Department of Obstetrics and Gynecology, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110, USA.
Hum Reprod. 2013 Oct;28(10):2720-7. doi: 10.1093/humrep/det292. Epub 2013 Jul 11.
Does obesity influence the chance of pregnancy after IVF in donor oocyte recipients?
The chance of pregnancy after IVF is no different in obese donor oocyte recipients versus those in the normal BMI range.
Obesity is associated with decreased chances of pregnancy in women undergoing IVF with autologous oocytes. Prior studies have investigated the impact of obesity on IVF outcomes in donor oocyte recipients, with disparate results. This is the first systematic review and meta-analysis to address this topic.
STUDY DESIGN, SIZE, DURATION: A systematic review and meta-analysis of published literature identified in Medline, EMBASE and Scopus through December of 2011 were performed to address the association between BMI and outcomes for donor oocyte recipients. The primary outcome of this study was implantation.
PARTICIPANTS/MATERIALS, SETTING, METHODS: Two authors conducted the searches independently, selected the studies and abstracted the data. Studies in English of first donor oocyte cycles with reported recipient BMI were included. Primary data collected from the IVF program at Washington University were also included as one study (n = 123 donor oocyte recipients). Studies limited to frozen embryo transfer were excluded. Data were synthesized using DerSimonian-Laird random effects models for implantation, clinical pregnancy, miscarriage and live birth.
Of 475 screened articles, 7 were reviewed and 5 were included together with primary data from Washington University, giving a total of 4758 women who were included for the assessment of the primary outcome. No associations between obesity (BMI ≥ 30 kg/m(2)) and chance of pregnancy after IVF were noted in women using donor oocytes [risk ratio (RR): 0.98, 95% confidence intervals (CI): 0.83-1.15, I(2): 61.6%]. Additional analyses assessing associations between recipient obesity and embryo implantation (RR: 0.93, 95% CI: 0.80-1.07, I(2): 0%), miscarriage (RR: 1.12, 95% CI: 0.83-1.50, I(2): 0%) and live birth (RR: 0.91, 95% CI: 0.65-1.27, I(2) 47.9%) also failed to show a negative effect.
LIMITATIONS, REASONS FOR CAUTION: Included studies were small and they were performed in a variety of locations and practice settings where stimulation and laboratory protocols may differ, and extremes of BMI may also differ. Furthermore, included studies had different inclusion and exclusion criteria. These factors could not be controlled for in this meta-analysis and statistical heterogeneity was noted for some outcomes.
These data suggest obesity does not affect IVF outcomes in women using donor oocytes. Oocyte quality rather than endometrial receptivity may be the overriding factor influencing IVF outcomes in obese women using autologous oocytes.
STUDY FUNDING/COMPETING INTEREST(S): E.S.J. and M.G.T receive support from the Women's Reproductive Health Research Program sponsored by the National Institutes of Health (K12 HD063086). The authors do not have any competing interests.
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肥胖是否会影响接受供卵者试管婴儿治疗后的妊娠机会？
肥胖的供卵者试管婴儿治疗后妊娠的机会与正常 BMI 范围内的患者没有不同。
肥胖与接受自体卵子试管婴儿治疗的女性妊娠机会降低有关。先前的研究已经调查了肥胖对供卵者试管婴儿治疗结果的影响，但结果存在差异。这是首次针对该主题进行的系统评价和荟萃分析。
研究设计、大小和持续时间：通过 Medline、EMBASE 和 Scopus 进行了系统评价和荟萃分析，检索了截至 2011 年 12 月发表的文献，并对 BMI 与供卵者接受者的结果之间的关系进行了研究。本研究的主要结局是胚胎着床。
参与者/材料、地点和方法：两名作者独立进行了检索、选择研究并提取了数据。纳入了报告患者 BMI 的首次供卵者试管婴儿周期的研究。还纳入了华盛顿大学的一项初级数据研究（n = 123 名供卵者接受者）。排除了仅涉及冷冻胚胎移植的研究。使用 DerSimonian-Laird 随机效应模型对胚胎着床、临床妊娠、流产和活产进行了数据综合。
在筛选出的 475 篇文章中，有 7 篇进行了综述，5 篇与华盛顿大学的初级数据一起纳入，共有 4758 名女性被纳入主要结局的评估。使用供卵者的肥胖（BMI≥30kg/m2）与试管婴儿治疗后的妊娠机会之间没有关联[风险比（RR）：0.98，95%置信区间（CI）：0.83-1.15，I2：61.6%]。进一步评估了肥胖受体与胚胎着床（RR：0.93，95%CI：0.80-1.07，I2：0%）、流产（RR：1.12，95%CI：0.83-1.50，I2：0%）和活产（RR：0.91，95%CI：0.65-1.27，I2：47.9%）之间的关系，也未显示出负面影响。
局限性、谨慎的原因：纳入的研究规模较小，且在各种地点和实践环境中进行，刺激和实验室方案可能存在差异，BMI 的极端值也可能存在差异。此外，纳入的研究有不同的纳入和排除标准。这些因素在荟萃分析中无法控制，并且一些结果存在统计学异质性。
这些数据表明肥胖不会影响接受供卵者的试管婴儿治疗结果。在使用自体卵子的肥胖女性中，卵子质量而不是子宫内膜容受性可能是影响试管婴儿治疗结果的主要因素。
研究资助/利益冲突：E.S.J.和 M.G.T 得到美国国立卫生研究院（NIH）妇女生殖健康研究计划的支持（K12 HD063086）。作者没有任何利益冲突。
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