New Debate: Is It Time for Infertility Weight-loss Programmes to be Couple-based?

Damian Best; Alison Avenell; Siladitya Bhattacharya; Gertraud Stadler


Hum Reprod. 2017;32(12):2359-2365. 

In This Article

Individual-based Weight-loss Interventions

Weight loss requires dietary modification, with or without a change in physical activity, to induce a caloric deficit resulting in the body metabolizing fat. Individual-based programmes described in the literature to improve fertility have utilized such strategies as low calorie diets, usually low in fat and saturated fat and added sugars, (Mavropoulos et al., 2005; Qublan et al., 2007; Thomson et al., 2009; Turner-McGrievy et al., 2014), low glycaemic index diets (Becker et al., 2015), very low calorie diets (Kiddy et al., 1992; van Dam et al., 2004; Tsagareli et al., 2006) and a variety of different diets with exercise (Hollman et al., 1996; Miller et al., 2008; Thomson et al., 2008; Karimzadeh and Javedani, 2010; Moran et al., 2011, 2003; Khaskheli et al., 2013; Mahoney, 2014; Sim et al., 2014b; De Frene et al., 2015; Salama et al., 2015; Mutsaerts et al., 2016). Motivational interviewing has also been described as a useful tool (Karlsen et al., 2013; Koning, 2015).

Poor programme compliance has been a problem in many weight-loss programmes. In a systematic review of discontinuation rates in such interventions among obese infertile women (Mutsaerts et al., 2013), 10 of 15 studies reported discontinuation, with the median discontinuation rate at 24% (range 0–31%). The programmes ranged from 6 to 32 weeks in duration, with a median of 24 weeks. Given the small number of studies, it was difficult to identify correlates of discontinuation, but the authors noted that weight loss and pregnancy rates were lower in non-compliant persons (Mutsaerts et al., 2013). Two studies suggest that very stringent diets (e.g. vegan or low-carbohydrate ketogenic) may be particularly hard to follow with even higher discontinuation rates than less restricted diets (Mavropoulos et al., 2005; Turner-McGrievy et al., 2014). Studies aiming to improve motivation seem to achieve greater success. Two programmes integrated motivational interviewing and had relatively low discontinuation rates of 10.6% at 6 months (Mutsaerts et al., 2016), and 10.9%, respectively (Koning, 2015). An exercise programme for obese infertile women to improve psychological well-being (Galletly et al., 1996) showed a discontinuation rate of 33.3%, with women who dropped out having higher anxiety and depression scores and lower self-esteem at baseline. In summary, weight-loss interventions which are mainly focussed on the individual, have high discontinuations rates, even for patients thought to be motivated in order to improve their fertility, and this results in less weight loss associated with lower pregnancy rates.