Impact of low levels of AMH

Anti-Mullerian Hormone (AMH) is a protein hormone, found in females, produced by cells within the ovary and indicating the ovarian egg reserve and therefore fertility of the woman. AMH levels are, mostly very low in women over 40 or in very highly overweight women. Those with very low AMH levels are unlikely to respond well to the drugs involved in conventional IVF.

How do we define Obesity/overweight’?

For adults, overweight and obesity ranges are determined by using weight and height to calculate a number called the “body mass index” (BMI). BMI is used because, for most people, it correlates with their amount of body fat.

An adult who has a BMI between 25 and 29.9 is considered overweight.

An adult who has a BMI of 30 or higher is considered obese.

adult wo has a BMI between 20 and 25 is considered having an ideal BMI.

BMI Calculation

BMI is calculated by the following formula: BMI=Weight in kg/ (Height in meters)

We at Ankoor Fertility clinic directly calculate the fat percentage of a patient depending upon the height and weight with a relatively newer type of machine. This differentiates patients who are overweight because of their bone mass and patients who are overweight because of their fat. The interpretation is note on patients file and accordingly diet and exercise instructions are given.

What can women do?

First line treatment for obesity-related infertility is weight loss and lifestyle modification. While any amount of weight loss in obese women may improve fertility, a loss of 5 percent to 10 percent in overall body weight can result in spontaneous ovulation in 60 percent of patients. Efforts should be made to restrict calories to 1000 to 1200kcal/day, and to exercise at moderate intensity for at least 30 minutes, three times a week. Participation in a formal weight loss program can be very helpful.
Apart from weight loss, treatments for infertility in obese women do not differ substantially from treatments in non-obese women. For anovulation, first line treatment generally consists of ovulation induction with oral medications such as clomiphene citrate or anastrazole. Women who fail to achieve pregnancy with oral medications are often treated with injectable ovulation induction agents such as recombinant or urinary gonadotropins. In vitro fertilization is often performed if these treatments fail or if there are other factors contributing to infertility.

How does Obesity affect male fertility?

Recent studies have found a link between male fertility problems and obesity. A study found that men with a higher body mass index (BMI) had a significantly higher risk of being infertile compared with men considered to be normal weight. A separate study found that a link between obesity and sperm health. Deteriorated sperm quality increased significantly as BMI passed 25 and was severe in participants whose BMI was over 30. Poor sperm quality not only leads to infertility but also an increase incidence of abortion. Also IUI and IVF done with sperms of obese men have high failure rate as compared to sperms of normal weight men. In addition, obesity can have a number of other effects on male fertility:

low sperm count and concentration

hormonal imbalance.

increased scrotal temperature

decreased libido

As such, it is important to maintain good overall health in order to reduce the risk of male fertility problems and in order to maintain good reproductive health. Starting a healthy exercise regimen and a healthy diet plan can help to increase fertility.

How does anybody manage Obesity or Overweight?

Its easy to calculate IBW. In males, height in cms minus 100 and in females height in cms minus 105, should be your ideal body weight. Body weight 20 % more than Ideal body weight is Obese and greater than two times ideal body weight is morbidly Obese.
Waist/ Hip ratio also can be measured; it should be within 0.7 range to have optimum levels of Estrogen. Diet plays an important role in the genesis of Obesity. Personal choices, advertising, social customs and cultural influences, as well as food availability and pricing all play a role in determining what and how much we eat.
Weight loss occurs when energy expenditure exceeds energy intake. An energy deficit of 500–1,000 kcal/day will result in a loss of 1–2 pounds/week and an average total weight loss of about 8% after 6 months.

DIET PLAN – Special tips not to forget.

Remember: Half a loaf of bread is better than no bread..Something is better than nothing.
That is, eat something more frequently than absolutely not eating anything…..which is a wrong myth. Rather eat less but more frequently. Don’t starve yourself for a long period as that will turn into fats.

Be slow and steady but persistently go on and don’t give up!

Take at least 2-3 litre of water daily. Half a litre between meals.

In a day try to have 5-6 meals with a gap of 3 hours.

Aim at having 3 fruits daily. Have a whole fruit but no juice. Avoid chikoo, papaya, mango, banana, custard apple.

Try to consume homemade skimmed milk and also curd made out of this milk. As this milk provide all goodness of milk except fats.

Eat all colourful vegetables, include green leafy too. Avoid potato, brinjal, sweet potato, peas.

Eat lot of salads before every meal. Make your salads interesting by adding pomegranate or apples or pineapple or raisins, sprouts or chicken slices.

Eat your meals very slowly and don’t watch TV or read book or talk on phone, just be with your food only.

Try and suffice 3 teaspoons of oil in the entire day food preparation. To use minimum oil, start using different methods like steaming, baking grilling, roasting and start using pressure cooker preparations.

Limit your daily sugar intake as excess turns easily into fats.

Add a variation to daily cereals intake in breakfast like can have rawa or dalia, oats, jowar, bajra , nachni preparations. Don’t follow” NO CARBS” diet plans…

Avoid legumes and whole pulses in night. Thin moong dals is a good option.Use plenty of sprouts and soy in your diet.

Exercise daily…..as negative energy balance is possible by only exercising….floor exercises are the best, like surya namaskars, skipping, climb up the stairs, make a conscious efforts to do stretchings.

Start saying NO to excess food

If there is a will, there is a way…don’t wait, lose excess weight happily and start feeling fresh all the time.