Higher preconceptional maternal body mass index is associated with faster early preimplantation embryonic development: the Rotterdam periconception cohort

Abstract

Background Overweight and obesity affect millions of people globally, which has also serious implications for reproduction. For example, treatment outcomes after in vitro fertilisation (IVF) are worse in women with a high body mass index (BMI). However, the impact of maternal BMI on embryo quality is inconclusive. Our main aim is to study associations between preconceptional maternal BMI and morphokinetic parameters of preimplantation embryos and predicted implantation potential. In addition, associations with clinical IVF outcomes are investigated. Methods From a tertiary hospital, 268 women undergoing IVF or IVF with intracytoplasmic sperm injection (ICSI) were included; 143 normal weight, 79 overweight and 46 obese women. The embryos of these women were cultured in the EmbryoScope, a time-lapse incubator. The morphokinetic parameters of preimplantation embryos and predicted implantation potential, assessed by the KIDScore algorithm were longitudinally evaluated as primary and secondary outcomes, respectively. The tertiary outcomes included clinical outcomes, i.e., fertilization, implantation and live birth rate. Results After adjustment for patient- and treatment-related factors, we demonstrated in 938 embryos that maternal BMI is negatively associated with the moment of pronuclear appearance (βtPNa -0.070 h (95%CI -0.139, -0.001), p = 0.048), pronuclear fading (βtPNf -0.091 h (95%CI -0.180, -0.003), p = 0.043 and the first cell cleavage (βt2 -0.111 h (95%CI -0.205, -0.016), p = 0.022). Maternal BMI was not significantly associated with the KIDScore and tertiary clinical treatment outcomes. In embryos from couples with female or combined factor subfertility, the impact of maternal BMI was even larger (βtPNf -0.170 h (95%CI -0.293, -0.047), p = 0.007; βt2 -0.199 h (95%CI -0.330, -0.067), p = 0.003). Additionally, a detrimental impact of BMI per point increase was observed on the KIDScore (β -0.073 (se 0.028), p = 0.010). Conclusions Higher maternal BMI is associated with faster early preimplantation development. In couples with female or combined factor subfertility, a higher BMI is associated with a lower implantation potential as predicted by the KIDScore. Likely due to power issues, we did not observe an impact on clinical treatment outcomes. However, an effect of faster preimplantation development on post-implantation development is conceivable, especially since the impact of maternal BMI on pregnancy outcomes has been widely demonstrated.

A relationship between progesterone, maternal body weight, and offspring sex following the frozen/thawed single embryo transfer.

“…The authors found that female and male BMI affected the abortion rate and the LBR in IVF and ICSI cycles (16). Among the embryos after ICSI cultured in the time-lapse incubator EmbryoScope, higher maternal BMI is associated with faster early pre-implantation development (17). In addition, women with obesity experience a higher rate of miscarriage after euploid embryo transfer than women with a normal weight, suggesting that mechanisms other than aneuploidy are responsible for this outcome (18).…”

Update on obesity and assisted reproductive technology

“…A significant rise in euploid miscarriage in obese women implies that endometrial variables are involved in weaker IVF consequences in obese women. A greater body mass index (BMI) is linked to a decreased fertilization possibility [13]. There is really growing recognition of deficient embryo implantation in obese IVF patient populations [14].…”

Obesity and fertility: a literature review of the association between parental obesity at the time of conception and embryo quality

“…Van Duijn et al [2] 268 couples Maternal (adjusted for paternal BMI) Weight and height measured Maternal BMI negatively associated with tPNa, tPNf and the timing of first cell cleavage (faster preimplantation development)…”