In a study published in the New England Journal of Medicine, Mutsaerts and his colleagues conducted clinical trials at six university medical centers and 17 general hospitals in Netherlands during June 2009-June 2012 to compare results of prompt infertility treatment and lifestyle intervention. They found that infertility rates do not differ with fluctuations in weight as previous studies had suggested.
They took a total of 577 infertile women between the ages of 18-39, all of whom had a body mass index (BMI) of 29 or higher. They were then divided into two treatment strategy groups. 290 women were assigned to a six-month lifestyle intervention program and the other group, the control group consisting of 287 women, was assigned to prompt infertility treatment for 24 months. Women suffering from severe endometriosis, premature ovarian failure and endicrinopathy were not included in the sample as well as those who had qualified for donor insemination due to azoospermia.
The goal of the lifestyle program was to achieve weight loss of up to 5-10% of the woman’s body weight at randomization in 24 weeks. During this period, six outpatient visits and four telephone consultations were allowed. A standardized computer system was also used which collected information about body weight, menstrual date and calorie intake. Women were advised to reduce their calorie intake by 600 kcal per day and maintain a minimum calorie intake of 1,200 kcal. They were also instructed to practice 30 minutes of moderate intensity exercise, two or three times per week. Outcomes of live birth, time to pregnancy and birth weight were also assessed within 24 months of randomization.
Those who became pregnant were discontinued from the intervention and those who did not become pregnant after six months were treated according to the Dutch infertility guidelines. The control group was also treated under the same guidelines with ovulation inducing drugs and intrauterine insemination of IVF/ICSI. They were given a dose of clomiphene citrate starting from 50 mg per day for five days after natural or progestin induced menses. If pregnancy did not occur within six to twelve cycles of clomiphene, it was replaced with a low dose of gondotropin therapy starting with 75 IU per day and then gradually increasing with time.
The discontinuation rate in the intervention group was 21.8%, the mean weight loss was 4.4 as compared to the control group where it was 1.1kg.
Results showed that within 24 months, the frequency of vaginal births of healthy individuals was lower than those in the control group. The mean time to pregnancy that resulted in a live birth was longer in the intervention group with 8.8 months and 5.2 months in the control group.
Further per protocol and post hoc analyses revealed that there were no significant differences in the rates of vaginal births of healthy singletons or in live birth rates between the groups. A healthy vaginal birth was defined as an infant born in less than 37 weeks with no congenital anomalies.
Authors of the study suggest that ‘a more intensive program or one involving better strategies to enhance adherence might have resulted in more weight loss but it is unknown whether more weight loss would have led to a higher birth rate than the rate in our trial’. They also mentioned how ‘excessive weight loss in a short period of time was discouraged since such a reduction in weight has been reported to have a negative effect on the outcome of assisted reproductive technology and to be associated with an increased risk or adverse pregnancy outcomes such as low birth weight or miscarriage’.
Other limitations of the study that may have influenced the time taken to get pregnant or lower birth rates were that participants knew about the infertility treatment prior to randomization. Moreover, those who were in the intervention group were given permission to access fertility treatment for only 18 months as compared to the control group who were granted 24 months.
Another factor that might have impacted the results is the age. Dr Alexander, a fertility specialist at los Angeles Reproductive Center, points out how to women over 35 might already have unhealthy eating habits and also have physical exercise routines and fertility remedies in order to improve time for conception.
She says, “After evaluating for thyroid issues and blood insulin resistance, we generally review proper diet and recommend growing exercise especially cardio exercise.” She also suggests reducing the consumption of processed meals, soda, caffeine and alcohol to achieve desired results.
Though diet counseling and weight reduction is encouraged, the more pressing matter is the fact that egg quality decreases with age as ovarian reserve testing has displayed, thus conceiving sooner is a better and wiser option.
The research was funded by the Netherlands Organization for Health Research and Development.