Live birth outcomes in infertile patients with class III and class IV obesity following fresh embryo transfer
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Live birth outcomes in infertile patients with class III and class IV obesity following fresh embryo transfer Phillip A. Romanski 1 & Pietro Bortoletto 1 & Brady Magaoay 2 & Alice Chung 2 & Zev Rosenwaks 1 & Steven D. Spandorfer 1 Received: 17 August 2020 / Accepted: 9 November 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Objective Assess the effect of class III (body mass index [BMI, kg/m2] 40–49.9) and class IV obesity (≥ 50) on clinical pregnancy and live birth outcomes after first oocyte retrieval and fresh embryo transfer cycle. Design Cohort study Setting Academic center Patients Patients undergoing their first oocyte retrieval with planned fresh embryo transfer in our clinic between 01/01/2012 and 12/31/2018. Patients were stratified by BMI: 18.5–24.9 (n = 4913), 25–29.9 (n = 1566) 30–34.9 (n = 559), 35–39.9 (n = 218), and ≥ 40 (n = 114). Intervention None Main outcome measure Live birth rate Results Following embryo transfer, there were no differences in pregnancy rates across all BMI groups (p value, linear trend = 0.86). However among pregnant patients, as BMI increased, a significant trend of a decreased live birth rate was observed (p value, test for linear trend = 0.004). Additionally, as BMI increased, a significant trend of an increased miscarriage rate was observed (p value, linear trend = < 0.001). Compared to the normal-weight cohort, women with a BMI ≥ 40 had a significantly higher rate of cancelled fresh transfers after retrieval (18.4% vs. 8.2%, OR 2.51; 95%CI 1.55–4.08). Among singleton deliveries, a significant trend of an increased c-section rate was identified as the BMI increased (p value, linear trend = 40 have worse IVF treatment outcomes compared to normal-weight patients. After embryo transfer, their pregnancy rate is comparable to normal-weight women; however, their miscarriage rate is higher, leading to a lower live birth rate for pregnant women in this population. Patients with a BMI > 40 have a c-section rate that is 50% higher than normal-weight patients. Keywords Obese . Class III obesity . Class IV obesity . Overweight . Infertility
Introduction Obesity and its impact on disease morbidity is a serious concern that has been growing worldwide for the last few decades [1]. In the USA alone, an estimated $190 billion US dollars are spent each year on obesity-related healthcare costs [2]. The negative effects of obesity on health outcomes are likely to
* Steven D. Spandorfer [email protected] 1
The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical Center, 1305 York Avenue, New York, NY 10021, USA
2
Weill Medical College of Cornell University, New York, NY 10021, USA
only increase in prevalence, with recent projections showing that by the year 2030, half of adults in the USA will have a body mass index (BMI; kg/m2) > 30 [3]. Furthermore, it is projected that in the next ten years, almost one-third of females will have a BMI > 35, which will make it the mos
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