Doctor, doctor: Losing weight and IVF

At 57, my weight has gradually crept up so that my BMI is at the top of the healthy range. I used to be able to lose a few pounds by increasing my exercise and reducing portion size, but now that seems almost impossible. Why is it harder to keep the pounds off as we grow older?
It's mainly because we become imperceptibly less active physically over the years, and we don't really reduce our food intake enough to compensate for it. At the same time, it is less easy to exercise as vigorously as we once used to. The basic science is still the same: if we take in more calories than we expend in energy, we will put on weight. That is true of any age, and the principle doesn't change. You say that your BMI is at the top of the healthy range – I presume, then, that it's around the 25 mark. As a matter of fact, that is still healthy, and you should be happy with it. Your life expectancy, judged from the latest figures, is marginally longer than that of someone whose BMI is in the lower half (20 to 22.5) of what we accept as "normal".

My wife and I have had cycles of IVF and ICSI, and in both cases fertilisation has been very poor – with IVF one in 10 eggs and with ICSI none from 10. Our consultant says she cannot give a reason for the lack of fertilisation, but says that in light of the results she cannot see us ever conceiving and says that we should now look to adopt. We are happy to do this, but the lack of explanation is worrying. Are our chances really nil? We have no problems with egg or sperm quality.
Your chances are not nil, but they do seem small. In some couples, sadly, there seems to be an incompatibility between the egg and the sperm that prevents conception, but we still don't know why. However, I can offer some hope – I know of one couple just like yourselves who did adopt and decided not to worry any more about their fertility. Two years later the wife conceived while on a relaxing holiday in Greece. Although it's based on just one case report, my advice would be to adopt and let the future take its course.

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