The Effect Of Weight Reduction Prior To IVF On Assisted Reproductive And Perinatal Outcomes In Overweight And Obese Infertile Patients

BackgroundOverweight and obesity is known to be associated with a number of comorbidities,such as type 2 diabetes,hypertension,certain cancers,and stroke.A large number of studies have reported the relationship between high body mass index and poor assisted reproductive outcomes.Women who are overweight(BMI≥25kg/m2)requiring a higher dose of gonadotropin to receive adequate ovarian response,reducing the rate of implantation and pregnancy,and increasing the rate of biochemical pregnancy and miscarriage.Obese women experience inferior outcomes including increased rates of gestational hypertension,preeclampsia,gestational diabetes,preterm birth and postpartum hemorrhage.Obese pregnant women also have higher risks of shoulder dystocia and infants with macrosomia,and birth defects and perinatal or infant death.Given the adverse effects of overweight and obesity,there is an urgent need to build an effective,evidence-based,patient friendly and supportive lifestyle intervention for overweight and obese infertility women.Various guidelines have advocated lifestyle modification aiming at weight loss of 5 to 10%or more of body weight proceed to becoming pregnancy for both themselves and the baby they may conceive.However,no compelling evidence of the value of lifestyle intervention for weight loss on live birth rates was gained from these studies.Meanwhile,there are still controversies about how to lose weight,how much and how fast.ObjectiveTo assess the effectiveness of a lifestyle intervention preceding infertility treatment in overweight and obese infertility women,and how much weight loss will make effects.MethodsData from 285 obese women from Reproductive Hospital Affiliated to Shandong University who were advised to participate in weight management for several months before undergoing their first IVF/ICSI-ET from May 2015 to December 2017.Those eligible for the study were infertile women between 22 and 43 years with indications for IVF/ICSI and with a BMI≥25Kg/m2.The control group with immediate infertility treatment was matched to the intervention group by the following criteria:1.age(±2 years);2.PCOS status;3.baseline BMI(±0.5),4.type of infertility (primary or secondary).we attempted to match at closely as possible.Reproductive and perinatal outcomes after weight loss in overweight and obese patients were compared between two groups.ResultsThe BMI in the therapy group was significantly reduced from 31.98±3.2kg/m2 to 28.69±3.07 kg/m2,which dropped significantly compared with the control group.The mean(±SD)weight loss was 8.62±5.32 kg in the weight management group after a median of four months,and 139 of them(48.77%)lost 10%or more of their original body weight.The intervention group required more less gonadotropin dose total for cycle for ovulation induction(P=0.007).The pre-specified primary outcomes of this study,live birth rate and clinical pregnancy rate of participants post intervention,were markedly greater in the weight reduction group compared to the control group(P =0.014,.029 respectively).No significant differences were observed in secondary pregnancy outcomes and neonatal outcomes.The final multivariable model of live birth contained five variables:baseline estradiol(E2),baseline follicle stimulating hormone(FSH),endometrial thickness of human chorionic gonadotrophin day,age of women and weight loss≥10%.The multivariable-adjusted OR for live birth was 0.99 for baseline E2(95%CI:0.98-0.99),0.89 for baseline FSH(95%CI:0.81-0.98),1.16 for endometrial thickness of HCG day(95%CI:1.01-1.27),0.95 for age of women(95%CI:0.92-0.99)and 1.69 for weight loss≥10%(95%CI:1.110-2.58).Overweight and obese infertility patients who were younger,and who had a lower FSH and/or E2 and possessed a higher endometrial thickness and lost weight 10%or more of original weight were more likely to have a higher live birth rate.Baseline FSH,endometrial thickness of HCG day,age of women and weight loss≥10%also proved to be independent predictors of clinical pregnancy.ConclusionsPre-pregnancy weight management in overweight and obese patients can re ctify assisted reproductive outcomes,reduce the amount of ovulation-promoting drugs,and significantly improve live birth and clinical pregnancy rates.Actively advocating overweight and obese infertility patients to practice pre-pregnancy weight loss is important to improve live birth and clinical pregnancy rates.