Journal of Shandong University (Health Sciences) ›› 2024, Vol. 62 ›› Issue (3): 54-60.doi: 10.6040/j.issn.1671-7554.0.2024.0145

• Clinical Medicine • Previous Articles     Next Articles

Impact of BMI on cumulative birth rate in patients with normal ovarian response

LIU Wen1, FENG Wenjuan2, YANG Yang1, JI Changli1, CHAO Lan1   

  1. 1. Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan 250012, Shandong, China;
    2. Department of Reproductive Medicine, Jinan Central Hospital, Jinan 250013, Shandong, China
  • Published:2024-05-06

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Abstract: Objective To compare the effects of different body mass index(BMI)on the cumulative birth rate(CLBR)in patients with normal ovarian response undergoing in vitro fertilization/intracytoplasmic sperm microinjection(IVF/ICSI). Methods A retrospective analysis of 3,227 oocyte retrieval cycles treated with IVF/ICSI was performed. Patients were divided into low BMI group(BMI<18.5, n=167), normal BMI group(18.5≤BMI<24.0, n=2,024), overweight group(24.0≤BMI<28.0, n=816), and obese group(BMI≥28.0, n=220). Clinical characteristics, laboratory indicators and pregnancy outcomes were compared among the groups. Results The total amount of gonadotrophin(Gn)elevated with increasing BMI in all four groups, with significant difference(P<0.001). There were no significant differences in the number of oocytes, number of high-quality embryos, 2PN fertilization rate, and 2PN cleavage rate among the four groups(P>0.05). The high-quality embryo rate and blastocyst formation rate in the obese group were lower than those in the normal BMI group(P=0.012, P<0.001)and overweight group(P=0.014, P<0.001). Oocyte utilization was significantly lower in the overweight and obese groups than in the normal BMI group(P=0.031, P=0.002). The miscarriage rate was higher in the overweight group than in the normal BMI group(P=0.013). CLBR was lower in the obese and overweight groups than in the normal BMI group(P=0.009, P=0.023). There were no significant differences in the clinical pregnancy rate and preterm labor rate among the four groups(P>0.05). Higher BMI was significantly associated with lower CLBR, and an adjusted OR(95%CI)was 0.953(0.948-0.958). Conclusion In patients with normal ovarian response undergoing assisted reproductive technology, overweight and obesity lead to increased total dosage of Gn, and the high-quality embryo rate, blastocyst formation rate, oocyte utilization rate and CLBR are significantly lower in obese patients, indicating that such patients should undergo aggressive weight loss before proceeding to assisted reproduction therapy.

Key words: Body mass index, Cumulative birth rate, In vitro fertilization-embryo transfer, Obesity

CLC Number: 

  • R711.6
[1] Ng M, Fleming T, Robinson M, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013[J]. Lancet, 2014, 384(9945): 766-781.
[2] Bibi R, Jahan S, Afsar T, et al. The influence of paternal overweight on sperm chromatin integrity, fertilization rate and pregnancy outcome among males attending fertility clinic for IVF/ICSI treatment[J]. BMC Pregnancy Childbirth, 2022, 22(1): 620. doi: 10.1186/s12884-022-04953-z
[3] Shen X, Xie Y, Chen D, et al. Effect of female and male body mass index on cumulative live birth rates in the freeze-all strategy[J]. J Clin Endocrinol Metab, 2022, 107(4): e1467-e1476.
[4] 宋海霞, 袁彩霞, 范玲玲. 体质量指数对夫精人工授精妊娠结局的影响[J]. 山东大学学报(医学版), 2020, 58(1): 49-53. SONG Haixia,YUAN Caixia,FAN Lingling. Impact of body mass index on pregnancy outcomes in artificial insemination by husband[J]. Journal of Shandong University(Health Sciences), 2020, 58(1): 49-53.
[5] Van der Steeg JW, Steures P, Eijkemans MJ, et al. Obesity affects spontaneous pregnancy chances in subfertile, ovulatory women[J]. Hum Reprod, 2008, 23(2): 324-328.
[6] Sermondade N, Huberlant S, Bourhis-Lefebvre V, et al. Female obesity is negatively associated with live birth rate following IVF: a systematic review and meta-analysis[J]. Hum Reprod Update, 2019, 25(4): 439-451.
[7] 黄晓燕, 吕红, 吴春香, 等. 多囊卵巢综合征患者的体质量指数和脂代谢水平对促性腺激素释放激素拮抗剂方案妊娠结局的影响[J]. 中华生殖与避孕杂志, 2018, 38(12): 969-975. HUANG Xiaoyan, LYU Hong, WU Chunxiang, et al. Effect of body mass index and lipid metabolism on pregnancy outcome of polycystic ovary syndrome patients undergoing in vitro fertilization/intracytoplasmic sperm injection using gonadotropin-releasing hormone antagonist protocol[J]. Chin J Reprod Contracep, 2018, 38(12): 969-975.
[8] 刘梦麒, 陈贝, 罗金, 等. 体质量指数对卵巢正常反应人群体外受精-胚胎移植结局的影响[J]. 生殖医学杂志, 2022, 31(9): 1216-1220. LIU Mengqi, CHEN Bei, LUO Jin, et al. Impact of body mass index on outcomes of IVF-ET cycles in individuals with normal response[J]. J Reprod Med, 2022, 31(9): 1216-1220.
[9] Kawwass JF, Kulkarni AD, Hipp HS, et al. Extremities of body mass index and their association with pregnancy outcomes in women undergoing in vitro fertilization in the United States[J]. Fertil Steril, 2016, 106(7): 1742-1750.
[10] Insogna IG, Lee MS, Reimers RM, et al. Neutral effect of body mass index on implantation rate after frozen-thawed blastocyst transfer[J]. Fertil Steril, 2017, 108(5): 770-776.
[11] 胡琳莉, 黄国宁, 孙海翔, 等. 辅助生殖技术临床关键指标质控专家共识[J]. 生殖医学杂志, 2018, 29(9): 828-835. HU Linli, HUANG Guoning, SUN Haixiang, et al. CSRM consensus on key indicators for quality control in ART clinical operation[J]. J Reprod Med, 2018, 29(9): 828-835.
[12] 李宣, 刘嘉茵, 陈文森, 等. 比较长方案与拮抗剂方案在正常反应人群中的应用[J]. 中华生殖与避孕杂志, 2018, 38(8): 219-223. LI Xuan, LIU Jiayin, CHEN Wensen, et al. Comparison of the agonist protocol and antagonist protocol in normal responders[J]. Chin J Reprod Contracep, 2018, 38(8): 219-223.
[13] 中国肥胖问题工作组. 中国成人超重和肥胖症预防与控制指南(节录)[J]. 营养学报, 2004, 26(1): 1-4.
[14] González-García I, García-Clavé E, Cebrian-Serrano A, et al. Estradiol regulates leptin sensitivity to control feeding via hypothalamic Cited1[J]. Cell Metab, 2023, 35(3): 438-455.
[15] 卜晓萌, 刘艳君, 周丽颖, 等. 卵巢储备正常不孕女性低获卵数的高危因素分析[J]. 生殖医学杂志, 2022, 31(6): 777-781. BU Xiaomeng, LIU Yanjun, ZHOU Liying, et al. High risk fators of low oocyte retrieval in infertile women with normal ovarian reserve[J]. J Reprod Med, 2022, 31(6): 777-781.
[16] Datta AK, Maheshwari A, Felix N, et al. Mild versus conventional ovarian stimulation for IVF in poor, normal and hyper-responders: a systematic review and meta-analysis[J]. Hum Reprod Update, 2021, 27(2): 229-253.
[17] Becker GF, Passos EP, Moulin CC. Short-term effects of a hypocaloric diet with low glycemic index and low glycemic load on body adiposity, metabolic variables, ghrelin, leptin, and pregnancy rate in overweight and obese infertile women: a randomized controlled trial[J]. Am J Clin Nutr, 2015, 102(6): 1365-1372.
[18] Yong W, Wang J, Leng Y, et al. Role of obesity in female reproduction[J]. Int J Med Sci, 2023, 20(3): 366-375.
[19] Martinez RM, Baccarelli AA, Liang L, et al. Body mass index in relation to extracellular vesicle-linked microRNAs in human follicular fluid[J]. Fertil Steril, 2019, 112(2): 387-396.
[20] Hughes LM, McQueen DB, Jungheim ES, et al. Maternal body mass index is not associated with increased rates of maternal embryonic aneuploidy[J]. Fertil Steril, 2022, 117(4): 783-789.
[21] Schliep KC, Mumford SL, Ahrens KA, et al. Effect of male and female body mass index on pregnancy and live birth success after in vitro fertilization[J]. Fertil Steril, 2015, 103(2): 388-395.
[22] Liu X, Shi S, Sun J, et al. The influence of male and female overweight/obesity on IVF outcomes: a cohort study based on registration in Western China[J]. Reprod Health, 2023, 20(1): 3. doi: 10.1186/s12978-022-01558-9.
[23] 江元元, 乔岩岩. BMI对卵巢储备功能正常不孕女性助孕结局的影响[J]. 生殖医学杂志, 2023, 32(5): 763-766.
[24] 解晋琳, 田莉, 柏海燕, 等. 不同体重指数的年轻患者行IVF-D助孕结局分析[J]. 中国妇幼健康研究, 2017, 28(2): 126-127. XIE Jinlin, TIAN Li, BAI Haiyan, et al. IVF-ET outcomes of young women with different body mass index[J]. Chinese Journal of Woman and Child Health Research, 2017, 28(2): 126-127.
[25] 胡亚会, 李昊雨, 王金玉, 等. 首次行IVF/ICSI助孕的单纯高BMI女性累积分娩率及其影响因素分析[J]. 生殖医学杂志, 2022, 31(7): 948-953. HU Yahui, LI Haoyu, WANG Jinyu, et al. Cumulative delivery rate and its influencing factors in women with high BMI undergoing IVF/ICSI for the first time[J]. J Reprod Med, 2022, 31(7): 948-953.
[26] 中国医师协会生殖医学专业委员会. 基于单次促排卵周期的累积分娩/活产率专家共识[J]. 中华生殖与避孕杂志, 2018, 38(12): 963-968.
[27] 张乾乾, 何玉洁. BMI与IVF新鲜周期活产率的相关性及其预测价值[J]. 临床与病理杂志, 2021, 41(1): 45-51.
[28] Goldman RH, Farland LV, Thomas AM, et al. The combined impact of maternal age and body mass index on cumulative live birth following in vitro fertilization[J]. Am J Obstet Gynecol, 2019, 221(6): 617 e611-617 e613.
[29] Yang AM, Xu X, Han Y, et al. Risk Factors for Different types of pregnancy losses: analysis of 15,210 pregnancies after embryo transfer[J]. Front Endocrinol(Lausanne), 2021, 12: 683236. doi: 10.3389/fendo.2021.683236.
[30] Cozzolino M, Garcia-Velasco JA, Meseguer M, et al. Female obesity increases the risk of miscarriage of euploid embryos[J]. Fertil Steril, 2021, 115(6): 1495-1502.
[31] Cai J, Liu L, Zhang J, et al. Low body mass index compromises live birth rate in fresh transfer in vitro fertilization cycles: a retrospective study in a Chinese population[J]. Fertil Steril, 2017, 107(2): 422-429.
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