Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
Department of Gynecological Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
J Ovarian Res. 2024 Oct 2;17(1):195. doi: 10.1186/s13048-024-01521-1.
Obesity poses a significant global health challenge, with profound implications for women's reproductive health. The relationship between ovarian reserve and body mass index (BMI) remains a subject of debate. While obesity is generally associated with poorer outcomes in assisted reproductive technology (ART), the evidence remains inconclusive. This study aimed to investigate the effect of pre-pregnancy BMI on ovarian reserve and ART outcomes in infertile patients.
We conducted a retrospective cohort study involving women who underwent in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) procedures at Tongji Hospital between 2016 and 2023. The study included 30,746 initial fresh cycles and 5,721 singleton deliveries. Patients were stratified by age and further categorized into four BMI groups: lean (< 18.5 kg/m²), normal weight (18.5-24.9 kg/m²), overweight (25.0-29.9 kg/m²), and obese (≥ 30.0 kg/m²). The primary endpoints of the study were pregnancy and perinatal outcomes. To explore the association between BMI and these outcomes, we adjusted for relevant confounding factors and utilized multivariate linear regression models, complemented by multifactorial logistic regression analyses.
Anti-Müllerian hormone (AMH) levels were significantly lower in the overweight and obese groups compared to the normal weight group. After adjusting for age, a negative correlation was found between AMH and BMI in the age subgroups of 20-30 and 30-35 years. Among women aged 20-35 years, those in the overweight and obese groups had significantly fewer retrieved oocytes, mature oocytes, and two-pronuclear (2PN) embryos than their normal weight counterparts. Despite these differences, pregnancy outcomes in the overweight and obese groups were comparable to those in the normal weight group across all age categories. Additionally, obesity was linked to an increased risk of gestational diabetes mellitus, hypertensive disorders of pregnancy, and macrosomia.
An age-related decrease in AMH levels was evident with increasing BMI. Although being overweight or obese is associated with poorer embryo and perinatal outcomes, it does not seem to have a substantial impact on fertility.
肥胖是一个全球性的健康挑战，对女性的生殖健康有深远的影响。卵巢储备与体重指数（BMI）之间的关系仍然存在争议。虽然肥胖通常与辅助生殖技术（ART）的结果较差有关，但证据仍不确定。本研究旨在调查孕前 BMI 对不孕患者卵巢储备和 ART 结局的影响。
我们进行了一项回顾性队列研究，纳入了 2016 年至 2023 年期间在同济医院接受体外受精（IVF）或胞浆内单精子注射（ICSI）的妇女。该研究包括 30746 个初始新鲜周期和 5721 个单胎分娩。患者按年龄分层，并进一步分为四个 BMI 组：消瘦（<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）。研究的主要终点是妊娠和围产期结局。为了探讨 BMI 与这些结局之间的关系，我们调整了相关混杂因素，并使用了多元线性回归模型，辅以多因素逻辑回归分析。
超重和肥胖组的抗苗勒管激素（AMH）水平明显低于正常体重组。在调整年龄后，发现 AMH 与 BMI 呈负相关，在 20-30 岁和 30-35 岁年龄亚组中均如此。在 20-35 岁的女性中，超重和肥胖组的获卵数、成熟卵数和二倍体（2PN）胚胎数明显少于正常体重组。尽管存在这些差异，但超重和肥胖组在所有年龄组的妊娠结局与正常体重组相当。此外，肥胖与妊娠期糖尿病、妊娠高血压疾病和巨大儿的风险增加有关。
随着 BMI 的增加，AMH 水平呈年龄相关下降。虽然超重或肥胖与胚胎和围产期结局较差有关，但似乎对生育能力没有显著影响。
