Obesity Abstracts

The impact of obesity on fertility and pregnancy is well-established. The literature remains conflicting around optimal BMI threshold and weight loss strategy on reproductive outcomes. We describe a series of twenty-six women with obesity that were planning a future pregnancy or seeking assisted fertility services. They were initially reviewed for weight management at Imperial College Healthcare between September 2020 and September 2022. Clinical case information was retrieved from documentation on electronic patient records up to November 2023. The median age was 31 years (range 22 to 41) and mean baseline weight 112.9kg (SD +/-21.7kg). Polycystic ovarian syndrome was the aetiology for subfertility reported in 76.9% (n=20) with pelvic or unknown cause in the remainder (n=1 and n=5, respectively). Other metabolic comorbidities noted included dyslipidaemia (38.5%,n=10), type 2 diabetes (23.1%,n=6), pre-diabetes (15.4%,n=4) and fatty liver disease (11.5%,n=3). By September 2022, half of the twenty-six patients (n=13) had been initiated on a GLP-1 analogue (semaglutide n=10; liraglutide n=3). At this point in time, for those receiving a GLP-1 analogue of various duration (3 to 24 months), the percentage change from baseline weight ranged from 2.88% to -20.2% (3.5kg to 21kg) with a mean loss of -9.38kg or -8.23% in body weight (SD +/-6.55kg and +/-5.92%, respectively). 42.3% reported use of orlistat and three patients had already undergone bariatric surgery prior to initial review. By November 2023, a further three patients had undergone a sleeve gastrectomy and three patients were awaiting planned weight loss surgery. Eight patients had proceeded to have a natural pregnancy or received access to assisted conception after meeting BMI eligibility. Our case series demonstrate the clinical need for special input around weight management for women with overweight or obesity seeking fertility support. A clearer treatment pathway will support existing NHS guidelines around BMI eligibility criteria to access assisted reproduction. Current limitations include the limited supply of GLP-1 pharmacotherapy, long waitlist for bariatric surgery and the need to avoid pregnancy for 12-18 months thereafter. There is a need to address obesity-related subfertility at an earlier age, which will also reduce the risk of pregnancy complications secondary to metabolic comorbidities.