From the Division of Reproductive Medicine, Department of Obstetrics, Gynecology, and Reproductive Biology, and the Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, and the Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts.
Obstet Gynecol. 2011 Jul;118(1):63-70. doi: 10.1097/AOG.0b013e31821fd360.
To estimate the effect of body mass index (BMI) on oocyte and embryo parameters and cycle outcomes in women undergoing in vitro fertilization (IVF).
We evaluated a retrospective cohort of 1,721 women undergoing a first IVF cycle with fresh, autologous embryos between 2007 and 2010 in an academic infertility practice. Main outcome measures included number of mature and normally fertilized oocytes, embryo morphology, estradiol on the day of human chorionic gonadotropin administration, clinical pregnancy, spontaneous abortion, and live birth. We performed multivariable analyses, adjusting for potential confounders, including age at cycle start, infertility diagnosis, type of stimulation, total gonadotropin dose, use of intracytoplasmic sperm injection, and number of embryos transferred.
Compared with women of normal BMI, women with class II (BMI 35-39.9) and III (BMI 40 or higher) obesity had fewer normally fertilized oocytes (9.3 compared with 7.6 and 7.7, P<.03) and lower estradiol levels (2,047 pg/mL compared with 1,498 and 1,361, P<.001) adjusting for age and despite similar numbers of mature oocytes. Odds of clinical pregnancy (odds ratio [OR] 0.50, 95% confidence interval [CI] 0.31-0.82) and live birth (OR 0.51, 95% CI 0.29-0.87) were 50% lower in women with class III obesity as compared with women of normal BMI.
Obesity was associated with fewer normally fertilized oocytes, lower estradiol levels, and lower pregnancy and live birth rates. Infertile women requiring IVF should be encouraged to maintain a normal weight during treatment.
评估体重指数（BMI）对接受体外受精（IVF）的女性的卵子和胚胎参数以及周期结局的影响。
我们评估了 2007 年至 2010 年期间在一家学术不孕诊所接受首次新鲜自体胚胎 IVF 周期的 1721 名女性的回顾性队列。主要结局指标包括成熟卵子和正常受精卵子的数量、胚胎形态、人绒毛膜促性腺激素给药日的雌二醇、临床妊娠、自然流产和活产。我们进行了多变量分析，调整了潜在的混杂因素，包括周期开始时的年龄、不孕诊断、刺激类型、总促性腺激素剂量、胞浆内精子注射的使用和移植的胚胎数量。
与正常 BMI 的女性相比，BMI 为 II 级（35-39.9）和 III 级（40 或更高）肥胖的女性正常受精的卵子数量较少（9.3 与 7.6 和 7.7，P<.03），雌二醇水平较低（2047 pg/mL 与 1498 和 1361，P<.001），尽管成熟卵子数量相似。与 BMI 正常的女性相比，III 级肥胖的女性临床妊娠（优势比[OR]0.50，95%置信区间[CI]0.31-0.82）和活产（OR 0.51，95% CI 0.29-0.87）的几率降低了 50%。
肥胖与正常受精卵子数量减少、雌二醇水平降低以及妊娠和活产率降低有关。需要接受 IVF 的不孕女性在治疗期间应鼓励保持正常体重。
