nach oben

Current Obstetrics and Gynecology Reports

Erschienen in:

14.04.2023 | REVIEW

Infertility Treatment in Women with Obesity

verfasst von: Miriam A. Andrusier, Rajesh Reddy, Elizabeth S. Ginsburg

Erschienen in: Current Obstetrics and Gynecology Reports | Ausgabe 2/2023

Einloggen, um Zugang zu erhalten

Abstract

Purpose of Review

The rising prevalence of obesity has focused attention on its impact on gynecologic health, especially on fertility. Recent research has sought to understand the relationship of excess body fat on reproductive outcomes. Although it has become clear that obesity has detrimental effects on fertility, the effects of obesity-focused infertility treatments are not well established. This article examines the interplay of obesity with fertility treatment and reviews the most recent evidence on how weight loss treatments impact reproductive outcomes.

Recent Findings

Although weight loss can improve ovulatory dysfunction, the sum of evidence does not show improved birth rates or ART outcomes. For those with PCOS and obesity, bariatric surgery may play a role in improving both natural conception rates and ART outcomes. Physical activity has also been shown to improve ART outcomes regardless of BMI or weight loss achievement.

Summary

Weight loss may be useful in improving fecundity though recent research suggests that ART treatment should not be delayed for the purpose of achieving weight loss. Physical activity is a useful tool to improve ART outcomes and natural conception in women across the BMI spectrum. The optimal approach to ART treatment in women with obesity is not well established and no guidelines exist to answer this question. Future research should aim to elucidate strategies for improving natural fertility and ART outcomes in women with obesity. Studies should focus on optimizing ART to maximize positive outcomes in this population.

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.

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.CrossRefPubMed

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.CrossRefPubMed

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.CrossRefPubMed

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.CrossRefPubMed

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.CrossRefPubMed

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.CrossRefPubMed

10.

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.CrossRefPubMed

11.

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.CrossRefPubMed

12.

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.CrossRefPubMed

13.

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.CrossRefPubMed

14.

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.CrossRefPubMed

15.

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.CrossRefPubMed

16.

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.CrossRefPubMed

17.

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.CrossRefPubMed

18.

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.CrossRefPubMed

19.

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.CrossRefPubMed

20.

• 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.CrossRefPubMed

21.

• 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/s10815-022-02624-8. This study showed no difference in euploidy rates in women with obesity undergoing IVF compared to those with normal BMI.

22.

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.CrossRefPubMedPubMedCentral

23.

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.CrossRefPubMedPubMedCentral

24.

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.CrossRef

25.

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.CrossRefPubMed

26.

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.CrossRefPubMed

27.

• 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.CD003053. A Cochrane review finding that preconception advice on weight for women with infertility is uncertain to affect live birth rates.

28.

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.CrossRef

29.

• 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.CrossRefPubMedPubMedCentral

30.

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.CrossRefPubMed

31.

• 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.CrossRefPubMed

32.

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.CrossRefPubMed

33.

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.CrossRefPubMed

34.

• 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.CrossRefPubMed

35.

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.CrossRef

36.

• 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.CrossRefPubMed

37.

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.CrossRefPubMed

38.

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.CrossRefPubMed

39.

• 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.

40.

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.CrossRefPubMed

41.

• Legro RS, Dodson WC, Kris-Etherton PM, et al. Randomized controlled trial of preconception interventions in infertile women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2015;100(11):4048–58. https://doi.org/10.1210/jc.2015-2778. The OWL-PCOS trial is an important randomized controlled trial of 149 women with infertility, PCOS and elevated BMI. It randomized women to either 16 weeks of oral contraceptive pills versus lifestyle modifications with meal replacements and medications versus both of these interventions. Cumulative ovulation rates were superior after weight loss but there were no significant differences in birth rates. The prevalence of metabolic syndrome also was significantly higher after preconception treatment.CrossRefPubMedPubMedCentral

42.

• Legro RS, Dodson WC, Kunselman AR, et al. Benefit of delayed fertility therapy with preconception weight loss over immediate therapy in obese women with PCOS. J Clin Endocrinol Metab. 2016;101(7):2658–66. https://doi.org/10.1210/jc.2016-1659. This was a secondary analysis of two randomized controlled trials (PPCOS II and OWL PCOS), examining if fertility outcomes differ between immediate versus deferred clomiphene treatment relative to lifestyle modifications for weight loss. It found an improved cumulative ovulation and live birth rate with deferred treatment.CrossRefPubMedPubMedCentral

43.

Einarsson S, Bergh C, Friberg B, et al. Weight reduction intervention for obese infertile women prior to IVF: a randomized controlled trial. Hum Reprod. 2017;32(8):1621–30. https://doi.org/10.1093/humrep/dex235.CrossRefPubMed

44.

Chavarro JE, Ehrlich S, Colaci DS, et al. Body mass index and short-term weight change in relation to treatment outcomes in women undergoing assisted reproduction. Fertil Steril. 2012;98(1):109–16. https://doi.org/10.1016/j.fertnstert.2012.04.012.CrossRefPubMedPubMedCentral

45.

• Palomba S, Falbo A, Valli B, et al. Physical activity before IVF and ICSI cycles in infertile obese women: an observational cohort study. Reprod Biomed Online. 2014;29(1):72–9. https://doi.org/10.1016/j.rbmo.2014.03.006. This study found that obese infertile women who exercised regularly were 3-4 times more likely to have successful clinical pregnancies and live birth after ART treatment compared to obese infertile women who did not exercise, irrespective of whether weight loss was achieved.CrossRefPubMed

46.

Boedt T, Vanhove AC, Vercoe MA, Matthys C, Dancet E, Lie Fong S. Preconception lifestyle advice for people with infertility. Cochrane Gynaecology and Fertility Group, ed. Cochrane Database Syst Rev. 2021;2021(4). https://doi.org/10.1002/14651858.CD008189.pub3.

47.

Rao M, Zeng Z, Tang L. Maternal physical activity before IVF/ICSI cycles improves clinical pregnancy rate and live birth rate: a systematic review and meta-analysis. Reprod Biol Endocrinol. 2018;16(1):11. https://doi.org/10.1186/s12958-018-0328-z.CrossRefPubMedPubMedCentral

48.

Johansson K, Cnattingius S, Näslund I, et al. Outcomes of Pregnancy after Bariatric Surgery. N Engl J Med. 2015;372(9):814–24. https://doi.org/10.1056/NEJMoa1405789.CrossRefPubMed

49.

Falcone V, Stopp T, Feichtinger M, et al. Pregnancy after bariatric surgery: a narrative literature review and discussion of impact on pregnancy management and outcome. BMC Pregnancy Childbirth. 2018;18(1):507. https://doi.org/10.1186/s12884-018-2124-3.CrossRefPubMedPubMedCentral

50.

Rochester D, Jain A, Polotsky AJ, et al. Partial recovery of luteal function after bariatric surgery in obese women. Fertil Steril. 2009;92(4):1410–5. https://doi.org/10.1016/j.fertnstert.2008.08.025.CrossRefPubMed

51.

Legro RS, Dodson WC, Gnatuk CL, et al. Effects of Gastric Bypass Surgery on Female Reproductive Function. J Clin Endocrinol Metab. 2012;97(12):4540–8. https://doi.org/10.1210/jc.2012-2205.CrossRefPubMedPubMedCentral

52.

Sarwer DB, Spitzer JC, Wadden TA, et al. Changes in Sexual Functioning and Sex Hormone Levels in Women Following Bariatric Surgery. JAMA Surg. 2014;149(1):26. https://doi.org/10.1001/jamasurg.2013.5022.CrossRefPubMed

53.

Menke MN, King WC, White GE, et al. Contraception and Conception After Bariatric Surgery. Obstet Gynecol. 2017;130(5):979–87. https://doi.org/10.1097/AOG.0000000000002323.CrossRefPubMedPubMedCentral

54.

Menke MN, King WC, White GE, et al. Conception rates and contraceptive use after bariatric surgery among women with infertility: Evidence from a prospective multicenter cohort study. Surg Obes Relat Dis. 2019;15(5):777–85. https://doi.org/10.1016/j.soard.2018.12.026.CrossRefPubMed

55.

• Kominiarek MA, Jungheim ES, Hoeger KM, Rogers AM, Kahan S, Kim JJ. American Society for Metabolic and Bariatric Surgery position statement on the impact of obesity and obesity treatment on fertility and fertility therapy Endorsed by the American College of Obstetricians and Gynecologists and the Obesity Society. Surg Obes Relat Dis. 2017;13(5):750–7. https://doi.org/10.1016/j.soard.2017.02.006. The ASMBS position concluded that although weightloss can improve weight-loss associated causes for infertility but the specific impact on subsequent infertility treatments is not clearly understood.CrossRefPubMed

56.

Skubleny D, Switzer NJ, Gill RS, et al. The Impact of Bariatric Surgery on Polycystic Ovary Syndrome: a Systematic Review and Meta-analysis. Obes Surg. 2016;26(1):169–76. https://doi.org/10.1007/s11695-015-1902-5.CrossRefPubMed

57.

Conway G, Dewailly D, Diamanti-Kandarakis E, et al. The polycystic ovary syndrome: a position statement from the European Society of Endocrinology. Eur J Endocrinol. 2014;171(4):P1–29. https://doi.org/10.1530/EJE-14-0253.CrossRefPubMed

Titel: Infertility Treatment in Women with Obesity
verfasst von: Miriam A. Andrusier
Rajesh Reddy
Elizabeth S. Ginsburg
Publikationsdatum: 14.04.2023
Verlag: Springer US
Erschienen in: Current Obstetrics and Gynecology Reports / Ausgabe 2/2023
Elektronische ISSN: 2161-3303
DOI: https://doi.org/10.1007/s13669-023-00360-z

Neu im Fachgebiet Gynäkologie und Geburtshilfe

Alter der Mutter beeinflusst Risiko für kongenitale Anomalie

28.05.2024 Kinder- und Jugendgynäkologie Nachrichten

Welchen Einfluss das Alter ihrer Mutter auf das Risiko hat, dass Kinder mit nicht chromosomal bedingter Malformation zur Welt kommen, hat eine ungarische Studie untersucht. Sie zeigt: Nicht nur fortgeschrittenes Alter ist riskant.

Fehlerkultur in der Medizin – Offenheit zählt!

28.05.2024 Fehlerkultur Podcast

Darüber reden und aus Fehlern lernen, sollte das Motto in der Medizin lauten. Und zwar nicht nur im Sinne der Patientensicherheit. Eine negative Fehlerkultur kann auch die Behandelnden ernsthaft krank machen, warnt Prof. Dr. Reinhard Strametz. Ein Plädoyer und ein Leitfaden für den offenen Umgang mit kritischen Ereignissen in Medizin und Pflege.

Mammakarzinom: Brustdichte beeinflusst rezidivfreies Überleben

26.05.2024 Mammakarzinom Nachrichten

Frauen, die zum Zeitpunkt der Brustkrebsdiagnose eine hohe mammografische Brustdichte aufweisen, haben ein erhöhtes Risiko für ein baldiges Rezidiv, legen neue Daten nahe.

Mehr Lebenszeit mit Abemaciclib bei fortgeschrittenem Brustkrebs?

24.05.2024 Mammakarzinom Nachrichten

In der MONARCHE-3-Studie lebten Frauen mit fortgeschrittenem Hormonrezeptor-positivem, HER2-negativem Brustkrebs länger, wenn sie zusätzlich zu einem nicht steroidalen Aromatasehemmer mit Abemaciclib behandelt wurden; allerdings verfehlte der numerische Zugewinn die statistische Signifikanz.

Update Gynäkologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert – ganz bequem per eMail.

Newsletter bestellen

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

Infertility Treatment in Women with Obesity

Abstract

Purpose of Review

Recent Findings

Summary

Neu im Fachgebiet Gynäkologie und Geburtshilfe

Alter der Mutter beeinflusst Risiko für kongenitale Anomalie

Fehlerkultur in der Medizin – Offenheit zählt!

Mammakarzinom: Brustdichte beeinflusst rezidivfreies Überleben

Mehr Lebenszeit mit Abemaciclib bei fortgeschrittenem Brustkrebs?

Update Gynäkologie

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

Abstract

Purpose of Review

Recent Findings

Summary

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 2/2023

Stroke in Pregnancy

Self-Managed Abortion in the United States

Preventing Adverse Cardiovascular Outcomes in Pregnancy Complicated by Obesity

Management of Labor and Delivery to Reduce Risk for Cesarean Birth in Women with Obesity

Congenital Anomalies in Women with Obesity

Updates in the Management of Pregnancy of Unknown Location: A Focus on Expediting and Streamlining Care

Neu im Fachgebiet Gynäkologie und Geburtshilfe

Alter der Mutter beeinflusst Risiko für kongenitale Anomalie

Fehlerkultur in der Medizin – Offenheit zählt!

Mammakarzinom: Brustdichte beeinflusst rezidivfreies Überleben

Mehr Lebenszeit mit Abemaciclib bei fortgeschrittenem Brustkrebs?

Update Gynäkologie