IVI-RMA, IVI Foundation, Valencia, Spain; Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut; Rey Juan Carlos University, Madrid, Spain.
Rey Juan Carlos University, Madrid, Spain; IVI-RMA Madrid, Madrid, Spain.
Fertil Steril. 2021 Jun;115(6):1495-1502. doi: 10.1016/j.fertnstert.2020.09.139. Epub 2020 Nov 30.
To determine whether female body mass index (BMI) is associated with an increased risk of miscarriage after euploid embryo transfer.
A retrospective, observational, multicenter cohort study.
University-affiliated in vitro fertilization center.
PATIENT(S): In this study, 3,480 cycles of in vitro fertilization with preimplantation genetic testing for aneuploidy (PGT-A) in the blastocyst stage and euploid embryo transfer were divided into four groups according to patient BMI.
INTERVENTION(S): In vitro fertilization with PGT-A.
MAIN OUTCOME MEASURE(S): The primary outcome was the miscarriage rate, which included both biochemical and clinical miscarriages. Secondary outcomes were implantation, pregnancy, clinical pregnancy, and live birth rates.
RESULT(S): Cycles were divided into four groups according to BMI (kg/m): underweight (<18.5; n = 155), normal weight (18.5-24.9; n = 2,549), overweight (25-29.9; n = 591), and obese (≥30; n = 185). The number of PGT-A cycles per patient was similar in the four groups. Fertilization rate, day of embryo biopsy, technique of chromosomal analysis, number of euploid embryos, number of transferred embryos, and method of endometrial preparation for embryo transfer were similar in the four BMI groups. Miscarriage rates were significantly higher in women with obesity compared to women with normal weight, mainly due to a significant increase in the clinical miscarriage rates. Live birth rates also were lower in women with obesity. Obesity in women and day 6 trophectoderm biopsy were found to influence the reduced live birth rate.
CONCLUSION(S): Women with obesity experience a higher rate of miscarriage after euploid embryo transfer than women with a normal weight, suggesting that other mechanisms than aneuploidy are responsible for this outcome.
确定女性体重指数（BMI）是否与胚胎整倍体转移后流产风险增加有关。
回顾性、观察性、多中心队列研究。
大学附属体外受精中心。
在这项研究中，根据患者 BMI 将 3480 个胚胎整倍体转移周期分为四组，这些周期均接受了胚胎植入前遗传学检测（PGT-A）的囊胚阶段和整倍体胚胎转移。
PGT-A 体外受精。
主要结局是流产率，包括生化和临床流产。次要结局是胚胎着床率、妊娠率、临床妊娠率和活产率。
根据 BMI（kg/m）将周期分为四组：体重不足（<18.5；n=155）、正常体重（18.5-24.9；n=2549）、超重（25-29.9；n=591）和肥胖（≥30；n=185）。每位患者的 PGT-A 周期数在四组中相似。受精率、胚胎活检日、染色体分析技术、整倍体胚胎数、移植胚胎数和胚胎移植的子宫内膜准备方法在四组 BMI 中相似。肥胖组的流产率明显高于体重正常组，主要是由于临床流产率显著增加。肥胖组的活产率也较低。肥胖和第 6 天滋养外胚层活检被发现影响了活产率的降低。
与体重正常的女性相比，肥胖女性在胚胎整倍体转移后流产的风险更高，这表明除了非整倍体之外，还有其他机制导致了这一结果。
