Bodies come in all shapes and sizes that are normal and healthy. Being in a larger body does not automatically mean you will have fertility issues. However if you find yourself having difficulty TTC, here are some things to consider. Living in a larger body, you’ve probably heard plenty about your body size from friends, family, healthcare providers, and even strangers. This has likely come with conflicting advice and biased information. How do you sort through information to identify legitimate health concerns versus obstacles you’re facing due to weight stigma? And what can you do about either issue? Let’s start with a breakdown of some health concerns you could be facing.
There are some health conditions that are strongly associated with living in a bigger body. This is not a cause and effect relationship, but a correlative one. Nonetheless, knowing about challenges you might face can help you identify specific symptoms to bring up to your provider so you can work together to optimize your health and fertility.
The menstrual cycle is dependent upon several hormones “communicating” with one another in the body. When one is off, it can have a ripple effect, disrupting the whole menstrual cycle. This means if you’re experiencing irregular menstrual cycles, it’s possible you aren’t producing the right levels of hormone to cause you to ovulate monthly, this can make TTC very difficult to impossible.
Hormonal imbalance can also cause insulin resistance, something more common for those in larger bodies. Insulin resistance is when the body’s cells don’t respond effectively to insulin hormone. This causes elevated blood sugars and increased fat stores. This shift affects the hormones involved in the menstrual cycle and can cause skipped periods and cycle irregularity among other health issues. If you’re concerned you may be experiencing something like this, you should definitely speak with your provider about it. They can do testing to diagnose insulin resistance and you can work together to treat it!
Along similar lines, Polycystic Ovary Syndrome (PCOS) is the most common endocrine disturbance in women of reproductive-age in the world. It is also the most common cause of infertility and causes changes in the hormones involved in the menstrual cycle and metabolism. PCOS commonly causes cycle irregularities, anovulation (not releasing an egg during your cycle), or even amenorrhea (lack of a period/cycles for several months) along with other physical symptoms like having many benign (non-cancerous) cysts on the ovaries, extra hair growth on the face and hair loss on the top of the head. It’s important to note that not everyone with PCOS will have all of these symptoms.
You should know that in addition to infertility, the hormonal shifts caused by PCOS can lead to other significant health issues like diabetes and heart disease. So if you suspect you may have PCOS, it is very important from an overall health standpoint to talk to your provider. If you are diagnosed with PCOS, it may also be necessary to work closely with your provider when TTC. While PCOS causes infertility, in many cases, conception is possible with the right treatment.
Weight stigmas and what you can do
Beyond these common health concerns, you may get advice that is solely based upon the size of your body and not your health status. For example, the most common “health” advice given to those in larger bodies is to “lose weight.” But it is important to note, the science of weight and body size consistently shows that dieting for weight loss is ineffective and damaging to our health. This type of messaging in healthcare and from social sources as well can really take a toll on your mental and physical health. One of the ways that is commonly manifested is in disordered eating. This is an all too common issue amongst people of all sizes and can be very dangerous.
When people are told the first step to getting pregnant is to lose weight, they limit calories, cut out entire food groups, and stop honoring their internal hunger and fullness signals. This can lead to nutrient deficiencies, binge eating, and fear or obsessive thinking around food. And, it doesn’t end in weight loss in the long run! In fact, many people who diet end up at a weight higher than they were when they started.
This all might leave you wondering what you can be doing to improve your chances of conceiving in a bigger body. We’re here to help with some evidence-based information, free of fatphobic bias.
First, throw away your scale. This might sound unconventional, but the number on the scale is irrelevant to your health and can be very triggering. In fact, research has shown that simply changing one’s body weight alone is not a direct indicator of health improvement. Health promoting behaviors are what improve our health outcomes (independent of weight). Setting goals based on how you feel, how your body functions, and what you personally need to be living in a healthier body is more reliably associated with overall improvement in one’s health.
So what is a health-promoting behavior?
- Managing stress
- Getting adequate sleep
- Engaging in physical activity
- Nourishing your body with food and water
Now that you know what a health promoting behavior is, how can you put them into practice in your life? It can be very effective to set a SMART goal. S for Specific, M for Measurable, A for Attainable, R for Relevant, and T for Time-sensitive. To make a SMART goal for yourself, you’ll have to do some critical thinking to make it possible to follow through on. Here’s an example of that process:
Initial thought: “I want to exercise more often.”
Things to consider: “What type of exercise do I enjoy, what time am I going to use to do this, what equipment do I need, how will I make it sustainable, when will I reassess and change the goal as needed?”
SMART goal: I will walk around my neighborhood for 30 minutes three evenings a week after dinner for the next two weeks.
You can apply SMART goals to all sorts of challenges. When it comes to nutrition, try to eat a variety of nutritious foods and avoid any diets or “lifestyle changes” that are meant to change your body size or suggest cutting out entire food groups. You could set the goal for yourself to check in with your body 15 minutes before one meal a week and see what you’re really craving and hungry for and commit to following your body’s lead for that meal. (Note: If you have to cut out a specific type of food for medical reasons like allergies or celiac disease, of course, that’s important and appropriate advice to follow)
This quote from Jen McLellan sums up the way nutrition fits into the picture: “Food choices that aim at regulating blood sugar and insulin (low glycemic foods and missing minerals/vitamins) are the best option to help turn the hormone train back around. It isn’t about weight, it is about how a woman’s body is using the tools and food being put in.”
If you’re struggling with disordered eating, please know this is not your fault and recovery is possible with support. Here are some resources that can help:
- National Eating Disorders Association (NEDA)
- Families Empowered and Supporting Treatment of Eating Disorders (F.E.A.S.T.)
Beyond health promotion: Finding the right care team
Another major obstacle to TTC in a larger body is finding the right healthcare team for you and your family. Unfortunately, size discrimination is very common in the fertility world. And you may have to spend more time and emotional energy than you’d like on finding a provider who respects you and practices weight-inclusive care. You may also choose to involve a more diverse team of experts in your healthcare than your primary fertility/obstetric provider. For example, working with a weight-inclusive dietician can help you immensely in learning which foods nourish your body and help you meet your goals.
It is your right to play an active role in your own healthcare. That means being a part of the treatment decision making, which medications you take, and which interventions you choose for yourself. In some cases, you may need to ask what other options are available. In situations where you feel you are being discriminated against because of your size, it can be helpful to have some idea of what you want to say in response. Here is an example of a card you can carry with you with some suggested wording you can use.
Remember, even though these obstacles can be difficult to confront, you don’t have to do it alone. You can always talk to a doctor. Support groups, care teams, and loved ones are also excellent resources. The effort is worth it for you as an individual and for your growing family.
Reviewed by the Ovia Health Clinical Team
- Fertility hormones: multi-tasking, heavy lifting, pretty incredible chemicals
- Polycystic Ovary Syndrome (PCOS)
- Jen McLellan. “Infertility for Plus Size Women: When Weight Loss isn’t the Only Answer.” Plus size birth. https://plussizebirth.com/infertility-for-plus-size-women/.
- “Fat Positive Fertility Resources.” Nicola Salmon, https://nicolasalmon.co.uk/resources/.