CHICAGO – July 9, 2025 – Weight gain isn’t just a result of what you eat and how you move your body. It’s also related to genetic, societal, and environmental factors. For many, obesity is a disease. But for those wanting to start a family, healthy behaviors and lifestyle choices are important to help achieve reproductive goals, which is why the Northwestern Medicine PEARL Program (Preconception and Early Assessment Care Rooted in Lifestyle Management) was launched to  support people with obesity who are planning a pregnancy.  

“Here at Northwestern Medicine, we receive a lot of referrals for patients with higher body mass index (BMI) that might not be cared for at other health systems, and with the PEARL Program, we’re eliminating that bias to help provide the obstetrics care they need,” said Christina Boots, MD, a reproductive endocrinology and infertility specialist at Northwestern Medicine who co-founded the PEARL Program. “We’re really proud to have established a multidisciplinary clinic to care for these women who are trying to get pregnant, want to reduce health risks during pregnancy, and manage their mental health and possible weight gain postpartum.”

The PEARL Program was designed for patients who have a BMI more than 27, are planning an immediate pregnancy or looking ahead to the future. Some women with higher BMI will have ovulatory dysfunction, a condition where the ovaries don’t release an egg during a menstrual cycle. A drop in weight can sometimes help women ovulate more consistently, thus increasing their rate of spontaneously getting pregnant. Weight loss can also help prevent the risk of health complications during pregnancy.  

“When we look at clinical obesity, we can’t just define the disease as having a BMI over 30, but we need to look at how the disease impacts one’s overall health,” said Veronica Johnson, MD, an obesity medicine specialist at Northwestern Medicine who co-founded the PEARL Program. “Excess body fat can impact a woman’s health including infertility, irregular menstrual cycles and polycystic ovary syndrome (PCOS), but it can also cause other health-related conditions such as obstructive sleep apnea, cardiovascular disease, high blood pressure and osteoarthritis of the knees or the hips. These are all things we really want to have the patient improve upon before getting pregnant.”

What to expect during a consultation with the PEARL Program

For each patient, a team of experts from reproductive endocrinology and infertility, obesity medicine, maternal-fetal medicine, psychology and more, design a personalized weight loss program to fit a patient’s needs and goals which may include nutrition, physical activity, mental health, lifestyle treatment options, and in some cases, using weight loss medications such as GLP-1 agonists.

During a patient’s first consult with the PEARL Program, a physician will typically ask questions such as:

-        How do you feel about your weight?

-        Do you think you’d benefit from extra nutrition counseling?

-        Do you need motivation to move your body more?

-        When do you think you might want to start a family?

-        What’s your ideal family size?   

Depending on answers to the questions, next steps will then be taken for planning a future pregnancy.

“Preconception counseling is so important because everyone’s prenatal care might be different, their delivery might be different and their postpartum care might be different,” said Michelle Kominiarek, MD, a maternal-fetal medicine specialist at Northwestern Medicine who co-founded the PEARL Program. “It takes time to have meaningful weight loss, which can result in some tough conversations.”

Obesity’s impact on fertility and pregnancy 

When it comes to a patient’s fertility, physicians with the PEARL Program emphasize that age, much more so than BMI, influences how likely a woman is to get pregnant, which is why it’s important for women to talk to a physician sooner rather than later.

“For example, if a woman first comes to us in her late 20s or early 30s, she should still generally have good egg quality and quantity left, but if a woman is approaching 40, that’s when she really needs to be worried about the decline in her fertility. For some women, that means we’re freezing eggs or creating embryos ahead of time and then making the weight loss goal a priority before she tries to conceive,” said Dr. Boots. “That’s why thoughtful, individualized conversations are needed to come up with a strategy.”

For patients with higher BMI who need to undergo in vitro fertilization (IVF) treatments, excess body fat can make it more difficult to administer fertility treatments because the ultrasound imaging is more challenging. Higher BMI may also play a role in egg quality, implantation, embryo development and increased risk of miscarriage. With higher BMI, physicians also see higher rates of thyroid disfunction, insulin resistance, diabetes, high blood pressure and hypertension.

“We see that having excess body fat and an energy imbalance can also influence how our hypothalamus talks to our pituitary, which talks to our ovary. It’s a really delicate system that can get interrupted,” said Dr. Boots. “The primary way a lot of weight affects getting pregnant is just not having regular menstrual cycles and not ovulating with consistency.”

Once pregnant, patients with higher BMI face several risks during pregnancy such as preeclampsia (high blood pressure) which can lead to organ damage, stroke, seizures or death; gestational diabetes; blood clots; premature delivery; longer labor; and possibly needing a cesarean section (C-section). The baby may also be at high risk for birth defects that affect the brain and spinal cord.

Are weight loss medications safe to use during pregnancy?

GLP-1 agonists can be used to lower weight which may improve pregnancy outcomes, however, there can be rebound weight gain after stopping the medication. Physicians are monitoring how that rebound weight gain will impact the pregnancy; does it blend in with the expected weight gain of pregnancy or does it magnify it? Currently, physicians with the PEARL Program don’t recommend patients stay on GLP-1 agonists during pregnancy.

“GLP-1 agonists shouldn’t be used during pregnancy because there isn’t enough research to show what they’ll do to a growing baby,” said Jacqueline Hairston, MD, a maternal-fetal medicine specialist at Northwestern Medicine who is part of the clinical team for the PEARL Program. “We also have to be really careful about recommending fast meaningful weight loss right before someone is trying to get pregnant because their metabolism is going to change so much. Diminishing a patient’s nutrition and energy imbalance isn’t the best time to be growing a baby, so we’ll tell patients they should wait a year or two from that massive weight loss before trying to get pregnant. Just telling patients, ‘Lose a bunch of weight and you’ll get pregnant,’ isn’t the right answer.”

Postpartum weight gain management

The PEARL Program is also working to help decrease weight bias in clinical settings; define clinical obesity and review the current treatment options; understand the data associating fertility outcomes with BMI; and improve preconception counseling in women with higher BMI. The program also monitors women postpartum to help them manage the weight gain from the pregnancy.

“Pregnancy is unique because it’s one of the few times people have a doctor say to them, ‘We expect you to gain weight.’ What that means for their mental health to see their body change after successful weight loss is certainly something that is a very individual experience,” said Dr. Kominiarek.

“The mental health piece is so important, so making sure we connect them with a mental health provider as they’re going through their weight loss journey, or weight gain that comes with pregnancy, is important. They need support from their physicians, psychologists, family and friends,” said Dr. Hairston.

For patients wanting to discuss how to optimize their health before pregnancy, a consultation can be scheduled with the PEARL Program by calling 312.695.7269. Additional information on obstetrics care at Northwestern Medicine can be found at nm.org.

CHICAGO – April 2, 2025 – At the start of the pandemic, Iona Woolmington was installing artwork at a contemporary art museum in downtown Chicago when she first began having trouble in the bathroom. Blood in her stool prompted the then 35-year-old to see a doctor, leading to a devastating diagnosis: stage 3 rectal cancer.

This was not Woolmington’s first encounter with cancer. In 2014, the cartoonist and vegetable farmer originally from North Bennington, Vt., underwent surgery to remove a cancerous spot on her face caused by early-stage melanoma. After five years cancer-free, Woolmington found herself back at the doctor’s office, but this time with concerns about how chemotherapy and radiation would impact her fertility.

“Iona’s tumor was located deep within her pelvis, which is a complicated area,” said Mary Mulcahy, MD, medical oncologist with the Robert H. Lurie Comprehensive Cancer Center of Northwestern University at Northwestern Memorial Hospital. “Chemotherapy and radiation would be necessary to shrink the tumor before surgical removal. However, these treatments would likely impact her egg quality, damage her ovaries, and trigger premature menopause. Given all the difficulties ahead for Iona, it was important for her to explore her options.”

Before beginning cancer treatment, Dr. Mulcahy referred Woolmington to specialists at the Northwestern Medicine Center for Fertility and Reproductive Medicine, who recommended a fertility-sparing solution.

First, Woolmington had the option to remove and freeze her eggs for later use in fertility treatments such as in vitro fertilization (IVF). Then, a surgical procedure known as ovarian transposition could protect her ovaries from the damaging effects of radiation by moving the organ out of harm’s way.

“When we see a patient early on, the goal is to do as much as we can to potentially preserve the possibility of having a child down the road,” said Emily Jungheim, MD, chief of reproductive endocrinology and infertility at Northwestern Medicine. “Iona was young, and so we knew the eggs we got were going to be high quality. By examining the ovaries with ultrasound, we can estimate the potential number of eggs available for egg banking, and we were pleased to see that things looked good for Iona. Egg banking in combination with ovarian transposition put Iona on track for more control of her future reproductive health.”

“During ovarian transposition, we take the ovaries, which are normally located in the pelvis, and move them into the abdomen as far away from the field of radiation as possible to avoid any kind of injury,” said Magdy Milad, MD, chief of minimally invasive gynecologic surgery at Northwestern Medicine. “By doing so, we protect the patient from premature menopause and the associated risks of cardiovascular disease, osteoporosis, cognitive decline, and even early death.”

After successfully freezing her eggs and moving her ovaries out of the field of radiation, Woolmington began chemotherapy and radiation to treat her primary tumor. Six months later, doctors determined she had responded well enough to treatment to become a candidate for a colon resection.

In Feb. 2021, surgeons removed the cancerous part of Woolmington’s rectum and sewed the healthy parts back together. While her gastrointestinal tract healed, Woolmington was given a temporary ileostomy bag to prevent waste from passing onward to the large intestine and rectum.

“For patients with colorectal cancer, chemotherapy doesn’t typically cause you to lose your hair, so the ileostomy bag was the most concrete change in my experience with cancer,” said Woolmington. “I was initially very concerned about living with my ileostomy, but ended up being very wrong about how much of an impact it had on my day-to-day life. That made me want to write about it.”

To raise awareness for a disease that is becoming increasingly common in people under the age of 50, and to illustrate the ways young adults are uniquely impacted by cancer, Woolmington created Tough Shit under the pen name, Iona Fox. The comic explores navigating a cancer diagnosis in a pandemic, its impact on dating and relationships, and adjusting to life with a stoma.

Today, Woolmington is cancer-free, and her ovarian function is normal.

“The fact that my Northwestern Medicine medical team not only helped me beat cancer, but also helped me come out of it with my 35-year-old body still intact, with the door still open on parenthood… there are no words to express my appreciation for that,” said Woolmington.

In February 2020, Shelly Battista of Arlington Heights, Ill., was breastfeeding her newborn daughter, Emilia, when she felt a lump. She thought it was a clogged milk duct, but when it didn’t get better, Shelly went to the doctor and received a shocking diagnosis.

At 34-years-old, with no family history of breast cancer, Shelly was diagnosed with triple-negative breast cancer and the BRCA1 mutation, which is associated with an increased risk of breast cancer and other types of cancer. Knowing she wanted to have more children, Shelly immediately scheduled an appointment with Kara Goldman, MD, medical director of Fertility Preservation at Northwestern Medicine Center for Fertility and Reproductive Medicine. Shelly’s care team was able to freeze eight embryos (fertilized eggs) before she started cancer treatment.

Shelly went through chemotherapy, followed by a double mastectomy. On Dec. 9, 2020, Shelly’s pathology results came back clear – she was cancer-free. Unfortunately, the chemotherapy treatments resulted in ovarian insufficiency, a condition where the ovaries stop working before age 40. Shelly’s BRCA1 mutation increased her chance of ovarian cancer, so after careful counseling Shelly opted to have her ovaries and fallopian tubes surgically removed.   

In December 2021, one year after finishing treatment, Shelly was cleared for pregnancy from a cancer standpoint, and Dr. Goldman prepared Shelly’s uterus for transfer.

“Even without ovaries, we’re able to provide the supplemental hormones necessary for pregnancy. This alone is an important teaching point because many people are surprised to learn that you can use in vitro fertilization to become pregnant even if ovaries have been surgically removed or are no longer functioning,” said Dr. Goldman. “This requires the use of a patient’s previously frozen eggs or embryos, or eggs from an egg donor, so it’s critical that patients at risk of losing their ovaries or losing ovarian function have the opportunity to preserve their fertility.”

When it came time for embryo transfers, the first one didn’t work and neither did the second. 

In April 2022, with only six embryos remaining, and Shelly still hoping for two more children, Dr. Goldman transferred another embryo with cautious optimism, knowing that without her ovaries, Shelly had no more eggs to be fertilized.

Dr. Goldman’s positivity paid off. Shelly’s pregnancy test was positive, and at her first ultrasound appointment, Shelly learned she was having identical twin girls.  

Exactly two years to the day after she was declared cancer-free, Shelly was induced and delivered her identical twin girls, Nina and Margot, at Northwestern Medicine Prentice Women’s Hospital on Dec. 9, 2022.

“Despite a breast cancer diagnosis, chemotherapy, and losing both ovaries, Shelly’s dream of having three children came true,” said Dr. Goldman. “One perfect embryo, frozen urgently before chemotherapy, became two beautiful baby girls. They are the reason why I care so deeply about my patients and my job. Caring for patients during the most vulnerable times of their lives, and helping them build the families they dreamed of, is an incredible privilege.”  

“I’m blessed to have a medical team who let me advocate for my medical needs and the future of my family,” said Shelly. “It’s a true miracle. We have two babies, exactly two-years cancer-free. My heart is very full.”