Could fatty liver be affecting your fertility? What every woman should know

Many women in our society are unaware of the fact that fatty liver is not just a liver problem. Most do not know it can significantly affect reproductive health and fertility. Metabolic dysfunction–associated steatotic liver disease (MASLD), referred previously as non-alcoholic fatty liver disease (NAFLD), has become one of the most common metabolic disorders among women of reproductive age. Researchers are increasingly talking of the ‘hepato-ovarian axis’, highlighting the close connection between liver health and ovarian function. It is seen that women with insulin resistance or obesity often experience hormonal disturbances that can interfere with ovulation and reduce fertility.It has been observed that women with polycystic ovary syndrome (PCOS) are particularly vulnerable. Many studies show a significantly higher prevalence of fatty liver disease in women with PCOS. Globally, it’s seen that fatty liver disease affects nearly one in four adults. The numbers are rising among younger women, in India too. Studies suggest that in our country its prevalence ranges from 9% to 32%, with higher rates in urban areas, due to sedentary lifestyles and metabolic disorders.The liver plays a central role in regulating hormones, metabolism, and insulin balance. These are important factors in women’s reproductive health.

It helps process estrogen and androgens. Hormonal imbalance occurs when fat accumulates in the liver and many of its key functions will get disrupted in the process.Emerging studies suggest that women with fatty liver disease may experience lower reproductive outcomes, largely because associated metabolic dysfunction can affect egg maturation, embryo quality, and implantation potential. This is especially relevant for women planning assisted reproductive treatments such as IVF.Fatty liver disease has also been linked with a higher risk of gestational diabetes mellitus (GDM), hypertensive disorders such as preeclampsia, and preterm birth. This makes preconception screening especially important in women planning pregnancy.Many women may not show any symptoms at all and hence fatty liver is often called a silent disease. In some others symptoms may emerge in the form of unexplained fatigue, weight gain, irregular periods etc. Thankfully, fatty liver disease is often preventable and reversible especially if the condition is discovered in its early stages. Weight management, right nutrition, physical exercise, sleep and early screening are important.1. As far as weight management is concerned losing even five per cent of the body weight can help. Weight reduction will help to remove liver fat, gain insulin sensitivity and ovulation. 2. A diet rich in fruits, vegetables and whole grains can play a big role. Processed foods and saturated fats should also be avoided. 3. Consistent physical activity helps in improving hormonal balance and metabolic health.4. Quality of sleep helps with hormonal wellness.5. Women with PCOS, obesity etc should go in for liver function tests when advised.As gynaecologists, we try to address the root causes, looking beyond mere symptoms. Evaluating one’s metabolic health, including liver function, may be an important first step when struggling to conceive.Dr. Nandita Palshetkar, Scientific Director & Head of the Bloom IVF Unit at Lilavati Hospital, Mumbai, and Medical Director of Bloom IVF Centres