Women, weight, and fertility: The effect of body mass index on the outcome of superovulation/intrauterine insemination cycles

Souter, Irene; Baltagi, L.M.; Kuleta, D.; Meeker, John D.; Petrozza, John C.

doi:10.1016/j.fertnstert.2010.11.062

Cited by 117 publications

(69 citation statements)

References 56 publications

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“…Obese patients have been found to have a lower follicular count, but with no demonstrable impact on the clinical pregnancy and spontaneous miscarriage rate across all BMI categories [9]. Women with a higher BMI have been shown to require higher dosages and a longer duration of stimulation when treated with gonadotrophins for ovulation induction [10].…”

Section: Bmi and Ovulation Inductionmentioning

confidence: 99%

The Impact of Body Mass Index on Assisted Reproductive Treatments

Supramaniam¹,

Mittal²,

Lim³

2017

OJOG

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Multiparity amongst women with a body mass index (BMI) ≥ 30 Kg/m 2 is a common occurrence despite there being a known clear association with a decline in fecundity in women who are overweight or obese. These women, also pose further concerns, as they are at increased risk of antenatal complications such as preeclampsia and gestational diabetes. Over the years, a number of different modalities of fertility treatments have been tried and tested in this cohort of women to find the optimal treatment to improve their reproductive capacity. There has been an exponential increase in knowledge and understanding towards managing patients with a raised BMI, particularly through assisted reproductive treatments. Although the efficacies of various forms of fertility treatments have been shown to be affected by a rise in BMI, there is yet to be a definitive understanding as to the optimal management of these patients. The literature supports weight loss alone as an effective intervention in improving the reproductive capacity of women with a raised BMI with unexplained infertility. Furthermore, if live birth rate is taken as the desired outcome measure, then ovarian drilling and in vitro fertilisation (IVF) treatment have been shown to yield the best results in overweight and obese patients when comparisons are drawn to other interventions such as natural conception and treatment with clomiphene citrate.

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Section: Bmi and Ovulation Inductionmentioning

confidence: 99%

The Impact of Body Mass Index on Assisted Reproductive Treatments

Supramaniam¹,

Mittal²,

Lim³

2017

OJOG

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“…The effect of obesity on medication requirements has been reported in several studies. Souter et al (71) found that BMI was negatively associated with the estradiol level produced per preovulatory follicle, resulting in lower estradiol levels with increasing BMI. Some of these studies demonstrated that obesity is related with elevated gonadotropin requirements, lack of follicular development, and reduction in the number of oocytes (72)(73)(74)(75).…”

Section: Obesity and Assisted Conceptionmentioning

confidence: 99%

Impact of obesity on infertility in women

Dağ

Dilbaz

2015

J Turkish German Gynecol Assoc

225

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Review 111 IntroductionObesity, which is an important health issue, is a common problem among women of reproductive age. Obesity and overweight involves an abnormal and excessive fat accumulation that negatively affects the health of the body. According to the World Health Organization (WHO), if the body mass index (BMI) equals to or is greater than 25 kg/m 2 , it is considered overweight, whereas if the BMI equals to or is greater than 30 kg/m 2 , it is considered obesity (1). Obesity brings out many problems such as social, psychological, demographic, and health problems. It is related to increased health risks such as diabetes mellitus, hypertension, coronary heart disease, and osteoarthritis and is linked to various malignancies, particularly endometrium, breast, and colon cancers. Obesity also plays a significant role in reproductive disorders, particularly in women. It is associated with anovulation, menstrual disorders, infertility, difficulties in assisted reproduction, miscarriage, and adverse pregnancy outcomes. In obese women, gonadotropin secretion is affected because of the increased peripheral aromatization of androgens to estrogens. The insulin resistance and hyperinsulinemia in obese women leads to hyperandrogenemia. The sex hormone-binding globulin (SHBG), growth hormone (GH), and insulin-like growth factor binding proteins (IGFBP) are decreased and leptin levels are increased. Thus, the neuroregulation of the hypothalamic-pituitary-gonadal (HPG) axis deteriorates (2). These alterations may explain impaired ovulatory function and so reproductive health. Because of lower implantation and pregnancy rates, higher miscarriage rates, and increased maternal and fetal complications during pregnancy, obese women have a lower chance to give birth to a healthy newborn (3)(4)(5)(6). In this review, the effects of obesity on fertility and effective management of infertility in obese and overweight women is summarized. Epidemiology of obesityThe prevalence of obesity is increasing significantly worldwide. The International Obesity Task Force reported that 1,1 billion adults are overweight. They also reported that 312 million of them are obese (7). Approximately 3,4 million adults die each year because of health problems associated with obesity and being overweight. Of these, 44% of the problems are related to diabetes, 23% to ischemic heart disease, and between 7% and 41% to some malignancies associated with overweight and obesity (7). The prevelence of obesity has increased in developed countries because of a change in lifestyle, including reduced physical activity, changes in nutrition style, and an increased calorie intake (8). However, some other factors such as endocrine disorders, hormonal disorders, psychological disorders, and use of some drugs such as steroids and antidepressants may lead to obesity (9). The World Health Organization reported that 60% of women are overweight (≥25 kg/m 2 ) in the United States and most European countries and 30% of these are obese (≥30 kg/m 2 ) and 6% of these are mo...

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“…This finding is supported by studies done by Dinelli L et al, Yavuz A et al and Ashrafi M et al [5][6][7] Souter I et al found that higher BMI was associated with poor pregnancy outcome supporting the result of our study. 10 Increased endometrial thickness was associated with a significant increase in the pregnancy outcome in IUTPI. Similar results were found in studies done by Dinelli L et al, Wolff EF et al and Habibzadeh V et al 5,8,9 Decreased duration of infertility was also associated with improved pregnancy outcome as found by Ashrafi M et al in their study.…”

Section: Discussionmentioning

confidence: 95%

Role of intrauterine tubo-peritoneal insemination and intrauterine insemination in the treatment of infertility

et al. 2017

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INTRODUCTIONInfertility is defined as one year of unprotected intercourse without conception during child bearing age affecting approximately 7.4% of the population. Intrauterine insemination (IUI) with husband's semen has been widely used as a low cost first line assisted reproductive therapeutic option for infertile couples. A newer modified form of IUI called intrauterine tuboperitoneal insemination (IUTPI) has been developed for infertile patients using 10ml of the inseminate instead of 0.5ml used in IUI. This procedure is made possible by a specially designed instrument, the Double Nut Bivalve speculum (DNB) which clamps the cervix tightly during the procedure preventing back flow of the inseminate. The objective of our study was to compare the clinical pregnancy rate of IUTPI and IUI in the treatment of infertile patients.1,2 ABSTRACT Background: Infertility management has become more substantial and relevant with an increase in the number of infertile patients as well as advances in the science of reproduction. The objective of our study was to assess the role of intrauterine tuboperitoneal insemination (IUTPI) and intrauterine insemination (IUI) in the treatment of infertile patients. Methods: 236 infertile patients, 118 in each group attending the infertility clinic, after applying both inclusion and exclusion criteria were enrolled in the present study. Patients in each study group were given clomiphene citrate for ovarian stimulation followed by injection hCG for triggering ovulation. Insemination with washed husband's sperm was performed about 36-40 hours after hCG administration, using 10ml of inseminate in IUTPI and 0.5ml inseminate in IUI. The patient was then called after 2 weeks for urine pregnancy test (UPT) which, if positive was considered as clinical pregnancy. Results: Out of the total 236 cases, 42 cases had a positive outcome. Out of these 42 positive cases, 27 were from IUTPI group whereas 15 from IUI group. The pregnancy rate was 22.88% in IUTPI and 12.71% in IUI (p=0.039), which was a statistically significant difference. Endometrial thickness, preovulatory follicle number and prewash sperm motility significantly affected positive outcome in IUTPI. Factors like patient's age, BMI<25, bilateral patent tubes and decreased duration of infertility also positively affected the treatment outcome. Conclusions: Our study found IUTPI to have better pregnancy rate compared to IUI. IUTPI may become a first line option for treatment of infertile patients.

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Women, weight, and fertility: The effect of body mass index on the outcome of superovulation/intrauterine insemination cycles

Cited by 117 publications

References 56 publications

The Impact of Body Mass Index on Assisted Reproductive Treatments

The Impact of Body Mass Index on Assisted Reproductive Treatments

Impact of obesity on infertility in women

Role of intrauterine tubo-peritoneal insemination and intrauterine insemination in the treatment of infertility

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