Recently, yet another major article was published in the fertility literature that demonstrates the negative impact of being severely obese on infertility treatment outcomes. Piggybacking on that, Canada is currently debating whether obese women should even be allowed to undergo In Vitro Fertilization (IVF). As we have long known, being extremely obese (i.e. a BMI over 50) greatly impacts a woman’s chances to conceive. Obesity reduces the body’s ability to respond well to fertility medications, can make egg retrieval a nightmare, reduces the pregnancy rate after IVF, and increases the possibility that the woman will miscarry. 

So now what? Do we just tell overweight women that they are out of luck unless they can diet and exercise, throwing guilt into the frustration and sadness that they already have regarding their inability to conceive? The reality is that most of these women have dieted and tried to control their weight for many years. In fact, many have a metabolic condition that makes it extremely hard to lose weight. 

So what is the best way to help these heavy ladies? Weight loss, exercise, and diet plans work for some, but even with the motivation brought on by their desire to have a baby, they rarely can acheive the goals. It also takes time to institute lifestyle changes, which is a big problem when you’re talking about having a baby. In many cases, time is of the essence, since egg quality and quantity decline so rapidly after age 30. How do we get these patients to lose weight quickly in order to proceed to fertility management? 

There are number of approved prescription medications available that currently are in use. Some have been used and reported in the fertility literature, but the only drug I have found useful is phentermine, of Phen-Fen infamy. Go with me for a moment on this. In the Phen-Fen debacle, the treatment regimen included two drugs: fenfluramine which tragically caused some fatalities and is rightfully off the market; and phentermine, which has been on the market for over 40 years and has been shown to be very useful with rapid weight loss. 

Unfortunately for patients, however, the use of phentermine is largely vilified in the medical community. Why? In my opinion, it is frowned upon because it is perceived as a quick fix and, while results will include rapid weight loss, the dependence on a drug rather than lifestyle changes virtually guarantees the weight will go right back on post-medication use.

Most doctors probably think, “What's the point of using a weight loss drug if the patient will gain it all back right soon after?” But in the field of fertility, that’s really exactly what I’m trying to achieve with my patients. I want my patients to lose enough weight to successfully and safely get pregnant, then gain weight (albeit carefully and by making healthy choices) as their baby grows. 

Under the watchful eye of a careful doctor, phentermine can work very well. A well motivated patient who exercises 3 times a week for 30-40 minutes, watches carbohydrate intake and takes the prescribed dose of phentermine daily can lose 40 pounds or more in six months. Many patients who typically do not ovulate on their own will start to do so after losing that much weight, and some even conceive spontaneously. 

Is phentermine safe? Yes. I have now had over 500 patients on a regimen that included phentermine and have found many of the bad press the drug has received to be unfounded. Other than the annoying side effects of “cotton mouth” and constipation, my patients have done extremely well with short-term, carefully monitored use of the drug.

There is no doubt that if you are very overweight, your fertility journey is going to be harder and less successful. Instead of turning you away, however, as some other infertility clinics do, Fertility Partnership will work with you to safely and effectively manage your weight and help you get pregnant. We have seen great results from our philosophy that well-supervised weight loss programs - which include the short-term use of medications like phentermine - are very successful in getting the weight off quickly in preparation for achieving the dream of having a baby.