It’s time to include couple-based body mass index counseling in the infertility clinic visit

Abstract

The impact of female abnormalities of body mass index (BMI) and its association with subfertility and increased time to pregnancy (TTP) have been well-characterized (1Gesink Law D.C. Maclehose R.F. Longnecker M.P. Obesity and time to pregnancy.Hum Reprod. 2007; 22: 414-420Crossref PubMed Scopus (270) Google Scholar). This may be due to the impact of BMI on ovulatory status in women, though TTP is increased even among women with a high BMI and reportedly regular cycles (2van der Steeg J.W. Steures P. Eijkemans M.J.C. Habbema J.D.F. Hompes P.G.A. Burggraaff J.M. et al.Obesity affects spontaneous pregnancy chances in subfertile, ovulatory women.Hum Reprod. 2008; 23: 324-328Crossref PubMed Scopus (265) Google Scholar). Patients with higher BMIs, those in the overweight and obese categories, are at increased risk for gestational issues including gestational diabetes, hypertension, and difficulty with fetal monitoring. Furthermore, in relation to assisted reproductive technologies (ART)-related outcomes, some studies suggest that high BMI seems to confer a risk of fewer oocytes, poorer egg quality, and lower fertilization rates, implantation rates, and slightly increased risk of miscarriage (3Luke B. Brown M.B. Missmer S.A. Leach R. Stern J.E. The effect of increasing obesity on the response to and outcome of assisted reproductive technology: a national study.Fertil Steril. 2011; 96: 820-825Abstract Full Text Full Text PDF PubMed Scopus (78) Google Scholar). The impact of male partner BMI on TTP in optimizing fertility is less well understood, with a limited number of studies to guide clinical practice (4Ramlau-Hansen C.H. Thulstrup A.M. Nohr E.A. Bonde J.P. Sørensen T.I.A. Olsen J. Subfecundity in overweight and obese couples.Hum Reprod. 2007; 22: 1634-1637Crossref PubMed Scopus (280) Google Scholar). The article by Zhang et al. (5Zhang Y. Zhang J. Zhao J. Hong X. Zhang H. Dai Q. et al.Couples’ pre-pregnancy body mass index and time to pregnancy among those attempting to conceive their first pregnancy.Fertil Steril. 2020; 114: 1067-1075Abstract Full Text Full Text PDF Scopus (2) Google Scholar) sheds light on the importance of male partner and couples’ (heterosexual) combined BMI and health status in optimizing fertility as measured by time to conception. The study team evaluated a retrospective cohort of Chinese heterosexual couples attending a preconception clinic and found that there was a prolonged TTP when both females and males had abnormal BMIs. Pregnancy rates were reduced by a clinically significant meaningful increment, measured by the fecundability odds ratio (FOR), i.e., by 10%, (FOR 0.90, 95% confidence interval 0.88-0.92) and 19% (FOR 0.81, 95% confidence interval 0.78-0.84) among couples who were both underweight and obese, respectively, compared to those with normal BMIs. Of note, optimal body mass for shortest TTP in the cohort were noted as 20.61to 23.06kg/m2 and 22.69 to 27.74 kg/m2 for females and males, respectively. These findings are clinically applicable to counseling and prevention, especially among couples who are seeking health optimization before attempting pregnancy. A key population that might benefit are those presenting for fertility preservation with gamete freezing or for a preconception counseling visit for fertility planning. Several clinics have BMI thresholds beyond which they do not perform in vitro fertilization. In the United States, the upward trend in BMI is multifactorial and affected by the industrialization of our food supply chain and with increasingly processed foods combined with increasingly sedentary lives and stress. As rates of obesity increase globally, the need for early identification, screening, and prevention will not only benefit obesity related chronic disease burden, but also will facilitate optimization of preconception health to support a timely conception and healthy pregnancy. Multiple trends converge on the need for prevention of infertility including reduced access to ART in certain populations and regions. It is critically important to consider and optimize health factors in the population at large and at a couple (male plus female) level to not only reduce the risk for infertility but also to improve gestational and birth outcomes. As fertility care providers, we must invest time in counseling regarding the optimization of health parameters (BMI, diet, exercise, sleep hygiene, smoking, and substance use) prior to utilization of ART. Public health practitioners must also collaborate to identify and manage challenges in preconception health optimization that are the result of societal, industrial, governmental, socio-economic, individual-level, and network-level factors. Counseling on optimizing preconception health, particularly for those in the preconception time window must be thoughtfully addressed within the reproductive endocrinology visit. Couples’ prepregnancy body mass index and time to pregnancy among those attempting to conceive their first pregnancyFertility and SterilityVol. 114Issue 5PreviewTo explore the relationship between couples’ prepregnancy body mass index (BMI) and time to pregnancy (TTP) among those with no prior gravidity. Full-Text PDF