Centre for Women's Health research, Department of Women's and Children's Health, Institute of Life Course and medical Sciences, University of Liverpool, Member of Liverpool Health Partners, Liverpool, L8 7SS, UK.
Liverpool University Hospitals NHS Foundation Trust, Liverpool, L7 8XP, UK.
BMJ Open. 2024 Nov 1;14(10):e082123. doi: 10.1136/bmjopen-2023-082123.
An increased body mass index (BMI) can lead to subfertility; however, current literature fails to exclude the effect of other confounding medical conditions, raising questions regarding the direct link between increased BMI and fertility outcomes.
To conduct a systematic review and meta-analysis to elucidate the effects of increased BMI on fertility outcomes in females with no other comorbidities.
A comprehensive search was conducted using EMBASE, MEDLINE and the Cochrane library from January 2000 until July 2023.
Two authors independently conducted data extraction and assessed study quality. Odds ratio (OR) (dichotomous data), standardised mean difference (SMD) (continuous data) and 95% CIs were calculated.
Nine eligible studies were identified: one natural conception and eight assisted reproductive technology (ART). Aggregated data revealed women with BMI ≥25 were less likely to attain clinical pregnancy (OR 0.76, 95% CIs 0.62 to 0.93, p=0.007), with BMI ≥30 associated with a further decreased likelihood of clinical pregnancy (OR 0.61, 95% CIs 0.39 to 0.98, p=0.04). Women with raised BMI required longer duration of stimulation (SMD=0.08, 95% CIs 0.00 to 0.16, p=0.04) and obtained reduced oocytes (SMD=-0.11, 95% CIs -0.18 to -0.04, p=0.002).
These data demonstrate an adverse impact of being overweight/obese on ART outcomes in women with no other diagnosed medical comorbidities and highlight the distinct lack of data concerning the effects of isolated obesity on natural conception. Infertility represents an enormous burden for couples and society; it is essential to identify and tackle modifiable risk factors to improve chances of conception.
CRD42022293631.
体重指数（BMI）升高会导致生育能力下降；然而，目前的文献未能排除其他混杂医疗条件的影响，这使得 BMI 升高与生育结局之间的直接联系受到质疑。
进行系统评价和荟萃分析，阐明在无其他合并症的女性中，BMI 升高对生育结局的影响。
从 2000 年 1 月至 2023 年 7 月，我们对 EMBASE、MEDLINE 和 Cochrane 图书馆进行了全面检索。
两位作者独立进行了数据提取和研究质量评估。计算了比值比（OR）（二分类数据）、标准化均数差（SMD）（连续数据）和 95%置信区间（CI）。
确定了 9 项符合条件的研究：1 项自然妊娠和 8 项辅助生殖技术（ART）。汇总数据显示，BMI≥25 的女性获得临床妊娠的可能性较低（OR 0.76，95%CI 0.62 至 0.93，p=0.007），BMI≥30 与临床妊娠可能性进一步降低相关（OR 0.61，95%CI 0.39 至 0.98，p=0.04）。BMI 升高的女性需要更长的刺激时间（SMD=0.08，95%CI 0.00 至 0.16，p=0.04），获得的卵母细胞减少（SMD=-0.11，95%CI -0.18 至 -0.04，p=0.002）。
这些数据表明，在无其他诊断性合并症的女性中，超重/肥胖对 ART 结局有不良影响，并突出表明，关于单纯肥胖对自然妊娠影响的数据非常缺乏。不孕症给夫妇和社会带来了巨大的负担；识别和解决可改变的危险因素对于提高受孕机会至关重要。
PROSPERO 注册号： CRD42022293631。
