Infertility treatment outcome in sub groups of obese population.
Awartani Khalid A,Nahas Samar,Al Hassan Saad H,Al Deery Mashael A,Coskun Serdar
Reproductive biology and endocrinology : RB&E
BACKGROUND:Obesity is a common disorder with a negative impact on IVF treatment outcome. It is not clear whether morbidly obese women (BMI >= 35 kg/m2) respond to treatment differently as compared to obese women (BMI = 30-34.9 kg/m2) in IVF. Our aim was to compare the outcome of IVF or ICSI treatments in obese patients to that in morbidly obese patients. METHODS:This retrospective cohort study was conducted in a tertiary care centre. Patients inclusion criteria were as follows; BMI >or= 30, age 20-40 years old, first cycle IVF/ICSI treatment with primary infertility and long follicular pituitary down regulation protocol. RESULTS:A total of 406 obese patients (group A) and 141 morbidly obese patients (group B) satisfied the inclusion criteria. Average BMI was 32.1 +/- 1.38 kg/m2 for group A versus 37.7 +/- 2.99 kg/m2 for group B. Patient age, cause of infertility, duration of stimulation, fertilization rate, and number of transferred embryos were similar in both groups. Compared to group A, group B had fewer medium size and mature follicles (14 vs. 16), fewer oocytes collected (7 vs. 9) and required higher doses of HMG (46.2 vs. 38.5 amps). There was also a higher cancellation rate in group B (28.3% vs. 19%) and lower clinical pregnancy rate per started cycle (19.9% vs. 28.6%). CONCLUSION:In a homogenous infertile and obese patient population stratified according to their BMI, morbid obesity is associated with unfavorable IVF/ICSI cycle outcome as evidenced by lower pregnancy rates. It is recommended that morbidly obese patients undergo appropriate counseling before the initiation of this expensive and invasive therapy.
Cumulative live birth rates after weight reduction in obese women scheduled for IVF: follow-up of a randomized controlled trial.
Kluge L,Bergh C,Einarsson S,Pinborg A,Mikkelsen Englund A-L,Thurin-Kjellberg A
Human reproduction open
STUDY QUESTION:Did weight reduction in obese women scheduled for IVF increase cumulative live birth rate (CLBR) after 2 years? SUMMARY ANSWER:Weight loss prior to IVF did not increase CLBR. WHAT IS KNOWN ALREADY:Few studies have investigated the effect of weight reduction in obese infertile women scheduled for IVF. In a recent randomized controlled trial (RCT), including one IVF cycle, we found no increase in live birth rate after weight reduction. Weight regain after obesity reduction treatment often occurs, and children born to obese women have a higher risk of childhood obesity. STUDY DESIGN SIZE DURATION:A 2-year follow-up of a multicenter, RCT running between 2012 and 2018 was performed. Out of 317 women randomized to weight reduction followed by IVF treatment or IVF treatment-only, 305 remained in the full analysis set. Of these women, 90.5% (276/305) participated in this study. PARTICIPANTS/MATERIALS SETTING METHODS:Nine infertility clinics in Sweden, Denmark and Iceland participated in the RCT. Obese women under 38 years of age having a BMI ≥30 and < 35 kg/m were randomized to weight reduction and IVF or IVF-only. In all, 160 patients were randomized to a low calorie diet for 12 weeks and 3-5 weeks of weight stabilization, before IVF and 157 patients to IVF-only. Two years after randomization, the patients filled in a questionnaire regarding current weight, live births and ongoing pregnancies. MAIN RESULTS AND THE ROLE OF CHANCE:42 additional live births were achieved during the follow-up in the weight reduction and IVF group, and 40 additional live births in the IVF-only group, giving a CLBR, the main outcome of this study, of 57.2% (87/152) and 53.6% (82/153), respectively ( = 0.56; odds ratio (OR) 1.16, 95% CI: 0.74-1.52). Most of the women in the weight reduction and IVF group had regained their pre-study weight after 2 years. The mean weight gain over the 2 years was 8.6 kg, while women in the IVF-only group had a mean weight loss of 1.2 kg. At the 2-year follow-up, the weight standard deviation scores of the children born in the original RCT (index cycle) were 0.218 (1.329) (mean, SD) in the weight reduction and IVF group and - 0.055 (1.271) (mean, SD) in the IVF-only group ( = 0.25; mean difference between groups, 0.327; 95% CI: -0.272 to 0.932). LIMITATIONS REASON FOR CAUTION:All data presented in this follow-up study were self-reported by the participants, which could affect the results. A further limitation is in power for the main outcome. The study is a secondary analysis of a large RCT, where the original power calculation was based on live-birth rate after one cycle and not on CLBR. WIDER IMPLICATIONS OF THE FINDINGS:The follow-up indicates that for women with a BMI ≥30 and < 35 kg/m and scheduled for IVF, the weight reduction did not increase their chance of a live birth either in the index cycle or after 2 years. It also shows that even in this highly motivated group, a regain of pre-study weight occurred. STUDY FUNDING/COMPETING INTERESTS:The 2-year follow-up was financed by grants from the Swedish state under the agreement between the Swedish Government and the county councils, the ALF-agreement (ALFGBG-70940 and ALFGBG-77690), Merck AB, Solna, Sweden (an affiliate of Merck KGaA, Darmstadt, Germany), Hjalmar Svensson Foundation. Ms Kluge has nothing to disclose. Dr Bergh has been reimbursed for lectures and other informational activities (Ferring, MSD, Merck, Gedeon Richter). Dr Einarsson has been reimbursed for lectures for Merck and Ferring. Dr Thurin-Kjellberg reports grants from Merck, and reimbursement for lectures from Merck outside the submitted work. Dr Pinborg has been reimbursed for lectures and other informational activities (Ferring, MSD, Merck, Gedeon Richter). Dr Englund has nothing to disclose. TRIAL REGISTRATION NUMBER:ClinicalTrials.gov number, NCT01566929.
Does body mass index of infertile women have an impact on IVF procedure and outcome?
Wittemer C,Ohl J,Bailly M,Bettahar-Lebugle K,Nisand I
Journal of assisted reproduction and genetics
PURPOSE:The objective was to explore whether body mass index (BMI) of women related to the different parameters of the in vitro fertilization (IVF) procedure and outcome. METHODS:This retrospective study on 398 couples analyzed epidemiological features, characteristics of ovarian stimulation, number and quality of retrieved oocytes, as well as pregnancy outcome according to three groups of BMI values: BMI < 20, 20 < or = BMI < 25 and BMI > or = 25 kg/m2. RESULTS:The prevalence of underweight and overweight women was 21.8% and 22.3%, respectively. The mean ratio follicle-stimulating hormone-luteinizing hormone increased significantly according to BMI. An increase in the mean number of consummated gonadotropin ampoules together with a decrease in the number of collected oocytes was observed in long stimulating protocol cycles when BMI > or = 25 kg/m2. The same observations were made in short stimulation protocol cycles of BMI < 20 and > or = 25 kg/m2. No significant difference could be found in clinical pregnancy and miscarriage rates between underweight, normal weight, and overweight patients. CONCLUSIONS:Both underweight and overweight have negative effects on IVF parameters and outcome leading to decreased chances of pregnancy.
Increased body mass index has a deleterious effect on in vitro fertilization outcome.
Loveland J B,McClamrock H D,Malinow A M,Sharara F I
Journal of assisted reproduction and genetics
PURPOSE:Few studies have addressed the effect of weight on IVF outcome, with some showing a decrease in IVF success and some showing no change in overweight women (BMI > 25 kg/m2) compared to women with normal weight (BMI < 25 kg/m2). METHODS:One hundred thirty-nine women < 40 years old undergoing 180 IVF cycles with fresh embryo transfers were retrospectively evaluated between January 1997 and March 1999, stratified by body mass index (BMI) (cutoff of 25). RESULTS:In the group with BMI > 25 kg/m2, basal FSH, implantation rates (IR), and pregnancy rates (PR) were significantly lower, while the duration of stimulation, gonadotropin requirements, and spontaneous miscarriages were slightly higher, compared to the BMI < or = 25 group. CONCLUSIONS:Excess weight defined as BMI > 25 kg/m2 has a negative impact on IVF outcome. Future prospective studies evaluating oocyte and/or embryo quality, and androgen and insulin levels, between overweight women and those with normal weight are needed.
Impact of body mass index on in vitro fertilization outcomes.
Frattarelli John L,Kodama Catherine Lee
Journal of assisted reproduction and genetics
PURPOSE:To determine if body mass index (BMI) impacts IVF outcome. METHODS:Retrospective, cohort study. Main outcome measure was number of oocytes obtained. RESULTS:BMI did not correlate with the prestimulation parameters. There was a significant positive correlation between BMI and the number of follicles on ultrasound prior to egg retrieval. A threshold analysis revealed a significant change in parameters at a BMI > 24 kg/m2. Patients with BMI > 24 kg/m2 demonstrated a significant increase in the number of follicles after stimulation (p = 0.03) and a comparative decrease in the number ampules of gonadotropins used (p = 0.04) and days of stimulation required (p = 0.01). CONCLUSION:These data demonstrated that an elevated BMI significantly correlates with the number of follicles, days of stimulation, and number of ampules of gonadotropins used. Further correlation to an actual increase in number of oocytes and pregnancy rates may be limited by insufficient power in this study.
IVF outcomes in obese donor oocyte recipients: a systematic review and meta-analysis.
Jungheim E S,Schon S B,Schulte M B,DeUgarte D A,Fowler S A,Tuuli M G
Human reproduction (Oxford, England)
STUDY QUESTION:Does obesity influence the chance of pregnancy after IVF in donor oocyte recipients? SUMMARY ANSWER:The chance of pregnancy after IVF is no different in obese donor oocyte recipients versus those in the normal BMI range. WHAT IS KNOWN ALREADY:Obesity is associated with decreased chances of pregnancy in women undergoing IVF with autologous oocytes. Prior studies have investigated the impact of obesity on IVF outcomes in donor oocyte recipients, with disparate results. This is the first systematic review and meta-analysis to address this topic. STUDY DESIGN, SIZE, DURATION:A systematic review and meta-analysis of published literature identified in Medline, EMBASE and Scopus through December of 2011 were performed to address the association between BMI and outcomes for donor oocyte recipients. The primary outcome of this study was implantation. PARTICIPANTS/MATERIALS, SETTING, METHODS:Two authors conducted the searches independently, selected the studies and abstracted the data. Studies in English of first donor oocyte cycles with reported recipient BMI were included. Primary data collected from the IVF program at Washington University were also included as one study (n = 123 donor oocyte recipients). Studies limited to frozen embryo transfer were excluded. Data were synthesized using DerSimonian-Laird random effects models for implantation, clinical pregnancy, miscarriage and live birth. MAIN RESULTS AND THE ROLE OF CHANCE:Of 475 screened articles, 7 were reviewed and 5 were included together with primary data from Washington University, giving a total of 4758 women who were included for the assessment of the primary outcome. No associations between obesity (BMI ≥ 30 kg/m(2)) and chance of pregnancy after IVF were noted in women using donor oocytes [risk ratio (RR): 0.98, 95% confidence intervals (CI): 0.83-1.15, I(2): 61.6%]. Additional analyses assessing associations between recipient obesity and embryo implantation (RR: 0.93, 95% CI: 0.80-1.07, I(2): 0%), miscarriage (RR: 1.12, 95% CI: 0.83-1.50, I(2): 0%) and live birth (RR: 0.91, 95% CI: 0.65-1.27, I(2) 47.9%) also failed to show a negative effect. LIMITATIONS, REASONS FOR CAUTION:Included studies were small and they were performed in a variety of locations and practice settings where stimulation and laboratory protocols may differ, and extremes of BMI may also differ. Furthermore, included studies had different inclusion and exclusion criteria. These factors could not be controlled for in this meta-analysis and statistical heterogeneity was noted for some outcomes. WIDER IMPLICATIONS OF THE FINDINGS:These data suggest obesity does not affect IVF outcomes in women using donor oocytes. Oocyte quality rather than endometrial receptivity may be the overriding factor influencing IVF outcomes in obese women using autologous oocytes. STUDY FUNDING/COMPETING INTEREST(S):E.S.J. and M.G.T receive support from the Women's Reproductive Health Research Program sponsored by the National Institutes of Health (K12 HD063086). The authors do not have any competing interests. TRIAL REGISTRATION NUMBER:N/A.
Elevated body mass index (BMI) does not adversely affect in vitro fertilization outcome in young women.
Martinuzzi Kurt,Ryan Sarah,Luna Martha,Copperman Alan B
Journal of assisted reproduction and genetics
OBJECTIVE:To determine if elevated body mass index in young women with normal ovarian reserve was associated with poorer ovarian response, difficulty at embryo transfer, and lower clinical pregnancy rates. MATERIALS AND METHODS:Retrospective study of 417 first, fresh in vitro fertilization cycles performed between October 2004 and December 2006. All women were under the age of 35 and had normal cycle day 3 follicle stimulating hormone and estradiol levels. Subjects were divided into groups by BMI: <18.5, 18.5-24.9, 25-29.9, > or = 30. RESULTS:Cancellation rates, peak estradiol levels, and mean number of oocytes retrieved were similar in all groups. There was a trend toward increasing difficulty in visualizing the air bubble at time of embryo transfer and lower implantation rates at higher body mass indices. Clinical and ongoing pregnancy rates were similar among groups. CONCLUSION:Obesity in young women does not adversely affect clinical pregnancy rates in patients treated with in vitro fertilization.
The correlation between raised body mass index and assisted reproductive treatment outcomes: a systematic review and meta-analysis of the evidence.
Supramaniam Prasanna Raj,Mittal Monica,McVeigh Enda,Lim Lee Nai
BACKGROUND:Public funding for fertility services within the United Kingdom is limited, and therefore, strict guidance exists regarding who can be offered treatment under the National Health Service (NHS). Body mass index (BMI) is a universal criteria adopted by both the public and private sector. This study addresses an important aspect of the impact of a raised BMI on fertility treatment outcomes. We standardise the analysis of the data by only including studies incorporating the WHO BMI criteria; the current reference point for clinicians and clinical commissioning groups in ascertaining which group of patients should receive treatment. This study is an update of the previous systematic review performed in 2010, with the inclusion of a larger number of cycles from central databases such as the Society for Assisted Reproductive Technology (SART). METHODS:An electronic literature search was conducted through the Cochrane, Medline and Embase libraries. Data extraction for each outcome measure was pooled and expressed as an odds ratio with 95% confidence intervals. Where clinical heterogeneity was evident, the random effects model was used to calculate the risk ratio and a fixed effects model was used for the remaining studies. A p value < 0.05 was considered statistically significant. RESULTS:A total of 49 studies have been identified and included in this systematic review. Overweight and obese (BMI ≥ 25 kg/m) women have a statistically significant lower live birth rate (OR 0.81, 95% CI 0.74-0.89, p < 0.00001) following Assisted Reproductive Technology (ART) when comparisons are drawn to women with a normal BMI. An increase is also demonstrated in the number of miscarriages experienced by women with a BMI ≥ 30 kg/m (OR 1.52, 95% CI 1.28-1.81, p < 0.00001). CONCLUSION:Although this review concludes that a clear impact of BMI on ART outcomes is demonstrated, there remains questions as to the pathophysiology underlying these differences. This review supports the government's stringent criteria regarding BMI categories under which NHS funding is made available for ART, through a clear description of poor reproductive outcomes in women with a BMI ≥ 30 kg/m.
The impact of male overweight on semen quality and outcome of assisted reproduction.
Thomsen Lise,Humaidan Peter,Bungum Leif,Bungum Mona
Asian journal of andrology
It is well-documented that male overweight and obesity causes endocrine disorders that might diminish the male reproductive capacity; however, reports have been conflicting regarding the influence of male body mass index (BMI) on semen quality and the outcome of assisted reproductive technology (ART). The aim of this study was to investigate whether increased male BMI affects sperm quality and the outcome of assisted reproduction in couples with an overweight or obese man and a non-obese partner. Data was prospectively collected from 612 infertile couples undergoing ART at a Danish fertility center. Self-reported information on paternal height and weight were recorded and BMI was calculated. The men were divided into four BMI categories: underweight BMI < 20 kg m(-2) normal BMI 20-24.9 kg m(-2), overweight BMI 25-29.9 kg m(-2) and obese BMI > 30 kg m(-2). Conventional semen analysis was performed according to the World Health Organization guideline and sperm DNA integrity was analyzed by the Sperm Chromatin Structure Assay (SCSA). No statistically significant effect of male BMI was seen on conventional semen parameters (sperm concentration, total sperm count, seminal volume and motility) or on SCSA-results. Furthermore, the outcome of ART regarding fertilization rate, number of good quality embryos (GQE ), implantation and pregnancy outcome was not influenced by the increasing male BMI.
Body mass index and pregnancy outcome after assisted reproduction treatment.
Kasim Khaled,Roshdy Ahmed
International journal of reproductive medicine
The present study aimed to evaluate the impact of body mass index (BMI) on pregnancy outcome after intracytoplasmic sperm injection (ICSI). The study analyzed pregnancy outcome of 349 women who underwent ICSI by their BMI: <25, 25-<30, and ≥30 kg/m(2). The associations were generated by applying logistic regression models. A significant reduction in positive pregnancy outcome was observed among overweight and obese women (odds ratio (OR) = 0.50; 95% confidence interval (CI) = 0.25-0.99 for overweight women and OR = 0.45; 95% CI = 0.20-0.89 for obese women). These estimates show that the pregnancy rates are reduced with increasing BMI. The effect of obesity on pregnancy outcome was absent when three and more embryos were transferred. Our study contributes to the reports linking overweight and obesity with decreased positive pregnancy outcome after ICSI and suggests women's age, infertility type, and number of embryos transferred to modify this reducing effect.
Morbid obesity and pregnancy outcomes after single blastocyst transfer: a retrospective, North American study.
Russo Miguel,Ates Senem,Shaulov Talya,Dahan Michael H
Journal of assisted reproduction and genetics
PURPOSE:Maternal obesity has been shown to affect reproductive function and pregnancy outcomes following in vitro fertilization. More recently, studies have demonstrated lower live birth rates after single blastocyst transfer (SBT) in patients who are overweight or obese. However, the impact of morbid obesity on pregnancy outcomes after SBT has not been well elucidated. The present study aimed to determine whether morbid obesity has a detrimental impact on pregnancy outcomes after SBT in a North American population. METHODS:A retrospective, cohort study including 520 nulliparous and multiparous women undergoing top-quality SBT between August 2010 and March 2014 at a University Health Centre in North America was conducted. Primary outcomes included: miscarriage rate, clinical pregnancy rate, and live birth rate. Subjects were divided into different BMI categories (kg/m), including <20, 20-24.9, 25.0-29.9, 30-40, and 40 or more. RESULTS:The miscarriage rate per pregnancy for each group, respectively, was 36, 64, 59, 61, and 50% (p = 0.16); the clinical pregnancy (per patient) rate per group was 36, 52, 38, 26, and 10% (p = 0.009); and the live birth rate (per patient) per group was 35, 50, 38, 26 and 10% (p = 0.03). CONCLUSION:Morbid obesity is a strong and independent predictor of poor pregnancy outcomes in patients undergoing top-quality SBT.
Does obesity have detrimental effects on IVF treatment outcomes?
Ozekinci Murat,Seven Ali,Olgan Safak,Sakinci Mehmet,Keskin Ugur,Akar Munire Erman,Ceyhan Seyit Temel,Ergun Ali
BMC women's health
BACKGROUND:The aim of this study was to investigate the influence of body mass index (BMI) on the in vitro fertilization (IVF) treatment outcomes in a cohort of women undergoing their first IVF, using an intracytoplasmic sperm injection (ICSI). METHODS:This retrospective cohort study included 298 cycles from women younger than 38 years old undergoing IVF-ICSI at a university infertility clinic. The treatment cycles were divided into three groups according to the BMI of the women involved: normal weight (18.5 ≤ BMI < 25 kg/m(2), 164 cycles), overweight (25 ≤ BMI < 30 kg/m(2), 70 cycles), and obese (BMI ≥ 30 kg/m(2), 64 cycles). The underweight women (BMI < 18.5 kg/m(2)) were not included in the analysis due to small sample size (n = 22). The patient characteristics and IVF-ICSI treatment outcomes were compared between the BMI groups. RESULTS:The total gonadotropin dose (p <0.001) and duration of stimulation (p = 0.008) were significantly higher in the obese group when compared to the normal BMI group. There were no significant differences across the BMI categories for the other IVF-ICSI cycle outcomes measured, including the number of retrieved oocytes, mature oocytes, embryos suitable for transfer, proportion of oocytes fertilized, and cycle cancellation rates (p >0.05 for each). Additionally, clinical pregnancy, spontaneous abortion, and the ongoing pregnancy rates per transfer were found to be comparable between the normal weight, overweight, and obese women (p >0.05 for each). CONCLUSION:Obese women might require a significantly higher dose of gonadotropins and longer stimulation durations, without greatly affecting the pregnancy outcomes.
Effect of pregravid obesity on perinatal outcomes in singleton pregnancies following in vitro fertilization and the weight-loss goals to reduce the risks of poor pregnancy outcomes: A retrospective cohort study.
Liu Lu,Wang Hongmei,Zhang Yang,Niu Jinlei,Li Zhongyuan,Tang Rong
OBJECTIVE:In the present study, we aimed to determine whether pregravid obesity independently predicts increased risks of perinatal complications following in vitro fertilization (IVF) and the weight loss goals to reduce the risk of poor pregnancy outcomes. DESIGN:Retrospective cohort study. POPULATION:All pregnancies after first the fresh IVF cycle from January 2014 to December 2016 in the Reproductive Center affiliated to Shandong University were reviewed. A total of 3,962 eligible singleton births were stratified into cohorts based on the body mass index (BMI) definitions of the Working Group on Obesity in China (WGOC). MAIN OUTCOME MEASURES:Adverse perinatal outcomes. RESULTS:Pregravid overweight and obesity were associated with increased risks of gestational diabetes mellitus (GDM), hypertensive disorders of pregnancy (HDP), including gestational hypertension (GH) and pre-eclampsia (PE), polyhydramnios, preterm premature rupture of the membranes (PPROM), placental abruption, preterm birth (PTB) <37 weeks, caesarean section (CS), fetal macrosomia, large for gestational age (LGA) >90th percentile, neonatal respiratory distress syndrome (NRDS), neonatal intensive care unit (NICU) admission and congenital anomalies as compared with the normal-weight group after adjustment of differences in age, parity, polycystic ovary syndrome (PCOS) and type of controlled ovarian hyperstimulation (COH). The increased risks of PPROM, NRDS and congenital anomalies were eliminated after adjustment of GDM development, whereas the increased risk of NRDS disappeared after adjustment of HDP. Placenta previa was not significantly different between the obese group and reference group (REF). Moreover, the rates of postpartum hemorrhage (PPH), PTB<32 weeks, small for gestational age (SGA) >90th percentile and perinatal mortality were also not significantly different between above-mentioned two groups. For obese women, a 10%-15% reduction in prepregnancy BMI was associated with significantly decreased risks of GH, CS and fetal macrosomia. For overweight women, just a 5% reduction in BMI could significantly reduce the risks of GDM, CS and fetal macrosomia. CONCLUSIONS:Pregravid obesity could independently predict a higher risk of adverse pregnancy outcomes after adjustment of differences in maternal age, parity, PCOS, and type of COH in IVF pregnancies. The potential mechanism that obesity potentiated the risks of some poor perinantal outcomes might occur through the development of GDM and HDP. A 10%-15% reduction in pregravid BMI for obese women and a 5% reduction for overweight women were associated with a significant reduction of poor perinatal complications.
The influence of body mass index on pregnancy outcome following single-embryo transfer.
Ben-Haroush Avi,Sirota Ido,Salman Lina,Son Weon-Young,Tulandi Togas,Holzer Hananel,Oron Galia
Journal of assisted reproduction and genetics
PURPOSE:The association between obesity and reproductive outcome is controversial. The aim of this study is to evaluate the effects of obesity on clinical pregnancy rates following transfer of a single fresh embryo. METHODS:A retrospective cohort study was conducted at a single tertiary medical center, including all first, fresh, single-embryo transfers using non-donor oocytes, during 2008-2013. We compared clinical pregnancy rate and pregnancy outcomes of singleton live births resulting from the transfer of a single fresh embryo in normal weight, overweight, and obese women, defined as body mass index (BMI) < 25 kg/m, ≥ 25 BMI <30 kg/m, and BMI ≥ 30 kg/m, respectively. RESULTS:Overall, 1345 cases met the inclusion criteria with 864 single-embryo transfers (SETs) in normal weight women, 292 in overweight women, and 189 SETs in obese women, resulting in 538 clinical pregnancies and 354 singleton births. The clinical pregnancy rate per transfer was similar among the three groups (41.3, 37.6, 37.5%, respectively, p = 0.416). Similarly, there were no significant differences in live births or ongoing pregnancies. On multivariate logistic regression analysis, BMI did not impact the likelihood for clinical pregnancy (OR 0.98, 95% CI 0.96-1.008, p = 0.216). CONCLUSIONS:Our study demonstrated that obesity has no detrimental effect on the clinical pregnancy rate resulting from the transfer of a single fresh embryo.
Effect of male and female body mass index on pregnancy and live birth success after in vitro fertilization.
Schliep Karen C,Mumford Sunni L,Ahrens Katherine A,Hotaling James M,Carrell Douglas T,Link Megan,Hinkle Stefanie N,Kissell Kerri,Porucznik Christina A,Hammoud Ahmad O
Fertility and sterility
OBJECTIVE:To assess the effects of both male and female body mass index (BMI), individually and combined, on IVF outcomes. DESIGN:Prospective cohort study. SETTING:University fertility center. PATIENT(S):All couples undergoing first fresh IVF cycles, 2005-2010, for whom male and female weight and height information were available (n = 721 couples). INTERVENTION(S):None. MAIN OUTCOME MEASURE(S):Embryologic parameters, clinical pregnancy, and live birth incidence. RESULT(S):The average male BMI among the study population was 27.5 ± 4.8 kg/m(2) (range, 17.3-49.3 kg/m(2)), while the average female BMI (n = 721) was 25.2 ± 5.9 kg/m(2) (range, 16.2-50.7 kg/m(2)). Neither male nor female overweight (25-29.9 kg/m(2)), class I obese (30-34.9 kg/m(2)), or class II/III obese (≥35 kg/m(2)) status was significantly associated with fertilization rate, embryo score, or incidence of pregnancy or live birth compared with normal weight (18.5-24.9 kg/m(2)) status after adjusting for male and female age, partner BMI, and parity. Similar null findings were found between combined couple BMI categories and IVF success. CONCLUSION(S):Our findings support the notion that weight status does not influence fecundity among couples undergoing infertility treatment. Given the limited and conflicting research on BMI and pregnancy success among IVF couples, further research augmented to include other adiposity measures is needed.
Cumulative Live Birth Rates According to Maternal Body Mass Index After First Ovarian Stimulation for Fertilization: A Single Center Analysis of 14,782 Patients.
Xue Xia,Shi Wenhao,Zhou Hanying,Tian Li,Zhao Zhenghao,Zhou Dangxia,Shi Juanzi
Frontiers in endocrinology
To investigate the cumulative live birth rates (CLBR) according to body mass index (BMI) in women undergoing their first fertilization (IVF). Retrospective cohort analysis. An IVF clinic in a public hospital. This is a retrospective study of 14,782 patients undergoing their first fresh IVF cycles and subsequent frozen embryo transfers in our clinic from January 2014 to January 2017. The follow-up for CLBR continued until January 2019. Patients with a BMI <18.5 kg/m were considered to be underweight and those with a BMI > 24 kg/m were considered to be overweight. Patients with a BMI ≥ 28 kg/m were considered to be obese. None. The primary outcome was cumulative live birth rate (CLBR). This study illustrated the "inverted U shape" associations between body weight and IVF outcome (CLBR). The turning points in threshold analysis, as found by an automatic search, were BMIs of 18.5 and 30.4 kg/m. The main finding of this retrospective data analysis is that the CLBR increased in underweight women, plateaued for normal weight and overweight women with a BMI between 18.5 and 30.4 kg/m, and decreased in obese women. The data suggested an "inverted U shape" association between BMI and CLBR. The CLBR increases in underweight women, plateaus in normal weight and overweight women, and then decreases in obese women.
Impact of Women Obesity and Obesity Severity on Live Birth Rate after In Vitro Fertilization.
Brunet Cécile,Aouinti Safa,Huguet Fanchon,Macioce Valérie,Ranisavljevic Noémie,Gala Anna,Avignon Antoine,Mura Thibault,Sultan Ariane
Journal of clinical medicine
Access to in vitro fertilization (IVF) for obese women varies across centers, and the impact of obesity on IVF outcomes is widely discussed. We assessed the impact of obesity and its severity on live birth rate (LBR) after IVF. We included women treated for IVF in our center. Data were prospectively collected in the BabySentry software. LBR per cycle and cumulative LBR including all attempts of the couple were calculated, considering transfer of both fresh and frozen embryos. Of 1588 included women (2379 controlled ovarian stimulations), 70.2%, 19.5%, 7.9%, and 2.4% were normal-weight, overweight, class I obesity, and class II/III obesity, respectively. For each cycle, LBR did not differ according to BMI category. Adjusted odds ratios (95% confidence intervals) for obtaining a live birth at the first cycle were 1.11 (0.78-1.58) for overweight, 1.17 (0.70-1.95) for class I obese, and 1.05 (0.48-2.31) for class II/III obese women, as compared with normal-weight women. Similarly, no significant associations were found at cycles 2, 3, and 4. Cumulative LBR increased with the number of cycles, independently of the BMI class ( log-rank = 0.91). After adjustment, obesity status did not impact significantly the miscarriage rate, regardless of the cycle. In conclusion, neither women obesity nor its severity impacted the cumulative LBR after IVF.
The effect of female body mass index on in vitro fertilization cycle outcomes: a multi-center analysis.
Kudesia Rashmi,Wu Hongyu,Hunter Cohn Karen,Tan Lei,Lee Joseph A,Copperman Alan B,Yurttas Beim Piraye
Journal of assisted reproduction and genetics
PURPOSE:The aim of this study is to examine the impact of female body mass index (BMI) on IVF cycle outcomes. METHODS:This is a retrospective cohort study including 51,198 women who initiated their first autologous IVF cycle in 13 fertility centers in the USA between 2009 and 2015. The effect of underweight, overweight, and obese BMI on four different IVF cycle outcomes (cycle cancellation, oocyte and embryo counts, and ongoing clinical pregnancy [OCP]) was evaluated in logistic or Poisson regression analyses with confounders adjusted. RESULTS:Women with an overweight or obese BMI experienced worse outcomes than those with a normal BMI. These differences included (1) greater odds of cycle cancellation (aOR [95%CI] 1.17 [1.08, 1.26] for overweight, 1.28 [1.15, 1.41] for class-I obesity, and 1.50 [1.33, 1.68] for class-II/III obesity, P < .001 for all); (2) fewer oocytes retrieved (aIRR [95%CI] 0.98 [0.98,0.99] for class-I obesity, 0.93 [0.92,0.94] for class-II/III obesity, P < .001 for both); (3) fewer usable embryos (aIRR [95%CI] 0.98 [0.97,0.99] for overweight, 0.97 [0.96,0.99] for class-I obesity, 0.95 [0.93,0.97] for class-II/III obesity, P < .01 for all); and (4) lower odds of OCP (aOR [95%CI] 0.89 [0.83,0.95] for class-I obesity, 0.86 [0.79,0.93] for class-II/III obesity, P < .001 for both). In a subgroup analysis based on primary infertility diagnosis, these trends persisted in those with male or uterine factor and were especially pronounced in women with ovulatory dysfunction or PCOS. CONCLUSIONS:A BMI above the normal range was an independent negative prognostic factor for multiple outcomes, including cycle cancellation, oocyte and embryo counts, and OCP. These negative outcomes were most profound in women with class-II/III obesity, ovulatory dysfunction, or PCOS.
A Comprehensive Analysis of Body Mass Index Effect on in Vitro Fertilization Outcomes.
Sarais Veronica,Pagliardini Luca,Rebonato Giorgia,Papaleo Enrico,Candiani Massimo,Viganò Paola
The effect of a raised body mass index (BMI) on the outcome of assisted reproduction technology (ART) still represents a controversial issue. Even less clear is whether BMI acts with a potential detrimental effect on IVF outcomes via a deleterious effect on innate quality of oocytes or on the environmental milieu within the uterus. With the aim to better understand the mechanisms underlying the potential deleterious effect of an increased BMI on IVF outcomes, we have evaluated the effects of female BMI on number and quality of retrieved oocytes, fertilization rate, embryo score and incidences of ongoing pregnancy and live births among couples undergoing IVF in an Italian population. Data from 1602 women who underwent their first IVF cycle were retrospectively analyzed. A significantly reduced percentage of mature oocytes when comparing obese (BMI ≥ 30 kg/m²) and normal-weight patients (BMI = 18.50-24.99 kg/m²) was found. After adjusting for maternal age and other confounders, odds for ongoing pregnancy rate showed no differences across different BMI categories. However, a significant increased odds ratio (OR) could be observed for miscarriage rate in patients with BMI ≥ 25 (OR = 2.5; p = 0.04). These results should be taken into account in order to define optimal strategies for overweight and obese patients referring to ART procedures.
The Effects of Maternal and Paternal Body Mass Index on Live Birth Rate after Intracytoplasmic Sperm Injection Cycles.
Arabipoor Arezoo,Ashrafi Mahnaz,Hemat Mandana,Zolfaghari Zahra
International journal of fertility & sterility
Background:We designed the present study to evaluate the simultaneous effect of obesity in couples on in vitro fertilization/ intracytoplasmic sperm injection (IVF/ICSI) outcomes. Materials and Methods:In this cross-sectional study, performed at Royan Institute between January 2013 and January 2014, we evaluated the recorded data of all patients during this time period. The study population was limited to couples who underwent ICSI or IVF/ICSI cycles with autologous oocytes and fresh embryo transfers. We recorded the heights and weights of both genders and divided them into groups according to body mass index (BMI). Multilevel logistic regression analysis was used to determine the odds ratio for live births following ICSI or IVF/ICSI. Results:In total, 990 couples underwent IVF/ICSI cycles during the study period. Among the ovulatory women, a significant difference existed between the BMI groups. There was a 60% decrease [95% confidence interval (CI): 0.11-0.83] in the odds of a live birth among overweight subjects and 84% (95% CI: 0.02-0.99) decrease among obese subjects. Among the anovulatory women, the association between the BMI and live births presented no clear tendencies. We did not observe any significant relationship between male BMI and live birth rate. The results demonstrated no significant association between the couples' BMI and live birth rate. Conclusion:Based on the present findings, increased female BMI independently and negatively influenced birth rates after ICSI. However, increased male BMI had no impact on live births after ICSI, either alone or combined with increased female BMI.
Effect of weight status on pregnancy outcome in intra cytoplasmic sperm injection.
Rehman Rehana,Hussain Zahir,Fatima Syeda Sadia
Iranian journal of reproductive medicine
BACKGROUND:There has been an increase in number of obese infertile females booked for advanced infertility treatment procedures like in vitro fertilization (IVF) and intra cytoplasmic sperm injection (ICSI). The knowledge of impact of body mass index (BMI) on reproductive outcome can help to counsel these patients. OBJECTIVE:To compare reproductive outcome in females of different BMI after ICSI. MATERIALS AND METHODS:Cross-sectional study of 323 females was conducted from June 2010 till August 2011. Females were grouped on the basis of BMI; underweight, (BMI <18 kg/m(2)), normal weight, (BMI 18-22.9 kg/m(2)) overweight (BMI 23-25.9 kg/m(2)) and obese (BMI ≥26 kg/m(2)). The procedure involved down regulation of ovaries, controlled ovarian stimulation, ovulation induction by hCG, oocyte pickup, in vitro fertilization and embryo transfer of blastocysts. The oocyte yield and embryological data of all BMI groups was compared by ANOVA (analysis of variance). Pregnancy outcome of these was categorized as; no conception βhCG <5 m IU/ml, preclinical abortion with βhCG >5 m IU/ml, no cardiac activity on trans vaginal scan (TVS) and clinical pregnancy with βhCG >5mIU/ml and cardiac activity on trans vaginal scan. RESULTS:Females with BMI 23-25.99 kg/m(2) had maximum oocyte retrieval, fertilization, implantation and clinical pregnancy rates in comparison to obese females with BMI ≥26 kg/m(2). CONCLUSION:A BMI cut off value of above 26 kg/m(2) in our study population is associated with a negative impact on pregnancy outcome.
Men's body mass index in relation to embryo quality and clinical outcomes in couples undergoing in vitro fertilization.
Colaci Daniela S,Afeiche Myriam,Gaskins Audrey J,Wright Diane L,Toth Thomas L,Tanrikut Cigdem,Hauser Russ,Chavarro Jorge E
Fertility and sterility
OBJECTIVE:To evaluate the association between men's body mass index (BMI), early embryo quality, and clinical outcomes in couples undergoing in vitro fertilization (IVF). DESIGN:Prospective cohort study. SETTING:Fertility clinic in an academic medical center. PATIENT(S):114 couples who underwent 172 assisted reproduction cycles. INTERVENTION(S):None. MAIN OUTCOME MEASURE(S):Fertilization rate, embryo quality, implantation rate, clinical pregnancy rate, and live birth rate. RESULT(S):The fertilization rate was higher among obese men than among normal weight men in conventional IVF cycles. No statistically significant associations were found between men's BMI and the proportion of poor-quality embryos on day 3, slow embryo cleavage rate, or accelerated embryo cleavage rate. Men's BMI was unrelated to positive β-human chorionic gonadotropin rate, clinical pregnancy rate, or live-birth rate per embryo transfer. Among couples undergoing intracytoplasmic sperm injection, the odds of live birth in couples with obese male partners was 84% lower than the odds in couples with men with normal BMI. CONCLUSION(S):Our data suggest a possible deleterious effect of male obesity on the odds of having a live birth among couples undergoing intracytoplasmic sperm injection.
The impact of female obesity on the outcome of fertility treatment.
Pandey Shilpi,Pandey Suruchi,Maheshwari Abha,Bhattacharya Siladitya
Journal of human reproductive sciences
The rising prevalence of obesity has had a profound impact on female reproductive health. Increased body mass index (BMI) is associated with ovulatory subfertility and anovulatory infertility. Overweight and obese women have poorer outcomes following fertility treatment. They respond poorly to clomiphene induction of ovulation and require higher doses of gonadotrophins for ovulation induction and superovulation. Ovarian stimulation for assisted reproduction produces fewer follicles resulting in the harvest of fewer oocytes. Fertilization rates are poorer and the embryo quality is impaired in younger women who are obese. Pregnancy rate in some studies is lower and there is an increased risk of early pregnancy loss. Weight loss regularizes menstrual cycles and increases the chance of spontaneous ovulation and conception in anovulatory overweight and obese women. Gradual sustained weight loss is beneficial whereas crash dieting is detrimental.
Effect of body mass index on in vitro fertilization outcomes in women.
Sathya Anjali,Balasubramanyam Sathya,Gupta Shalu,Verma Thankam
Journal of human reproductive sciences
BACKGROUND:Obesity has become a major health problem across the world. In women, it is known to cause anovulation, subfecundity, increased risk of fetal anomalies and miscarriage rates. However, in women going for assisted reproduction the effects of obesity on egg quality, embryo quality, clinical pregnancy, live birth rates are controversial. OBJECTIVES:To assess the effect of women's body mass index (BMI) on the reproductive outcome of non donor In vitro fertilization (IVF)/Intracytoplasmic sperm injection (ICSI). The effects of BMI on their gonadotrophin levels (day 2 LH, FSH), gonadotrophin dose required for ovarian stimulation, endometrial thickness and oocyte/embryo quality were looked at, after correcting for age and poor ovarian reserve. MATERIALS AND METHODS:Retrospective study of medical records of 308 women undergoing non donor IVF cycles in a University affiliated teaching hospital. They were classified into three groups: normal weight (BMI<25 kg/m(2)), overweight (BMI>25 <30 kg/m(2)) and obese (BMI>30 kg/m(2)). All women underwent controlled ovarian hyper stimulation using long agonist protocol. RESULTS:There were 88 (28.6%) in the normal weight group, 147 (47.7%) in the overweight and 73 (23.7%) in the obese group. All three groups were comparable with respect to age, duration of infertility, female and male causes of infertility. The three groups were similar with respect to day 2 LH/FSH levels, endometrial thickness and gonadotrophin requirements, oocyte quality, fertilization, cleavage rates, number of good quality embryos and clinical pregnancy rates. CONCLUSION:Increase in body mass index in women does not appear to have an adverse effect on IVF outcome. However, preconceptual counselling for obese women is a must as weight reduction helps in reducing pregnancy-related complications.
Body mass index and short-term weight change in relation to treatment outcomes in women undergoing assisted reproduction.
Chavarro Jorge E,Ehrlich Shelley,Colaci Daniela S,Wright Diane L,Toth Thomas L,Petrozza John C,Hauser Russ
Fertility and sterility
OBJECTIVE:To assess the relation between body mass index (BMI) and short-term weight change with assisted reproductive technology (ART) outcomes. DESIGN:Prospective cohort study. SETTING:Fertility center. PATIENT(S):A total of 170 women undergoing 233 ART cycles. INTERVENTION(S):Baseline BMI and short-term weight change were related to ART outcomes. Regression models accounting for repeated observations were used to adjust data for potential confounders. MAIN OUTCOME MEASURE(S):Peak E2 levels, oocyte yield, MII yield, fertilization rate, embryo quality, postive [beta]-hCH, clinical pregnancy and live birth rates. RESULT(S):Overweight and obesity were associated with lower live birth rates. The adjusted live birth rate (95% confidence interval) was 42% (28%-58%) among women with a BMI between 20 and 22.4 kg/m(2) and 23% (14%-36%) among overweight or obese women. Short-term weight loss was associated with a higher proportion of metaphase II (MII) oocytes retrieved. The adjusted proportion of MII eggs was 91% (87%-94%) for women who lost 3 kg or more and 86% (81%-89%) for women whose weight remained stable. This association was stronger among women who were overweight or obese at baseline. Short-term weight loss was unrelated to positive β-hCG, clinical pregnancy, or live birth rates. CONCLUSION(S):Overweight and obesity were related to lower live birth rates in women undergoing ART. Short-term weight loss was related to higher MII yield, particularly among overweight and obese women, but unrelated to clinical outcomes.
Correlation between body mass index of Chinese males and assisted reproductive technology outcome.
Wu Zhengmu,Lu Xiang,Wang Min,Cheng Huaijin
International journal of clinical and experimental medicine
OBJECTIVE:To investigate the relationship between male's body mass index (BMI) and the outcome of assisted reproductive technology (ART). In this retrospective study, we analyzed the data from 729 cycles of female patients aged 38 years or less, with normal BMI and who received IVF treatments between January, 2013 and June, 2014. The patients were divided into normal weight (n = 358), overweight (n = 267), and obese (n = 104) groups according to the BMI of their male partners. Embryonic development and pregnancy outcomes in these three groups were compared. RESULTS:With increasing BMI, fertilization rates decreased proportionately (P < 0.05); but embryonic cleavage rates and effective embryo rates were not significantly affected (P > 0.05). There was no significant difference in implantation rates, pregnancy rates, or early miscarriage rates (P > 0.05) among the three groups. CONCLUSIONS:High male BMI affects fertilization rate with ART; and we recommend that men of reproductive age adjust their lifestyles accordingly and make efforts to control their weight.
Effect of Body Mass Index on the Outcome of Fertilization/Intracytoplasmic Sperm Injection in Women.
Banker Manish,Sorathiya Dipesh,Shah Sandeep
Journal of human reproductive sciences
BACKGROUND:Obesity, a known epidemic, is a leading cause of various reproductive disorders. Association of body mass index (BMI) with pregnancy outcomes, either ovarian or endometrial, is controversial and least elucidated. AIM:This study aimed to analyze the effect of BMI on fertilization (IVF)/intracytoplasmic sperm injection (ICSI) outcome in women using self-oocytes, embryos prepared from donor oocytes (DE), or vitrified/frozen embryos (VE) obtained from both the SE and DE groups. MATERIALS AND METHODS:A 9-month retrospective study was conducted on women undergoing IVF/ICSI. The women were grouped according to the World Health Organization classification of BMI (<18.50, 18.50-24.99, 25.00-29.99, and ≥30.00 kg/m). They were further subcategorized as SE, DE, and VE groups. Ongoing pregnancy rate (OPR) was recorded as primary, whereas pregnancy rate (PR), clinical PR (CPR), implantation rate (IR), and clinical abortion rate (CAR) were secondary endpoints. Age, number of mature eggs, usable embryos, and embryos transferred were also measured. The data were statistically analyzed using chi-square and analysis of variance. -value <0.05 was considered statistically significant. RESULTS:OPR was statistically insignificant across all the groups. Secondary outcomes were statistically insignificant in all the groups except in VE, where IR ( = 0.008) and CAR ( = 0.0002) were statically significant. Other parameters were statistically insignificant among all the groups. However, in the SE and VE groups, the mean age was statistically significant (SE, = 0.0001; VE, = 0.0191). CONCLUSION:This study showed marginal/no effect of BMI on oocyte quality/endometrial receptivity and, subsequently, on the pregnancy outcome. However, well-designed, larger prospective studies are needed to clarify the role of BMI in pregnancy outcome in women undergoing IVF/ICSI.
Effect of parental physiological conditions and assisted reproductive technologies on the pregnancy and birth outcomes in infertile patients.
Zhong Xinqi,Liu Jianqiao,Cui Qiliang,Liang Shaozhen,Lin Yuanqing,Liu Haiying,Zeng Qiyi
Assisted reproductive technologies (ART) are widely used to treat infertility. Emerging evidence suggested that ART was associated with perinatal or neonatal problems, however, little is known about the ART related risk factors. Here using 21136 ART cases, we determined the impacts of parental physiological conditions in the ART mediated pregnancy outcomes. In addition, we further evaluated the effects of three different ART methods (frozen-thawed embryo transfer [FET], in vitro fertilization [IVF] and intracytoplasmic sperm injection [ICSI]) in the pregnancy and birth outcomes in ART mediated pregnancy. Our data revealed that older parental age increases the risks of abortion, preterm birth and low body weight birth. Higher maternal BMI (Body mass index) level correlates with higher abortion rate. Moreover, pregnancy with multiple fetuses has severer adverse outcomes compared to singleton pregnancy. Among the three ART methods, ICSI is associated with lower ratios of ectopic pregnancy, abortion and deformity compared to FET and IVF. Our study revealed new clinical insights into the ART related risk factors and suggested that both the parental physiological conditions and ART methods should be evaluated to develop better ART mediated infertility treatments.
Outcome of assisted reproductive technology in overweight and obese women.
MacKenna Antonio,Schwarze Juan Enrique,Crosby Javier A,Zegers-Hochschild Fernando
JBRA assisted reproduction
OBJECTIVE:The main objective of this study was to assess the prevalence of overweight and obesity among patients undergoing assisted reproductive technology (ART) in Latin America and its consequences on treatment outcomes. METHODS:We used the Latin American Registry of ART to obtain women's age and body mass index (BMI), cancellation rate, number of oocytes retrieved and embryos transferred, clinical pregnancy, live birth and miscarriage rates from 107.313 patients undergoing autologous IVF and ICSI during four years; a multivariable analysis was performed to determine the effect of BMI on cancellation, oocytes retrieved, pregnancy, live birth and miscarriage, adjusting for age, number of embryos transferred and embryo developmental stage upon embryo transfer, when appropriate. RESULTS:The prevalence of overweight and obesity was 16.1% and 42.4%, respectively; correcting for age of female partner, overweight and obesity were associated to an increase in the odds of cancellation and to a lower mean number of oocytes retrieved; after adjusting for age, number of embryos transferred and stage of embryo development at transfer, we found that the BMI category was not associated to a change in the likelihoods of pregnancy, live birth and miscarriage. CONCLUSIONS:The prevalence of obesity among women seeking ART in Latin America is surprisingly high; however, BMI does not influence the outcome of ART performed in these women.
Does body mass index impact assisted reproductive technology treatment outcomes in gestational carriers.
Fuchs Weizman Noga,Defer Miranda K,Montbriand Janice,Pasquale Julia M,Silver Adina,Librach Clifford L
Reproductive biology and endocrinology : RB&E
BACKGROUND:The purpose of this study was to assess whether increased body mass index (BMI) negatively affects assisted reproductive technology (ART) outcomes among gestational carriers. METHODS:A retrospective matched case-control cohort, including all gestational carrier (GC) cycles performed at CReATe Fertility Centre (Toronto, ON, Canada) between 2003 and 2016. SETTING:A Canadian fertility clinic, with a large surrogacy program. PATIENTS:All gestational carriers that had undergone a cycle completed to a transfer at our clinic, and had BMI and outcome data available, were matched by BMI to infertile patients treated at our clinic during the same years provided they had undergone a cycle completed to a transfer, and had outcomes data available. INTERVENTIONS:None. MAIN OUTCOME MEASURES:Clinical pregnancies rates, miscarriage rates and live birth rates. RESULTS:BMI was not a reliable prediction factor of any of the measured outcomes. Importantly, the gestational carrier population had better outcomes and a significantly lower overall incidence of maternal, fetal and neonatal complications when compared with infertile patients, treated at our clinic during the same years. CONCLUSION:BMI is not a reliable predictor of outcomes among gestational carriers.
Effect of the Interaction Between Pre-pregnancy Body Mass Index and Fresh/Frozen Embryo Transfer on Perinatal Outcomes of Assisted Reproductive Technology-Conceived Singletons: A Retrospective Cohort Study.
Qu Pengfei,Mi Yang,Zhao Doudou,Wang Min,Dang Shaonong,Shi Wenhao,Shi Juanzi
Frontiers in endocrinology
To demonstrate the association between pre-pregnancy maternal overweight, obesity, and perinatal outcomes of singletons conceived by assisted reproductive technology (ART). Retrospective cohort study from 2006 to 2015 data from a single ART center. Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, Northwestern China. We included 7,818 women undergoing ART and their singleton infants. None. The primary outcome measures were preterm birth (PTB), macrosomia, low birth weight, small for gestational age, and large for gestational age (LGA). We experienced an increase in the risk of PTB, macrosomia, and LGA in overweight and obese groups compared with that in normal-weight groups [PTB: overweight vs. normal weight: odds ratio [OR] = 1.44, 95% CI: 1.18-1.75; obesity vs. normal weight: OR = 1.53, 95% CI: 1.04-2.25; macrosomia: overweight vs. normal weight: OR = 1.78, 95% CI: 1.48-2.14; obesity vs. normal weight: OR = 2.16, 95% CI: 1.52-3.06; LGA: overweight vs. normal weight: OR = 1.63, 95% CI: 1.39-1.90; obesity vs. normal weight: OR = 2.11, 95% CI: 1.57-2.83]. We observed a significant interaction between maternal BMI and fresh/frozen embryo transfer on PTB and LGA ( = 0.030; = 0.030). Fresh embryo transfer significantly increased the effect of maternal BMI on LGA (fresh: OR = 1.14, 95% CI: 1.10-1.18; frozen: OR = 1.09, 95% CI: 1.04-1.13), and frozen embryo transfer increased the effect of maternal BMI on PTB (fresh: OR = 1.03, 95% CI: 0.99-1.08; frozen: OR = 1.09, 95% CI: 1.04-1.15). Pre-pregnancy maternal overweight and obesity were associated with higher risks of PTB, macrosomia, and LGA in ART-conceived singletons. These associations were affected by the timing of embryo transfer (fresh/frozen embryo transfer). Therefore, we recommend women before ART to maintain a normal BMI for the prevention of adverse perinatal outcomes.