Effect of a very-low-calorie diet on in vitro fertilization outcomes

doi:10.1016/j.fertnstert.2005.12.041

Fertility and Sterility

Volume 86, Issue 1, July 2006, Pages 227-229

https://doi.org/10.1016/j.fertnstert.2005.12.041 Get rights and content

A low-calorie diet in a group of overweight or obese patients for a short period before and during IVF results in variable tolerance to the dietary regime and an unsatisfactory IVF outcome.

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Worth the wait? Preconception weight reduction in women and men with obesity and infertility: a narrative review
2022, Fertility and Sterility
Citation Excerpt :
Lifestyle interventions induce weight loss by creating a negative energy balance through hypocaloric diets and increased physical activity. While no guidelines recommend a specific diet to support women attempting to lose weight while trying to conceive, most dietary interventions employed in randomized trials in women with infertility and obesity aim to reduce daily caloric intake to 1500 Kcal per day, while some interventions have employed a very low-calorie diet consisting of <800 Kcal per day over a shorter term to induce more rapid weight loss (8–10). Guidelines for activity goals for women trying to conceive aim to increase steps per day gradually to an average of 10,000 steps per day and/or moderate aerobic exercise for 150 minutes/week, although a longer duration of exercise may be required for weight reduction with exercise alone (11).
Short and long-term weight reduction interventions are considered in the preconception period for women and men with obesity and infertility as obesity is associated with poorer reproductive outcomes. Short-term weight loss achieved with diet, exercise, and medications does not improve per cycle conception or live birth rates in women undergoing ovulation induction, intrauterine insemination, or in vitro fertilization (IVF), but may increase the rate of natural conception. Long-term weight loss achieved through surgical interventions may increase spontaneous conceptions, particularly among women with polycystic ovary syndrome, and may increase the live birth rate from IVF, though these findings are limited by recent evidence. There is a clear need for additional treatment options and well-designed weight loss intervention trials that address the heterogeneous causes of obesity among women and men with infertility and include fertility outcomes and perinatal morbidity as outcome measures.
A Retrospective Study Examining Phentermine on Preconception Weight Loss and Pregnancy Outcomes
2020, Endocrine Practice
Citation Excerpt :
Lastly, timing and rate of weight loss are likely to be important. Too rapid weight loss may be detrimental as it has been associated with increased risk of small-forgestational age infants and neonatal deaths in the bariatric surgery literature and perhaps poorer ART outcomes (15,27). Sustained weight loss of perhaps several months before conception may be necessary to achieve the metabolic and endocrine changes needed to restore fertility.
Objective: Obesity is a well-known risk factor for infertility. However, the use of weight loss medications prior to conception is underutilized. The objectives of our study are to describe weight loss, pregnancy rates, and live birth rates after short-term phentermine use in women with obesity and infertility.
Methods: This was a retrospective analysis of 55 women (18 to 45 years old) who were overweight or obese, diagnosed with infertility, and prescribed phentermine for weight loss in an ambulatory endocrinology clinic at a single, tertiary level academic medical center. Main outcome measures were mean percent weight change at 3 months after starting phentermine, and pregnancy, and live birth rates from start of phentermine to June 30, 2017.
Results: Median duration of phentermine use was 70 days (Q1, Q3 [33, 129]). Mean ± SD percent weight change at 3 months after starting phentermine was -5.3 ± 4.1% (P<.001). The pregnancy rate was 60% and the live birth rate was 49%. There was no significant difference in pregnancy rates (52% versus 68%; P = .23) or live birth rates (44% versus 54%; P = .50) in women who lost ≥5% versus <5% of their baseline weight. The number of metabolic comorbidities was negatively associated with the pregnancy rate. Phentermine was generally well-tolerated with no serious adverse events.
Conclusion: Phentermine can produce clinically significant weight loss in women with obesity during the preconception period. Higher pregnancy or live birth rates were not observed with a greater degree of weight loss with phentermine.
Epigenomic reprogramming of caloric restriction on aging
2019, Nutritional Epigenomics
The three well-known, closely interacting caloric restriction (CR) epigenenomic reprograming mechanisms are DNA methylation, histone modification and expression of non-coding microRNAs and long non-coding RNAs. These epigenenomic changes are mediated via three pathways: a direct influence on gene expression, including circadian clock gene expression, activation of nuclear receptors by ligands and modification of membrane receptor signaling cascades. Caloric restriction elicited epigenetic mechanisms provide the organism with a robust, and time responsive system for adapting gene expression that is tissue-type specific, appropriate for the developmental state of the organism and responsive to signals from the external and internal environment. In summary, the cellular effects of CR are enhanced oxidative metabolism, increased resistance to oxidative stress, increased genome and telomere stability that prolong the period of healty aging and lead to an increased lifespan.
Weight decrease improves live birth rates in obese women undergoing IVF: a pilot study
2017, Reproductive BioMedicine Online
Obese women have lower pregnancy rates than normal-weight women undergoing assisted reproductive treatment. We conducted a pilot study to evaluate whether a 12-week diet and exercise intervention before an IVF cycle would influence pregnancy rates in obese women. Forty-one patients were enrolled in this study. They were randomly allocated to two groups: an intervention group (n = 21), who underwent an individualized diet and physical exercise programme supervised by a dietician, and a control group (n = 20), who started IVF with no previous intervention. The primary outcome was clinical pregnancy rate after a single treatment cycle. Mean weight loss in the study group after the intervention was 5.4 kg (range 1.1–14.6 kg). The study and control groups had similar total FSH consumption, number of oocytes and embryos obtained, and number and quality of embryos transferred. There was a non-significant trend towards a higher clinical pregnancy rate after fresh embryo transfer (66.7% versus 41.2%). The intervention group had a significantly higher cumulative live birth rate (61.9% versus 30%, P = 0.045) (odds ratio for intervention group, 3.8; 95% confidence interval, 1.03 to 13.9) The data suggest that weight loss resulted in a significantly increased cumulative live birth rate.
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
2017, Surgery for Obesity and Related Diseases
Citation Excerpt :
However, the effects of these improvements on fecundity have been mixed [65–68]. Moreover, very-low-calorie diets, utilized in adult obesity treatment with variable success, have been shown to worsen infertility treatment outcomes [69]. Overall, there is also a paucity of literature regarding the specific impact of bariatric surgery on the responsiveness to subsequent treatments for infertility.
Effects of obesity treatment on female reproduction: results do not match expectations
2017, Fertility and Sterility
Citation Excerpt :
No such studies of dose or duration of treatment exist for preconception weight loss. The timing of the intervention to fertility treatment is also unclear, although there is evidence both from bariatric surgery (43) and lifestyle modification (44) that severe caloric restriction and overall energy deficit immediately before or concordant with infertility results are associated with poor gamete and embryo quality and implantation failure. There may be a theoretical benefit in clearly separating the intervention to lower weight from the treatment of infertility, given the long time period from follicular recruitment to ovulation, to allow the oocyte to recover from the period of relative caloric restriction with a recovery phase of eucaloric nutrition.
The adverse effects of obesity of female reproduction have been extensively documented. However, there are few prospective studies that have examined preconception weight loss interventions. There is a need to develop successful interventions with significant weight loss and compliance and most importantly document the effects of preconception interventions on important perinatal outcomes such as live birth and the health of the infant and mother. The existing data from randomized trials that come closest to meeting these criteria have failed to document improved live-birth rates after the intervention compared with control groups. There is a tendency to equate favorable weight change both before and during pregnancy with a direct qualitative improvement in all perinatal outcomes, yet the results from the most successful treatment of morbid obesity, that is, bariatric surgery, with on average 40% weight loss, suggest a mixed risk-benefit ratio on perinatal outcomes. Although interventions to control gestational weight gain have been more completely studied than preconception ones, and have documented successful interventions to achieve appropriate weight gain, there is no clear evidence that controlling gestational weight gain actually improves any important perinatal outcome. Future studies must develop more successful and effective interventions, capture perinatal outcomes instead of weight change as the primary outcomes, use, at least preconception, new antiobesity drugs (in combination with other therapies), and study bariatric surgery in prospective trials to improve our understanding of the effectiveness of obesity treatment before pregnancy.

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: This study was supported by The University of Adelaide in Adelaide, Australia, and sponsored with a product (Optifast VLCD) by Novartis USA.

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CorrespondenceEffect of a very-low-calorie diet on in vitro fertilization outcomes

Overweight and obesity in Australiathe 1999–2000 Australian Diabetes, Obesity and Lifestyle Study (AusDiab)

Med J Aust

Body mass and probability of pregnancy during assisted reproduction treatmentretrospective study

BMJ

Physical activity, body mass index, and ovulatory disorder infertility

Epidemiology

Overweight and obese anovulatory patients with polycystic ovariesparallel improvements in anthropometric indices, ovarian physiology and fertility rate induced by diet

Hum Reprod

Improving reproductive performance in overweight/obese women with effective weight management

Hum Reprod Update

Obesity increases the risk of spontaneous abortion during infertility treatment

Obes Res

Association of moderate obesity with a poor pregnancy outcome in women with polycystic ovary syndrome treated with low dose gonadotrophin

Br J Obstet Gynaecol

Impact of overweight and underweight on assisted reproduction treatment

Hum Reprod

Weight loss results in significant improvement in pregnancy and ovulation rates in anovulatory obese women

Hum Reprod

Correspondence
Effect of a very-low-calorie diet on in vitro fertilization outcomes