Skip to main content

Advertisement

SpringerLink
Log in

Obesity alters retrieved oocyte count and clinical pregnancy rates in high and poor responder women after in vitro fertilization

  • Reproductive Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Objective

Ovarian responsiveness to ovulation induction agents is essential for a successful clinical outcome in assisted reproductive technology (ART) cycles. We aimed to evaluate the accuracy of multinominal logistic models for the prediction of ovarian reserve and pregnancy in women undergoing ART cycles.

Patients and methods

1,970 patients who underwent ovarian stimulation for ART programs were evaluated. Patients were designated to ovarian response with body mass index (BMI) and age.

Results

When evaluating the factors affecting the egg quantity in poor responder and high responder patient groups according to the BMI, we observed that there was a lower probability of extracting less than five eggs in patients with a BMI of over 30 kg/m2. The BMI was not an influential parameter for the amount of eggs obtained when compairing norm responder and high responder patient groups. Otherwise, obesity does not constitute a risk factor for positive pregnancy. Being 36–40 years of age is an important risk factor in foreseeing pregnancy.

Conclusion

Predicting and managing the variability between patients is a significant clinical challenge in stimulation protocols. Research into predictive factors and the construction of multivariate models are the first steps towards evidence-based individualized treatment. The current practice of individualized treatment is based only on clinical experience and has poor reproducibility.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Kwee J, Schats R, Mc Donnell J, Schoemaker J, Lambalk CB (2006) The clomiphene citrate challenge test versus the exogenous follicle stimulation hormone ovarian reserve test (EFORT) as single test for identification of low or hyperresponders to IVF. Fertil Steril 85:1714–1722

    Article  PubMed  Google Scholar 

  2. Lee SJ, Lenton EA, Sexton L, Cooke ID (1988) The effect of age on the clnical paterns of plasma LH, FSH, eostradiol and progesterone in women with regular menstrual cycles. Hum Reprod 69:1010–1014

    Google Scholar 

  3. Hugues JN, Cedrin DI (1998) Revisting gonodotropin relasing hormone agonist protocols and management of poor ovarian responses to gonodotrophins. Hum Reprod Update 4:83–101

    Article  CAS  PubMed  Google Scholar 

  4. Garcia JE, Jones GS, Acosta AA, Wright G Jr (1983) Human menopausal gonadotropin/human chorionic gonadotropin follicular maturation for oocyte aspiration: phase II, 1981. Fertil Steril 39(2):174–179

    CAS  PubMed  Google Scholar 

  5. Barri PN, Coroleu B, Martinez F, Veiga A (2000) Stimulation protocols for poor responders and aged women. Mol Cell Endocrinol 166:15–20

    Article  CAS  PubMed  Google Scholar 

  6. Ferraretti AP, Gianaroli L, Magli MC, Bafaro G, Colacurci N (2000) Female poor responders. Mol Cell Endocrinol 161:59–66

    Article  CAS  PubMed  Google Scholar 

  7. Keay SD, Liversedge NH, Mathur RS, Jenkins JM (1997) Assisted conception following poor ovarian response to gonadotrophin stimulation. Br J Obstet Gynaecol 104(5):521–527 Review

    CAS  PubMed  Google Scholar 

  8. Damario MA, Barmat L, Liu HC, Davis OK, Rosenwaks Z (1997) Dual suppression with oral contraceptives and gonadotrophin releasing-hormone agonists improves in vitro fertilization outcome in high responder patients. Hum Reprod 12(11):2359–2365

    Article  CAS  PubMed  Google Scholar 

  9. Dor J, Shulman A, Levran D, Ben-Rafael Z, Rudak E, Mashiach S (1990) The treatment of patients with polycystic ovarian syndrome by in vitro fertilization and embryo transfer: a comparison of results with those of patients with tubal infertility. Hum Reprod 5(7):816–818

    CAS  PubMed  Google Scholar 

  10. Rich-Edwards JW, Spiegelman D, Garland M, Hertzmark E, Hunter DJ, Colditz GA, Willett WC, Wand H, Manson JE (2002) Physical activity, body mass index, and ovulatory disorder infertility. Epidemiology 13(2):184–190

    Article  PubMed  Google Scholar 

  11. Pasquali R, Pelusi C, Genghini S, Cacciari M, Gambineri A (2003) Obesity and reproductive disorders in women. Hum Reprod Update 9(4):359–372

    Article  PubMed  Google Scholar 

  12. Metwally M, Cutting R, Tipton A, Skull J, Ledger WL, Li TC (2007) Effect of increased body mass index on oocyte and embryo quality in IVF patients. Reprod Biomed Online 15(5):532–538

    Article  CAS  PubMed  Google Scholar 

  13. Bray GA (1997) Obesity and reproduction. Hum Reprod 12(Suppl 1):26–32 Review

    CAS  PubMed  Google Scholar 

  14. Lewis CG, Graham MW, Wang X et al (1991) Failure of body mass index to influence markedly the response to ovarian hyperstimulation in normal cycling women. Fertil Steril 53:1097–1099

    Google Scholar 

  15. Fedorcsak P, Dale PO, Storeng R, Ertzeid G, Bjercke S, Oldereid N, Omland AK, Abyholm T, Tanbo T (2004) Impact of overweight and underweight on assisted reproduction treatment. Hum Reprod 19:2523–2528

    Article  PubMed  Google Scholar 

  16. Maheshwari A, Stofberg L, Bhattacharya S (2007) Effect of overweight and obesity on assisted reproductive technology–a systematic review. Hum Reprod Update 13(5):433–444

    Article  CAS  PubMed  Google Scholar 

  17. Huques JN (2008) Impact of overweight on the outcome of ovarian stimulation. Bull Acad Natl Med 192(4):661–671

    Google Scholar 

  18. Navot D, Rosenwaks Z, Margalioth EJ (1987) Prognostic assessment of female fecundity. Lancet 2:645–647

    Article  CAS  PubMed  Google Scholar 

  19. Scheffer GJ, Broekmans FJ, Dorland M, Habbema JD, Looman CW (1999) Antral follicul counts by transvaginal ultrasonography are related to age in womenwith proven naturel fertility. Fertil Steril 72:845–851

    Article  CAS  PubMed  Google Scholar 

  20. Hendriks DJ, Broekmans FJ, Bancsi LF, Looman CW, de Jong FH, te Velde ER (2005) Single and repeated GnRH agonist stimulation tests compared with basal markers of ovarian reserve in the prediction of outcome in IVF. J Assist Reprod Genet 22(2):65–73

    Article  CAS  PubMed  Google Scholar 

  21. Loh S, Wang JX, Matthews CD (2002) The influence of body mass index, basal FSH and age on the response to gonadotrophin stimulation in non-polycystic ovarian syndrome patients. Hum Reprod 17(5):1207–1211

    Article  CAS  PubMed  Google Scholar 

  22. Kably-Ambe A, Barron-Vallejo J, Limon-Luque LM (1999) Effect of body mass index and follicular synchrony in the ovarian response to ovulation induction with menotropins. Int J Fertil Women’s Med 44:156–159

    CAS  Google Scholar 

  23. Wittemer C, Ohl J, Bailly M, Bettahar-Lebugle K, Nisand I (2000) Does body mass index of infertile women have an impact on IVF procedure and outcome? J Assist Reprod Genet 17(10):547–552

    Article  CAS  PubMed  Google Scholar 

  24. Chong AP, Rafael RW, Forte CC (1986) Influence of weight in the induction of ovulation with human menopausal gonadotrophin and human chorionic gonadotrophin. Fertil Steril 46:599–603

    CAS  PubMed  Google Scholar 

  25. Maheshwari A, Scotland G, Bell J, McTavish A, Hamilton M, Bhattacharya S (2009) The direct health services costs of providing assisted reproduction services in overweight or obese women: a retrospective cross-sectional analysis. Hum Reprod 24(3):633–639

    Article  PubMed  Google Scholar 

  26. Matalliotakis I, Cakmak H, Sakkas D, Mahutte N, Koumantakis G, Arici A (2008) Impact of body mass index on IVF and ICSI outcome: a retrospective study. Reprod Biomed Online 16(6):778–783

    Article  PubMed  Google Scholar 

  27. Dokras A, Baredziak L, Blaine J, Syrop C, VanVoorhis BJ, Sparks A (2006) Obstetric outcomes after in vitro fertilization in obese and morbidly obese women. Obstet Gynecol 108(1):61–69

    PubMed  Google Scholar 

  28. Thum MY, El-Sheikhah A, Faris R, Parikh J, Wren M, Ogunyemi T, Gafar A, Abdalla H (2007) The influence of body mass index to in vitro fertilisation treatment outcome, risk of miscarriage and pregnancy outcome. J Obstet Gynaecol 27(7):699–702

    Article  CAS  PubMed  Google Scholar 

  29. Lashen H, Ledger W, Bernal AL, Barlow D (1999) Extremes of body mass do not adversely affect the outcome of superovulation and in vitro fertilization. Hum Reprod 14(3):712–715

    Article  CAS  PubMed  Google Scholar 

  30. Chuang CC, Chen CD, Chao KH, Chen SU, Ho HN, Yang YS (2003) Age is a better predictor of pregnancy potential than basal follicle-stimulating hormone levels in women undergoing in vitro fertilization. Fertil Steril 79(1):63–68

    Article  PubMed  Google Scholar 

  31. Scott RT, Toner JP, Muasher SJ, Oehninger S, Robinson S, Rosenwaks Z (1989) FSH levels on cycle day 3 are predictive of IVF outcome. Fertil Steril 51:651–654

    CAS  PubMed  Google Scholar 

  32. Scott RT Jr, Hofmann GE, Oehninger S, Muasher SJ (1990) Intercycle variabillty of day 3 FSH levels and its effect on stimulation quality in IVF. Fertil Steril 54:297–302

    PubMed  Google Scholar 

  33. Loutradis D, Vlismas A, Drakakis P, Antsaklis A (2008) Pharmacogenetics in ovarian stimulation–current concepts. Ann N Y Acad Sci 1127:10–19

    Article  CAS  PubMed  Google Scholar 

  34. Achrekar SK, Modi DN, Desai SK, Mangoli VS, Mangoli RV, Mahale SD (2009) Follicle-stimulating hormone receptor polymorphism (Thr(307)Ala) is associated with variable ovarian response and ovarian hyperstimulation syndrome in Indian women. Fertil Steril 91(2):432–439

    Article  CAS  PubMed  Google Scholar 

Download references

Conflict of interest statement

None.

Author information

Authors and Affiliations

  1. Department of Reproductive Endocrinology and ART, Dr. Zekai Tahir Burak Women Health Educational and Resarch Hospital, Ankara, Turkey

    Sevtap Kilic, Nafiye Yilmaz, Ebru Zülfikaroglu, Esma Sarıkaya, Onur Topcu & Sertac Batioglu

  2. Department of Biostatistics, University of Ankara Medical School, Ankara, Turkey

    Kenan Kose

  3. 7.Cadde 70 A/14, 06490, Bahçelıevler, Ankara, Turkey

    Ebru Zülfikaroglu

Authors
  1. Sevtap Kilic
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nafiye Yilmaz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ebru Zülfikaroglu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Esma Sarıkaya
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kenan Kose
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Onur Topcu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Sertac Batioglu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ebru Zülfikaroglu.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kilic, S., Yilmaz, N., Zülfikaroglu, E. et al. Obesity alters retrieved oocyte count and clinical pregnancy rates in high and poor responder women after in vitro fertilization. Arch Gynecol Obstet 282, 89–96 (2010). https://doi.org/10.1007/s00404-010-1359-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-010-1359-7

Keywords

Search

Navigation