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Adebayo FO, Ameh N, Adesiyun AG, Ekele BA, Wada I. Correlation of female age with outcome of IVF in a low-resource setting. Int J Gynaecol Obstet 2023; 161:283-288. [PMID: 36330818 DOI: 10.1002/ijgo.14545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 10/07/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To determine the effect of female age on pregnancy outcome after in vitro fertilization/embryo transfer (IVF-ET). METHODS A prospective study was conducted involving 266 women who had IVF-ET at Nisa Fertility and Genetic Center, Abuja, Nigeria. All eligible consenting women were recruited to the study. The main outcome measure was clinical pregnancy. Data were analyzed using IBM SPSS Statistics version 25. P < 0.05 at 95% confidence intervals was taken as significant. RESULTS A total of 266 patients were recruited and included in the study; 104 pregnancies were recorded, giving an overall pregnancy rate of 39.1%. The age range of the patient was 26-43 years (mean age 33.9 ± 2.41 years) while the mean number of embryo transfers per patient was 2.2. The clinical pregnancy rate for women aged below 30 years was 69.4% while the pregnancy rate for patients aged 30-34 years, 35-39 years, and 40-43 years was 52.6%, 24.7%, and 9.4%, respectively (P < 0.0001). CONCLUSION The study found that the success rate of IVF-ET decreases significantly in women aged over 34 years. Women should be counseled about the age-related risk of infertility and referred to a fertility center as early as possible.
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Affiliation(s)
- Francis O Adebayo
- Invitro Fertilization Unit, Nisa Fertility and Genetic Center, Abuja, Nigeria
| | - Nkeiruka Ameh
- Invitro Fertilization Unit, Nisa Fertility and Genetic Center, Abuja, Nigeria
| | - Adebiyi G Adesiyun
- Department of Obstetrics and Gynecology, Ahmadu Bello University, Zaria, Nigeria
| | - Bissallah A Ekele
- Department of Obstetrics and Gynecology, University of Abuja Teaching Hospital, Abuja, Nigeria
| | - Ibrahim Wada
- Invitro Fertilization Unit, Nisa Fertility and Genetic Center, Abuja, Nigeria
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2
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Hu D, Huang B, Xiong M, Yao J, Yang S, Wu R, Zhang H, Zhao Y. Impact of elevated body mass index on cumulative live birth rate and obstetric safety in women undergoing assisted reproductive technology. Sci Rep 2022; 12:18858. [PMID: 36344718 PMCID: PMC9640544 DOI: 10.1038/s41598-022-23576-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 11/02/2022] [Indexed: 11/09/2022] Open
Abstract
This study evaluated the impact of elevated body mass index (BMI) on short- and long-term outcomes of in-vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) treatments. A total of 7229 patients undergoing IVF/ICSI fresh cycles and subsequent frozen embryo transfer cycles from 2014 to 2020 were divided into normal (18.5-24.9 kg/m2) and high BMI (≥ 25 kg/m2) groups. Ovarian response, pregnancy outcomes, and safety of both mother and fetus were the main outcome measures. Furthermore, multivariate analysis was used to determine whether BMI was associated with cumulative live birth rate (CLBR). Results showed that for younger women (< 38 year), CLBR was significantly reduced in the high BMI group compared with the normal BMI control and was accompanied by fewer retrieved oocytes and available embryos. Additionally, the incidence of hypertensive disorders of pregnancy, fetal macrosomia, and cleft lip and palate birth defects resulting from cumulative live births was significantly higher compared with the normal BMI group. No differences were observed among older women (≥ 38 year). Multivariate analysis revealed that high BMI was a risk factor for CLBR. Our study suggested that elevated BMI has a greater adverse impact on younger women.
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Affiliation(s)
- Dan Hu
- grid.33199.310000 0004 0368 7223Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 JieFang Avenue, Wuhan, 430030 People’s Republic of China
| | - Bo Huang
- grid.33199.310000 0004 0368 7223Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 JieFang Avenue, Wuhan, 430030 People’s Republic of China
| | - Min Xiong
- grid.33199.310000 0004 0368 7223Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 JieFang Avenue, Wuhan, 430030 People’s Republic of China
| | - Junning Yao
- grid.33199.310000 0004 0368 7223Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 JieFang Avenue, Wuhan, 430030 People’s Republic of China
| | - Shulin Yang
- grid.33199.310000 0004 0368 7223Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 JieFang Avenue, Wuhan, 430030 People’s Republic of China
| | - Ruxing Wu
- grid.33199.310000 0004 0368 7223Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 JieFang Avenue, Wuhan, 430030 People’s Republic of China
| | - Hanwang Zhang
- grid.33199.310000 0004 0368 7223Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 JieFang Avenue, Wuhan, 430030 People’s Republic of China
| | - Yiqing Zhao
- grid.33199.310000 0004 0368 7223Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 JieFang Avenue, Wuhan, 430030 People’s Republic of China
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Riess K, Zippl AL, Reh L, Feil K, Toth B. Erniedrigter und erhöhter BMI: Prävalenz bei Kinderwunsch-Patientinnen in Österreich. Geburtshilfe Frauenheilkd 2022. [DOI: 10.1055/s-0042-1750215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Fernandez RGO, Barbosa CP, Christofolini DM, de Alcantara Sousa LV, de Oliveira R, Bianco B. Impact of blood levels of progesterone on the day of ovulation onset on clinical, laboratory and reproductive parameters of young patients undergoing assisted reproduction: a cross-sectional study. EINSTEIN-SAO PAULO 2022; 20:eAO6896. [PMID: 35649054 PMCID: PMC9126603 DOI: 10.31744/einstein_journal/2022ao6896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 09/22/2021] [Indexed: 11/23/2022] Open
Abstract
Objective: To assess whether there is an association between the level of progesterone on the day of administration of human chorionic gonadotropin and clinical and laboratory characteristics, in addition to the results of in vitro fertilization of patients with a good prognosis. Methods: A cross-sectional study comprising 103 women who underwent intracytoplasmic sperm injection treatment, between November 2009 and May 2015, aged ≤35 years, with no comorbidities, with fresh embryo transfer. Data were collected from patient medical records. Results: There was a weak positive correlation between the level of progesterone on the day of human chorionic gonadotropin and the number of follicles larger than 14mm (ß=0.02, p=0.001), retrieved oocytes (ß=0.01, p=0.01) and oocytes in metaphase II (MII) (ß=0.02, p=0.02); that is, the increase in progesterone level has a slight association with increased values of these variables. Body mass index was inversely correlated with progesterone level on the day of human chorionic gonadotropin (ß=-0.01, p=0.02). No association was found between the level of progesterone on the day of human chorionic gonadotropin and the protocols used for controlled ovarian stimulation, quality of transferred embryos and the pregnancy rate. Conclusion: There is an association between the value of progesterone on the day of human chorionic gonadotropin administration with body mass index, number of follicles larger than 14mm, number of retrieved oocytes and oocytes in metaphase II. Unlike embryo quality and pregnancy rate, which do not have a statistically significant relation with this value in the population studied.
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Embryonic Development in Relation to Maternal Obesity Does Not Affect Pregnancy Outcomes in FET Cycles. Healthcare (Basel) 2022; 10:healthcare10040703. [PMID: 35455880 PMCID: PMC9024931 DOI: 10.3390/healthcare10040703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/04/2022] [Accepted: 04/07/2022] [Indexed: 02/04/2023] Open
Abstract
This retrospective cohort study examined the effect of maternal BMI on embryo morphokinetics using a time-lapse incubator (TLI) and evaluated the effect on outcomes of frozen embryo transfer (FET) cycles. The study included 641 women who underwent FET of a total of 2553 embryos from January 2017 to August 2019. The women were divided into four groups according to BMI: underweight (<18.5 kg/m2), normal weight (18.5−24.99 kg/m2), overweight (25.0−29.99 kg/m2), and obese (≥30 kg/m2). Embryos were transferred on day 3 or 5, and their development was monitored using a TLI. We found that oocytes from obese patients were slower in the extraction of the second polar body (tPB2) after fertilization and the two pronucleus stage appeared later compared to normal-weight women. The time to fading of the pronucleus (tPNf), t2, and t4 were comparable between the four groups. Oocytes from underweight and overweight women had significantly faster cleavage at t3 and t5−t8 compared to normal weight. We did not find any significant difference in pregnancy rate, clinical pregnancy rate, or miscarriage rate among groups. In conclusion, embryos from normal-weight patients had slower cleavage rates compared to obese patients, while embryo quality was similar between BMI groups. The cycle outcomes demonstrated comparable pregnancy rates among the BMI groups.
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Overweight, obesity and assisted reproduction: a systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2022; 271:117-127. [DOI: 10.1016/j.ejogrb.2022.01.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 11/01/2021] [Accepted: 01/18/2022] [Indexed: 12/12/2022]
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Wyse BA, Fuchs Weizman N, Defer M, Montbriand J, Szaraz P, Librach C. The follicular fluid adipocytokine milieu could serve as a prediction tool for fertility treatment outcomes. Reprod Biomed Online 2021; 43:738-746. [PMID: 34474976 DOI: 10.1016/j.rbmo.2021.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 06/07/2021] [Accepted: 07/02/2021] [Indexed: 10/20/2022]
Abstract
RESEARCH QUESTION Can the adipocytokine milieu of the follicular niche improve the ability to predict treatment outcomes in infertile patients? DESIGN Follicular fluid samples from overweight patients were analysed and compared with samples from matched normal-weight patients. Concentrations of adiponectin, chemerin, C-reactive protein, interleukin-6 (IL-6), IL-10, IL-18, insulin, leptin, prolactin, resistin, tumour necrosis factor alpha (TNF-α) and bone morphogenetic protein-15 (BMP-15) were assessed by multiple magnetic bead immunoassay (MMBI) and enzyme-linked immunosorbent assay and correlated with fertility treatment outcomes. RESULTS Analysis of samples from 22 overweight and 22 normal-weight patients demonstrated that TNF-α can predict oocyte maturation rate. When stratified by body mass index (BMI), IL-10 emerges as a better predictor of oocyte maturation in normal-weight patients. Prolactin was a negative predictor for fertilization rate in the full cohort, and this prediction power was lost upon stratification. No adipocytokines were predictive of blastulation rate, and only age remained predictive. BMP-15 was a strong predictor of high-quality blastulation in the full cohort, more so in the normal-weight population. CONCLUSIONS The adipocytokine milieu of the follicular fluid provides a snapshot of the growing oocyte's environment and can help predict fertility treatment outcomes, fine-tuning understanding of the dysregulation caused by increasing BMI. Inflammatory cytokines can predict oocyte maturation; prolactin, oocyte competence; and BMP-15, high-quality blastulation. Further analysis of these findings with a larger sample size and assessing individual oocytes will help shed more light on the clinical significance of these findings.
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Affiliation(s)
| | | | | | - Janice Montbriand
- Department of Anaesthesia, Sunnybrook Health Sciences Centre, Toronto Ontario, Canada
| | - Peter Szaraz
- CReATe Fertility Centre, Toronto Ontario, Canada
| | - Clifford Librach
- CReATe Fertility Centre, Toronto Ontario, Canada; Department of Obstetrics and Gynaecology, University of Toronto, Toronto Ontario, Canada; Department of Physiology and Institute of Medical Sciences, University of Toronto, Toronto Ontario, Canada
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García-Ferreyra J, Carpio J, Zambrano M, Valdivieso-Mejía P, Valdivieso-Rivera P. Overweight and obesity significantly reduce pregnancy, implantation, and live birth rates in women undergoing In Vitro Fertilization procedures. JBRA Assist Reprod 2021; 25:394-402. [PMID: 33710838 PMCID: PMC8312282 DOI: 10.5935/1518-0557.20200105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 01/04/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The objective of this study was to evaluate the effects of overweight and obesity on fertility outcomes in IVF procedures. METHODS This was a retrospective and nonrandomized study that included 191 IVF/ICSI cycles using non-donor oocytes performed between July 2016 and December 2018 that were allocated according to Body Mass Index (BMI) in three groups: Normal group: 18.5-24.9 (n=67 women), Overweight group: 25.0-29.9 (n=86 women) and Obesity group: ≥30.0 (n=38 women). We compared fertilization rates, embryo quality at day 3, development and quality of blastocyst, pregnancy rates, implantation rates, and live birth rates. RESULTS Patients from all groups had similar stimulation days, but those women with overweight and obesity used more hormones compared to women with normal weight (p<0.05). Fertilization rates, zygotes that underwent cleavage and good-quality embryos at Day 3 were similar between the three evaluated groups. The groups of overweight and obesity had embryos at Day 3 with significantly less cells, compared to those from the normal group (p<0.05). The blastocyst development rate was significantly lower in women with overweight and obesity compared to women with normal BMI (p<0.05); but, the percentages of good blastocysts were similar in all studied patients. Pregnancy, implantation and live birth rates were significantly lower in the group of women with overweight and obesity, compared to those women with normal weight (p<0.05). Obese women had significantly more miscarriages compared to those in the other groups (p<0.05). CONCLUSIONS Our data shows that an increased BMI affects embryo development and significantly reduces the pregnancy, implantation and live birth rates.
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Affiliation(s)
| | - Jorge Carpio
- Laboratory of Assisted Reproduction. Alcívar Hospital, Guayaquil, Ecuador
| | - Milton Zambrano
- Laboratory of Assisted Reproduction. Alcívar Hospital, Guayaquil, Ecuador
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9
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Xiong Y, Wang J, Huang S, Liu C, Liu Y, Qi Y, Li L, Wang W, Zou K, Tan J, Sun X. Association between maternal prepregnancy body mass index and pregnancy outcomes following assisted reproductive technology: A systematic review and dose-response meta-analysis. Obes Rev 2021; 22:e13219. [PMID: 33554474 DOI: 10.1111/obr.13219] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/05/2021] [Accepted: 01/22/2021] [Indexed: 02/05/2023]
Abstract
This systematic review investigated dose-response relationship between maternal prepregnancy body mass index (BMI) and pregnancy outcomes following assisted reproductive technology, including clinical pregnancy rate (CPR), miscarriage rate (MR), and live birth rate (LBR). We searched four major databases and finally included 105 studies involving more than 271,632 pregnant women. We performed linear or nonlinear dose-response meta-analyses using random effects models. At per-woman level, pooling of unadjusted estimates shown an inverted J-shaped relationship between maternal BMI and CPR; pooling of adjusted estimates showed a linear association, suggesting statistical association between higher maternal BMI and lower CPR (adjusted OR [aOR] for 5-unit increase in BMI: 0.96, 95%CI: 0.94-0.98). At per-cycle level, linear dose-response relationship was found between maternal BMI and CPR (crude relative risk, RR, [cRR] for 5-unit increase in BMI 0.97, 0.96-0.98; aOR 0.96, 0.94-0.99). Linear dose-response relationship was established between maternal BMI and the outcomes of MR or LBR (higher BMI associated with higher MR [cRR 1.15, 1.08-1.22] and lower LBR [cRR 0.91, 0.88-0.94] at per-woman level). Sensitivity analyses showed no significant changes. In conclusion, there is dose-response relationship between maternal BMI and pregnancy outcomes following assisted reproductive technology. Higher BMI values may suggest suboptimal pregnancy outcomes.
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Affiliation(s)
- Yiquan Xiong
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Jing Wang
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Shiyao Huang
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Chunrong Liu
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yanmei Liu
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yana Qi
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Ling Li
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Wen Wang
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Kang Zou
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Jing Tan
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Xin Sun
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, China
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Liu W, Sha T, Huang Y, Guo Z, Yan L, Ma J. Factors Influencing the Live Birth Rate Following Fresh Embryo Transfer Cycles in Infertile Women After Endometrioma Cystectomy. Front Med (Lausanne) 2021; 8:622087. [PMID: 33718403 PMCID: PMC7947290 DOI: 10.3389/fmed.2021.622087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 01/04/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Reproductive outcomes after fresh in vitro fertilization/intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET) cycles are diverse in infertile women with a history of ovarian cystectomy for endometriomas. We aimed to develop a logistic regression model based on patients' characteristics including number of embryos transferred and stimulation protocols to predict the live birth rate in fresh IVF/ICSI-ET cycles for such patients. Methods: We recruited 513 infertile women with a history of ovarian cystectomy for endometriomas who underwent their first fresh ET with different stimulation protocols following IVF/ICSI cycles in our unit from January 2014 to December 2018. One or two embryo are implanted. Clinical and laboratory parameters potentially affecting the live birth rate following fresh ET cycles were analyzed. Univariable and multivariable analyses were performed to assess the relationship between predictive factors and live birth rate. Results: The overall live birth rate was 240/513 (46.8%). Multivariable modified Poisson regression models showed that two factors were significantly lowers the probability of live birth: female age ≥ 5 years (aOR 0.603; 95% CI 0.389-0.933; P = 0.023); BMI range 21-24.99 kg/m2 compared with BMI <21 kg/m2 (aOR 0.572; 95% CI 0.372-0.881, P = 0.011). And two factors significantly increased the probability of live birth: AFC >7 (aOR 1.591; 95% CI 1.075-2.353; P = 0.020); two embryos transferred (aOR 1.607; 95% CI 1.089-2.372; P = 0.017). Conclusions: For these infertile women who had undergone ovarian cystectomy for endometriosis, female age <35 years, AFC > 7, and two embryos transferred might achieve better clinical fresh IVF/ICSI-ET outcomes. BMI <21 kg/m2 or ≥25 kg/m2 might also have positive effects on the live birth rate, but different ovarian stimulation protocols had no significant effects. However, a larger sample size may be needed for further study.
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Affiliation(s)
- Wei Liu
- School of Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China.,Center for Reproductive Medicine, Cheeloo College of Medicine, Hospital Affiliated to Shandong University, Shandong University, Jinan, China.,Department of Obstetrics and Gynecology, Shanxi Bethune Hospital, Shanxi Medical University, Taiyuan, China
| | - Tongye Sha
- Department of Obstetrics, Rizhao Hospital of Traditional Chinese Medicine, Rizhao, China
| | - Yuzhen Huang
- Center for Reproductive Medicine, Cheeloo College of Medicine, Hospital Affiliated to Shandong University, Shandong University, Jinan, China
| | - Zizhen Guo
- School of Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Lei Yan
- School of Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China.,Center for Reproductive Medicine, Cheeloo College of Medicine, Hospital Affiliated to Shandong University, Shandong University, Jinan, China
| | - Jinlong Ma
- School of Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China.,Center for Reproductive Medicine, Cheeloo College of Medicine, Hospital Affiliated to Shandong University, Shandong University, Jinan, China
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Romanski PA, Bortoletto P, Magaoay B, Chung A, Rosenwaks Z, Spandorfer SD. Live birth outcomes in infertile patients with class III and class IV obesity following fresh embryo transfer. J Assist Reprod Genet 2021; 38:347-355. [PMID: 33200310 PMCID: PMC7884488 DOI: 10.1007/s10815-020-02011-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 11/09/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Assess the effect of class III (body mass index [BMI, kg/m2] 40-49.9) and class IV obesity (≥ 50) on clinical pregnancy and live birth outcomes after first oocyte retrieval and fresh embryo transfer cycle. DESIGN Cohort study SETTING: Academic center PATIENTS: Patients undergoing their first oocyte retrieval with planned fresh embryo transfer in our clinic between 01/01/2012 and 12/31/2018. Patients were stratified by BMI: 18.5-24.9 (n = 4913), 25-29.9 (n = 1566) 30-34.9 (n = 559), 35-39.9 (n = 218), and ≥ 40 (n = 114). INTERVENTION None MAIN OUTCOME MEASURE: Live birth rate RESULTS: Following embryo transfer, there were no differences in pregnancy rates across all BMI groups (p value, linear trend = 0.86). However among pregnant patients, as BMI increased, a significant trend of a decreased live birth rate was observed (p value, test for linear trend = 0.004). Additionally, as BMI increased, a significant trend of an increased miscarriage rate was observed (p value, linear trend = < 0.001). Compared to the normal-weight cohort, women with a BMI ≥ 40 had a significantly higher rate of cancelled fresh transfers after retrieval (18.4% vs. 8.2%, OR 2.51; 95%CI 1.55-4.08). Among singleton deliveries, a significant trend of an increased c-section rate was identified as the BMI increased (p value, linear trend = <0.001). CONCLUSION Overall, patients with a BMI > 40 have worse IVF treatment outcomes compared to normal-weight patients. After embryo transfer, their pregnancy rate is comparable to normal-weight women; however, their miscarriage rate is higher, leading to a lower live birth rate for pregnant women in this population. Patients with a BMI > 40 have a c-section rate that is 50% higher than normal-weight patients.
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Affiliation(s)
- Phillip A Romanski
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical Center, 1305 York Avenue, New York, NY, 10021, USA
| | - Pietro Bortoletto
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical Center, 1305 York Avenue, New York, NY, 10021, USA
| | - Brady Magaoay
- Weill Medical College of Cornell University, New York, NY, 10021, USA
| | - Alice Chung
- Weill Medical College of Cornell University, New York, NY, 10021, USA
| | - Zev Rosenwaks
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical Center, 1305 York Avenue, New York, NY, 10021, USA
| | - Steven D Spandorfer
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical Center, 1305 York Avenue, New York, NY, 10021, USA.
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Brunet C, Aouinti S, Huguet F, Macioce V, Ranisavljevic N, Gala A, Avignon A, Mura T, Sultan A. Impact of Women Obesity and Obesity Severity on Live Birth Rate after In Vitro Fertilization. J Clin Med 2020; 9:jcm9082414. [PMID: 32731470 PMCID: PMC7463979 DOI: 10.3390/jcm9082414] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/02/2020] [Accepted: 07/24/2020] [Indexed: 11/16/2022] Open
Abstract
Access to in vitro fertilization (IVF) for obese women varies across centers, and the impact of obesity on IVF outcomes is widely discussed. We assessed the impact of obesity and its severity on live birth rate (LBR) after IVF. We included women treated for IVF in our center. Data were prospectively collected in the BabySentryTM software. LBR per cycle and cumulative LBR including all attempts of the couple were calculated, considering transfer of both fresh and frozen embryos. Of 1588 included women (2379 controlled ovarian stimulations), 70.2%, 19.5%, 7.9%, and 2.4% were normal-weight, overweight, class I obesity, and class II/III obesity, respectively. For each cycle, LBR did not differ according to BMI category. Adjusted odds ratios (95% confidence intervals) for obtaining a live birth at the first cycle were 1.11 (0.78–1.58) for overweight, 1.17 (0.70–1.95) for class I obese, and 1.05 (0.48–2.31) for class II/III obese women, as compared with normal-weight women. Similarly, no significant associations were found at cycles 2, 3, and 4. Cumulative LBR increased with the number of cycles, independently of the BMI class (p log-rank = 0.91). After adjustment, obesity status did not impact significantly the miscarriage rate, regardless of the cycle. In conclusion, neither women obesity nor its severity impacted the cumulative LBR after IVF.
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Affiliation(s)
- Cécile Brunet
- Reproductive Medicine Unit, Univ Montpellier, CHU Montpellier, 34295 Montpellier, France; (C.B.); (N.R.)
| | - Safa Aouinti
- Clinical Research and Epidemiology Unit, Univ Montpellier, CHU Montpellier, 34295 Montpellier, France; (S.A.); (V.M.)
| | - Fanchon Huguet
- Nutrition Endocrinology Diabetes Department, Univ Montpellier, CHU Montpellier, 34295 Montpellier, France; (F.H.); (A.A.)
| | - Valérie Macioce
- Clinical Research and Epidemiology Unit, Univ Montpellier, CHU Montpellier, 34295 Montpellier, France; (S.A.); (V.M.)
| | - Noémie Ranisavljevic
- Reproductive Medicine Unit, Univ Montpellier, CHU Montpellier, 34295 Montpellier, France; (C.B.); (N.R.)
| | - Anna Gala
- Reproductive Biology Unit, Univ Montpellier, CHU Montpellier, 34295 Montpellier, France;
| | - Antoine Avignon
- Nutrition Endocrinology Diabetes Department, Univ Montpellier, CHU Montpellier, 34295 Montpellier, France; (F.H.); (A.A.)
- PhyMedExp, INSERM, CNRS UMR, University of Montpellier, CHRU Montpellier, 34295 Montpellier, France
| | - Thibault Mura
- Department of Biostatistics, Epidemiology and Public Health, Univ Montpellier, CHU Nimes, 30029 Nimes, France;
| | - Ariane Sultan
- Nutrition Endocrinology Diabetes Department, Univ Montpellier, CHU Montpellier, 34295 Montpellier, France; (F.H.); (A.A.)
- PhyMedExp, INSERM, CNRS UMR, University of Montpellier, CHRU Montpellier, 34295 Montpellier, France
- Correspondence: ; Tel.: +33-467-338-964
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13
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Fuchs Weizman N, Defer MK, Montbriand J, Pasquale JM, Silver A, Librach CL. Does body mass index impact assisted reproductive technology treatment outcomes in gestational carriers. Reprod Biol Endocrinol 2020; 18:35. [PMID: 32359356 PMCID: PMC7195786 DOI: 10.1186/s12958-020-00602-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 04/24/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The purpose of this study was to assess whether increased body mass index (BMI) negatively affects assisted reproductive technology (ART) outcomes among gestational carriers. METHODS A retrospective matched case-control cohort, including all gestational carrier (GC) cycles performed at CReATe Fertility Centre (Toronto, ON, Canada) between 2003 and 2016. SETTING A Canadian fertility clinic, with a large surrogacy program. PATIENTS All gestational carriers that had undergone a cycle completed to a transfer at our clinic, and had BMI and outcome data available, were matched by BMI to infertile patients treated at our clinic during the same years provided they had undergone a cycle completed to a transfer, and had outcomes data available. INTERVENTIONS None. MAIN OUTCOME MEASURES Clinical pregnancies rates, miscarriage rates and live birth rates. RESULTS BMI was not a reliable prediction factor of any of the measured outcomes. Importantly, the gestational carrier population had better outcomes and a significantly lower overall incidence of maternal, fetal and neonatal complications when compared with infertile patients, treated at our clinic during the same years. CONCLUSION BMI is not a reliable predictor of outcomes among gestational carriers.
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Affiliation(s)
- Noga Fuchs Weizman
- grid.490031.fCReATe Fertility Centre, 790 Bay St #1100, Toronto, ON M5G 1N8 Canada
| | - Miranda K. Defer
- grid.490031.fCReATe Fertility Centre, 790 Bay St #1100, Toronto, ON M5G 1N8 Canada
| | - Janice Montbriand
- grid.413104.30000 0000 9743 1587Department of Anesthesia, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room M3200, Toronto, ON M4N 3M5 Canada
| | - Julia M. Pasquale
- grid.490031.fCReATe Fertility Centre, 790 Bay St #1100, Toronto, ON M5G 1N8 Canada
| | - Adina Silver
- grid.490031.fCReATe Fertility Centre, 790 Bay St #1100, Toronto, ON M5G 1N8 Canada
| | - Clifford L. Librach
- grid.490031.fCReATe Fertility Centre, 790 Bay St #1100, Toronto, ON M5G 1N8 Canada
- grid.17063.330000 0001 2157 2938Department of Obstetrics and Gynecology; Faculty of Medicine, University of Toronto, 123 Edward St. Suite 1200, Toronto, ON M5G 1E2 Canada
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14
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Xue X, Shi W, Zhou H, Tian L, Zhao Z, Zhou D, Shi J. Cumulative Live Birth Rates According to Maternal Body Mass Index After First Ovarian Stimulation for in vitro Fertilization: A Single Center Analysis of 14,782 Patients. Front Endocrinol (Lausanne) 2020; 11:149. [PMID: 32328028 PMCID: PMC7160227 DOI: 10.3389/fendo.2020.00149] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 03/04/2020] [Indexed: 11/13/2022] Open
Abstract
Objective: To investigate the cumulative live birth rates (CLBR) according to body mass index (BMI) in women undergoing their first in vitro fertilization (IVF). Design: Retrospective cohort analysis. Setting: An IVF clinic in a public hospital. Patients: This is a retrospective study of 14,782 patients undergoing their first fresh IVF cycles and subsequent frozen embryo transfers in our clinic from January 2014 to January 2017. The follow-up for CLBR continued until January 2019. Patients with a BMI <18.5 kg/m2 were considered to be underweight and those with a BMI > 24 kg/m2 were considered to be overweight. Patients with a BMI ≥ 28 kg/m2 were considered to be obese. Intervention(s): None. Primary Outcome Measure: The primary outcome was cumulative live birth rate (CLBR). Result(s): This study illustrated the "inverted U shape" associations between body weight and IVF outcome (CLBR). The turning points in threshold analysis, as found by an automatic search, were BMIs of 18.5 and 30.4 kg/m2. The main finding of this retrospective data analysis is that the CLBR increased in underweight women, plateaued for normal weight and overweight women with a BMI between 18.5 and 30.4 kg/m2, and decreased in obese women. Conclusion(s): The data suggested an "inverted U shape" association between BMI and CLBR. The CLBR increases in underweight women, plateaus in normal weight and overweight women, and then decreases in obese women.
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Affiliation(s)
- Xia Xue
- Department of Pathology, Medical School, Xi'an Jiaotong University, Xi'an, China
- The Assisted Reproduction Center, Northwest Women's and Children's Hospital, Affiliated With Xi'an Jiaotong University, Xi'an, China
| | - Wenhao Shi
- The Assisted Reproduction Center, Northwest Women's and Children's Hospital, Affiliated With Xi'an Jiaotong University, Xi'an, China
| | - Hanying Zhou
- The Assisted Reproduction Center, Northwest Women's and Children's Hospital, Affiliated With Xi'an Jiaotong University, Xi'an, China
| | - Li Tian
- The Assisted Reproduction Center, Northwest Women's and Children's Hospital, Affiliated With Xi'an Jiaotong University, Xi'an, China
| | - Zhenghao Zhao
- The Assisted Reproduction Center, Northwest Women's and Children's Hospital, Affiliated With Xi'an Jiaotong University, Xi'an, China
| | - Dangxia Zhou
- Department of Pathology, Medical School, Xi'an Jiaotong University, Xi'an, China
| | - Juanzi Shi
- The Assisted Reproduction Center, Northwest Women's and Children's Hospital, Affiliated With Xi'an Jiaotong University, Xi'an, China
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15
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Maged AM, Fahmy RM, Rashwan H, Mahmood M, Hassan SM, Nabil H, Hany A, Lotfy R, Lasheen YS, Dahab S, Darwish M. Effect of body mass index on the outcome of IVF cycles among patients with poor ovarian response. Int J Gynaecol Obstet 2018; 144:161-166. [DOI: 10.1002/ijgo.12706] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 08/22/2018] [Accepted: 11/05/2018] [Indexed: 11/07/2022]
Affiliation(s)
- Ahmed M. Maged
- Obstetrics and Gynecology Department; Kasr Al Aini Hospital; Cairo University; Cairo Egypt
| | - Radwa M. Fahmy
- Obstetrics and Gynecology Department; Kasr Al Aini Hospital; Cairo University; Cairo Egypt
| | - Hamsa Rashwan
- Obstetrics and Gynecology Department; Kasr Al Aini Hospital; Cairo University; Cairo Egypt
| | - Maryam Mahmood
- Obstetrics and Gynecology Department; Kasr Al Aini Hospital; Cairo University; Cairo Egypt
| | - Sarah M. Hassan
- Obstetrics and Gynecology Department; Kasr Al Aini Hospital; Cairo University; Cairo Egypt
| | - Hala Nabil
- Obstetrics and Gynecology Department; Kasr Al Aini Hospital; Cairo University; Cairo Egypt
| | - Ayman Hany
- Obstetrics and Gynecology Department; Kasr Al Aini Hospital; Cairo University; Cairo Egypt
| | - Rehab Lotfy
- Obstetrics and Gynecology Department; Kasr Al Aini Hospital; Cairo University; Cairo Egypt
| | - Yossra S. Lasheen
- Obstetrics and Gynecology Department; Kasr Al Aini Hospital; Cairo University; Cairo Egypt
| | - Sherif Dahab
- Obstetrics and Gynecology Department; Kasr Al Aini Hospital; Cairo University; Cairo Egypt
| | - Mohamed Darwish
- Department of Gynecology and Obstetrics; Faculty of Medicine; Beni-Suef University; Beni Suef Egypt
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16
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Kasum M, Orešković S, Čehić E, Lila A, Ejubović E, Soldo D. The role of female obesity on in vitro fertilization outcomes. Gynecol Endocrinol 2018; 34:184-188. [PMID: 29037105 DOI: 10.1080/09513590.2017.1391209] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The aim of this review is to analyze the role of obesity on fertility outcome in women undergoing in vitro fertilization (IVF) with respect to clinical or live birth rates and pregnancy loss rates. Despite findings from several earlier and newer studies that obesity does not adversely affect pregnancy outcome in women attempting conception, numerous reports from mostly recent studies suggest that obesity undoubtedly impairs IVF outcomes. Obesity impairs ovarian responsiveness to gonadotrophin stimulation, requiring higher doses of medication, increased risk of cycle cancelation, pre-term delivery, low birth weight or miscarriage, and decreases implantation, clinical pregnancy or live birth rates compared to women of normal weight. The mechanisms underlying the adverse effects of female obesity on IVF outcome may be primarily explained by functional alterations to the hypothalamic-pituitary-ovarian axis. Additionally, obesity appears to affect deleteriously the number and quality of oocytes or embryos, and impairs endometrial decidualization which is necessary for uterine receptivity. Nevertheless, attaining normal body weight by the use of lifestyle modifications, including a healthy diet and exercise over time of several months before and during an IVF treatment, may be successful in achievement of gradual and sustainable weight loss with improvement of IVF outcome.
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Affiliation(s)
- Miro Kasum
- a Department of Obstetrics and Gynaecology, School of Medicine , University Hospital Centre Zagreb , Zagreb , Croatia
| | - Slavko Orešković
- a Department of Obstetrics and Gynaecology, School of Medicine , University Hospital Centre Zagreb , Zagreb , Croatia
| | - Ermin Čehić
- b Department of Obstetrics and Gynaecology , Cantonal Hospital Zenica , Zenica , Bosnia and Herzegovina
| | - Albert Lila
- c Gynaecology Cabinet , Kosovo Ocupational Health Institute , Giakove , Kosovo
| | - Emina Ejubović
- b Department of Obstetrics and Gynaecology , Cantonal Hospital Zenica , Zenica , Bosnia and Herzegovina
| | - Dragan Soldo
- d Department of Obstetrics and Gynaecology , University Clinical Hospital Mostar , Mostar , Bosnia and Herzegovina
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17
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Amsiejiene A, Drasutiene G, Usoniene A, Tutkuviene J, Vilsinskaite S, Barskutyte L. The influence of age, body mass index, waist-to-hip ratio and anti-Mullerian hormone level on clinical pregnancy rates in ART. Gynecol Endocrinol 2017; 33:41-43. [PMID: 29264991 DOI: 10.1080/09513590.2017.1399692] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The aim of this study was to estimate the influence of age, body mass index, waist-to-hip ratio and anti-Mullerian hormone levels on clinical pregnancies in assisted reproduction technologies (ART). We used the database of the fertility clinic both the in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) units. A total of 1134 treatment cycles from 2013 through 2015 were analyzed. We evaluated clinical pregnancy rate in terms of age, body mass index, waist-to-hip ratio, anti-Mullerian hormone level. The clinical pregnancy rate was 39.9%. The live birth rate was 25.5%. Women who conceived where statistically significantly younger and had lower body mass index. No statistical differences across pregnancy groups were found for waist-to-hip ratio, and anti-Mullerian hormone levels. Low AMH levels do not influence pregnancy rates in younger patients (<36 years).
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Affiliation(s)
- Andre Amsiejiene
- a Department of Clinics of Obstetrics and Gynecology , Faculty of Medicine Vilnius University , Vilnius , Lithuania
- b 'Vaisingumo Klinika' , Vilnius , Lithuania
| | - Grazina Drasutiene
- a Department of Clinics of Obstetrics and Gynecology , Faculty of Medicine Vilnius University , Vilnius , Lithuania
| | | | - Janina Tutkuviene
- c Department of Anatomy, Histology and Anthropology , Faculty of Medicine Vilnius University , Vilnius , Lithuania
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