The national trend toward obesity is hampering womens ability to conceive children and to maintain pregnancies, says Dr. Edwin Robins, a Spokane physician who specializes in fertility issues.


Robins, of Spokanes Center for Reproductive Endocrinology & Fertility, says that weight gain is an increasing fertility issue in his practice. Recent research bears him out and seeks to isolate the physiological processes affected by excess weight.


Robins says that when he began his practice here a decade ago, about 20 percent of the patients he treated for infertility were overweight. Now, about 40 percent of the 250 patients he sees each year are either overweight or obese, he says. Robins claims to be the only doctor providing in-vitro fertilization here, though some Seattle-based clinics maintain satellite offices in Spokane.


According to the Centers for Disease Control and Prevention, a body mass index of 25 and above is considered overweight, and a BMI of 30 and over is considered obese. The most recent available data from a study called the National Health and Nutrition Examination Survey says that 66 percent of Americans were overweight or obese in 2004, an increase of almost 20 percentage points from 1976.


Being overweight can have a number of effects on womens ability to conceive, including interruption of ovulation and increased risk of polycistic ovarian syndrome, or cysts on the ovaries, which can interfere with fertility, Robins says. He notes, however, that the problem of excess weight is not without its own complexities, including other health issues.


No one wants to be overweight, Robins says.


Still, he says many women could significantly increase their chances of becoming pregnant by working to get their weight down to within 15 percent of their normal weight range.


For patients in whom obesity may have interrupted ovulation, such weight loss is enough to restore an ovulation cycle about 70 percent of the time, Robins says. He says that for the other 30 percent, other factors might be responsible for the lack of ovulation.


Robins says that not only does he see more and more patients, men and women, who are over their ideal weight, but those patients dont respond as well to assisted reproductive therapies such as in-vitro fertilization.


He says all of the processes of assisted reproductive therapy are more complicated with overweight patients, and the results are less positive in his practice, which he says has an overall 71 percent success rate in helping women conceive through assisted reproductive therapies.


A study published in August by researchers at the University of Adelaide in Woodville, Australia, found that a protein that nourishes developing mouse eggs is inhibited by obesity. Cadence Minge, a Ph.D. student who led the study, found that the protein, called peroxisome proliferator-activated receptor gamma, could be triggered by a common diabetes medication. Minge says in the study that further research is needed, however, on whether the findings apply to humans.


Another study, published this year in a journal called Human Reproduction, asserts that when both partners are overweight or obese, they have a higher rate of sub-fertility, defined as taking more than 12 months to conceive than the general population.


The study was led by Cecilia Ramlau-Hansen, a Danish doctoral student who was at the University of California Los Angeles School of Public Health on a visiting scholarship. It examined the records of about 47,000 Danish couples from 1996 to 2002, and found that couples who both were obese took almost three times as long to conceive as couples of normal weight, and couples who were both overweight took 1.4 times as long to conceive.


The study also examined about 3,000 women who had more than one pregnancy, and found that those who lost weight reduced the amount of time they took to conceive a child by about five and a half days for every two pounds of weight they lost.


Robins says he believes one of the reproductive problems caused by excess weight is simply inefficient mechanics. He says the female anatomy is altered by excess weight, increasing the distance a womans partners sperm must travel. If her partner is overweight as well, that can increase the distance further.


I think a lot of times women arent getting any sperm, Robins says.


Besides in vitro fertilization, other treatments are available for women with a diagnosis of infertility, depending largely on what the cause of the infertility is, Robins says.


Counseling on weight and other lifestyle issues, such as smoking, which inhibits production of estrogen, can be an important intervention to improve a womans chances of conception, Robins says.


Intrauterine or intracervical insemination, frequently called artificial insemination, introduces sperm directly to a womans uterus or cervix.


Egg production is mandatory for that process to work, but sometimes that can be a problem. In some cases, Robins uses minimal egg-stimulation cycles, in which a woman receives a combination of drugs to induce ovulation.


The patient first takes an estrogen repressorone that Robins uses is called Letrasolwhich makes her bodys own estrogen production increase, causing more than one egg to be matured. The patient is monitored through bloodwork and ultrasound, and when just a few eggs are mature receives a follicle stimulating hormone to induce ovulation.


Using lower levels of estrogen for the stimulation decreases some of the risk associated with earlier estrogen suppressors, which he says led to more risky multiple births.


Tubal adhesive disease also can inhibit reproduction, although Robins says its more of an anatomical description than a single disease. The condition is most frequently caused by scarring from sexually transmitted diseases left untreated, he says.


He says surgery can be successful in some cases, particularly to reverse tubal ligation. Robins says, however, patients with tubal scarring frequently see higher success rates for pregnancy with IVF than they would with surgery.


We tend to think of the fallopian tube as a conduit, when really its an organ, Robins says. He adds that surgery to remove scar tissue doesnt necessarily cure the damaged organ.


Contact Jeanne Gustafson at (509) 344-1264 or via e-mail at jeanneg@spokanejournal.com.