A weighty issue

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A weighty issue
How a woman’s weight impacts the risk of miscarriage

A miscarriage is a devastating experience for couples, perhaps even more so for those who have struggled with infertility and gone through the initial joy of a successful fertility treatment. Statistics have shown that in both natural and IVF conception, about one in six pregnancies will end in a miscarriage before the 20th week, with the rate being higher in older couples.

Understandably, couples are frightened of miscarriages and would rather not think or talk about it. However, it is important for couples to understand why miscarriages happen, as well as what they can do to reduce their risks.

Although the exact reason for a miscarriage is often unexplainable, it can occur due to a number of reasons. These include chromosomal abnormality, improper implantation of the egg and maternal health problems or trauma. The mother’s age also plays a significant role, as does her lifestyle, which includes exposure to stress, smoking, drug use, malnutrition, excessive caffeine, radiation and toxins.

Another well-studied factor than increases a woman’s risk for miscarriage, is her weight. As these studies indicate, if the mother is obese or underweight, this increases her risk of not only infertility, but miscarriage as well, regardless of the method of conception.

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According to researchers at the Department of Obstetrics and Gynaecology, University of Adelaide, Australia, being overweight increase a woman’s risk of miscarriage by 29%, while being obese can increase the risk by 71% or more. However, for women undergoing assisted reproduction, researchers at the Assisted Fertilization Center, Brazil concluded that maternal obesity could increase the risk of miscarriage by up to 1330%.

Obesity also compounds miscarriage rates in women with PCOS. The Department of Obstetrics and Gynecology, Faculty of Medicine, Erciyes University, Turkey found that the miscarriage rate in obese women with PCOS is about nine times higher than average.

And while miscarriage is often the result of an unhealthy fetus, researchers from the Department of Obstetrics and Gynecology, Stanford Hospital and Clinics, CA, USA found that the risk of miscarriage of a healthy fetus is significantly higher in obese women (with BMIs of 25 or more).

While obesity has been identified as a risk factor for spontaneous miscarriage, the mechanism for it remains unclear. But a study by The Academic Unit of Reproductive and Developmental Medicine, The University of Sheffield and Sheffield Teaching Hospitals, Sheffield, UK points to the endocrinological changes in obesity as possibily causing complex adverse effects including circulating adipokines, sex steroids and insulin resistance.

Women who are underweight, with a BMI of under 20, also face an increased miscarriage risk. A study by researchers at the German Cancer Research Centre found that pregnant women who were underweight faced a 70 % higher risk of having a miscarriage.

Therefore, it can be concluded that among intrauterine environmental factors, nutrition appears to play the most critical role in influencing placental and fetal growth. Since maternal undernutrition or overnutrition during pregnancy can impair fetal growth, women must adopt healthier diets and incorporate exercise to lower their risk of miscarriage.

If you have any concerns regarding miscarriage, especially after IVF, please do not hesitate to consult with your fertility consultant for advice.

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New Year Surprises

Giggle baby

My New Year was filled with a few good news, which is definitely a good way to start a brand new year.

A patient of mine, Madam P, gave birth to a baby girl vaginally after an induction of labour. Madam P was a patient with severe Polycystic Ovary Syndrome, who had come to see me in a very depressed condition. She had consulted 5 different gynaecologists before, and was told that she will never get pregnant. At that time, she was already married for 7 years. She was obese, stressed and depressed. She hardly have any menses. Most of the time, she needed medication to induce menstruation.

She told me that she was discriminated from her relatives as she was not able to get pregnant. Relatives stopped inviting her to weddings and baby showers as they feel that she was infertile, which may bring bad luck to other couples.

One unique thing which strikes me about Madam P is her husband Mr A, a very loving and supportive husband, who literally stood by her throughout this special journey.

The first thing I told Madam P is that she needs to lose weight and bring down her sugar level. Madam P is a high-flying executive in a bank, and the pressure of work caused her to eat for comfort. This causes a spiraling vicious cycle on her body image and stressed her even more.

It took me a few months to convince her to see a dietitian to change her habit of eating and reluctantly she signed up for gym to lose some weight.

Along the way, she went into depression, requiring clinical psychologist’s support.

Six months along the way, she decided to quit her job and change her lifestyle. She started cooking at home so that she can eat healthily, spend more time with her dogs, exercise and to pursue fertility treatment.

I went on with her and started an IUI cycle which did not work out. She attempted an IVF cycle but the follicles failed to grow. She was devastated.

She stopped seeing me for  4-5 months, and then one day she appeared at my clinic again.

At that time, her father had passed away unexpectedly at the age of 60 due to a heart attack. Suddenly, it threw things into perspective for her: She told me that she is going to go all out to have a baby, for the sake and the remembrance of her dad, who had supported her throughout this journey but have not lived to see this dream of hers coming true. She felt that this was the only thing she can do to keep her dad alive in her heart.

She gritted her teeth and started a weight loss programme with the help of a dietitian and a gym instructor, and managed to lose 15 kgs within 2-3 months. Her period started to become regular again. Upon her return from India for the prayers of her late father, we noticed that things beginning to change for her. She was also seeing an acupuncturist to  prepare her body prior to an IVF.

I scanned her as part of my assessment prior to IVF, and I was delighted to see a growing follicle which was just about to ovulate. I suggested an IUI for that particular cycle.

Lo and behold, she got PREGNANT!!!!

We could not believe our eyes when we saw the urine pregnancy test, which was further confirmed by the blood test result.

P & A was over the moon, and of course the rest was history.

This whole journey took us two years and it ended up with a sweet victory.

The point I wish to bring forward to many of you who are out there and still struggling with trying to have a baby is:  Nothing is impossible. The key thing is to keep moving forward and do the right thing. Like Madam P, she was told that she could never get pregnant but yet she did not give up, even though she have had some setbacks with Fertility Treatment.

The story of P had definitely inspired me, and taught me a good lesson about life. I hope it will be the same for you!