BABY BLOOMERS: SESSION TWO - FERTILITY TREATMENT FOR HER
On 15 July 2009, the second ‘’Baby Bloomers’’ GP professional development session in Reproductive Medicine took place at Greenslopes Private Hospital. In this session, devoted to female infertility, issues associated with obesity, fertility and the role of laparoscopic banding were addressed.
Dr Clare Boothroyd: Obesity and fertility
Dr Clare Boothroyd began her presentation by discussing the associated risks of obesity and pregnancy. These include: increased incidence of miscarriage, hypertension, gestational diabetes, oesophageal reflux, wound infection, DVT, maternal morbidity and risks for the baby.
Of interest, both the Australian and British medical authorities consider a BMI of around 35 to be a contraindication to assisted reproduction. Dr Boothroyd, therefore, believes GPs play a significant role in advising these patients on weight loss and healthy living. Obese women who wish to become pregnant are also highly motivated and these patients can achieve life long benefits with weight reduction.
Dr Boothroyd presented the relevant Cochrane Reviews on interventions for obesity. These reviews suggest that dietary restriction is the mainstay rather than increasing exercise alone. However exercise in combination with dietary restriction is better than diet alone. Of the different types of diet data from a well-conducted randomised controlled trial suggest that total calories consumed the most important factor. Allocation of calories to different food groups can therefore be modified according to personal preference. Motivation also plays a big part and studies suggest that behavioural therapy can be an effective adjunct to diet.
Since obesity has such a profound effect on women in their 20s and 30s, Dr Boothroyd considers laparoscopic banding is an effective option for women with a BMI over 40.
It is important to stress that women with a BMI over 40 do not receive fertility treatment at ACA.
Dr John Copp: Obesity, fertility and laparoscopic banding
Greenslopes Specialist, Dr John Copp, a bariatric surgeon, discussed the benefits of laparoscopic (LAP) banding in obese women before, during and after pregnancy. This technique has now been used for many years and a number of studies have looked at the issues associated with LAP banding and pregnancy.
Many of the women who took part in these studies had polycystic ovarian syndrome (PCOS), which is associated with female infertility. PCOS leads to increased ovarian androgens, increased hepatic steroid hormone binding globulins and increased free testosterone; and weight loss is arguably the best method for treatment of these women.
In many of the studies cited, Dr Copp demonstrated effective weight loss with laparoscopic banding after 18 months. Woman who had experienced laparoscopic banding for approximately 18 months, who went on to become pregnant, were able to achieve similar results to groups of women within a normal weight range: in terms of average weight gain during pregnancy, good neonatal outcomes and similar incidence of pregnancy induced conditions such as hypertension and gestational diabetes.
To retain the bands during pregnancy, fluid in the bands is reduced when pregnant, and removed at 36 weeks.
In conclusion, Dr Copp surmised that laparoscopic banding is considered a safe and effective treatment for obese women wishing to become pregnant, and can be used safely through pregnancy and delivery.
For further information visit: www.lapbanding.com.au