Why Do We Talk About Weight at a Fertility Clinic?

Ask Monica is a Q&A video series hosted by Nurse Practitioner Monica Moore.

Doctor's appointments often generate anxiety. Whether it’s getting your blood drawn, having to undergo a painful procedure or test, or the fear of receiving bad news about your health, going to the doctor’s office doesn’t feel like a walk in the park for most people.

In this article:

• Acknowledging the Impact of Weight Bias
• Why This Conversation Is Important
• Your BMI Can Impact Fertility
• Early Intervention is Key
• Your Providers Want You to Be Successful
• The Truth: It's Not All Your Fault
• Can Ozempic or Mounjaro help with weight?
• Understanding External Factors
• Losing Weight Is Not the Main Goal
• The Good News? You're Not Alone
• What If I Don’t Want to Be Weighed?
• We're Here to Support You

Acknowledging the Impact of Weight Bias

For those who struggle with their weight, the stress typically starts WAY before they even walk in the door. Just the thought of having to step on the scale to be weighed can generate strong feelings of anxiety, self-judgment, discomfort, or embarrassment.  

Many people in bigger bodies have experienced some form of weight bias, even (sadly) from the medical professionals who are there to take care of them. At times, it can feel that your physician is focused more on your weight than the issue that brought you into their office. 

Knowing this, why do fertility specialists even talk about weight at all? Wouldn’t it be easier to not bring it up? Well, there are many reasons why a doctor may bring up your weight, but let's discuss three important ones to consider, particularly in relation to fertility. 

Why This Conversation Is Important 

Your fertility specialists have a unique opportunity to check in with you frequently before pregnancy, and it would be irresponsible of us to not introduce you to methods that support healthy weight gain in this next phase of your journey.

These methods can help optimize your health during this important life stage. Not only can optimizing your metabolism now sometimes help you get pregnant, but it can also decrease potential pregnancy complications and set you up for future health and success. 

Here are the three reasons this conversation around weight is important: 

#1 Your BMI Can Impact Fertility

Firstly, it is clear that both extremes of body weight - either very low or very high body mass index (BMI) can negatively affect your fertility, says Illume's Dr. Josh Hurwitz. This is true for both women and men. Finding a healthy weight for you and adopting positive lifestyle changes are important - no matter which end of the BMI spectrum you fall on.

#2 Early Intervention is Key

Secondly, pregnancy has been identified as a key period associated with a high risk for weight gain. Trying to conceive is an important intervention period for preventing large amounts of weight gain, because we know that once weight is gained, it is difficult to lose.

#3 Your Providers Want You to Be Successful

Lastly, as uncomfortable as these conversations can be, by not discussing it, we would be giving you incomplete guidance. As healthcare providers, it is always our job to do our very best to help you achieve your healthiest pregnancy and maintain overall wellness. 

We recognize that healthy people come in all shapes and sizes and that the factors that lead to higher body weight are incredibly complex and often not under our control. 

The Truth: It's Not All Your Fault 

Reproductive endocrinologists also understand and appreciate that there is a robust hormonal contribution to gaining and retaining weight. For example, being resistant to insulin (a hormone) can skew your appetite regulation system and make you feel hungry, even after you have had enough to eat. 

There is another hormone called leptin that is produced after eating. For some people, the brain doesn’t sense leptin production adequately, so the signal to stop eating is either delayed or non-existent.

These hormonal pathways can impede our ability to rely on intuitive eating because it often causes one to feel hungry, yet rarely feel full.

Can Ozempic or Mounjaro help with weight?

A newer class of medications, called glucagon-like peptide receptor agonists (GLP-1 RAs), such as Ozempic, Mounjaro, and Wegovy, can help turn off "food noise" and cravings, as well as combat insulin resistance. While GLP-1 medications aren't the answer for every person, it's worth discussing these options with your healthcare provider.

Considering Ozempic?

GLP-1 medications can be used to treat type 2 diabetes, but they also show promise in treating PCOS and managing insulin resistance. Here's what to know.

Understanding External Factors

Did you know there is a strong genetic component that predisposes some people to weight gain? There are many factors outside of one's control when it comes to weight - meaning that for many people, the oversimplified "eat less, move more" advice simply won't solve the problem. 

It is important to acknowledge that we also live in an environment where many external factors promote weight gain, such as the availability of ultra-processed food and portion sizes that seem to never stop increasing.

Many cities don’t have bike lanes or safe places to walk, and not everyone has access to a gym membership, making a regular exercise habit or movement practice more difficult to maintain. 

Losing Weight Is Not the Main Goal

Ultimately, our mission is to help you achieve a healthy pregnancy. In keeping with this, we always recommend adopting healthy lifestyle changes, regardless of whether they end up affecting your weight. 

You don't necessarily need to lose 50 pounds in order to make a big, positive impact on your health! Adopting simple, consistent lifestyle changes is the most important and sustainable action you can take. 

The Good News? You're Not Alone

At Illume Fertility, we can help you navigate this journey with a full range of care:

• Registered dietitian nutritionists who provide education and help you optimize your food choices throughout your fertility journey and into pregnancy.
• A referral network of vetted mental health professionals to help you identify ways to manage stress and take care of yourself while navigating fertility treatment.
• Licensed acupuncturists specializing in fertility who can help balance the body, add calm to the process, and even increase successful embryo implantation rates during IVF.
• Health coaches who can provide you with strategies to sleep better, move more, and eat in a way that is metabolically healthy for you.
• A dedicated Patient Advocate and weekly events (like Fertile Yoga classes) to connect you with a community of likeminded individuals who are navigating infertility.

What if I don’t want to be weighed?

If you are someone in eating disorder recovery or simply prefer not to discuss your exact weight, please know that our team will always respect your wishes. 

Here are three things you can request:

1. To step onto the scale facing out so you don’t have to see the exact number.
2. That your Care Team does not reference your exact weight during visits, unless absolutely necessary.
3. If you are working with our nutrition team, talk about your history and discuss anything that might be challenging for you (i.e. feeling restricted) so you can work together to create the most sustainable, successful plan for you.

We're Here to Support You

If you feel nervous about booking that first appointment or worry that weight will be an issue, please remember that our job is to support you on your journey, not pass judgment on your body! Our ultimate goal is always the healthiest parents, pregnancy and baby possible, and everything we do together gets you one step closer to making your dreams a reality.