{"id":11606,"date":"2017-08-16T13:59:37","date_gmt":"2017-08-16T19:59:37","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/?p=11606"},"modified":"2026-04-07T15:02:29","modified_gmt":"2026-04-07T21:02:29","slug":"this-study-aims-to-enhance-understanding-of-why-obesity-affects-fertility","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/this-study-aims-to-enhance-understanding-of-why-obesity-affects-fertility\/","title":{"rendered":"Study aims to enhance understanding of why obesity affects fertility"},"content":{"rendered":"<div style=\"margin-top: 0px; margin-bottom: 0px;\" class=\"sharethis-inline-share-buttons\" ><\/div><p>Heavier women are less fertile. For each unit increase above a body mass index (<a href=\"https:\/\/www.nhlbi.nih.gov\/health\/educational\/lose_wt\/BMI\/bmicalc.htm\">BMI<\/a>) of 25, where the \u201cnormal\u201d weight range tops out, there\u2019s a 3 percent drop in fertility in a given month.<\/p>\n<p>That may not sound like much, but it means a woman at the bottom of the obese range \u2013 with a BMI of 30 \u2013 is 15 percent less fertile than someone of normal weight. And fertility keeps dropping from there even as other problems mount.<\/p>\n<p>\u201cIt takes longer to get pregnant, there\u2019s more pregnancy loss, more cesarean sections, more surgical complications from C-sections, and there\u2019s double the risk of having an obese child,\u201d said <a href=\"https:\/\/arm.coloradowomenshealth.com\/\">Nanette Santoro, MD<\/a>, chair of the University of Colorado School of Medicine\u2019s Department of Obstetrics and Gynecology.<\/p>\n<p>With <a href=\"https:\/\/www.cdc.gov\/nchs\/data\/databriefs\/db219.pdf\">more than one-third<\/a> of U.S. women of childbearing age being obese, this is a problem of epidemic proportions. Long ago, Santoro, who sees patients at <a href=\"https:\/\/arm.coloradowomenshealth.com\/\">UCHealth\u2019s Reproductive Medicine &#8211; Stapleton<\/a><u>,<\/u> asked the simple question: why?<\/p>\n<p>Nearly 15 years later, she\u2019s closing in on an answer \u2013 with help from a <a href=\"https:\/\/clinicaltrials.gov\/ct2\/show\/NCT02653092\">new study<\/a> explicitly excluding overweight and obese women. It could, she hopes, lead to treatments that improve fertility without requiring extreme weight loss, something few manage to achieve, much less sustain over time.<\/p>\n<figure id=\"attachment_11607\" aria-describedby=\"caption-attachment-11607\" style=\"width: 300px\" class=\"wp-caption alignleft\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-11607 size-medium\" src=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2017\/08\/16075911\/EXT_08XX17-NanetteSantoro.webp\" alt=\"Nanette Santoro, MD, chair of the University of Colorado School of Medicine Department of Obstetrics and Gynecology is shown in this photo.\" width=\"300\" height=\"214\" srcset=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2017\/08\/16075911\/EXT_08XX17-NanetteSantoro.webp 1200w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2017\/08\/16075911\/EXT_08XX17-NanetteSantoro-300x214.webp 300w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2017\/08\/16075911\/EXT_08XX17-NanetteSantoro-1024x731.webp 1024w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2017\/08\/16075911\/EXT_08XX17-NanetteSantoro-768x548.webp 768w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2017\/08\/16075911\/EXT_08XX17-NanetteSantoro-150x107.webp 150w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2017\/08\/16075911\/EXT_08XX17-NanetteSantoro-200x143.webp 200w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-11607\" class=\"wp-caption-text\">Nanette Santoro, MD, chair of the University of Colorado School of Medicine Department of Obstetrics and Gynecology, in her office on July 24, 2017. Santoro is doing pioneering work determining the cause of reduced fertility among obese women.<\/figcaption><\/figure>\n<p><strong>Hormones the culprit<\/strong><\/p>\n<p>As it is with science, Santoro\u2019s work started with that of others \u2013 in this case, the Study of Women\u2019s Health Across the Nation, or SWAN. In the mid-2000s, she and colleagues parsed the data and noted that, as she put it, \u201cthe bigger you are, the lower your reproductive hormones.\u201d<\/p>\n<p>She followed that insight up with a study that measured reproductive hormones among women who lost 25 percent or more of their body weight after <a href=\"https:\/\/www.uchealth.org\/services\/weight-and-metabolism\/surgical-weight-loss\/\">bariatric surgery<\/a>. Reproductive hormone levels returned towards normal in those patients, she and colleagues found. So there was definitely a connection. Now came the hard part: where along the reproductive hormone-producing chain was the problem? The hypothalamus in the brain? The pituitary gland hanging just below the hypothalamus? The ovaries themselves?<\/p>\n<p>The hypothalamus, deep in the brain and producing dozens of molecules related to appetite and reproduction, would make for a difficult target, Santoro knew. The pituitary, below the blood-brain barrier and less prolific, would be somewhat more accessible, so to speak. The chain of interest involved both: the hypothalamus produces gonadatropin-releasing hormone (GnRH). GnRH then prods the pituitary to release two key gonadotropins: luteinizing hormone (LH), which triggers ovulation; and follicle-stimulating hormone (FSH), which helps control egg production by the ovaries as well as the menstrual cycle.<\/p>\n<p>Santoro\u2019s team found that, among obese women, the pituitary gland was the weak link: essentially, weight-based dose of GnRH led to less LH and FSH production with increasing weight. The question then was what was causing the pituitary gland to fail these women?<\/p>\n<p><strong>Help from a friend<\/strong><\/p>\n<p>Santoro suspected that the pituitary was capitulating due to inflammation caused by some combination of floods of sugar-processing insulin as well as free fatty acids such as cholesterol in the bloodstreams of obese women. But, as Santoro put it, \u201cWe had enough for a hypothesis, but not enough for anybody to give me a grant\u201d to put the hypothesis to the scientific test.<\/p>\n<p>\u201cThen we got lucky,\u201d she said.<\/p>\n<p>It happened that Irene Schauer, PhD, a CU School of Medicine endocrinologist, was doing a diabetes study. It included healthy controls \u2013 cyclists \u2013 who were taking six-hour infusions of free fatty acids and insulin. Santoro and colleagues tested them and found that, indeed, the cholesterol and insulin caused cyclists\u2019 FSH and LH levels to plunge.<\/p>\n<p>The team reported those results in the journal <em>Obesity<\/em> in February. It was the evidence they needed for a four-year, $1 million grant leading to her new study of non-obese women to understanding the obesity-fertility link. The study, involving about 30 women, is being done in two stages.<\/p>\n<p>The first, like the work with Schauer that led to it, infuses women with insulin and free fatty acids while monitoring the pituitary\u2019s output of FSH and LH. Genie Hendley, 33, is one of those women. She works in accounting at the CU School of Medicine\u2019s Department of Pathology and learned about the study through an email blast.<\/p>\n<p>\u201cI\u2019m interested in science and the evolutionary part of medicine, and if I can do my part, that\u2019s awesome,\u201d Hendley said.<\/p>\n<p>Her part included being infused with saline for six hours as someone did a blood draw every ten minutes, with a repeat \u2013 this time with infusions of insulin and free fatty acids and blood checks every five minutes \u2013 scheduled for this month.<\/p>\n<p>\u201cI pretty much sit in a bed for six hours,\u201d Hendley said. \u201cIt\u2019s really not that bad.\u201d<\/p>\n<p>While the study is ongoing, Santoro says study subjects\u2019 data so far have backed up the conclusions of the team\u2019s previous work, Santoro said.<\/p>\n<p><strong>Bacon <\/strong><\/p>\n<p>The study\u2019s second phase will put women on a closely controlled high-fat diet for a month. It\u2019s heavy on things like potato chips, eggs, cheese, bacon, pork chops, peanut butter and peanuts. Santoro tried it herself first.<\/p>\n<p>\u201cI\u2019m a vegetarian, but I ate bacon for science for two weeks,\u201d she said. The diet is no higher in calories than more standard fare, she added. \u201cThat was important, because nobody\u2019s going to do it if they\u2019re going to gain weight.\u201d<\/p>\n<p>The research team will measure daily urine samples for a full suite of reproductive hormones along the way. They think the added fat \u2013 largely in the form of inflammation-producing omega-6 rather than anti-inflammatory omega-3 fatty acids \u2013 may also bump up insulin levels. That would naturally create the pituitary-unfriendly combination delivered by the study\u2019s infusions.<\/p>\n<p>The work, as Santoro put it, \u201cis at the interface of metabolism and reproduction.\u201d<\/p>\n<p>If Santoro and colleagues\u2019 hunches are correct, an interesting question arises: what if it\u2019s not obesity per se, but rather the diets of obese women that are stressing so many pituitaries and suppressing fertility? That may be a good thing, in fact. Should the results from Hendley and her fellow non-obese study volunteers prove out as hypothesized, Santoro and colleagues would follow up with studies of treatments that could be as simple as cutting back on bad fats, boosting omega-3 intake, or even just taking anti-inflammatories such as baby aspirin or low-dose steroids.<\/p>\n<p>\u201cIf we\u2019re going to fix this and try to improve reproductive function, we really want to target the pituitary gland,\u201d Santoro said. \u201cThat\u2019s way easier than making obese people un-obese.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Heavier women are less fertile. For each unit increase above a body mass index (BMI) of 25, where the \u201cnormal\u201d weight range tops out, there\u2019s a 3 percent drop in fertility in a given month. That may not sound like much, but it means a woman at the bottom of the obese range \u2013 with [&hellip;]<\/p>\n","protected":false},"author":23,"featured_media":11607,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[5],"tags":[4811,309,4781,551],"class_list":["post-11606","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-innovative-care","tag-metabolic-and-bariatric-endoscopy","tag-pregnancy","tag-research-in-health-care","tag-weight-and-metabolism"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.2 (Yoast SEO v27.2) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Study: Why does obesity affect fertility? - UCHealth Today<\/title>\n<meta name=\"description\" content=\"Heavier women are less fertile. 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