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Effect of body mass index on pregnancy outcomes in a freeze-all policy: an analysis of 22,043 first autologous frozen-thawed embryo transfer cycles in China

BACKGROUND: Abnormal BMI is associated with discouraging IVF outcomes in fresh autologous or oocyte donor cycles, whether or not such a relation also holds true for women undergoing frozen-thawed embryo transfer (FET) remains unknown. In addition, it remains unclear the detrimental effect of abnorma...

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Autores principales: Zhang, Jie, Liu, Hongfang, Mao, Xiaoyan, Chen, Qiuju, Fan, Yong, Xiao, Yitao, Wang, Yun, Kuang, Yanping
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6593528/
https://www.ncbi.nlm.nih.gov/pubmed/31238940
http://dx.doi.org/10.1186/s12916-019-1354-1
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author Zhang, Jie
Liu, Hongfang
Mao, Xiaoyan
Chen, Qiuju
Fan, Yong
Xiao, Yitao
Wang, Yun
Kuang, Yanping
author_facet Zhang, Jie
Liu, Hongfang
Mao, Xiaoyan
Chen, Qiuju
Fan, Yong
Xiao, Yitao
Wang, Yun
Kuang, Yanping
author_sort Zhang, Jie
collection PubMed
description BACKGROUND: Abnormal BMI is associated with discouraging IVF outcomes in fresh autologous or oocyte donor cycles, whether or not such a relation also holds true for women undergoing frozen-thawed embryo transfer (FET) remains unknown. In addition, it remains unclear the detrimental effect of abnormal BMI on IVF outcomes occurs at the level of ovary or endometrium. METHODS: A retrospective study involved 22,043 first FET cycles of all women who had undergone a freeze-all policy during the period from January 2010 to June 2017. To control for the embryo factor, our analysis was restricted to women with high-quality embryo transfer. The main outcome measure was live birth rate per embryo transfer. The secondary endpoints included rates of implantation, clinical pregnancy, multiple pregnancy, and pregnancy loss. Multivariate logistic regression analysis was performed to detect the independent effect of BMI on live birth rate after adjusting for important confounding variables. RESULTS: In the crude analysis, reproductive outcomes were similar between underweight women and normal-weight controls whereas all parameter outcomes were significantly worse in patients with obesity. After adjustment for a number of confounding factors, underweight women had a marginally significant decrease in rates of implantation (adjusted odds ratio (aOR) 0.91; 95% CI 0.85–0.96), clinical pregnancy (aOR 0.91; 95% CI 0.83–0.99), and live birth (aOR 0.91; 95% CI 0.83–0.99) as compared to the women with normal weight. Obesity was significantly associated with decreased implantation (aOR 0.80; 95% CI 0.73–0.87), clinical pregnancy (aOR 0.81; 95% CI 0.71–0.91), and live birth rates (aOR 0.70; 95% CI 0.62–0.80). Moreover, the pregnancy loss rate, both in the first (aOR 1.46; 95% CI 1.15–1.87) and in the second trimester (aOR 2.76; 95% CI 1.67–4.58), was significantly higher in the obesity group than that in the reference group. CONCLUSIONS: Among women undergoing first FET with high-quality embryo transfer, low BMI has limited impact on pregnancy and live birth rates. On the contrary, obesity was associated with worse IVF outcomes. Our findings further highlighted that endometrial receptivity played an important role in the poor reproductive outcomes of women with abnormal weight status. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12916-019-1354-1) contains supplementary material, which is available to authorized users.
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spelling pubmed-65935282019-07-09 Effect of body mass index on pregnancy outcomes in a freeze-all policy: an analysis of 22,043 first autologous frozen-thawed embryo transfer cycles in China Zhang, Jie Liu, Hongfang Mao, Xiaoyan Chen, Qiuju Fan, Yong Xiao, Yitao Wang, Yun Kuang, Yanping BMC Med Research Article BACKGROUND: Abnormal BMI is associated with discouraging IVF outcomes in fresh autologous or oocyte donor cycles, whether or not such a relation also holds true for women undergoing frozen-thawed embryo transfer (FET) remains unknown. In addition, it remains unclear the detrimental effect of abnormal BMI on IVF outcomes occurs at the level of ovary or endometrium. METHODS: A retrospective study involved 22,043 first FET cycles of all women who had undergone a freeze-all policy during the period from January 2010 to June 2017. To control for the embryo factor, our analysis was restricted to women with high-quality embryo transfer. The main outcome measure was live birth rate per embryo transfer. The secondary endpoints included rates of implantation, clinical pregnancy, multiple pregnancy, and pregnancy loss. Multivariate logistic regression analysis was performed to detect the independent effect of BMI on live birth rate after adjusting for important confounding variables. RESULTS: In the crude analysis, reproductive outcomes were similar between underweight women and normal-weight controls whereas all parameter outcomes were significantly worse in patients with obesity. After adjustment for a number of confounding factors, underweight women had a marginally significant decrease in rates of implantation (adjusted odds ratio (aOR) 0.91; 95% CI 0.85–0.96), clinical pregnancy (aOR 0.91; 95% CI 0.83–0.99), and live birth (aOR 0.91; 95% CI 0.83–0.99) as compared to the women with normal weight. Obesity was significantly associated with decreased implantation (aOR 0.80; 95% CI 0.73–0.87), clinical pregnancy (aOR 0.81; 95% CI 0.71–0.91), and live birth rates (aOR 0.70; 95% CI 0.62–0.80). Moreover, the pregnancy loss rate, both in the first (aOR 1.46; 95% CI 1.15–1.87) and in the second trimester (aOR 2.76; 95% CI 1.67–4.58), was significantly higher in the obesity group than that in the reference group. CONCLUSIONS: Among women undergoing first FET with high-quality embryo transfer, low BMI has limited impact on pregnancy and live birth rates. On the contrary, obesity was associated with worse IVF outcomes. Our findings further highlighted that endometrial receptivity played an important role in the poor reproductive outcomes of women with abnormal weight status. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12916-019-1354-1) contains supplementary material, which is available to authorized users. BioMed Central 2019-06-26 /pmc/articles/PMC6593528/ /pubmed/31238940 http://dx.doi.org/10.1186/s12916-019-1354-1 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Zhang, Jie
Liu, Hongfang
Mao, Xiaoyan
Chen, Qiuju
Fan, Yong
Xiao, Yitao
Wang, Yun
Kuang, Yanping
Effect of body mass index on pregnancy outcomes in a freeze-all policy: an analysis of 22,043 first autologous frozen-thawed embryo transfer cycles in China
title Effect of body mass index on pregnancy outcomes in a freeze-all policy: an analysis of 22,043 first autologous frozen-thawed embryo transfer cycles in China
title_full Effect of body mass index on pregnancy outcomes in a freeze-all policy: an analysis of 22,043 first autologous frozen-thawed embryo transfer cycles in China
title_fullStr Effect of body mass index on pregnancy outcomes in a freeze-all policy: an analysis of 22,043 first autologous frozen-thawed embryo transfer cycles in China
title_full_unstemmed Effect of body mass index on pregnancy outcomes in a freeze-all policy: an analysis of 22,043 first autologous frozen-thawed embryo transfer cycles in China
title_short Effect of body mass index on pregnancy outcomes in a freeze-all policy: an analysis of 22,043 first autologous frozen-thawed embryo transfer cycles in China
title_sort effect of body mass index on pregnancy outcomes in a freeze-all policy: an analysis of 22,043 first autologous frozen-thawed embryo transfer cycles in china
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6593528/
https://www.ncbi.nlm.nih.gov/pubmed/31238940
http://dx.doi.org/10.1186/s12916-019-1354-1
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