Reproduction of the Dead and Obese
My boys were involved in scouting growing up. Younger scouts are expected to help older scouts with their Eagle projects, so over the years I’ve dropped many a kid plus friends off at various Eagle project sites. There seems to be a distinct theme to these projects, and the theme when my sons were younger was building hiking trials. I was bemoaning this lack of variety to a friend in Florida, who told me the Florida Eagle Scout theme was cleaning graveyards. I pointed out that they’d eventually run out of cemeteries to clean before we’d run out of space in the national forest to build trails, but she reminded me that she lived in Florida, the land of sunshine and old people. (Come to think of it, that joke was funnier when I was younger.) Like the Eagle Scouts, this year’s American Society of Reproductive Medicine conference had a distinct theme-posthumous reproduction and dealing with obesity related infertility.
I love the ASRM conference. Unlike the field of adoption, which has many small to medium conferences throughout the year, infertility has just this one huge conference, and it’s a doozy—everything you ever wanted to know about what’s currently happening in infertility. In fairness, the sessions covered many topics of interest which I posted and tweeted about last week, but I couldn’t help but wonder why more than one session was needed to discuss the medical and ethical issues of using egg, sperm or embryos to reproduce after the donor died. I find the ethical discussions fascinating, but surely it affects relatively few people, and one session would have been plenty.
Obesity, on the other hand, is painfully relevant to many of our audience. Weight– too much or too little– interferes with conception, but it was the excess weight that was the topic of much discussion at this year’s conference. Excess weight causes infertility and makes treatment more complicated and pregnancy more risky. For adults, a body mass index (BMI) of 25 or more is considered “overweight”, and a BMI of 30 or more is considered “obese”. The facts are stark and dismal:
- Obese women are three times as likely to be infertile as women with a BMI within the normal range, and women with a higher waist to hip ratio (apple vs. pear shaped) are at the greatest risk.
- Obese women require a higher dosage of medications with IVF and have a lower implantation rates.
- Embryo quality starts to decrease when the women’s BMI exceeds 25.
- Lower pregnancy rates result even with donor egg when the women’s BMI exceeds 25.
- Obese women have a higher miscarriage rate.
- Birth defects increase when the mother’s BMI exceeds 30.
- Obese men have lower sperm count and motility
This is not new information to those of you with a BMI upwards of 25. I was far more interested in what works to help people lose weight, but it seems that the infertility medical community is just a stymied as the rest of us on how to accomplish this goal. The desire for a child is a great motivator, but for many it is simply not enough. While genetics may play a role, the real “blame” falls on the environment. Although not surprising, I thought it was interesting that researchers have identified the following specific changes in our environment that have led to the obesity epidemic:
- Increased availability of high caloric foods.
- Computerization at home and work.
- Pastimes that require little or no physical effort.
Weight loss results in higher fertility and even a relatively modest loss helps. It doesn’t matter how you lose the weight– diet, exercise, or bariatric surgery. No one “diet” is considered superior. The key is to make small changes that you can keep up for life. For example, if you love carbohydrates, a diet that severely limits carbohydrates is likely not going to work for you in the long run. Exercise is not as effective as diet in reducing weight, but in one small study it was significantly more effective at inducing ovulation. Bariatric surgery can be effective for those patients who are highly motivated, but haven’t had success with diet and exercise alone. According to the researchers at ASRM, banding is less effective than gastric bypass for long term weight loss.
Another topic much on the minds of those in attendance at the ASRM conference was the slew of “personhood” amendments or legislation which would make certain standard parts of in vitro fertilization illegal. The Resolve Advocacy Committee posted a good summary of the “personhood” issue on last week’s blog.
OK, now to the highlight of the ASRM conference for most of you—the sperm chotskies. As you know, for the past several years I have posted on my kids’ reaction to the goodies I so graciously share with them. (Sperm are Cute and Other Things I Learned at the ASRM Conference and Sperm Chotskies–The Best Part of the ASRM Conference Their reactions are getting pretty predictable (although Son #2 did actually eat a piece of candy this year after I convinced him that it had absolutely nothing to do with egg or sperm), so I thought we would do something new. I want you to vote on the cutest sperm give-away from this year’s conference.
#1. Our first contender is a lime green smiling sperm key chain.
#2. Entry number two is what I affectionately call the sex pen. One pink egg surrounded by five blue sperm all tucked in the body of this little number. I dubbed it the sex pen to see if I could get a rise out of Son #2. Sure enough he asked why it was so named, and I started my spiel: “When a Mommy and Daddy love each other in a very special way…” He, of course, immediately ran from the room.
#3. Our last contestant is a sperm pen (no egg) with white sperm swimming around in a sparkly fluid. The pen lights up (as shown) with a delightful blue light with the press of a button.
Cast your vote in the comment section and share your reasoning, if you feel inclined.