Is my high BMI preventing pregnancy?

[TTCDiaries25]

Just after some honest opinions please. I am 36, and have been TTC my second for a year now. I have been on letrozole for the past 6 months. Still no sign of a BFP.

I have PCOS, with an AMH of 31. TSH 1.84 miu/L. The fertility clinic haven't flagged either of these results as an issue.

I have a BMI of 31.5. I am trying to lose weight but I lose a couple of pounds and seem to put them back on really quickly. Am I being stupid to think I will fall pregnant anytime soon with this BMI? I just can't seem to lose the weight and I'm really scared it will mean I won't be able to have a second.

The evidence shows that you have a better chance of getting pregnant and having a healthy baby if you are a healthy weight, even a small weight loss can improve fertility. There’s no knowing if it will be the thing that does it for you but it’s absolutely worth trying

I was around 30bmi when I got pregnant and after lack of periods for 14 months in a row. I’m heavier now and I’ve my periods bang every month despite pcos.

my sister had a healthy bmi. She also needed help getting pregnant for her 2 children because of infertility related illnesses.

doctod will tell you to loose weight. My experience has taught me that might not be the case

it is likely to be a factor yes. As PP says, studies show a link. Do you have support to lose some weight?

It is likely to make it harder/take longer. Just overweight, not so bad, but overweight AND pcos... trickier. Oestrogen is likely to be higher than ideal for a start, because of the PCOS and the excess weight.

Do you take inositol? It should give you a small edge to help lose weight, and also help regulate your cycles. Takes three months or so to start noticing and you will still have to work hard at the weight loss but it should be easier. I recommend a PCOS diet too (look it up, but low GI mostly).

Plenty of women with pcos conceive, some easily and some with struggles. But staying at a healthy weight is really vital for keeping the hormones and insulin issues in check. Getting there is the hard part but inositol should help.

I am trying. I have gone from 14stone down to 13st 9. Have managed to get as low as 13st 5lbs but I just seem to put it all back on really quickly at the moment.

I go to the gym and weight train twice a week. I struggle between trying to increase visits to the gym/stricter dieting and also not wanting to put extra strain on my body as in the past weight loss has sent my cycles a bit haywire, and I'm too anxious that will happen again.

I can't help but feel in wasting the letrozole if my weight will be lowering my chances anyway.

Lots of women with your BMI do get pregnant and lots thinner struggle. So its definitely not a hard and fast rule for every individual but it is a proven fact that a healthy BMI has better success rates overall.

I think a good way to frame it is rather than focus on weight focus on behaviours. Are you eating 3 solid meals a day and home cooking the majority of your food? Do you get your 10k steps in a day? Are you eating your 5 a day and drinking 2/3L of water? Do you do at least 20 minutes of excercise 3 times a week that gets your heart beating faster? Are you sticking to the NHS alcohol units per week?

If you focus on these things as your goals (one at a time if needs be!) rather than focusing specifically on a diet then you will likely find your weight drops as you regularly achieve each goal.

• If you eat 3 solid meals per day, which you make yourself, with your 5 a day, then you won't need to snack as often, or rely on junk. To get particularly 'slim' you may need to count calories etc, but to fall into a healthier weight bracket then these general rules should suffice.
• If you regularly get your 10k a day and 20 mins excercise 3 times a week then you can rest easy knowing you are doing the recommended amount of excercise you need. Not to be an athlete, or a size 6, but just to be healthy.
• If you drink 2/3 litres of water a day you'll be hydrated enough that you won't have the bladder capacity to fit in pop/energy drinks/sugary coffees etc and that will be a simple way to cut calories.
• If you stick to (or better yet, cut entirely, but that's not for everyone) the NHS alcohol units you won't be drinking excess calories that provide no susentance, and will overall feel better.

I'd suggest one of these things to begin with to have as a goal and once it's become routine add another. The 10k steps with excercise is always a good place to begin - when I'm walking and excerising I naturally find myself wanting to eat better.

I completely understand the struggle by the way, despite my best efforts I myself am at a BMI of 27 even with doing all these things. For myself it's down to my portions being too large, and that's my next goal to work on to hot the elusive 18-25!

If I understand your OP correctly you say you are trying to conceive your second child, is that right?
If so, what did pregnancy no1 look like and how long ago was it?
Has your partner had any testing?
I was your age when I conceived with a lot of symptoms of PCOS albeit undiagnosed and a similar BMI. It worked ok. I do take d-chiro and myo-inositol. Who knows if it made a difference but I took it anyway.

Hi OP
I know the BMA say your BMI should be under 35 and NHS say under 30 to be eligible for fertility treatment and I know it couldn’t hurt to be fit and healthy. But in all honesty, BMI is an outdated measurement tool, height and weight don’t always correlate to unhealthy.

I know plenty of girls who would be classed as overweight going by their BMI but they are super fit, healthy, lots of muscle and super low body fat percentage.

I also know a few girls who are over 20stone and have conceived naturally, one of the girls has even been through chemo and was told her fertility would be severely affected.

Personally, I think being fit and healthy is the top priority, physically and emotionally.

If you’re going for IVF and you know the BMI requirement of your clinic, aim to get below that, healthily so as not to affect your egg quality.

Eat well, exercise regularly and do stuff that makes you happy. Oh and of course lots of baby making practice too!

This is all really helpful thank you.

The clinic have never once mentioned my weight as an issue so I think perhaps I haven't been prioritising sorting it.

I am on my first month of inisotal, not noticing much of a difference but hopefully as the months go on I will.

Steps are something I do need to work on. I sit at a desk 9-6 every day and often finish the day on 2000 steps. The gym is great and I enjoy weight training but i probably do need to move more.

I have PCOS and needed 3 cycles of letrozole to conceive DD1 when I was 34. DD2 was a natural conception at 37 after i lost 12kg, which was around 12% of my body weight. I was still very overweight (BMI 29) but my consultant said that losing 10%+ bodyweight can kick start things, even if you are still overweight. I did Fast 800 and lost the weight over 12 weeks (i was doing it as you only qualify for fertility help in our trust if your BMI is under 30). So even if you cannot lose a lot, I think every little will help, especially with PCOS. Good luck!

Yes trying for my second. My first is 3, and my BMI was 28 at the time. So not low. But I was only 33. He was conceived naturally within 4 months of trying. We waited until after his 2nd birthday to start trying again and I'm really regretting that now as I thought it would take same length of time. I have put on weight since having him and I just cannot seem to shift the weight gain. Which is embarrassing as he is 3 years old, but it just seems much harder to do now. It also seems my PCOS is harder to manage, unsure if it's weight related but I imagine it is.

Thanks for this. Can I ask, did you still try whilst losing the weight? Anytime I diet, or go below 1200 calories my periods go haywire. Cycles can be up to 60 days and I hate the thought of that. Considering pausing letrozole for a few months and focusing on weight loss and contacting clinic again in say 6 months.

We kept trying naturally whilst I was losing the weight - I kept taking metformin but no letrozole or anything like that. Which is why it was such a surprise to find out we'd fallen pregnant naturally. I didn't use OPKs - we just tried to have sex at least 2-3 times per week and definitely if i was having EWCM. I ovulated on something like day 30 of that cycle so it didnt even occur to me that it was going to work!

What dose of letrozole are you on? 2.5mg wasn't effective for me and we had to increase the dose. Our trust didn't do more 6 cycles of letrozole anyway before moving to IVF so I was keen to maximise the opportunity for it to work.

OP please do not go anywhere near to 1200 or below! That is the daily calorie intake a toddler requires- of course that will impact your cycle.

Google TDEE calculator, put your info into that, and calculate your calories.

Prioritise 10k steps a day, prioritise 3 healthy balanced meals a day, prioritise getting your exercise in.

If it helps, when I lost weight with pcos, my diet looked roughly like this:
Cals 1250 (my maintenance cals were 1750 so I took off 500 for deficit). But I allowed myself 70cals of extra food per mile walked (the meanest estimate on the internet) and only counted proper 'going on a walk' miles, not steps from pottering round the house. I walked on average 5 miles per day so I actually ate 1600 cals. I weighed every morsel and tracked every walk.
My periods did not stop, I was not excessively hungry, and I got much fitter. I lost a pound a week on average on this diet. I'd been on inositol by about six months by this point and my periods had become regular so I assume it was working to regulate my insulin response. This was probably a big part of the weight loss happening so effectively.

Ten years later, I eat more but I still walk loads and the weight had stayed off. All praise inositol 😂

Yes it can be a factor but that BMI certainly doesn't make it impossible.

I am currently 30+3 with DD2 and am 42 years old. We conceived naturally and my BMI was 33.

It did take longer than it did with DD1 5 years ago but I doubt that was just down to BMI.