The Appraisal of Body Content (ABC) trial: Increased male or female adiposity does not significantly impact in vitro fertilization laboratory or clinical outcomes

Kim, Julia; Patounakis, George; Juneau, C.R.; Morin, S.J.; Neal, Shelby A.; Bergh, Paul A.; Seli, Emre; Scott, Richard T.

doi:10.1016/j.fertnstert.2020.12.037

Cited by 34 publications

(25 citation statements)

References 26 publications

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“…Many studies showing negative effects of BMI were based on fresh cycles [ 6 , 12 , 29 ]. In contrast, studies on frozen cycles showed neutral effect of BMI on pregnancy outcomes [ 13 , 14 , 30 ]. Our study was on frozen cycles, and the result was in consistent with the latter ones.…”

Section: Discussionmentioning

confidence: 99%

“…Early studies showed lower CPRs and LBRs, but higher miscarriage rates in women with increased BMIs [ 5 , 12 ]. However, more recent studies found no significant difference in the rate of pregnancy, live birth or miscarriage among patients with different BMI categories [ 13 , 14 ]. Second, most prior studies included only fresh cycles.…”

Section: Introductionmentioning

confidence: 99%

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Body mass index is associated with miscarriage rate and perinatal outcomes in cycles with frozen-thawed single blastocyst transfer: a retrospective cohort study

Zheng

Dong

Chen

et al. 2022

BMC Pregnancy Childbirth

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Background The association between body mass index (BMI) and IVF cycle outcomes remain inconclusive. In addition, the impact of BMI on perinatal outcomes has been less well-studied. The aim of this study was to assess the effects of BMI on pregnancy outcomes, as well as maternal and neonatal outcomes. Methods This was a retrospective cohort study on 10,252 frozen-thawed cycles with single blastocyst transfer between January 2016 and December 2019. Patients were divided into four groups: underweight (< 18.5 kg/m2), normal-weight (18.5–24 kg/m2), overweight (24–28 kg/m2), and obesity (≥ 28 kg/m2), according to the Chinese classification. Multivariate logistic regression and multivariate general linear model were used for statistical analysis. Results The rates of live birth and clinical pregnancy were comparable among groups. Miscarriage rate was higher in the obese women than that in the normal controls (27.51 vs. 20.91%, aOR = 1.453 (1.066–1.982)). Using the normal-weight women as reference, the underweight women had lower incidences of preterm birth (6.97 vs. 11.19%, aOR = 0.611 (0.422–0.884)), macrosomia (4.90 vs. 8.65%, aOR = 0.544 (0.353–0.837)) and large-for-gestational age (LGA, 11.18 vs. 16.54%, aOR = 0.643 (0.477–0.866)); the overweight women had higher prevalence of gestational diabetes (6.56 vs. 3.82%, aOR = 1.744 (1.232–2.468)), hypertension (4.42 vs. 2.32%, aOR = 1.822 (1.186–2.800)), macrosomia (12.93 vs. 8.65%, aOR = 1.596 (1.240–2.054)) and LGA (23.22 vs. 16.54%, aOR = 1.549 (1.270–1.890)); the obese women had higher incidences of preterm birth (16.87 vs. 11.19%, aOR = 1.646 (1.068–2.536)), cesarean delivery (93.98 vs. 87.91%, aOR = 2.078 (1.083–3.987)), gestational hypertension (4.82 vs. 2.32%, aOR = 2.138 (1.005–4.547)), macrosomia (14.88 vs. 8.65%, aOR = 1.880 (1.192–2.964)) and LGA (25.60 vs. 16.54%, aOR = 1.764 (1.218–2.555)). Conclusions BMI has no significant effect on the chance of pregnancy or live birth, but obesity increases the risk of miscarriage. Underweight is associated with better maternal and neonatal outcomes, while overweight and obesity are associated with worse maternal and neonatal outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Body mass index is associated with miscarriage rate and perinatal outcomes in cycles with frozen-thawed single blastocyst transfer: a retrospective cohort study

Zheng

Dong

Chen

et al. 2022

BMC Pregnancy Childbirth

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“…Regarding morphokinetics, two initial studies evaluated embryo dynamics until day 3 of development in obese women, finding no differences with respect to normal weight controls in the first [36], and a slower embryo development in the second [37]. Subsequently, the developmental kinetics of embryos up to the blastocyst stage was explored in another study [38], while a further two analyzed the blastocyst formation rate in overweight/obese women [2,39]. Leary et al [38] observed that embryos from overweight women placed in the Primovision time-lapse system reached the morula stage faster, and that the resulting blastocysts contained fewer cells -notably in the trophectodermin comparison with those from normal weight women.…”

Section: Morphologymentioning

confidence: 99%

“…Other anthropometric parameters more closely related to the health status of the patient, such as the waist-to-hip ratio or the thickness of several body skinfolds, have not been recorded or analyzed in most of the literature dealing with human reproduction. Other methods for assessing the impact of the percentage of body fat on assisted reproduction, such as bioelectric impedance analysis, have not proved to be more accurate than BMI for predicting reproductive outcomes in obese women [2]. Therefore, from a practical point of view, obesity is still defined by BMI, with three recognized grades of severity: class I (30–34.9 kg/m 2 ), class II (35–39.9 kg/m 2 ) and class III (≥ 40 kg/m 2 ).…”

Section: Obesity and Natural/assisted Conceptionmentioning

confidence: 99%

BMI and miscarriage after IVF

Bellver

2022

Current Opinion in Obstetrics &Amp; Gynecology

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Purpose of reviewTo summarize recent findings related to the risk of miscarriage in women with elevated BMI undergoing IVF, and the mechanisms involved in said risk.Recent findingsMiscarriage rates are increased in overweight and obese women in both natural and assisted reproduction. Oocyte and embryo quality assessed according to classic morphological static parameters does not seem to be affected by excessive female body weight. Despite the initial lack of consensus between studies regarding embryo morphokinetics in obese women, blastocyst formation and quality have recently been shown to be similar across BMI groups, even in the case of euploid embryos. However, some metabolomic differences have been described in oocytes and embryos from obese women, thus pointing to a functional alteration. In women with elevated BMI, the percentage of aneuploid embryos is similar to that of normal weight women, and rates of miscarriage are higher, despite the transfer of euploid embryos. Therefore, the origin of the increased pregnancy loss rate after IVF in these women may be related to metabolomic, epigenetic or mitochondrial oocyte and embryo disturbances, or to the abnormal endocrine, metabolic and inflammatory uterine environment induced by obesity, which seems to be also responsible for other numerous complications during pregnancy and the in-utero fetal programming of postnatal diseases. A displacement of the window of implantation in obese women undergoing artificial endometrial preparation has recently been described and may be related to the poorer embryo implantation rates and increased risk of miscarriage observed following fresh and frozen embryo transfers with autologous oocytes, and with donated ova in recipients with extremely high BMI.SummaryFemale obesity is related to poorer outcome in natural and assisted conception, including an increased risk of miscarriage. Embryo morphology, assessed by conventional methods or by morphokinetics, does not seem to be affected by excess weight, with similar blastocyst formation and quality than normal weight women reported in IVF cycles. Embryo aneuploidy is not increased, and higher miscarriages rates are seen after euploid embryo transfer in obese women. Disturbances of the uterus or its environment induced by female obesity seem to be the most likely cause of the increased risk of miscarriage, although metabolomic, epigenetic or mitochondrial oocyte and embryo dysfunction cannot be ruled out as cannot congenital anomalies. In the context of all the above, weight reduction before pregnancy should be advised in obese women trying to become pregnant.

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“…Live birth rates were similar in women of all BMI categories, and the authors concluded that frozen-warmed embryo transfer, with no or less hormonal stimulation, might be more optimal concerning embryo-endometrial synchrony, particularly in the overweight and obese population. Most previous studies, demonstrating a negative effect of obesity on IVF outcome, consisted largely of fresh transfers 32 . Other studies using frozen-warmed embryo transfer have reported similar results 33 , 34 .…”

Section: Discussionmentioning

confidence: 99%

Inflammatory and metabolic markers in relation to outcome of in vitro fertilization in a cohort of predominantly overweight and obese women

Svensson

Einarsson

Olausson

et al. 2022

Sci Rep

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For overweight and obese women undergoing in vitro fertilization (IVF) the pregnancy and live birth rates are compromised while the underlying mechanisms and predictors are unclear. The aim was to explore the association between adipose tissue-related inflammatory and metabolic markers and the pregnancy and live birth outcome of IVF in a cohort of predominantly overweight and obese women. Serum samples, fulfilling standardizing criteria, were identified from 195 women having participated in either the control (n = 131) or intervention (n = 64) group of a randomized controlled trial (RCT), seeking to evaluate the effect of a weight reduction intervention on IVF outcome in obese women. Serum high-sensitivity C-reactive protein (hsCRP) and the adipokines leptin and adipocyte fatty acid-binding protein (AFABP) were analyzed for the whole cohort (n = 195) in samples collected shortly before IVF [at randomization (control group), after intervention (intervention group)]. Information on age, anthropometry [BMI, waist circumference, waist-to-height ratio (WHtR)], pregnancy and live birth rates after IVF, as well as the spontaneous pregnancy rate, was extracted or calculated from collected data. The women of the original intervention group were also characterized at randomization regarding all variables. Eight women [n = 3 original control group (2.3%), n = 5 original intervention group (7.8%)] conceived spontaneously before starting IVF. BMI category proportions in the cohort undergoing IVF (n = 187) were 1.6/20.1/78.3% (normal weight/overweight/obese). The pregnancy and live birth rates after IVF for the cohort were 35.8% (n = 67) and 24.6% (n = 46), respectively. Multivariable logistic regression revealed that none of the variables (age, hsCRP, leptin, AFABP, BMI, waist circumference, WHtR) were predictive factors of pregnancy or live birth after IVF. Women of the original intervention group displayed reductions in hsCRP, leptin, and anthropometric variables after intervention while AFABP was unchanged. In this cohort of predominantly overweight and obese women undergoing IVF, neither low-grade inflammation, in terms of hsCRP, other circulating inflammatory and metabolic markers released from adipose tissue (leptin, AFABP), nor anthropometric measures of adiposity or adipose tissue distribution (BMI, waist, WHtR) were identified as predictive factors of pregnancy or live birth rate.Trial registration: ClinicalTrials.gov number, NCT01566929. Trial registration date 30-03-2012, retrospectively registered.

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The Appraisal of Body Content (ABC) trial: Increased male or female adiposity does not significantly impact in vitro fertilization laboratory or clinical outcomes

Cited by 34 publications

References 26 publications

Body mass index is associated with miscarriage rate and perinatal outcomes in cycles with frozen-thawed single blastocyst transfer: a retrospective cohort study

Body mass index is associated with miscarriage rate and perinatal outcomes in cycles with frozen-thawed single blastocyst transfer: a retrospective cohort study

BMI and miscarriage after IVF

Inflammatory and metabolic markers in relation to outcome of in vitro fertilization in a cohort of predominantly overweight and obese women

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