with the stress of an IVF cycle.

Move often and spend the last few minutes of movement to the point of discomfort. If you can easily have a conversation with your friend, you are not pushing yourself hard enough. Don’t do this to solely lose weight. Do it to achieve a sense of control, physical empowerment or to embody a stronger version of yourself. Go outside and walk when you can, it is a form of moving meditation (proven to reduce stress and maybe displace food as the sole trigger for pleasure areas of the brain).

Eat for body performance. Experiment with how certain foods make you feel as opposed to look. Devise short-term, attainable goals, such as not buying a sugary coffee drinks one week, then maybe no fast food (or fast food only once a week) as your next goal. Buy yourself a cool journal and record every time you meet that goal. Recording this daily is called a streak, and some research shows that meeting goals and maintaining streaks can increase the production of dopamine, the feel-good hormone, in the brain so that you derive pleasure from this and not necessarily from food.

Remember that journal?

Use it to record your thoughts. Maybe first thing in the morning, just write down whatever comes into your mind, clear the cobwebs to make room for the focus and creativity that you need for the day. It has been shown that journaling is one way to reduce stress and guess what chronic stress can cause? Weight gain (as well as depression and anxiety, we, as infertility clinicians, provide those in abundance during fertility cycles).

Find a group of people with the same issue and work on this together. The part about WW that I do believe in is the power of the group perspective and support. That’s the cornerstone of organizations that work, such as alcoholics anonymous: the gentle accountability and peer assistance with challenges that only a group of like-minded people can provide. Having a group of people available for support is powerful and necessary.

Finally, overeating is its own topic. The reasons for it are deep-rooted, multifactorial and genetic, and combating them is hard work. We will explore, in another post, how to examine your relationship with food, but in the meantime, I ask that you really search your soul. Start figuring out what (besides food or drink) calms and comforts you; what (or who) fills your tank and engage these people or strategies. What or who are your triggers? Discontinue, remove or limit these things or people from your life.

I have more than 20 years of experience as an infertility nurse practitioner and here is the one thing that I want you to remember

You are more than your weight. You are strong and brave and resilient, and you will get through this process. Deriving your worth from who you are as a person is so much more important than a number on a scale or the results of a test. Don’t worry about what happened before, proceed from this point on. Start from now.

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