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Bahrami, F., Dashti, S., Mangoli, E., & Hosseini, H. S. (2024). Does body mass index compromise assisted reproductive technique outcomes? A cross-sectional study. International Journal of Reproductive BioMedicine (IJRM), 21(12), 1021–1030. https://doi.org/10.18502/ijrm.v21i12.15040
https://doi.org/10.18502/ijrm.v21i12.15040
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authors
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Fereshteh Bahrami
Fereshteh Bahrami
Research and Clinical Center for Infertility, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
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Saeideh Dashti
Saeideh Dashti
Research and Clinical Center for Infertility, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
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Esmat Mangoli
Esmat Mangoli
Department of Reproductive Biology, Research and Clinical Center for Infertility, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
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Hanie Sadat Hosseini
Hanie Sadat Hosseini
Department of Physiology, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
Published Date
- Jan 23, 2024
Does body mass index compromise assisted reproductive technique outcomes? A cross-sectional study
Abstract
Background: Overweight and obese people face several health problems. Female obesity has been shown to reduce fertility in the general population. Assisted reproductive technology outcomes in obese cases are widely studied, but the results are inconclusive.
Objective: This study aimed to compare live birth rate (LBR) among women with 4 different types of body mass index (BMI).
Materials and Methods: In this cross-sectional study, data of 1611 women, who were candidates for fresh and frozen embryo transfer cycles, was extracted from 2051 medical files at the Reproductive Sciences Institute, Yazd, Iran from May 2019-May 2021. The participants were divided into 4 groups (underweight, normal, overweight, and obese) according to their BMI, and LBR was considered to be the main outcome.
Results: Of 1611 women, 39 were underweight, 585 were normal, 676 were overweight, and 311 were obese. Underweight women had the lowest LBR (12.8%), but there was no statistically significant difference (p = 0.55). In addition, LBR was compared in the 4 BMI groups according to age, type of transfer cycle (fresh or freeze), and cause of infertility, and there was comparable LBR in the 4 BMI groups. However, metaphase 2 oocyte rate, doses of gonadotropin usage in the cycles, and estradiol level had statistically significant differences (p < 0.001).
Conclusion: According to our study, obesity does not affect LBR in the IVF cycle, regardless of fresh or frozen embryo transfer cycles, different age groups, and causes of infertility.
Key words: Body mass index, Assisted reproductive technique, Pregnancy outcome, Live birth rate, Age.
References
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[2] Bellver J, Marín C, Lathi RB, Murugappan G, Labarta E, Vidal C, et al. Obesity affects endometrial receptivity by displacing the window of implantation. Reprod Sci 2021; 28: 3171–3180.
[3] Prost E, Reignier A, Leperlier F, Caillet P, Barrière P, Fréour T, et al. Female obesity does not impact live birth rate after frozen-thawed blastocyst transfer. Hum Reprod 2020; 35: 859–865.
[4] Jafari-Adli Sh, Jouyandeh Z, Qorbani M, Soroush A, Larijani B, Hasani-Ranjbar S. Prevalence of obesity and overweight in adults and children in Iran; a systematic review. J Diabetes Metab Disord 2014; 13: 121.
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[8] Provost MP, Acharya KS, Acharya CR, Yeh JS, Steward RG, Eaton JL, et al. Pregnancy outcomes decline with increasing recipient body mass index: An analysis of 22,317 fresh donor/recipient cycles from the 2008-2010 Society for Assisted Reproductive Technology Clinic Outcome Reporting System registry. Fertil Steril 2016; 105: 364–368.
[9] Sermondade N, Huberlant S, Bourhis-Lefebvre V, Arbo E, Gallot V, Colombani M, et al. Female obesity is negatively associated with live birth rate following IVF: A systematic review and meta-analysis. Hum Reprod Update 2019; 25: 439–451.
[10] Zhang J, Liu H, Mao X, Chen Q, Fan Y, Xiao Y, et al. Effect of body mass index on pregnancy outcomes in a freezeall policy: An analysis of 22,043 first autologous frozenthawed embryo transfer cycles in China. BMC Med 2019; 17: 114.
[11] Leary Ch, Leese HJ, Sturmey RG. Human embryos from overweight and obese women display phenotypic and metabolic abnormalities. Hum Reprod 2015; 30: 122– 132.
[12] Orvieto R. The effect of female body mass index on in vitro fertilization cycle outcomes. J Assist Reprod Genet 2018; 35: 2081.
[13] Zhang JJ, Feret M, Chang L, Yang M, Merhi Z. Obesity adversely impacts the number and maturity of oocytes in conventional IVF not in minimal stimulation IVF. Gynecol Endocrinol 2015; 31: 409–413.
[14] Ozekinci M, Seven A, Olgan S, Sakinci M, Keskin U, Akar ME, et al. Does obesity have detrimental effects on IVF treatment outcomes? BMC Women’s Health 2015; 15: 61.
[15] Wang Zh, Groen H, van Zomeren KC, Cantineau AE, Van Oers A, Van Montfoort AP, et al. Lifestyle intervention prior to IVF does not improve embryo utilization rate and cumulative live birth rate in women with obesity: A nested cohort study. Hum Reprod Open 2021; 2021: hoab032.
[16] Pantos K, Sfakianoudis K, Grigoriadis S, Maziotis E, Tsioulou P, Rapani A, et al. Could the age difference of a single calendar year between patients undergoing IVF at 34, 35 or at 36 years old affect the IVF outcome? A retrospective data analysis. Medicina 2020; 56: 92.
[17] Xue X, Shi W, Zhou H, Tian L, Zhao Z, Zhou D, et al. Cumulative live birth rates according to maternal body mass index after first ovarian stimulation for in vitro fertilization: A single center analysis of 14,782 patients. Front Endocrinol 2020; 11: 149.
[18] Kawwass JF, Kulkarni AD, Hipp HS, Crawford S, Kissin DM, Jamieson DJ. Extremities of body mass index and their association with pregnancy outcomes in women undergoing in vitro fertilization in the United States. Fertil Steril 2016; 106: 1742–1750.
[19] Sarais V, Pagliardini L, Rebonato G, Papaleo E, Candiani M, Vigano P. A comprehensive analysis of body mass index effect on in vitro fertilization outcomes. Nutrients 2016; 8: 109.
[20] Brunet C, Aouinti S, Huguet F, Macioce V, Ranisavljevic N, Gala A, et al. Impact of women obesity and obesity severity on live birth rate after in vitro fertilization. J Clin Med 2020; 9: 2414.
[21] Farhi J, Ben-Haroush A, Sapir O, Fisch B, Ashkenazi J. High-quality embryos retain their implantation capability in overweight women. Reprod Biomed Online 2010; 21: 706–711.
[22] Dokras A, Baredziak L, Blaine J, Syrop C, Van Voorhis BJ, Sparks A. Obstetric outcomes after in vitro fertilization in obese and morbidly obese women. Obstet Gynecol 2006; 108: 61–69.
[23] Metwally M, Cutting R, Tipton A, Skull J, Ledger W, Li T. Effect of increased body mass index on oocyte and embryo quality in IVF patients. Reprod Biomed Online 2007; 15: 532–538.
[24] Zander-Fox DL, Henshaw R, Hamilton H, Lane M. Does obesity really matter? The impact of BMI on embryo quality and pregnancy outcomes after IVF in women aged = 38 years. Aust N Z J Obstet Gynaecol 2012; 52: 270–276.
[25] Erel CT, Senturk LM. The impact of body mass index on assisted reproduction. Curr Opin Obstet Gynecol 2009; 21: 228–235.
[26] Eftekhar M, Mehrjardi SZ, Molaei B, Taheri F, Mangoli E. The correlation between endometrial thickness and pregnancy outcomes in fresh ART cycles with different age groups: A retrospective study. Middle East Fertil Soc J 2020; 24: 10.
[27] Eftekhar M, Tabibnejad N, Tabatabaie AA. The thin endometrium in assisted reproductive technology: An ongoing challenge. Middle East Fertil Soc J 2018; 23: 1–7.
[28] Crosby D, O’Brien Y, Glover L, Martyn F, Wingfield M. Influence of body mass index on the relationship between endometrial thickness and pregnancy outcome in single blastocyst frozen embryo transfer cycles. Hum Fertil 2020; 23: 32–37.
[29] Albu D, Albu A. The relationship between anti-Müllerian hormone serum level and body mass index in a large cohort of infertile patients. Endocrine 2019; 63: 157–163.
[30] Simoes-Pereira J, Nunes J, Aguiar A, Sousa S, Rodrigues C, Sampaio Matias J, et al. Influence of body mass index in anti-Müllerian hormone levels in 951 non-polycystic ovarian syndrome women followed at a reproductive medicine unit. Endocrine 2018; 61: 144–148.
[2] Bellver J, Marín C, Lathi RB, Murugappan G, Labarta E, Vidal C, et al. Obesity affects endometrial receptivity by displacing the window of implantation. Reprod Sci 2021; 28: 3171–3180.
[3] Prost E, Reignier A, Leperlier F, Caillet P, Barrière P, Fréour T, et al. Female obesity does not impact live birth rate after frozen-thawed blastocyst transfer. Hum Reprod 2020; 35: 859–865.
[4] Jafari-Adli Sh, Jouyandeh Z, Qorbani M, Soroush A, Larijani B, Hasani-Ranjbar S. Prevalence of obesity and overweight in adults and children in Iran; a systematic review. J Diabetes Metab Disord 2014; 13: 121.
[5] Djalalinia Sh, Saeedi Moghaddam S, Sheidaei A, Rezaei N, Naghibi Iravani SS, Modirian M, et al. Patterns of obesity and overweight in the Iranian population: Findings of STEPs 2016. Front Endocrinol 2020; 11: 42.
[6] Metwally M, Ong KJ, Ledger WL, Li TC. Does high body mass index increase the risk of miscarriage after spontaneous and assisted conception? A meta-analysis of the evidence. Fertil Steril 2008; 90: 714–726.
[7] Bellver J, Pellicer A, Garcia-Velasco JA, Ballesteros A, Remohi J, Meseguer M. Obesity reduces uterine receptivity: Clinical experience from 9,587 first cycles of ovum donation with normal weight donors. Fertil Steril 2013; 100: 1050–1058.
[8] Provost MP, Acharya KS, Acharya CR, Yeh JS, Steward RG, Eaton JL, et al. Pregnancy outcomes decline with increasing recipient body mass index: An analysis of 22,317 fresh donor/recipient cycles from the 2008-2010 Society for Assisted Reproductive Technology Clinic Outcome Reporting System registry. Fertil Steril 2016; 105: 364–368.
[9] Sermondade N, Huberlant S, Bourhis-Lefebvre V, Arbo E, Gallot V, Colombani M, et al. Female obesity is negatively associated with live birth rate following IVF: A systematic review and meta-analysis. Hum Reprod Update 2019; 25: 439–451.
[10] Zhang J, Liu H, Mao X, Chen Q, Fan Y, Xiao Y, et al. Effect of body mass index on pregnancy outcomes in a freezeall policy: An analysis of 22,043 first autologous frozenthawed embryo transfer cycles in China. BMC Med 2019; 17: 114.
[11] Leary Ch, Leese HJ, Sturmey RG. Human embryos from overweight and obese women display phenotypic and metabolic abnormalities. Hum Reprod 2015; 30: 122– 132.
[12] Orvieto R. The effect of female body mass index on in vitro fertilization cycle outcomes. J Assist Reprod Genet 2018; 35: 2081.
[13] Zhang JJ, Feret M, Chang L, Yang M, Merhi Z. Obesity adversely impacts the number and maturity of oocytes in conventional IVF not in minimal stimulation IVF. Gynecol Endocrinol 2015; 31: 409–413.
[14] Ozekinci M, Seven A, Olgan S, Sakinci M, Keskin U, Akar ME, et al. Does obesity have detrimental effects on IVF treatment outcomes? BMC Women’s Health 2015; 15: 61.
[15] Wang Zh, Groen H, van Zomeren KC, Cantineau AE, Van Oers A, Van Montfoort AP, et al. Lifestyle intervention prior to IVF does not improve embryo utilization rate and cumulative live birth rate in women with obesity: A nested cohort study. Hum Reprod Open 2021; 2021: hoab032.
[16] Pantos K, Sfakianoudis K, Grigoriadis S, Maziotis E, Tsioulou P, Rapani A, et al. Could the age difference of a single calendar year between patients undergoing IVF at 34, 35 or at 36 years old affect the IVF outcome? A retrospective data analysis. Medicina 2020; 56: 92.
[17] Xue X, Shi W, Zhou H, Tian L, Zhao Z, Zhou D, et al. Cumulative live birth rates according to maternal body mass index after first ovarian stimulation for in vitro fertilization: A single center analysis of 14,782 patients. Front Endocrinol 2020; 11: 149.
[18] Kawwass JF, Kulkarni AD, Hipp HS, Crawford S, Kissin DM, Jamieson DJ. Extremities of body mass index and their association with pregnancy outcomes in women undergoing in vitro fertilization in the United States. Fertil Steril 2016; 106: 1742–1750.
[19] Sarais V, Pagliardini L, Rebonato G, Papaleo E, Candiani M, Vigano P. A comprehensive analysis of body mass index effect on in vitro fertilization outcomes. Nutrients 2016; 8: 109.
[20] Brunet C, Aouinti S, Huguet F, Macioce V, Ranisavljevic N, Gala A, et al. Impact of women obesity and obesity severity on live birth rate after in vitro fertilization. J Clin Med 2020; 9: 2414.
[21] Farhi J, Ben-Haroush A, Sapir O, Fisch B, Ashkenazi J. High-quality embryos retain their implantation capability in overweight women. Reprod Biomed Online 2010; 21: 706–711.
[22] Dokras A, Baredziak L, Blaine J, Syrop C, Van Voorhis BJ, Sparks A. Obstetric outcomes after in vitro fertilization in obese and morbidly obese women. Obstet Gynecol 2006; 108: 61–69.
[23] Metwally M, Cutting R, Tipton A, Skull J, Ledger W, Li T. Effect of increased body mass index on oocyte and embryo quality in IVF patients. Reprod Biomed Online 2007; 15: 532–538.
[24] Zander-Fox DL, Henshaw R, Hamilton H, Lane M. Does obesity really matter? The impact of BMI on embryo quality and pregnancy outcomes after IVF in women aged = 38 years. Aust N Z J Obstet Gynaecol 2012; 52: 270–276.
[25] Erel CT, Senturk LM. The impact of body mass index on assisted reproduction. Curr Opin Obstet Gynecol 2009; 21: 228–235.
[26] Eftekhar M, Mehrjardi SZ, Molaei B, Taheri F, Mangoli E. The correlation between endometrial thickness and pregnancy outcomes in fresh ART cycles with different age groups: A retrospective study. Middle East Fertil Soc J 2020; 24: 10.
[27] Eftekhar M, Tabibnejad N, Tabatabaie AA. The thin endometrium in assisted reproductive technology: An ongoing challenge. Middle East Fertil Soc J 2018; 23: 1–7.
[28] Crosby D, O’Brien Y, Glover L, Martyn F, Wingfield M. Influence of body mass index on the relationship between endometrial thickness and pregnancy outcome in single blastocyst frozen embryo transfer cycles. Hum Fertil 2020; 23: 32–37.
[29] Albu D, Albu A. The relationship between anti-Müllerian hormone serum level and body mass index in a large cohort of infertile patients. Endocrine 2019; 63: 157–163.
[30] Simoes-Pereira J, Nunes J, Aguiar A, Sousa S, Rodrigues C, Sampaio Matias J, et al. Influence of body mass index in anti-Müllerian hormone levels in 951 non-polycystic ovarian syndrome women followed at a reproductive medicine unit. Endocrine 2018; 61: 144–148.