Preconception weight loss in the obese patient: overhyped or underutilized?

The associations between female obesity and adverse maternal and fetal outcomes are exhaustively documented with associations with ovulatory dysfunction, delayed time to pregnancy, increased pregnancy loss in all trimesters, increased rates of fetal anomalies, higher rates of gestational diabetes, increased rate of hypertensive disorders of pregnancy including pre-eclampsia, increased spontaneous and iatrogenic preterm delivery rates, conversely also higher rates of large for gestational age infants at term and increased risk of maternal and fetal birth trauma, increased rates of thromboembolic events. Although preconception weight loss is often recommended as the first step for women with obesity and infertility, there is no clear best method and the role of the treating infertility provider in managing the weight loss is often secondary, if at all. The risk benefit ratio of preconception weight loss is uncertain. Rebound weight gain often follows weight loss, especially after conception with recommended weight gain during pregnancy even among women with obesity. Even less is known about the effects of obesity and preconception weight loss in males.