Initial treatment of the infertile, overweight/obese patient should include a multidisciplinary approach to weight management that fosters lifestyle change through proper diet, exercise, behaviour modification and stress reduction in concert with pharmacological approaches (e.g. Metformin) when required.
By providing a more holistic approach to obesity and reproductive health preconceptually, this would enable a powerful impact on patients by enhancing their chances of conception (natural or otherwise), achieving a healthy obstetric outcome and possibly enhancing their overall health, for the long term.
Step 1 and 2, should form part of the pre-planning approach to potential fertility but not necessarily a burden on the NHS. Also, this should be implicit as much for the hopeful fathers as well as the hopeful mothers if they are medically obese.