Abstract
Abstract Obesity is associated with sub fertility and multiple adverse pregnancy outcomes including miscarriage and later pregnancy complications such as pre-eclampsia and gestational diabetes. Weight loss preconception is recommended for women with obesity and infertility. The etiology of infertility may affect the response to weight loss with WHO type 2 patients more likely to ovulate spontaneously or with oral medications after modest weight loss. The evidence for weight loss improving fertility outcomes is weak for women with unexplained infertility. There may also be unrecognized harms to weight loss including increased risks of miscarriage and weight rebounding excessively during pregnancy. Unique hurdles to weight loss interventions including the types, duration and best comparators will be discussed. Blanket recommendations that weight loss improves fertility and pregnancy outcomes should be avoided. Other factors such as age and ovarian reserve should be factored into any preconception weight loss strategies
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