Zander-Fox Deirdre L, Henshaw Richard, Hamilton Hamish, Lane Michelle
Repromed, 180 Fullarton Rd., Dulwich, SA 5065, Australia.
Aust N Z J Obstet Gynaecol. 2012 Jun;52(3):270-6. doi: 10.1111/j.1479-828X.2012.01453.x.
The increasing prevalence of obesity in women of child-bearing age is of growing concern in the health community. Obesity is associated with sub-optimal reproductive performance; therefore, it is understandable that the number of young women with elevated body mass index (BMI) accessing assisted reproductive treatment (ART) is on the rise. Consequently, this study not only assessed the impact of BMI on fertilisation rates, embryo development and freezing during ART in women aged ≤38 years but also determined their subsequent pregnancy and delivery rates.
Data were retrospectively analysed from all cycles initiated in 2006/2007 for women aged ≤38 years. The BMI categorisations were as follows: normal - 18.5-24.9 kg/m(2) ; overweight - 25-29.9 kg/m(2) ; obese - 30-34.9 kg/m(2) ; morbidly obese class I - 35-39.9 kg/m(2) ; morbidly obese class П -≥40 kg/m(2) .
Obese and morbidly obese women required a significantly higher follicle stimulating hormone start dose than normal BMI women; however, they obtained significantly fewer oocytes (P < 0.05). Although BMI did not affect embryo development, morbidly obese class Π women had significantly reduced pregnancy rates compared to normal BMI women (30.5 vs 41.7%, respectively; P < 0.05). Furthermore, increasing BMI was positively correlated to increasing rates of preterm delivery (P < 0.05). Increasing BMI was also positively correlated to increasing delivery rates of singleton term macrosomic offspring (≥4000 g).
Obesity in women aged≤38 years does not affect embryo development; however, it does reduce clinical pregnancy rates in women with a BMI≥40 and increases rates of preterm labour and delivery of macrosomic offspring.
育龄女性肥胖率的不断上升日益引起健康领域的关注。肥胖与生殖性能欠佳相关；因此，体重指数（BMI）升高的年轻女性接受辅助生殖治疗（ART）的人数不断增加也就不足为奇了。因此，本研究不仅评估了BMI对38岁及以下女性ART期间受精率、胚胎发育和冷冻的影响，还确定了她们随后的妊娠和分娩率。
对2006/2007年启动的所有38岁及以下女性的周期数据进行回顾性分析。BMI分类如下：正常——18.5 - 24.9kg/m²；超重——25 - 29.9kg/m²；肥胖——30 - 34.9kg/m²；病态肥胖I级——35 - 39.9kg/m²；病态肥胖II级——≥40kg/m²。
肥胖和病态肥胖女性所需的促卵泡激素起始剂量显著高于BMI正常的女性；然而，她们获得的卵母细胞显著较少（P < 0.05）。虽然BMI不影响胚胎发育，但病态肥胖II级女性的妊娠率与BMI正常的女性相比显著降低（分别为30.5%和41.7%；P < 0.05）。此外，BMI升高与早产率增加呈正相关（P < 0.05）。BMI升高还与单胎足月巨大儿（≥4000g）的分娩率增加呈正相关。
38岁及以下女性的肥胖不影响胚胎发育；然而，它确实会降低BMI≥40的女性的临床妊娠率，并增加早产和巨大儿分娩的发生率。
