The LIFESTYLE study: costs and effects of a structured lifestyle program in overweight and obese subfertile women to reduce the need for fertility treatment and improve reproductive outcome. A randomised controlled trial

Abstract

BackgroundIn the Netherlands, 30% of subfertile women are overweight or obese, and at present there is no agreement on fertility care for them. Data from observational and small intervention studies suggest that reduction of weight will increase the chances of conception, decrease pregnancy complications and improve perinatal outcome, but this has not been confirmed in randomised controlled trials. This study will assess the cost and effects of a six-months structured lifestyle program aiming at weight reduction followed by conventional fertility care (intervention group) as compared to conventional fertility care only (control group) in overweight and obese subfertile women. We hypothesize that the intervention will decrease the need for fertility treatment, diminish overweight-related pregnancy complications, and will improve perinatal outcome.Methods/DesignMulticenter randomised controlled trial in subfertile women (age 18-39 year) with a body mass index between 29 and 40 kg/m2. Exclusion criteria are azoospermia, use of donor semen, severe endometriosis, premature ovarian failure, endocrinopathies or pre-existent hypertensive disorders.In the intervention group the aim is a weight loss of at least 5% to10% in a six-month period, to be achieved by the combination of a diet, increase of physical activity and behavioural modification. After six months, in case no conception has been achieved, these patients will start fertility treatment according to the Dutch fertility guidelines. In the control group treatment will be started according to Dutch fertility guidelines, independently of the patient's weight.Outcome measures and analysisThe primary outcome measure is a healthy singleton born after at least 37 weeks of gestation after vaginal delivery. Secondary outcome parameters including pregnancy outcome and complications, percentage of women needing fertility treatment, clinical and ongoing pregnancy rates, body weight, quality of life and costs.Data will be analysed according to the intention to treat principle, and cost-effectiveness analysis will be performed to compare the costs and health effects in the intervention and control group.DiscussionThe trial will provide evidence for costs and effects of a lifestyle intervention aiming at weight reduction in overweight and obese subfertile women and will offer guidance to clinicians for the treatment of these patients.Trial registrationDutch Trial Register NTR1530

Impact of Male and Female Weight, Smoking, and Intercourse Frequency on Live Birth in Women With Polycystic Ovary Syndrome

“…Interventions to combat prepregnancy obesity with lifestyle modifications are only recently coming to the foreground of investigative attention (22,23). Most published studies on this subject lack sufficient length of follow-up and only involved women (24).…”

The Feto-placental Dialogue and Diabesity

“…From studies with interventions initiated before pregnancy (e.g., the Radiel study [67] or LIFESTYLE study [68]), no data are available on percentage body fat or fetal insulin levels at present. Hopefully, these data will become available in the coming years.…”

Obesity and reproductive function

“…Six of the studies investigated reproductive function after treatment with medical therapies including metformin, orlistat, sibutramine, and myoinositol [58][59][60][61][62][63] . One study outlined the strategy of an ongoing trial evaluating the costs and effects of a structured lifestyle program in overweight and obese subfertile women in Norway, but no results were available 64 . Only one study reported specifically on the effects of a lifestyle intervention on reproductive function in obese women, and this was in obese women preparing to undergo IVF 65 .…”