Infertility Treatment in Women with Obesity

Centers for Disease Control and Prevention. Obesity is a Common, Serious, and Costly Disease [Internet]. Accessed October 20, 2022. https://www.cdc.gov/obesity/data/adult.html.

Driscoll AK, Gregory ECW. Increases in Prepregnancy Obesity: United States, 2016–2019. NCHS Data Brief. 2020;392:1–8.

Google Scholar 

March of Dimes | PeriStats. Obesity Overview [Internet]. Accessed October 20, 2022. https://www.marchofdimes.org/peristats/data?reg=99&top=17&stop=350&lev=1&slev=1&obj.

Ramlau-Hansen CH, Thulstrup AM, Nohr EA, Bonde JP, Sørensen TIA, Olsen J. Subfecundity in overweight and obese couples. Hum Reprod. 2007;22(6):1634–7. https://doi.org/10.1093/humrep/dem035.

Article  CAS  PubMed  Google Scholar 

Wise LA, Rothman KJ, Mikkelsen EM, Sorensen HT, Riis A, Hatch EE. An internet-based prospective study of body size and time-to-pregnancy. Hum Reprod. 2010;25(1):253–64. https://doi.org/10.1093/humrep/dep360.

Article  PubMed  Google Scholar 

van der Steeg JW, Steures P, Eijkemans MJC, et al. Obesity affects spontaneous pregnancy chances in subfertile, ovulatory women. Hum Reprod. 2007;23(2):324–8. https://doi.org/10.1093/humrep/dem371.

Article  PubMed  Google Scholar 

Gesink Law DC, Maclehose RF, Longnecker MP. Obesity and time to pregnancy. Hum Reprod. 2006;22(2):414–20. https://doi.org/10.1093/humrep/del400.

Article  PubMed  Google Scholar 

Poretsky L, Cataldo NA, Rosenwaks Z, Giudice LC. The Insulin-Related Ovarian Regulatory System in Health and Disease. Endocr Rev. 1999;20(4):535–82. https://doi.org/10.1210/edrv.20.4.0374.

Article  CAS  PubMed  Google Scholar 

Rich-Edwards JW, Goldman MB, Willett WC, et al. Adolescent body mass index and infertility caused by ovulatory disorder. Am J Obstet Gynecol. 1994;171(1):171–7. https://doi.org/10.1016/0002-9378(94)90465-0.

Article  CAS  PubMed  Google Scholar 

Pasquali R. Obesity and androgens: facts and perspectives. Fertil Steril. 2006;85(5):1319–40. https://doi.org/10.1016/j.fertnstert.2005.10.054.

Article  CAS  PubMed  Google Scholar 

Moran LJ, Norman RJ, Teede HJ. Metabolic risk in PCOS: phenotype and adiposity impact. Trends Endocrinol Metab. 2015;26(3):136–43. https://doi.org/10.1016/j.tem.2014.12.003.

Article  CAS  PubMed  Google Scholar 

Luke B, Brown MB, Stern JE, et al. Female obesity adversely affects assisted reproductive technology (ART) pregnancy and live birth rates. Hum Reprod. 2011;26(1):245–52. https://doi.org/10.1093/humrep/deq306.

Article  PubMed  Google Scholar 

Shah DK, Missmer SA, Berry KF, Racowsky C, Ginsburg ES. Effect of Obesity on Oocyte and Embryo Quality in Women Undergoing In Vitro Fertilization. Obstet Gynecol. 2011;118(1):63–70. https://doi.org/10.1097/AOG.0b013e31821fd360.

Article  PubMed  Google Scholar 

Koning AMH, Mutsaerts MAQ, Kuchenbecher WKH, et al. Complications and outcome of assisted reproduction technologies in overweight and obese women. Hum Reprod. 2012;27(2):457–67. https://doi.org/10.1093/humrep/der416.

Article  CAS  PubMed  Google Scholar 

Marquard KL, Stephens SM, Jungheim ES, et al. Polycystic ovary syndrome and maternal obesity affect oocyte size in in vitro fertilization/intracytoplasmic sperm injection cycles. Fertil Steril. 2011;95(6):2146-2149.e1. https://doi.org/10.1016/j.fertnstert.2010.10.026.

Article  PubMed  Google Scholar 

Metwally M, Cutting R, Tipton A, Skull J, Ledger W, Li T. Effect of increased body mass index on oocyte and embryo quality in IVF patients. Reprod Biomed Online. 2007;15(5):532–8. https://doi.org/10.1016/S1472-6483(10)60385-9.

Article  CAS  PubMed  Google Scholar 

Mirabi P, Chaichi MJ, Esmaeilzadeh S, Jorsaraei SGA, Bijani A, Ehsani M. Does different BMI influence oocyte and embryo quality by inducing fatty acid in follicular fluid? Taiwan J Obstet Gynecol. 2017;56(2):159–64. https://doi.org/10.1016/j.tjog.2016.11.005.

Article  PubMed  Google Scholar 

Carrell DT, Jones KP, Peterson CM, Aoki V, Emery BR, Campbell BR. Body mass index is inversely related to intra-follicular HCG concentrations, embryo quality and IVF outcome. Reprod Biomed Online. 2001;3(2):109–11. https://doi.org/10.1016/S1472-6483(10)61977-3.

Article  CAS  PubMed  Google Scholar 

Bellver J, Ayllón Y, Ferrando M, et al. Female obesity impairs in vitro fertilization outcome without affecting embryo quality. Fertil Steril. 2010;93(2):447–54. https://doi.org/10.1016/j.fertnstert.2008.12.032.

Article  PubMed  Google Scholar 

• Provost MP, Acharya KS, Acharya CR, et al. Pregnancy outcomes decline with increasing body mass index: analysis of 239,127 fresh autologous in vitro fertilization cycles from the 2008–2010 Society for Assisted Reproductive Technology registry. Fertil Steril. 2016;105(3):663–9. https://doi.org/10.1016/j.fertnstert.2015.11.008. This study included over 239,000 IVF cycles and showed that patients with BMI > 30 kg/m2 had lower rates of implantation, clinical pregnancy, and live birth and had higher rates of pregnancy loss.

Article  PubMed  Google Scholar 

• Hallisey S, Makhijani R, Thorne J, et al. The association of obesity with euploidy rates in women undergoing in vitro fertilization with preimplantation genetic testing. J Assist Reprod Genet. Published online October 10, 2022. https://doi.org/10.1007/s10815-022-02624-8This study showed no difference in euploidy rates in women with obesity undergoing IVF compared to those with normal BMI.

Bhattacharya S, Pandey S, Pandey S, Maheshwari A. The impact of female obesity on the outcome of fertility treatment. J Hum Reprod Sci. 2010;3(2):62. https://doi.org/10.4103/0974-1208.69332.

Article  PubMed  PubMed Central  Google Scholar 

Luke B. Adverse effects of female obesity and interaction with race on reproductive potential. Fertil Steril. 2017;107(4):868–77. https://doi.org/10.1016/j.fertnstert.2017.02.114.

Article  PubMed  PubMed Central  Google Scholar 

Garcia-Ferreyra J, Carpio J, Zambrano M, Valdivieso-Mejia 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 Published online. 2021. https://doi.org/10.5935/1518-0557.20200105.

Article  Google Scholar 

Marci R, Lisi F, Soave I, et al. Ovarian stimulation in women with high and normal body mass index: GnRH agonist versus GnRH antagonist. Gynecol Endocrinol. 2012;28(10):792–5. https://doi.org/10.3109/09513590.2012.664192.

Article  CAS  PubMed  Google Scholar 

Souter I, Baltagi LM, Kuleta D, Meeker JD, Petrozza JC. Women, weight, and fertility: The effect of body mass index on the outcome of superovulation/intrauterine insemination cycles. Fertil Steril. 2011;95(3):1042–7. https://doi.org/10.1016/j.fertnstert.2010.11.062.

Article  PubMed  Google Scholar 

• Tang T, Norman RJ, Balen AH, Lord JM. Insulin-sensitising drugs (metformin, troglitazone, rosiglitazone, pioglitazone, D-chiro-inositol) for polycystic ovary syndrome. In: The Cochrane Collaboration, ed. Cochrane Database of Systematic Reviews. John Wiley & Sons, Ltd; 2003:CD003053. https://doi.org/10.1002/14651858.CD003053A Cochrane review finding that preconception advice on weight for women with infertility is uncertain to affect live birth rates.

Penzias A, Bendikson K, Butts S, et al. Role of metformin for ovulation induction in infertile patients with polycystic ovary syndrome (PCOS): a guideline. Fertil Steril. 2017;108(3):426–41. https://doi.org/10.1016/j.fertnstert.2017.06.026.

Article  CAS  Google Scholar 

• Legro RS, Brzyski RG, Diamond MP, et al. Letrozole versus clomiphene for infertility in the polycystic ovary syndrome. N Engl J Med. 2014;371(2):119–29. https://doi.org/10.1056/NEJMoa1313517. This study found that compared to clomiphene citrate, letrozole led to higher ovulation, clinical pregnancy, and live birth rates in women with PCOS irrespective of BMI.

Article  CAS  PubMed  PubMed Central  Google Scholar 

Tu J, Lin G, Lu C, Gong F. A novel modified ultra-long agonist protocol improves the outcome of high body mass index women with polycystic ovary syndrome undergoing IVF/ICSI. Gynecol Endocrinol. 2014;30(3):209–12. https://doi.org/10.3109/09513590.2013.860121.

Article  PubMed  Google Scholar 

• Zhang JJ, Feret M, Chang L, Yang M, Merhi Z. Obesity adversely impacts the number and maturity of oocytes in conventional IVF not in minimal stimulation IVF. Gynecol Endocrinol. 2015;31(5):409–13. https://doi.org/10.3109/09513590.2015.1014785. This study found that BMI was negatively correlated with the number of MII oocytes retrieved among patients who underwent a conventional IVF protocol but did not find this difference in those who received a minimal stimulation IVF protocol.

Article  PubMed  Google Scholar 

Nelson SM, Fleming RF. The preconceptual contraception paradigm: obesity and infertility. Hum Reprod. 2007;22(4):912–5. https://doi.org/10.1093/humrep/del473.

Article  PubMed  Google Scholar 

Clark AM, Thornley B, Tomlinson L, Galletley C, Norman RJ. Weight loss in obese infertile women results in improvement in reproductive outcome for all forms of fertility treatment. Hum Reprod. 1998;13(6):1502–5. https://doi.org/10.1093/humrep/13.6.1502.

Article  CAS  PubMed  Google Scholar 

• Kort JD, Winget C, Kim SH, Lathi RB. A retrospective cohort study to evaluate the impact of meaningful weight loss on fertility outcomes in an overweight population with infertility. Fertil Steril. 2014;101(5):1400–3. https://doi.org/10.1016/j.fertnstert.2014.01.036. This is a retrospective cohort study demonstrating that women with overweight that achieve weight loss > 10% had significantly higher conception and live birth rates than those who did not.

Article  PubMed  Google Scholar 

Penzias A, Azziz R, Bendikson K, et al. Obesity and reproduction: a committee opinion. Fertil Steril. 2021;116(5):1266–85. https://doi.org/10.1016/j.fertnstert.2021.08.018.

Article  Google Scholar 

• Vitek WS, Hoeger KM. Worth the wait? Preconception weight reduction in women and men with obesity and infertility: a narrative review. Fertil Steril. 2022;118(3):447–55. https://doi.org/10.1016/j.fertnstert.2022.07.001. This recent review concluded that weight loss achieved with short-term lifestyle modifications and medications does not improve conception or live birth rates in women undergoing fertility treatment but may improve rates of natural conception especially in patients who are anovulatory.

Article  PubMed  Google Scholar 

Sim KA, Dezarnaulds GM, Denyer GS, Skilton MR, Caterson ID. Weight loss improves reproductive outcomes in obese women undergoing fertility treatment: a randomized controlled trial: Weight loss and fertility treatment. Clin Obes. 2014;4(2):61–8. https://doi.org/10.1111/cob.12048.

Article  CAS  PubMed  Google Scholar 

Mutsaerts MAQ, van Oers AM, Groen H, et al. Randomized Trial of a Lifestyle Program in Obese Infertile Women. N Engl J Med. 2016;374(20):1942–53. https://doi.org/10.1056/NEJMoa1505297.

Article  CAS  PubMed  Google Scholar 

• Legro RS, Hansen KR, Diamond MP, et al. Effects of preconception lifestyle intervention in infertile women with obesity: The FIT-PLESE randomized controlled trial. Myers JE, ed. PLOS Med. 2022;19(1):e1003883. https://doi.org/10.1371/journal.pmed.1003883. The FIT-PLESE study is an important randomized controlled trial of 379 women with obesity and unexplained infertility, comparing an intervention of increased physical activity and weight loss via meal replacements and medications to a control group of increased physical activity alone without weight loss. There was no difference in fertility or birth outcomes.

Wang Z, Zhao J, Ma X, et al. Effect of Orlistat on Live Birth Rate in Overweight or Obese Women Undergoing IVF-ET: A Randomized Clinical Trial. J Clin Endocrinol Metab. 2021;106(9):e3533–45. https://doi.org/10.1210/clinem/dgab340.

Article  PubMed 

Comments (0)

No login
gif