Rafael Filipa, Rodrigues Maria Dias, Bellver Jose, Canelas-Pais Mariana, Garrido Nicolas, Garcia-Velasco Juan A, Soares Sérgio Reis, Santos-Ribeiro Samuel
Faculty of Medicine, University of Porto, Porto, Portugal.
Ginemed Porto, GeneraLife Portugal, Porto, Portugal.
Hum Reprod. 2023 May 2;38(5):886-894. doi: 10.1093/humrep/dead042.
For a woman with infertility and overweight/obesity, can infertility treatment be postponed to first promote weight loss?
Advice regarding a delay in IVF treatment to optimize female weight should consider female age, particularly in women over 38 years for whom only substantial weight loss in a short period of time (3 months) seems to provide any benefit.
Body weight excess and advanced age are both common findings in infertile patients, creating the dilemma of whether to promote weight loss first or proceed to fertility treatment immediately. Despite their known impact on fertility, studies assessing the combined effect of female age and BMI on cumulative live birth rates (CLBRs) are still scarce and conflicting.
STUDY DESIGN, SIZE, DURATION: We performed a multicentre retrospective cohort study including 14 213 patients undergoing their first IVF/ICSI cycle with autologous oocytes and subsequent embryo transfers, between January 2013 and February 2018 in 18 centres of a multinational private fertility clinic. BMI was subdivided into the following subgroups: underweight (<18.5 kg/m2), normal weight (18.5-24.9 kg/m2), overweight (25.0-29.9 kg/m2), and obesity (≥30.0 kg/m2).
PARTICIPANTS/MATERIALS, SETTING, METHODS: The primary outcome was CLBR. The secondary outcome was time to pregnancy. To assess the influence of female age and BMI on CLBR, two multivariable regression models were developed with BMI being added in the models as either an ordinal categorical variable (Model 1) or a continuous variable (Model 2) using the best-fitting fractional polynomials. CLBR was estimated over 1-year periods (Model 1) and shorter timeframes of 3 months (Model 2). We then compared the predicted CLBRs according to BMI and age.
When compared to normal weight, CLBRs were lower in women who were overweight (adjusted odds ratio (aOR) 0.86, 95% CI 0.77-0.96) and obese (aOR 0.74, 95% CI 0.62-0.87). A reduction of BMI within 1 year, from obesity to overweight or overweight to normal weight would be potentially beneficial up to 35 years old, while only a substantial reduction (i.e. from obesity to normal BMI) would be potentially beneficial in women aged 36-38 years. Above 38 years of age, even considerable weight loss did not compensate for the effect of age over a 1-year span but may be beneficial in shorter time frames. In a timeframe of 3 months, there is a potential benefit in CLBR if there is a loss of 1 kg/m2 in BMI for women up to 33.25 years and 2 kg/m2 in women aged 33.50-35.50 years. Older women would require more challenging weight loss to achieve clinical benefit, specifically 3 kg/m2 in women aged 35.75-37.25 years old, 4 kg/m2 in women aged 37.50-39.00 years old, and 5 kg/m2 or more in women over 39.25 years old.
LIMITATIONS, REASONS FOR CAUTION: This study is limited by its retrospective design and lower number of women in the extreme BMI categories. The actual effect of individual weight loss on patient outcomes was also not evaluated, as this was a retrospective interpatient comparison to estimate the combined effect of weight loss and ageing in a fixed period on CLBR.
Our findings suggest that there is potential benefit in weight loss strategies within 1 year prior to ART, particularly in women under 35 years with BMI ≥25 kg/m2. For those over 35 years of age, weight loss should be considerable or occur in a shorter timeframe to avoid the negative effect of advancing female age on CLBR. A tailored approach for weight loss, according to age, might be the best course of action.
STUDY FUNDING/COMPETING INTEREST(S): No specific funding was obtained for this study. All authors have no conflicts to declare.
N/A.
对于患有不孕症且超重/肥胖的女性，能否推迟不孕治疗，先促进体重减轻？
关于推迟体外受精（IVF）治疗以优化女性体重的建议应考虑女性年龄，特别是对于38岁以上的女性，似乎只有在短时间内（3个月）大幅减重才会有任何益处。
体重超标和高龄在不孕患者中都是常见现象，这就产生了是先促进体重减轻还是立即进行生育治疗的两难困境。尽管已知它们对生育有影响，但评估女性年龄和体重指数（BMI）对累积活产率（CLBR）综合影响的研究仍然很少且相互矛盾。
研究设计、规模、持续时间：我们进行了一项多中心回顾性队列研究，纳入了2013年1月至2018年2月期间在一家跨国私立生育诊所的18个中心接受首次自体卵母细胞IVF/卵胞浆内单精子注射（ICSI）周期及后续胚胎移植的14213例患者。BMI被细分为以下亚组：体重过轻（<18.5kg/m²）、正常体重（18.5 - 24.9kg/m²）、超重（25.0 - 29.9kg/m²）和肥胖（≥30.0kg/m²）。
参与者/材料、设置、方法：主要结局是CLBR。次要结局是怀孕时间。为了评估女性年龄和BMI对CLBR的影响，建立了两个多变量回归模型，在模型中BMI作为有序分类变量（模型1）或连续变量（模型2）加入，使用最佳拟合分数多项式。CLBR在1年期间（模型1）和3个月的较短时间框架（模型2）内进行估计。然后我们根据BMI和年龄比较预测的CLBR。
与正常体重相比，超重女性（调整优势比（aOR）0.86，95%置信区间0.77 - 0.96）和肥胖女性（aOR 0.74，95%置信区间0.62 - 0.87）的CLBR较低。在1年内将BMI从肥胖降至超重或从超重降至正常体重，对于35岁及以下的女性可能有益，而对于36 - 38岁的女性，只有大幅降低（即从肥胖降至正常BMI）才可能有益。38岁以上，即使大量减重在1年时间跨度内也无法弥补年龄的影响，但在较短时间框架内可能有益。在3个月的时间框架内，对于33.25岁及以下的女性，BMI每降低1kg/m²，CLBR可能有益；对于33.50 - 35.50岁的女性，BMI每降低2kg/m²可能有益。年龄较大的女性需要更具挑战性的减重才能获得临床益处，具体而言，35.75 - 37.25岁的女性需减重3kg/m²，37.50 - 39.00岁的女性需减重4kg/m²，39.25岁以上的女性需减重5kg/m²或更多。
局限性、谨慎理由：本研究受其回顾性设计以及极端BMI类别中女性数量较少的限制。由于这是一项回顾性患者间比较，以估计在固定时间段内体重减轻和年龄增长对CLBR的综合影响，因此未评估个体体重减轻对患者结局的实际影响。
我们的研究结果表明，在辅助生殖技术（ART）前1年内采取减重策略可能有益，特别是对于BMI≥25kg/m²的35岁以下女性。对于35岁以上的女性，体重减轻应幅度较大或在较短时间内发生，以避免女性年龄增长对CLBR的负面影响。根据年龄量身定制的减重方法可能是最佳行动方案。
研究资金/利益冲突：本研究未获得特定资金。所有作者均无利益冲突声明。
无。
