Obesity reduces uterine receptivity clinical experience from 9587 first cycles of ovum donation with normal weight donors

Capsule:
Female obesity impairs the reproductive outcome of ovum donation by reducing uterine receptivity.

Authors:
José Bellver, M.D., Antonio Pellicer, M.D., Juan Antonio García-Velasco, M.D., Agustín Ballesteros, M.D., José Remohí, M.D., Marcos Meseguer, Ph.D.

Volume 100, Issue 4, Pages 1050-1058.e2, October 2013

Abstract:

Objective:
To analyze the reproductive outcome of recipients of donated ova according to their body mass index (BMI).

Design:
Twelve-year retrospective cohort analysis.

Setting:
Fertility clinics.

Patient(s):
9,587 first cycles of ovum donation with ova from normoweight donors.

Intervention(s):
Recipients divided according to their BMI to analyze IVF laboratory and outcome parameters: lean with BMI <20 kg/m2 (n = 1,458; 15.2%); normoweight with BMI 20–24.9 kg/m2 (n = 5,706; 59.5%), overweight with BMI 25–29.9 kg/m2 (n = 1,770; 18.5%), and obese with BMI ≥30 kg/m2 (n = 653; 6.8%). Main Outcome Measure(s):
Implantation, biochemical and clinical pregnancy, miscarriage, and live-birth rates.

Result(s):
In vitro fertilization laboratory parameters did not differ according to BMI. However, implantation, pregnancy, clinical pregnancy, twin pregnancy, and live-birth rates were significantly reduced as BMI increased. In the lean, normoweight, overweight, and obese groups, the implantation rate was 40.4%, 39.9%, 38.5%, and 30.9%, clinical pregnancy rate was 56.9%, 55.9%, 54.3%, and 45.3%, and live-birth rate was 38.6%, 37.9%, 34.9%, and 27.7%, respectively. However, clinical miscarriage rates were similar in all the groups.

Conclusion(s):
Female obesity impairs the reproductive outcome of ovum donation probably as a result of reduced uterine receptivity.

  • hkliman

    These results are very consistent with our clinical experience in performing the Endometrial Function Test™ for the last 15 years. Women with either very low BMIs or BMIs in the obesity range often have abnormal endometrial development. Either gaining weight or losing weight, respectively, can induce a significant improvement on their endometrial development, and concomitantly improve their pregnancy outcomes.

  • Lauren Pinckney

    I agree with the previous post – great paper! I am a 4th year medical student, currently on an externship in REI and am presenting a journal club on this article next week. In discussing the outcome data with our research division director, we came across a few questions for the authors. I’m hoping they can reply back on this forum. They established a quantification of the effect of BMI such that, “from a basal clinical pregnancy rate of 40%, we may expect a decrease of 1.08% in the probability of becoming pregnant for every unit of BMI increase.” Was this quantified from the outcome data in table 4? And what made you choose to quantify the equation in regards to pregnancy rate rather than live birth rate?

  • Lauren Johnson

    I congratulate the authors on this intriguing and clinically relevant study. This
    large cohort study examined the impact of BMI on pregnancy outcomes among
    oocyte recipients and observed decreased implantation rate, CPR, and LBR among
    obese women.

    I wonder if the authors could comment as to whether they looked at the difficulty
    level of embryo transfer across the BMI groups. ET can be more challenging in
    the setting of obesity, and it would be interesting to see if ET difficulty contributed to the reduction in pregnancy outcomes observed in the study.

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