Michalopoulou Moscho, Jebb Susan Ann, Hobson Alice, Khaw Shen Chuen, Stevens Richard, Melo Pedro, Haffner Stella Jane Pierce, Sheridan Clay Kathryn, Mounsey Sarah, Granne Ingrid, Lim Lee, Child Tim, Astbury Nerys Marie
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom (M.M., S.A.J., A.H., R.S., S.J.P.H., K.S.C., S.M., N.M.A.).
Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom (S.C.K., L.L.).
Ann Intern Med. 2025 Aug 12. doi: 10.7326/ANNALS-24-01025.
It is unclear whether weight loss before in vitro fertilization (IVF) improves reproductive outcomes in women with obesity.
To assess whether weight loss interventions before IVF improve reproductive outcomes.
Five electronic databases through 27 May 2025.
Randomized controlled trials (RCTs) in women with obesity who were offered a weight loss intervention before planned IVF.
Dual independent screening, data extraction, and assessment of risk of bias (RoB) and certainty of evidence. Primary outcomes were pregnancy and live birth rates. Where appropriate, studies were pooled using random-effects meta-analyses.
Twelve RCTs (1921 randomly assigned participants) were included, 7 of which had high RoB. There was moderate certainty that pre-IVF weight loss interventions were associated with an increase in total pregnancy rates (risk ratio [RR], 1.21 [95% CI, 1.02 to 1.44]; 11 studies) and pregnancies resulting from unassisted conception (RR, 1.47 [CI, 1.26 to 1.73]; 10 studies), whereas the effect on pregnancies resulting solely from IVF was uncertain. Weight loss interventions were not associated with pregnancy loss rates (RR, 1.05 [CI, 0.98 to 1.13]; 8 studies; moderate certainty), but their effect on live birth rates was unclear (RR, 1.15 [CI, 0.95 to 1.40]; 9 studies; very low certainty).
Studies were small, had high RoB, and often did not report important outcomes, such as live births. Substantial clinical and methodological heterogeneity was unexplained by exploratory analyses.
Weight loss interventions before IVF appear to increase the chances of pregnancy, especially unassisted conceptions. However, studies were small, and heterogeneity made it difficult to determine the benefit of any particular intervention.
National Institute for Health and Care Research Applied Research Collaboration Oxford and Thames Valley. (PROSPERO: CRD42023441457).
体外受精（IVF）前减重是否能改善肥胖女性的生殖结局尚不清楚。
评估IVF前的减重干预措施是否能改善生殖结局。
截至2025年5月27日的五个电子数据库。
对计划进行IVF前接受减重干预的肥胖女性进行的随机对照试验（RCT）。
双人独立筛查、数据提取以及偏倚风险（RoB）和证据确定性评估。主要结局为妊娠率和活产率。在适当情况下，使用随机效应荟萃分析对研究进行合并。
纳入了12项RCT（1921名随机分配的参与者），其中7项具有高RoB。有中等确定性表明，IVF前的减重干预措施与总妊娠率增加相关（风险比[RR]，1.21[95%CI，1.02至1.44]；11项研究）以及自然受孕导致的妊娠（RR，1.47[CI，1.26至1.73]；10项研究），而对仅由IVF导致的妊娠的影响尚不确定。减重干预措施与流产率无关（RR，1.05[CI，0.98至1.13]；8项研究；中等确定性），但其对活产率的影响尚不清楚（RR，1.15[CI，0.95至1.40]；9项研究；极低确定性）。
研究规模小，RoB高，且常常未报告重要结局，如活产情况。探索性分析无法解释大量的临床和方法学异质性。
IVF前的减重干预措施似乎增加了妊娠机会，尤其是自然受孕。然而，研究规模小，且异质性使得难以确定任何特定干预措施的益处。
国家卫生与保健研究所牛津和泰晤士河谷应用研究合作中心。（国际前瞻性系统评价注册库：CRD42023441457）
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