Center for Reproductive Medicine, Skåne University Hospital, Malmö, Sweden.
Faculty of Medicine, Department of Laboratory Medicine, Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden.
Hum Reprod. 2022 Sep 30;37(10):2474-2481. doi: 10.1093/humrep/deac164.
Does previous bariatric surgery (BS) in women affect cumulative live birth rate in IVF?
Women having had BS seem to have the same cumulative live birth rate as non-operated women of the same BMI at IVF treatment.
Because of the perinatal risks of obesity to mother and infant as well as impaired outcomes of IVF, obese women are advised to reduce their weight, but it is not clear whether previous BS could affect IVF results.
STUDY DESIGN, SIZE, DURATION: This national register-based case-control study included all cases of BS (n = 30 436) undergoing IVF (n = 153) from 2007 until 2017.
PARTICIPANTS/MATERIALS, SETTING, METHODS: Swedish women between 18 and 45 years operated with BS, with at least one first started cycle of IVF after surgery, were included. For each woman having IVF after BS (n = 153), up to five non-operated control women (n = 744) starting their first IVF cycle during the study period were matched for age, parity and BMI at treatment. The primary outcome in this study was the cumulative live birth rate (CLBR) after the first IVF cycle, defined as all live births after the first cycle including fresh and frozen embryo transfers.
There was no significant difference in CLBR between the BS group and the matched controls (29.4% compared to 33.1%), even though the number of retrieved oocytes (7.6 vs 8.9, P = 0.005) and frozen embryos (1.0 vs 1.5, P = 0.041) were significantly fewer in the BS group. There was no association between cumulative live birth and BS, adjusted odds ratio 1.04, 95% CI (0.73, 1.51). However, the birth weight was significantly lower in the children born to mothers with previous BS, mean (SD) 3190 (690) vs 3478 (729) g, P = 0.037.
LIMITATIONS, REASONS FOR CAUTION: Confounders such as age, BMI and previous childbirth were accounted for by the matching design of the study, but there were no data on indication for IVF, anti-Müllerian hormone, smoking or previous comorbidities. The study was exploratory and did not reach sufficient power to detect potential smaller differences in live birth rates.
The findings concur with those in previously published smaller studies and provide somewhat reassuring results considering IVF outcomes after BS with a CLBR comparable to that of controls, despite a lower mean birth weight.
STUDY FUNDING/COMPETING INTEREST(S): This research was funded by grants from the Southern Health Care Region of Sweden. The authors have no competing interests to declare.
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女性之前的减肥手术（BS）是否会影响试管婴儿的累计活产率？
接受过 BS 的女性在试管婴儿治疗中的累计活产率似乎与相同 BMI 的未手术女性相同。
由于肥胖对母婴的围产期风险以及试管婴儿结果受损，肥胖女性被建议减肥，但尚不清楚之前的 BS 是否会影响试管婴儿的结果。
研究设计、大小和持续时间：这项全国性基于登记的病例对照研究纳入了 2007 年至 2017 年间所有接受过 BS（n=30436）并进行试管婴儿（n=153）的女性。
参与者/材料、地点、方法：纳入年龄在 18 至 45 岁之间接受过 BS 且术后至少有一次开始进行试管婴儿周期的瑞典女性。对于每一位在 BS 后进行试管婴儿的女性（n=153），按照年龄、产次和治疗时的 BMI 匹配至多 5 位在研究期间开始首次试管婴儿周期的未手术对照女性（n=744）。本研究的主要结局是首次试管婴儿周期后的累计活产率（CLBR），定义为首次周期后的所有活产，包括新鲜和冷冻胚胎移植。
BS 组与匹配对照组的 CLBR 无显著差异（分别为 29.4%和 33.1%），尽管 BS 组的取卵数（7.6 与 8.9，P=0.005）和冷冻胚胎数（1.0 与 1.5，P=0.041）显著较少。BS 与累计活产之间无关联，调整后的优势比为 1.04，95%CI（0.73，1.51）。然而，BS 组的新生儿出生体重明显较低，均值（SD）为 3190（690）g 与 3478（729）g，P=0.037。
局限性、谨慎的原因：研究采用匹配设计考虑了年龄、BMI 和既往分娩等混杂因素，但没有关于试管婴儿指征、抗苗勒管激素、吸烟或既往合并症的数据。该研究是探索性的，没有足够的效力来检测活产率的潜在较小差异。
这些发现与之前发表的较小研究结果一致，考虑到 BS 后试管婴儿的 CLBR 与对照组相当，尽管平均出生体重较低，但结果提供了一些令人安心的结果。
研究资金/竞争利益：本研究由瑞典南部医疗保健区的拨款资助。作者没有利益冲突需要申报。
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