Effect of obesity on assisted reproductive treatment outcomes and its management: a literature review

Abstract

Obesity is associated with infertility and poor obstetric outcomes. The current trends of advanced maternal age and rising obesity rates contribute indirectly to the growing demand for fertility treatment and assisted reproduction treatment (ART), posing clinical and ethical dilemmas for fertility service providers. The live-birth rate, after ART, is significantly lower in obese women than non-obese women, possibly due to impaired oocyte quality and/or defective endometrial receptivity. Poor ART outcomes correlate positively with the severity of obesity. Management of obesity-related infertility should include diet, exercise, cognitive behavioural interventions and possibly adjunctive pharmacotherapy. Bariatric surgery may benefit morbidly obese women who struggle to lose weight otherwise. Randomised controlled trials are required to clarify the effects of various therapeutic interventions for obesity on ART outcomes. Learning objectivesTo understand the association of obesity and infertility with ART outcomes. To learn the principles of obesity-related infertility management. Ethical issuesTo understand the ethical challenges in the provision of ART for obese women and to inform the stance of professional bodies, such as the British Fertility Society and the European Society of Human Reproduction and Embryology.Keywords: assisted reproduction treatment (ART) / bariatric surgery / infertility / pregnancy / obesity Linked resource: Single best answer questions are available for this article at https://stratog.rcog.org.uk/tutorial/tog-online-sba-resource Please cite this paper as: Khairy M, Rajkhowa M. Effect of obesity on assisted reproductive treatment outcomes and its management: A literature review.

An epigenetic association of malformations, adverse reproductive outcomes, and fetal origins hypothesis related effects

“…Since serum folate levels are inversely related to pre-pregnancy body mass [131], association findings would be expected, and do occur. Despite late macrosomia with obesity-related metabolic disturbances, there is excess growth restriction early on [132], as well as increases in limb reductions; anorectal, renal, and cardiovascular anomalies [133][134][135]; fertility issues [136]; prematurity; early losses and stillbirth; and possibly perinatal difficulties [137].…”

The casual effect of lifestyle factors on outcomes of assisted reproductive techniques: a protocol study on Iranian infertile couples

“…There is a lot of evidence that lifestyle factors can influence on ARTs outcomes [12, 13]. For example, studies have demonstrated that female age [14], smoking [15], weight [16], diet [17], exercise [18], psychological stress [19], caffeine consumption [20], alcohol consumption [20] and exposure to environmental pollutants [21] significantly decreases the chance of clinical pregnancy and live birth. Little has been done on the effects of male factors on the outcome of ARTs, and clinical observations in this field are small and contradictory.…”

Metabolic risk factors and fertility disorders: A narrative review of the female perspective

“…Obesity is also present in 20–70% of women with PCOS, depending on geographic region ( Li et al, 2018 , Lim et al, 2012 , Pandey et al, 2010 , Silvestris et al, 2018 ). Obese women exhibit reduced fecundity, even after several ART treatment cycles ( Khairy and Rajkhowa, 2017 , MacKenna et al, 2017 ).…”