The relationship between embryo quality and obesity in IVF patients: a single-center retrospective study

Öz

Purpose: The aim of this study is to retrospectively compare the relationship between female obesity and embryo quality and pregnancy outcome.
Materials and methods: In this retrospective study, which received approval by the ethical committee, data of in vitro fertilization (IVF) patients (n:542) between January 2019 and August 2021 were examined. The patients were divided into four groups: Group 1, Body Mass Index (BMI) <18.50 kg/m2 (n:16); Group 2, BMI 18.50-24.99 kg/m2 (n:263); Group 3, BMI 25.00-29.99 kg/m2 (n:156); Group 4, BMI ≥30 kg/m2 (n:107). Demographic characteristics of patients, baseline hormone levels, treatment protocols employed, counts of collected oocytes, day of embryo transfer, transferred embryo quality, a positive pregnancy test, and live births were collected, and statistical analysis was performed.
Results: There were no significant differences between the groups in terms of age, collected oocyte count, number of mature oocytes, maturation rate (p>0.05). Group 4 showed a statistically significant decrease in the number of 2PN (p=0.014) and fertilised oocyte count (p=0.006) compared to Group 2. When comparing pregnancy outcomes based on BMI groups, it was found that obesity did not significantly affect positive/negative pregnancy rates, live birth rates, miscarriage rates, biochemical pregnancy rates among the groups (p>0.05). Logistic regression analysis indicated a decrease in embryo quality with increasing age. Multiple regression analysis (MRA) results showed that a good quality of the transferred embryo had a positive impact on achieving a positive pregnancy outcome. The presence of pregnancy was negatively affected by increasing age. In Group 1 and Group 2, there were significantly more Day-5 transfers than in Group 4 (p=0.008).
Conclusion: This study showed that obese patients had a lower rate of Day 5 embryos compared to non-obese patients. However, no difference was found between BMI and pregnancy rates. The development of good quality embryos had a favourable effect on pregnancy outcomes, whereas increasing age had a negative effect. The present data suggest that further studies evaluating the mechanism underlying the effect of obesity on embryo development are warranted.

Anahtar Kelimeler

• Assisted reproduction
• infertility
• oocyte
• body mass index
• embryo quality

IVF hastalarında embriyo kalitesi ve obezite arasındaki ilişki: tek merkezli retrospektif bir çalışma

Öz

Amaç: Bu çalışmanın amacı, kadın obezitesi ile embriyo kalitesi ve gebelik sonuçları arasındaki ilişkiyi retrospektif olarak karşılaştırmaktır.
Gereç ve yöntem: Etik kurul onayı alan bu retrospektif çalışmada, Ocak 2019-Ağustos 2021 tarihleri arasında in vitro fertilizasyon (IVF) hastalarının (n:542) verileri incelendi. Hastalar dört gruba ayrılmıştır: Grup 1, Vücut Kitle İndeksi (VKİ) <18,50 kg/m2 (n:16); Grup 2, VKİ 18,50-24,99 kg/m2 (n:263); Grup 3, VKİ 25,00-29,99 kg/m2 (n:156); Grup 4, VKİ ≥30 kg/m2 (n:107). Hastaların demografik özellikleri, başlangıç hormon düzeyleri, uygulanan tedavi protokolleri, toplanan oosit sayıları, embriyo transfer günü, transfer edilen embriyo kalitesi, pozitif gebelik testi ve canlı doğumlar toplanmış ve istatistiksel analiz yapılmıştır.

Bulgular: Gruplar arasında yaş, toplanan oosit sayısı, olgun oosit sayısı ve olgunlaşma oranı açısından anlamlı bir fark yoktu (p>0,05). Grup 4’de Grup 2’ye göre 2 PN sayısı (p=0,014) ve fertilize olan oosit sayısı (p=0,006) istatistiksel olarak anlamlı azalmıştı. VKİ gruplarına göre gebelik sonuçları karşılaştırıldığında, obezitenin gruplar arasında pozitif/negatif gebelik oranlarını, canlı doğum oranlarını, düşük oranlarını ve biyokimyasal gebelik oranlarını önemli ölçüde etkilemediği bulunmuştur (p>0,05). Lojistik regresyon analizi, artan yaşla birlikte embriyo kalitesinde azalma olduğunu göstermiştir. Çoklu regresyon analizi (MRA) sonuçları, transfer edilen embriyo kalitesinin iyi olmasının olumlu gebelik sonucu elde edilmesini olumlu yönde etkilediğini göstermiştir. Gebelik varlığı artan yaştan olumsuz etkilenmiştir. Grup 1 ve Grup 2'de, Grup 4'e kıyasla anlamlı derecede daha fazla 5. Gün transferi yapılmıştır (p=0,008).
Sonuç: Bu çalışma obez hastaların obez olmayan hastalara kıyasla daha düşük 5. Gün embriyo oranına sahip olduğunu göstermiştir. Bununla birlikte, VKİ ile gebelik oranları arasında fark bulunmamıştır. İyi kalitede embriyo gelişimi gebelik sonuçları üzerinde olumlu bir etkiye sahipken, artan yaş olumsuz bir etkiye sahiptir. Mevcut veriler, obezitenin embriyo gelişimi üzerindeki etkisinin altında yatan mekanizmayı değerlendiren daha ileri çalışmalara ihtiyaç olduğunu göstermektedir.

Anahtar Kelimeler

• Yardımla üreme
• infertilite
• oosit
• vücut kitle indeksi
• embriyo kalitesi

Kaynakça

1. Chu SY, Kim SY, Lau J, et al. Maternal obesity and risk of stillbirth: a metaanalysis. Am J Obstet Gynecol. 2007;197(3):223-228. doi:10.1016/j.ajog.2007.03.027
2. Stothard KJ, Tennant PW, Bell R, Rankin J. Maternal overweight and obesity and the risk of congenital anomalies: a systematic review and meta-analysis. JAMA. 2009;301(6):636-650. doi:10.1001/jama.2009.113
3. Dokras A, Baredziak L, Blaine J, Syrop C, VanVoorhis BJ, Sparks A. Obstetric outcomes after in vitro fertilization in obese and morbidly obese women. Obstet Gynecol. 2006;108(1):61-69. doi:10.1097/01.AOG.0000219768.08249.b6
4. Sermondade N, Huberlant S, Bourhis Lefebvre V, et al. Female obesity is negatively associated with live birth rate following IVF: a systematic review and meta-analysis. Hum Reprod Update. 2019;1;25(4):439-451. doi:10.1093/humupd/dmz011
5. Jungheim ES, Moley KH. Current knowledge of obesity’s effects in the pre- and periconceptional periods and avenues for future research. Am J Obstet Gynecol. 2010;203(6):525-530. doi:10.1016/j.ajog.2010.06.043
6. Insogna IG, Lee MS, Reimers RM, Toth TL. Neutral effect of body mass index on implantation rate after frozen-thawed blastocyst transfer. Fertil Steril. 2017;108(5):770-776.e1. doi:10.1016/j.fertnstert.2017.08.024
7. Bartolacci A, Buratini J, Moutier C, et al. Maternal body mass index affects embryo morphokinetics: a time-lapse study. J Assist Reprod Genet. 2019;36(6):1109-1116. doi:10.1007/s10815-019-01456-3
8. World Health Organization. Obesity and overweight Available at: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight. Accessed: 19.03.2019

9. Sakkas D. Evaluation of embryo quality: A strategy for sequential analysis of embryo development with the aim of single embryo transfer. Textbook of assisted reproductive techniques. Gardner DK, Weissman A, Howles CM, Shoham Z. London, United Kingdom; Available at:https://www.taylorfrancis.com/books/edit/10.1201/9781439813942/textbook-assisted-reproductive-techniques-david-gardner-colin-howles-zeev-shoham-ariel-weissman?refId=29136d6a-47cb-4515-9c1b 87691f7a0169&context=ubx. Accessed 19.03. 2019
10. Gardner DK, Schoolcraft WB. Culture and transfer of human blastocysts. Curr Opin Obstet Gynecol. 1999;11(3):307-311. doi:10.1097/00001703-199906000-00013
11. Gambineri A, Laudisio D, Marocco C, Radellini S, Colao A, Savastano S. Obesity Programs of nutrition, Education, Research and Assessment (OPERA) group. Female infertility: which role for obesity? Int J Obes Suppl. 2019;9(1):65-72. doi:10.1038/s41367-019-0009-1
12. Hou YJ, Zhu CC, Duan X, Liu HL, Wang Q, Sun SC. Both diet and gene mutation induced obesity affect oocyte quality in mice. Sci Rep. 2016;6:18858. doi:10.1038/srep18858
13. Machtinger R, Combelles CM, Missmer SA, Correia KF, Fox JH, Racowsky C. The association between severe obesity and characteristics of failed fertilized oocytes. Hum Reprod. 2012;27(11):3198-3207. doi:10.1093/humrep/des308
14. Rhee JS, Saben JL, Mayer AL, et al. Diet-induced obesity impairs endometrial stromal cell decidualization: a potential role for impaired autophagy. Hum Reprod. 2016;31(6):1315-1326. doi:10.1093/humrep/dew048
15. Sarais V, Pagliardini L, Rebonato G, Papaleo E, Candiani M, Viganò P. Comprehensive Analysis of Body Mass Index Effect on in Vitro Fertilization Outcomes. Nutrients. 2016;23;8(3):109. doi:10.3390/nu8030109
16. Ozekinci M, Seven A, Olgan S, et al. Does obesity have detrimental effects on IVF treatment outcomes? BMC Womens Health. 2015;15:61. doi:10.1186/s12905-015-0223-0
17. Bellver J, Ayllón Y, Ferrando M, et al. Female obesity impairs in vitro fertilization outcome without affecting embryo quality. Fertil Steril. 2010;93(2):447-454. doi:10.1016/j.fertnstert.2008.12.032
18. Fawarseh A, Atzmon Y, Aslih N, Bilgory A, Shalom Paz E. Embryonic Development in Relation to Maternal Obesity Does Not Affect Pregnancy Outcomes in FET Cycles. Healthcare (Basel). 2022;10(4):703. doi:10.3390/healthcare10040703
19. Liu X, Shi S, Sun J, et al. The influence of male and female overweight/obesity on IVF outcomes: a cohort study based on registration in Western China. Reprod Health. 2023;2;20(1):3. doi:10.1186/s12978-022-01558-9
20. Younes G, Kugelman N, Blais I, et al. Does obesity affect embryo development and quality? A retrospective analysis. Reprod Biomed Online. 2025;51(4):104753. doi:10.1016/j.rbmo.2024.104753
21. Rittemberg V, Seshadri S, Sunkara SK, Sviatlana Sobaleva S, Oteng Ntim E, El Toukhy T. Effect of body mass index on IVF treatment outcome: an updated systematic review and meta-analysis. Reprod Biomed Online. 2011;23(4):421-439. doi:10.1016/j.rbmo.2011.06.018
22. van der Steeg JW, Steures P, Eijkemans MJ, et al. Obesity affects spontaneous pregnancy chances in subfertile, ovulatory women. Hum Reprod. 2008;23(2):324-328. doi:10.1093/humrep/dem371
23. Moragianni VA, Jones SM, Ryley DA. The effect of body mass index on the outcomes of first assisted reproductive technology cycles. Fertil Steril. 2012;98(1):102-108. doi:10.1016/j.fertnstert.2012.04.004
24. Kudesia R, Wu H, Hunter Cohn K, et al. The effect of female body mass index on in vitro fertilization cycle outcomes: a multi-center analysis. J Assist Reprod Genet. 2018;35(11):2013-2023. doi:10.1007/s10815-018-1290-6
25. Bellver J, Pellicer A, García Velasco JA, Ballesteros A, Remohí J, Meseguer M. Obesity reduces uterine receptivity: clinical experience from 9,587 first cycles of ovum donation with normal weight donors. Fertil Steril. 2013;100(4):1050-1058. doi:10.1016/j. fertnstert.2013.06.001
26. Zheng Y, Dong X, Chen B, et al. Body mass index is associated with miscarriage rate and perinatal outcomes in cycles with frozen-thawed single blastocyst transfer: a retrospective cohort study. BMC Pregnancy Childbirth. 2022;22(1):118. doi:10.1186/s12884-022-04443-2
27. Matalliotakis I, Cakmak H, Sakkas D, Mahutte N, Koumantakis G, Arici A. Impact of body mass index on IVF and ICSI outcome: a retrospective study. Reprod BioMed Online. 2008;16(6):778-783. doi:10.1016/S1472-6483(10)60142-3