IVF and Obesity

Being overweight before, during pregnancy and after birth:
This information is for you if you are overweight and are planning to become pregnant, planning for an IVF treatment, expecting a baby or have recently given birth. It may also be helpful if you are a partner, relative or friend of someone who is in this situation.
Most women who are overweight have a straightforward pregnancy ,successful IVF treatment and birth and have healthy babies. However, being overweight or obese has a negative impact on you getting pregnant. In addition to that it does increase the risk of complications to both you and your baby. You and your healthcare professionals can work together to reduce some of these risks.
Key points
BMI (body mass index) calculation is a simple way to find out whether you have a healthy weight for your height. A BMI of 18.5–24.9 is considered normal.
A BMI of 25 or above is associated with risks for you and your baby, and a BMI of 30 or above indicating obesity is decreasing your chances of achieving pregnancy if you are on IVF treatment. The higher your BMI, the greater the risks are.
Some of the risks during pregnancy with raised BMI include increased risk of thrombosis, gestational diabetes, high blood pressure, pre-eclampsia, induction of labour, caesarean birth, anaesthetic complications and wound infections.
A raised BMI also increases your risk of having a miscarriage, giving birth early, having a overweight baby or even having a stillbirth.
Healthy eating and exercise can benefit you and your baby.
If your BMI is 30 or above, you are advised to take a higher dose of folic acid (5mg per day) and a vitamin D supplementation .

When will BMI be calculated in pregnancy?
Your BMI will be calculated at your first visit to the IVF clinic.
You may be weighed again later in your pregnancy.
You can also calculate your BMI by using the calculator
with formula of ; weight/ height*height.

What are the risks of a high BMI in pregnancy?
Some women with a high BMI have a straightforward pregnancy and have healthy babies. Having a BMI of 30 and over will decrease pregnancy chances naturally and if you require IVF treatment you will need higher doses of medication with lower rates of pregnancy. Furthermore, being overweight or obese does increase the risk of complications for you and your baby. The higher your BMI, the greater the risks.
If your BMI at your antenatal booking visit is 30 or above, you may be offered close follow up throughout your pregnancy. Your healthcare professional will discuss with you any additional risks for you and your baby as well as how these can be reduced.

Risks to you and how to reduce some of these risks ;
Thrombosis is a blood clot in your legs (venous thrombosis) or in your lungs (pulmonary embolism), which can be even life-threatening. Pregnancy itself increases your risk of developing thrombosis. If you are overweight, the risk of developing thrombosis is further increased.
Your risk for thrombosis will be assessed at your first antenatal appointment and will be monitored during your pregnancy. You may be offered injections of a medication called low-molecular-weight heparin ( blood thinning drugs ) to reduce your risk of thrombosis. This is safe to take during pregnancy.
Gestational diabetes
Diabetes that is first diagnosed in pregnancy is known as gestational diabetes. If your BMI is 30 or above, you are three times more likely to develop gestational diabetes compared with women with a BMI under 25.
You will be offered a test for gestational diabetes between 22 and 26 weeks. If the test shows that you have gestational diabetes, you will be referred to a specialist for further testing and treatment as required.
High blood pressure and pre-eclampsia
Being overweight increases your risk of developing high blood pressure and
pre- eclampsia. If you have a BMI of 30 or above, your risk of pre-eclampsia is 2–4 times higher compared with those with a BMI under 25.
Your blood pressure and urine will be monitored at each of your appointments. Your risk of pre-eclampsia may be further increased if:
you are over 40 years old, if you have had pre-eclampsia in a previous pregnancy or your blood pressure was already high before pregnancy or if you have twin pregnancy.
If you have these or other risk factors, your healthcare professional may recommend a low dose of aspirin to reduce the risk of you developing pre-eclampsia from your 12 th week of your pregnancy.
Risks for your baby
The overall likelihood of a miscarriage in early pregnancy is 1 in 5 (20%), but if you have a BMI of 30 or above, your risk increases to 1 in 4 (25%).
If you are overweight before pregnancy or in early pregnancy, this can affect the way your baby develops in the uterus (womb). Overall, around 1 in 1000 babies are born with neural tube defects (problems with the development of the baby’s skull and spine), but if your BMI is 30 or above, this risk is nearly doubled (2 in 1000).
If you are overweight, you are more likely to have a baby weighing more than 4 kg, which increases the risk of complications for you and your baby during birth. If your BMI is 30 or above, your risk is doubled from 7 in
100 to 14 in 100 compared with women with a BMI of between 20 and 30.
The overall likelihood of stillbirth is 1 in every 200 births. If you have a BMI of 30 or above, this risk increases to 1 in every 100 births.
If you have a high BMI during pregnancy, you may need additional ultrasound scans to check your baby’s development, growth and position. Your baby’s growth is normally monitored during pregnancy by an ultrasound but if your BMI is over 35 it can be difficult to visualize your baby from tummy so the scan might be done from down below which is called as transvaginally that is also considered to be totally safe for your baby.
All women are offered an ultrasound scan at around 20 weeks to look for structural problems that your baby may have. This scan is less accurate at picking up problems if your BMI is raised.

How else can the risks to me and my baby be reduced?
Healthy eating
A healthy diet will benefit both you and your baby during pregnancy and after birth. You may be referred to a dietician for special advice about healthy eating.
Trying to lose weight by dieting during pregnancy is not recommended.
However, by making some changes to your diet, you may not gain any weight during pregnancy and you may even lose a small amount. This is not harmful.
You will be offered information and advice about being physically active during pregnancy.
Physical activity will benefit both you and your baby. If you have not previously exercised routinely, you should begin with about 15 minutes of continuous exercise, three times per week, increasing gradually to 30 minute sessions every day. Some examples of healthy exercise include swimming, walking and pregnancy yoga.
An increased dose of folic acid
Folic acid helps to reduce the risk of your baby having a neural tube defect. If your BMI is 30 or above, a daily dose of 5mg of folic acid is recommended. Ideally, you should start taking this 3 months before you conceive and continue to take it until you reach your 12 th week of pregnancy. However, if you have not started taking it early, there is still a benefit from taking it when you find out that you are pregnant. Vitamin D Supplement can be helpful as well.
Labour and giving birth;
There is an increased risk of complications during labour and birth, particularly if your BMI is 40 or more. These complications include:
your baby being born before 37 weeks of pregnancy (preterm birth) a longer labour, an emergency caesarean birth more complications during and after a caesarean birth, such as heavy bleeding, anaesthetic complications and wound infection.
Planning for labour and birth:
While you are pregnant you should have a discussion with your healthcare professional about where you will choose to give birth.
• •
What happens after giving birth?
After birth, some of your risks continue. By working together with your healthcare professionals, you can minimise the risks in a number of ways, as discussed below.
Monitoring blood pressure
If you developed high blood pressure or pre-eclampsia during pregnancy, you are at increased risk of high blood pressure for a few weeks after the birth of your baby and this will therefore be monitored.
Prevention of thrombosis
You are at increased risk of thrombosis for a few weeks after the birth of your baby. Your risk will be reassessed after your baby is born. To reduce the risk of a blood clot, try to be active as soon as you feel comfortable – avoid sitting still for long periods, wear special compression stockings, if you have been advised you need them. If you have a BMI of 40 or above, you may be offered blood-thinning injections (low-molecular- weight heparin treatment) for at least 10 days after the birth of your baby; it may sometimes be necessary to continue taking these medications for 6 weeks.
Information and support about breastfeeding
How you choose to feed your baby is a very personal decision. There are many benefits of breastfeeding for you and your baby. It is possible to breastfeed whatever your weight. Extra help is available if you need it from your healthcare professional and local breastfeeding support organisations.
If you have a BMI of 30 or above, whether you are planning your first pregnancy or are between pregnancies, it is advisable to lose weight. By losing weight you:
increase your ability to become pregnant and have a healthy pregnancy reduce the additional risks to you and your baby during pregnancy reduce your risk of developing diabetes in further pregnancies and in later life reduce the risk of your baby being overweight or developing diabetes in later life.
If you have fertility problems, it is also advisable to lose weight.
Having a BMI of 30 or above may mean that you have less chances of achieving pregnancy.
Your healthcare professional can offer you advice and support to lose weight. Crash dieting is not good for your health. Remember that even a small weight loss can give you significant benefits.
You may be offered a referral to a dietician or an appropriately trained healthcare professional. If you are not yet ready to lose weight, you should be given contact details for support for when you are ready.

Prof.Selman Laçin
Faruk Onur Basegmez,Md,RCOG
Sources and acknowledgements
© Royal College of Obstetricians and Gynaecologists

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