Effects of female body mass index on the outcome of in vitro fertilization/intracytoplasmic sperm injection or intrauterine insemination

Abstract

Background: Many studies have suggested that female obesity has an impact on oocyte quality, embryo quality, and endometrial maturation in couples undergoing in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI). In contrast, there are few data on the management of intrauterine insemination (IUI) in obese women. The objectives of the present study were to evaluate the clinical pregnancy and live birth rates in IVF/ICSI and IUI for overweight or obese women and to determine positive or negative predictive factors for pregnancy. Method: We analyzed long GnRH agonist or GnRH antagonist protocols with FSH/hMG for IVF/ICSI, and FSH/hMG alone for IUI. We classified the women into three groups: normal weight, overweight, and obesity. The latter group was divided into two obesity subgroups: class 1 and class 2/3. We recorded data on the patients' demographic, stimulation cycles, embryo cultures, and ongoing pregnancies obtained. For IVF/ICSI and IUI, we performed a univariate analysis of factors that were predictive of pregnancy and then selected a number for inclusion in a multivariate analysis. Results: The study included 1153 IVF/ICSI cycles and 541 IUI cycles. The clinical pregnancy and live birth rates in IVF/ICSI did not vary as a function of the female BMI. In IUI, the clinical pregnancy and live birth rates were significantly higher among obese women (21.6% and 17.7%, respectively) than among women of normal weight (12.2% and 9.3%, respectively; p<0.05). In IVF/ICSI and IUI, we did not observe an association between the spontaneous miscarriage rate and the BMI. In a univariate analysis, several predictive factors were found for IVF/ICSI and IUI. However, in a multivariate analysis, pregnancy in IVF/ICSI was notably predicted by the number of embryos obtained (≥5), whereas the absence of pregnancy in IUI was notably predicted by a monofollicular response to ovarian stimulation (p<0.001 for both). Conclusions: Our study did not find differences in clinical pregnancy and live birth rates as a function of female BMI in IVF/ICSI, and even evidenced higher rates among obese women in IUI. Nevertheless, women should be encouraged to lose weight if allowed by the setting and their age; this may decrease the incidence of obstetric complications during assisted reproductive technology programs.

Predictive factors of early pregnancy loss during in vitro fertilization/ intracytoplasmic sperm injection (IVF/ICSI): retrospective study on 1806 embryo transfers

“…Hipp [48] reported an increased risk of rst-trimester pregnancy loss after the transfer of frozen embryos compared with fresh embryos in women < 38 y.o, and this difference persisted in women < 30 y.o. This study did not show an impact of BMI on the EPL risk (26.8% of women were overweight and 16% were obese in all cycles), as in our previous study where we did not nd an association between clinical pregnancy and live birth rates and different BMI classes [49]. Similarly, Brunet [50] reported that after adjustment, obesity, including classes II/III, had no impact on EPL rates.…”