Causal Effects of Body Mass Index and Maternal Age on Oocyte Maturation in Assisted Reproductive Technology: Model-Average Causal Effect and Bayesian LASSO Method

BACKGROUND: Body Mass Index (BMI) and maternal age are related to various disorders of the female reproductive system. This study aimed to estimate the causal effects of BMI and maternal age on the rate of meta-phase II oocytes (MII) using a new statistical method based on Bayesian LASSO and model averaging. METHODS: This investigation was a historical cohort study and data were collected from women who underwent assisted reproductive treatments in Tehran, Iran during 2015 to 2018. Exclusion criteria were gestational surrogacy and donor oocyte. We used a new method based on Bayesian LASSO and model average to capture important confounders. RESULTS: Overall, 536 cycles of 398 women were evaluated. BMI and Age had inverse relationships with the number of MII based on univariate analysis, but after adjusting the effects of other variables, there was just a significant association between age and the number of MII (adjusted incidence rate ratio (aIRR) of age =0.989, 95% CI: [0.979, 0.998], P=0.02). The results of causal inference based on the new presented method showed that the overall effects of age and BMI of all patients were significantly and inversely associated with the number of MII (both P<0.001). Therefore the expected number of MII decreased by 0.99 for an increase of 1 year (95% CI: [−1.00, −0.97]) and decreased by 0.99 for each 1-unit increase in BMI (95% CI: [−1.01, −0.98]). CONCLUSION: Maternal age and BMI have significant adverse casual effects on the rate of MII in patients undergoing ART when the effects of important confounders were adjusted.