Overweight, obesity and assisted reproduction: A systematic review and meta-analysis

Ribeiro, Leandro Rodrigo; Sasaki, Lizandra Moura Paravidine; Silva, Adelino A.; Souza, Elivan Silva; Lyrio, Amanda Oliveira; Figueiredo, Ana Cláudia Morais Godoy; Göttems, Leila Bernarda Donato

doi:10.1016/j.ejogrb.2022.01.019

Cited by 27 publications

(12 citation statements)

References 62 publications

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“…Indeed, maintaining a healthy weight or BMI, as well as weight loss through bariatric surgery or lifestyle changes in obese women, reduced the risk of endometrial carcinoma ( Sundar et al , 2017 ). Being overweight or obese is considered to have a negative effect on fertility, conception, time to pregnancy and pregnancy outcomes ( Ribeiro et al , 2022 ). In overweight and obese women who have received endometrial carcinoma fertility-sparing therapy, weight loss could positively affect pregnancy rate and improve live birth rate ( Gonthier et al , 2014 ; Chen et al , 2016 ; Obermair et al , 2020 ).…”

Section: Resultsmentioning

confidence: 99%

ESGO/ESHRE/ESGE Guidelines for the fertility-sparing treatment of patients with endometrial carcinoma,

Rodolakis

Scambia

Acién

et al. 2022

Human Reproduction Open

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STUDY QUESTION How should fertility-sparing treatment of patients with endometrial carcinoma be performed? SUMMARY ANSWER Forty-eight recommendations were formulated on fertility-sparing treatment of patients with endometrial carcinoma. WHAT IS KNOWN ALREADY The standard surgical treatment of endometrial carcinoma consisting of total hysterectomy with bilateral salpingo-oophorectomy drastically affects the quality of life of patients and creates a challenge for clinicians. Recent evidence-based guidelines of the European Society of Gynaecological Oncology (ESGO), the European SocieTy for Radiotherapy & Oncology (ESTRO) and the European Society of Pathology (ESP) provide comprehensive guidelines on all relevant issues of diagnosis and treatment in endometrial carcinoma in a multidisciplinary setting. While addressing also work-up for fertility preservation treatments and the management and follow-up for fertility preservation, it was considered relevant to further extend the guidance on fertility-sparing treatment. STUDY DESIGN, SIZE, DURATION A collaboration was set up between the ESGO, the European Society of Human Reproduction and Embryology (ESHRE) and the European Society for Gynaecological Endoscopy (ESGE), aiming to develop clinically relevant and evidence-based guidelines focusing on key aspects of fertility-sparing treatment in order to improve the quality of care for women with endometrial carcinoma across Europe and worldwide. PARTICIPANTS/MATERIALS, SETTING, METHODS ESGO/ESHRE/ESGE nominated an international multidisciplinary development group consisting of practising clinicians and researchers who have demonstrated leadership and expertise in the care and research of endometrial carcinoma (11 experts across Europe). To ensure that the guidelines are evidence-based, the literature published since 2016, identified from a systematic search was reviewed and critically appraised. In the absence of any clear scientific evidence, judgement was based on the professional experience and consensus of the development group. The guidelines are thus based on the best available evidence and expert agreement. Prior to publication, the guidelines were reviewed by 95 independent international practitioners in cancer care delivery and patient representatives. MAIN RESULTS AND THE ROLE OF CHANCE The multidisciplinary development group formulated 48 recommendations in four sections; patient selection, tumour clinicopathological characteristics, treatment and special issues. LIMITATIONS, REASONS FOR CAUTION Of the 48 recommendations, none could be based on level I evidence and only 16 could be based on level II evidence, implicating that 66% of the recommendations are supported only by observational data, professional experience and consensus of the development group. WIDER IMPLICATIONS OF THE FINDINGS These recommendations provide guidance to professionals caring for women with endometrial carcinoma, including but not limited to professionals in the field of gynaecological oncology, onco-fertility, reproductive surgery, endoscopy, conservative surgery and histopathology, and will help towards a holistic and multidisciplinary approach for this challenging clinical scenario. STUDY FUNDING/COMPETING INTEREST(S) All costs relating to the development process were covered from ESGO, ESHRE and ESGE funds. There was no external funding of the development process or manuscript production. G.S. has reported grants from MSD Italia S.r.l., advisory boards for Storz, Bayer, Astrazeneca, Metronic, TESARO Bio Italy S.r.l and Johnson & Johnson, and honoraria for lectures from Clovis Oncology Italy S.r.l. M.G. has reported advisory boards for Gedeon Richter and Merck. The other authors have reported no conflicts of interest. DISCLAIMER This document represents the views of ESHRE, ESGO and ESGE which are the result of consensus between the relevant stakeholders and where relevant based on the scientific evidence available at the time of preparation. The recommendations should be used for informational and educational purposes. They should not be interpreted as setting a standard of care, or be deemed inclusive of all proper methods of care nor exclusive of other methods of care reasonably directed to obtaining the same results. They do not replace the need for application of clinical judgement to each individual presentation, nor variations based on locality and facility type.

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Section: Resultsmentioning

confidence: 99%

ESGO/ESHRE/ESGE Guidelines for the fertility-sparing treatment of patients with endometrial carcinoma,

Rodolakis

Scambia

Acién

et al. 2022

Human Reproduction Open

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“…8 Being overweight or obese is considered to have a negative effect on fertility, conception, time to pregnancy, and pregnancy outcomes. 9 In overweight and obese women who have received endometrial carcinoma fertility-sparing therapy, weight loss could positively affect pregnancy rate and improve live birth rate. [10][11][12] A recent study showed that ≥5% weight loss increased pregnancy and live birth rates significantly in overweight and obese women.…”

Section: Patient Selectionmentioning

confidence: 99%

ESGO/ESHRE/ESGE Guidelines for the fertility-sparing treatment of patients with endometrial carcinoma

Rodolakis

Scambia

Acién

et al. 2023

Int J Gynecol Cancer

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The standard surgical treatment of endometrial carcinoma, consisting of total hysterectomy with bilateral salpingo-oophorectomy, drastically affects the quality of life of patients and creates a challenge for clinicians. Recent evidence-based guidelines of the European Society of Gynaecological Oncology (ESGO), the European SocieTy for Radiotherapy and Oncology (ESTRO), and the European Society of Pathology (ESP) provide comprehensive information on all relevant issues of diagnosis and treatment in endometrial carcinoma in a multidisciplinary setting. While addressing also work-up for fertility preservation treatments and the management and follow-up for fertility preservation, it was considered relevant to further extend the guidance on fertility-sparing treatment.A collaboration was set up between the ESGO, the European Society of Human Reproduction and Embryology (ESHRE), and the European Society for Gynaecological Endoscopy (ESGE), aiming to develop clinically relevant and evidence-based guidelines focusing on key aspects of fertility-sparing treatment (patient selection, tumor clinicopathological characteristics, treatment, special issues) in order to improve the quality of care for women with endometrial carcinoma across Europe and worldwide.ESGO/ESHRE/ESGE nominated an international multidisciplinary development group consisting of practicing clinicians and researchers who have demonstrated leadership and expertise in the care and research of endometrial carcinoma (11 experts from across Europe). To ensure that the guidelines are evidence-based, the literature published since 2016, identified by a systematic search, was reviewed and critically appraised. In the absence of any clear scientific evidence, judgment was based on the professional experience and consensus of the development group. The guidelines are thus based on the best available evidence and expert agreement. Prior to publication, the guidelines were reviewed by 95 independent international practitioners in cancer care delivery and patient representatives.

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“…Another meta‐analysis of 115 158 male participants from 30 studies demonstrated that obese men had a higher odds ratio of infertility and a lower odds ratio of live births per cycle; a large proportion of these men had abnormalities in their semen 30 . A meta‐analysis of 53 studies with 1 445 406 treatment cycles showed that an increased BMI was associated with a weak negative impact on outcomes among women undergoing IVF or ICSI 31 . This shows that overweight and obesity in this group are associated with an increased number of complications that may prevent a successful pregnancy outcome, thereby increasing cost to the patient and the healthcare system.…”

Section: Access To Assisted Reproductive Technology and Inequitiesmentioning

confidence: 99%

“… 30 A meta‐analysis of 53 studies with 1 445 406 treatment cycles showed that an increased BMI was associated with a weak negative impact on outcomes among women undergoing IVF or ICSI. 31 This shows that overweight and obesity in this group are associated with an increased number of complications that may prevent a successful pregnancy outcome, thereby increasing cost to the patient and the healthcare system.…”

Section: Access To Assisted Reproductive Technology and Inequitiesmentioning

confidence: 99%

The challenges of obesity for fertility: A FIGO literature review

Gautam

Purandare

Maxwell

et al. 2023

Intl J Gynecology & Obste

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Obesity has been linked to infertility through several mechanisms, including at a molecular level. Those living with obesity face additional barriers to accessing fertility treatments and achieving a successful pregnancy, which can contribute to their economic and psychosocial stressors. There is scope to further improve care for people living with obesity and infertility with empathy, via a multidisciplinary approach.

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Overweight, obesity and assisted reproduction: A systematic review and meta-analysis

Cited by 27 publications

References 62 publications

ESGO/ESHRE/ESGE Guidelines for the fertility-sparing treatment of patients with endometrial carcinoma,

ESGO/ESHRE/ESGE Guidelines for the fertility-sparing treatment of patients with endometrial carcinoma,

ESGO/ESHRE/ESGE Guidelines for the fertility-sparing treatment of patients with endometrial carcinoma

The challenges of obesity for fertility: A FIGO literature review

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