Successful weight loss interventions before in vitro fertilization: fat chance?

Norman, Robert J.; Mol, Ben Willem J.

doi:10.1016/j.fertnstert.2018.05.029

Cited by 27 publications

(18 citation statements)

References 62 publications

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“…Previous research suggests that the age-related decline in fertility has a greater influence on CLBR than BMI in older women (23), which is consistent with our findings. Weight loss before IVF is widely recommended for women who are overweight or obese to improve underlying adverse pregnancy outcomes (24); however, the benefits of weight loss before ART interventions have been questioned in some clinical trials (25, 26), and undergoing fertility treatment before losing weight is recommended (27). It seems that achieving a lower BMI prior to IVF may be a good choice for younger PCOS patients.…”

Section: Discussionmentioning

confidence: 99%

A Slower Age-Related Decline in Treatment Outcomes After the First Ovarian Stimulation for in vitro Fertilization in Women With Polycystic Ovary Syndrome

Liu

et al. 2019

Front. Endocrinol.

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Background: Polycystic ovary syndrome (PCOS) patients have a better ovarian reserve and age-related improvement in endocrine disturbances than non-PCOS patients. The effects of age on in vitro fertilization (IVF) treatment outcomes associated with cumulative live birth rate (CLBR) remain unclear.Objectives: To study the effect of age on CLBR after the first ovarian stimulation in IVF in PCOS patients.Method: This retrospective cohort study included 3,502 PCOS patients and 18,596 patients with tubal factor infertility, who underwent their first IVF cycles and subsequent frozen embryo transfer (ET) attempts. The primary outcome was CLBR associated with a single stimulation cycle and secondary outcomes included the implantation rate, clinical pregnancy rate, live birth rate (LBR), large for gestational age (LGA) rate, small for gestational age (SGA) rate, and preterm birth (PTB) rate of fresh ET cycles.Results: PCOS patients over 40 years had a higher implantation rate (27.8 vs. 15.7%, P < 0.05), clinical pregnancy rate (51.4 vs. 26.1%, P < 0.05), LBR (42.3 vs. 18.2%, P < 0.05), and CLBR (50.0 vs. 21.5%, P < 0.05) than non-PCOS patients over 40 years. These rates were comparable between PCOS patients aged 35 to 40 years and those aged over 40 years (P = 0.263, 0.385, and 0.112, respectively). The changes in the implantation rate, clinical pregnancy rate, and CLBR by age were slower for PCOS patients than for non-PCOS patients (all P < 0.05). Among PCOS patients less than 35 years, BMI was negatively associated with CLBR [aOR: 0.961 (0.939–0.985); P < 0.05]; however, among PCOS patients over 35 years, instead of BMI (P = 0.353), age [aOR: 0.891 (0.803–0.990); P < 0.05] and the number of oocytes retrieved [aOR: 1.093 (1.002–1.078); P < 0.05] were significantly associated with CLBR. No significant differences in LGA, LGA, or PTB were detected between PCOS and non-PCOS patients over 35 years (all P > 0.05).Conclusions: The declines in treatment outcomes with age are slower for PCOS patients than for non-PCOS patients. For patients over 40 years, PCOS patients have reproductive advantages over non-PCOS patients. In contrast to younger PCOS patients (<35 years), older PCOS patients (≥35 years) may benefit less from taking time to lose weight before IVF treatment, and the immediate initiation of assisted reproductive treatment is essential.

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Section: Discussionmentioning

confidence: 99%

A Slower Age-Related Decline in Treatment Outcomes After the First Ovarian Stimulation for in vitro Fertilization in Women With Polycystic Ovary Syndrome

Liu

et al. 2019

Front. Endocrinol.

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“…It is widely accepted that elevated body mass index (BMI) exerts detrimental effects on female fecundity [2]. Obesity could affect nearly all the components of reproductive system, ranging from oocyte competence over embryo quality to uterine environment [3].…”

Section: Introductionmentioning

confidence: 99%

Effect of body mass index on pregnancy outcomes in a freeze-all policy: an analysis of 22,043 first autologous frozen-thawed embryo transfer cycles in China

Zhang

Liu

Mao

et al. 2019

BMC Med

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Background Abnormal BMI is associated with discouraging IVF outcomes in fresh autologous or oocyte donor cycles, whether or not such a relation also holds true for women undergoing frozen-thawed embryo transfer (FET) remains unknown. In addition, it remains unclear the detrimental effect of abnormal BMI on IVF outcomes occurs at the level of ovary or endometrium. Methods A retrospective study involved 22,043 first FET cycles of all women who had undergone a freeze-all policy during the period from January 2010 to June 2017. To control for the embryo factor, our analysis was restricted to women with high-quality embryo transfer. The main outcome measure was live birth rate per embryo transfer. The secondary endpoints included rates of implantation, clinical pregnancy, multiple pregnancy, and pregnancy loss. Multivariate logistic regression analysis was performed to detect the independent effect of BMI on live birth rate after adjusting for important confounding variables. Results In the crude analysis, reproductive outcomes were similar between underweight women and normal-weight controls whereas all parameter outcomes were significantly worse in patients with obesity. After adjustment for a number of confounding factors, underweight women had a marginally significant decrease in rates of implantation (adjusted odds ratio (aOR) 0.91; 95% CI 0.85–0.96), clinical pregnancy (aOR 0.91; 95% CI 0.83–0.99), and live birth (aOR 0.91; 95% CI 0.83–0.99) as compared to the women with normal weight. Obesity was significantly associated with decreased implantation (aOR 0.80; 95% CI 0.73–0.87), clinical pregnancy (aOR 0.81; 95% CI 0.71–0.91), and live birth rates (aOR 0.70; 95% CI 0.62–0.80). Moreover, the pregnancy loss rate, both in the first (aOR 1.46; 95% CI 1.15–1.87) and in the second trimester (aOR 2.76; 95% CI 1.67–4.58), was significantly higher in the obesity group than that in the reference group. Conclusions Among women undergoing first FET with high-quality embryo transfer, low BMI has limited impact on pregnancy and live birth rates. On the contrary, obesity was associated with worse IVF outcomes. Our findings further highlighted that endometrial receptivity played an important role in the poor reproductive outcomes of women with abnormal weight status. Electronic supplementary material The online version of this article (10.1186/s12916-019-1354-1) contains supplementary material, which is available to authorized users.

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“…In this trial, only 38% of participants achieved their target weight loss and 22% discontinued the intervention, and the unassisted pregnancy rate in the intervention group was 26% (versus 16% in controls), suggesting some benefit with weight reduction. Obese and overweight women with infertility should be encouraged to lose weight, but as no compelling evidence supports the use of weight loss to improve live-birth rates in women undergoing IVF, it may be advisable to start fertility treatment earlier than previously recommended in women who fail to meet weight targets despite their best efforts 234 .A healthy weight prior to starting fertility treatment not only improves pregnancy outcomes with or without assisted reproductive technologies (ART), but also reduces maternal and perinatal complications during pregnancy 234 . The long-term health of offspring is also a factor, as maternal obesity (that is, a BMI >30kg/m 2 ) is associated with an increased risk of premature death in adult offspring 235 .…”

Section: Box 2 Lifestyle Factors and The Management Of Female Subfermentioning

confidence: 99%

Female subfertility

2019

Nat Rev Dis Primers

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Subfertility is common, and affects one in six couples, half of whom lack an explanation for their delay in conceiving. Developments in the diagnosis and treatment of subfertility over the past 50 years have been truly remarkable. Indeed, current generations of couples with subfertility are more fortunate than previous generations as they have many more opportunities to become parents. The timely access to effective treatment for subfertility is important, as many couples have a narrow window of opportunity before the age-related effects of subfertility limit the likelihood of success. Assisted reproduction can overcome the barriers to fertility caused by tubal disease and low sperm counts, but little progress has been made in reducing the effect of increasing age on ovarian function. The next 5-10 years will likely see further increases in birth rates in women with subfertility, greater awareness of lifestyle factors and possible refinement of current assisted reproduction techniques and development of new ones. Such progress will bring challenging questions regarding the potential benefits and harms of treatments involving germ-cell manipulation, artificial gametes, genetic screening of embryos, and gene editing of embryos. We hope to see a major increase in fertility awareness, access to safe and cost-effective fertility care in low-income countries, and a reduction in the current disparity of access to fertility care.

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Successful weight loss interventions before in vitro fertilization: fat chance?

Cited by 27 publications

References 62 publications

A Slower Age-Related Decline in Treatment Outcomes After the First Ovarian Stimulation for in vitro Fertilization in Women With Polycystic Ovary Syndrome

A Slower Age-Related Decline in Treatment Outcomes After the First Ovarian Stimulation for in vitro Fertilization in Women With Polycystic Ovary Syndrome

Effect of body mass index on pregnancy outcomes in a freeze-all policy: an analysis of 22,043 first autologous frozen-thawed embryo transfer cycles in China

Female subfertility

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