The effect of female body mass index on in vitro fertilization cycle outcomes: a multi-center analysis
The effect of female body mass index on in vitro fertilization cycle outcomes: a multi-center analysis
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DOI：
10.1007/s10815-018-1290-6
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发表时间：
2018-11-01
影响因子：
3.1
通讯作者：
Beim, Piraye Yurttas
中科院分区：
文献类型：
--
作者：
Kudesia, Rashmi;Wu, Hongyu;Beim, Piraye Yurttas
目的探讨女性身体质量指数（BMI）对体外受精周期结果的影响。方法：这是一项回顾性队列研究，包括2009年至2015年在美国13个生育中心进行第一次自体体外受精周期的51198名妇女。体重过轻、超重和肥胖BMI对四种不同IVF周期结果（周期取消、卵母细胞和胚胎计数以及持续临床妊娠[OCP]）的影响通过调整混杂因素的logistic或泊松回归分析进行评估。结果体重指数超重或肥胖的妇女比体重指数正常的妇女的预后更差。这些差异包括：(1)更大的周期取消几率（超重的aOR [95%CI]为1.17 [1.08,1.26]，i类肥胖的aOR [95%CI]为1.28 [1.15,1.41]，ii /III类肥胖的aOR [95%CI]为1.50 [1.33,1.68],P < 0.001）；(2)获得的卵母细胞较少（i类肥胖的aIRR [95%CI] 0.98 [0.98,0.99]， ii /III类肥胖的aIRR [95%CI] 0.93[0.92,0.94]，两者P < 0.001）；(3)可使用胚胎较少（超重组aIRR [95%CI] 0.98[0.97,0.99]，ⅰ类肥胖组aIRR [95%CI] 0.97[0.96,0.99]，ⅱ/ⅲ类肥胖组aIRR [95%CI] 0.95 [0.93,0.97], P < 0.01）；(4)患OCP的几率较低（ⅰ类肥胖的aOR [95%CI] 0.89[0.83,0.95]，ⅱ/ⅲ类肥胖的aOR [95%CI] 0.86[0.79,0.93]，两者P < 0.001）。在基于原发性不孕症诊断的亚组分析中，这些趋势在男性或子宫因素的患者中持续存在，在排卵功能障碍或多囊卵巢综合征的女性中尤其明显。结论：BMI高于正常范围是一个独立的负面预后因素，包括周期取消、卵母细胞和胚胎计数以及OCP。这些负面结果在ii /III类肥胖、排卵功能障碍或多囊卵巢综合征的女性中最为严重。
Purpose The aim of this study is to examine the impact of female body mass index (BMI) on IVF cycle outcomes.Methods This is a retrospective cohort study including 51,198 women who initiated their first autologous IVF cycle in 13 fertility centers in the USA between 2009 and 2015. The effect of underweight, overweight, and obese BMI on four different IVF cycle outcomes (cycle cancellation, oocyte and embryo counts, and ongoing clinical pregnancy [OCP]) was evaluated in logistic or Poisson regression analyses with confounders adjusted.Results Women with an overweight or obese BMI experienced worse outcomes than those with a normal BMI. These differences included (1) greater odds of cycle cancellation (aOR [95%CI] 1.17 [1.08, 1.26] for overweight, 1.28 [1.15, 1.41] for class-I obesity, and 1.50 [1.33, 1.68] for class-II/III obesity, P < .001 for all); (2) fewer oocytes retrieved (aIRR [95%CI] 0.98 [0.98,0.99] for class-I obesity, 0.93 [0.92,0.94] for class-II/III obesity, P < .001 for both); (3) fewer usable embryos (aIRR [95%CI] 0.98 [0.97,0.99] for overweight, 0.97 [0.96,0.99] for class-I obesity, 0.95 [0.93,0.97] for class-II/III obesity, P < .01 for all); and (4) lower odds of OCP (aOR [95%CI] 0.89 [0.83,0.95] for class-I obesity, 0.86 [0.79,0.93] for class-II/III obesity, P < .001 for both). In a subgroup analysis based on primary infertility diagnosis, these trends persisted in those with male or uterine factor and were especially pronounced in women with ovulatory dysfunction or PCOS.Conclusions A BMI above the normal range was an independent negative prognostic factor for multiple outcomes, including cycle cancellation, oocyte and embryo counts, and OCP. These negative outcomes were most profound in women with class-II/III obesity, ovulatory dysfunction, or PCOS.