Female obesity is negatively associated with live birth rate following IVF: a systematic review and meta-analysis

Abstract

BACKGROUND A worldwide increase in the prevalence of obesity has been observed in the past three decades, particularly in women of reproductive age. Female obesity has been clearly associated with impaired spontaneous fertility, as well as adverse pregnancy outcomes. Increasing evidence in the literature shows that obesity also contributes to adverse clinical outcomes following in vitro fertilization (IVF) procedures. However, the heterogeneity of the available studies in terms of populations, group definition and outcomes prevents drawing firm conclusions. A previous meta-analysis published in 2011 identified a marginal but significant negative effect of increased female body mass index (BMI) on IVF results, but numerous studies have been published since then, including large cohort studies from national registries, highlighting the need for an updated review and meta-analysis. OBJECTIVE AND RATIONALE Our systematic review and meta-analysis of the available literature aims to evaluate the association of female obesity with the probability of live birth following IVF. Subgroup analyses according to ovulatory status, oocyte origin, fresh or frozen-embryo transfer and cycle rank were performed. SEARCH METHODS A systematic review was performed using the following key words: (‘obesity’, ‘body mass index’, ‘live birth’, ‘IVF’, ‘ICSI’). Searches were conducted in MEDLINE, EMBASE, Cochrane Library, Eudract and clinicaltrial.gov from 01 January 2007 to 30 November 2017. Study selection was based on title and abstract. Full texts of potentially relevant articles were retrieved and assessed for inclusion by two reviewers. Subsequently, quality was assessed using the Newcastle-Ottawa Quality Assessment Scales for patient selection, comparability and assessment of outcomes. Two independent reviewers carried out study selection and data extraction according to Cochrane methods. Random-effect meta-analysis was performed using Review Manager software on all data (overall analysis), followed by subgroup analyses. OUTCOMES A total of 21 studies were included in the meta-analysis. A decreased probability of live birth following IVF was observed in obese (BMI ≥ 30 kg/m2) women when compared with normal weight (BMI 18.5–24.9 kg/m2) women: risk ratio (RR) (95% CI) 0.85 (0.82–0.87). Subgroups analyses demonstrated that prognosis was poorer when obesity was associated with polycystic ovary syndrome, while the oocyte origin (donor or non-donor) did not modify the overall interpretation. WIDER IMPLICATIONS Our meta-analysis clearly demonstrates that female obesity negatively and significantly impacts live birth rates following IVF. Whether weight loss can reverse this deleterious effect through lifestyle modifications or bariatric surgery should be further evaluated.

Endometriosis Lowers the Cumulative Live Birth Rates in IVF by Decreasing the Number of Embryos but Not Their Quality

“…The significantly lower number of embryos and top-quality embryos available is the direct consequence of the lower oocyte yield. It is worth noting that the significantly lower BMI in the endometriosis group did not affect the IVF parameters, since both groups had a BMI in the normal range (<25), and the parameters are only affected in obese women with BMI > 30 [58].…”

Management of prepregnancy, pregnancy, and postpartum obesity from the FIGO Pregnancy and Non‐Communicable Diseases Committee: A FIGO (International Federation of Gynecology and Obstetrics) guideline

“…Obesity in pregnant mothers is also associated with immediate adverse outcomes such as stillbirth with risk increasing with higher maternal BMI 17 . Finally, maternal obesity places women at a higher risk of infertility 18 . Women with obesity are more likely to have issues with ovulation or endometrial function, and weight loss in women with obesity is associated with improved fertility 19,20 .…”

Mining of variables from embryo morphokinetics, blastocyst’s morphology and patient parameters: an approach to predict the live birth in the assisted reproduction service

“…Moreover, low BMI had a more profound effect on live birth rates in patients older than 35 years, whereas the effect in younger patients was insignificant (Cai et al, 2017). The inverse was also analyzed and demonstrated the declined probability of live birth following IVF in obese patients in comparison to normal weight patients (Sermondade et al, 2019).…”