I am 40 pounds over my ideal weight and have been unable to conceive for the past three years. I will be seeing a doctor for a complete evaluation, but a friend says I can't get pregnant until I lose weight because of all the excess estrogens being converted to androgens. I am not hirsute at all. Does obesity really cause infertility? If so, how does that happen, and how would I know that's happening in my case?

Barbara

Obesity may be linked with irregular menses and absent ovulation as a result of obesity-associated insulin resistance. However, obesity is not always a fertility problem in itself. If your menstrual cycles are normal and you do not show signs of excess male hormone production or thyroid disease, your fertility is most likely not affected.

Obesity can also create problems with the pregnancy once you conceive. Conditions such as toxemia of pregnancy and gestational diabetes are more common in obese women. Efforts to reduce your weight may not restore your fertility, but once you conceive, you will likely be healthier and will more likely have a satisfactory outcome.