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Clinical Research

Overweight and obesity determined by body mass index criteria for Asian populations adversely affect assisted reproductive outcomes among Chinese women with polycystic ovary syndrome

International Journal of Obesity volume 48, pages 394–402 (2024)Cite this article

Subjects

Abstract

Background

Obesity is a common feature in women with polycystic ovary syndrome (PCOS) and is associated with multiple adverse reproductive outcomes. However, the impact of overweight and obesity on reproductive outcomes of women with PCOS who underwent in vitro fertilization-embryo transfer (IVF-ET) is currently controversial and appropriate body mass index (BMI) levels differ across ethnic groups.

Methods

This was a retrospective study including 1066 women with PCOS receiving IVF treatment at our institution between January 2018 and June 2021, among whom 960 underwent their first fresh or frozen embryo transfer. Participants were categorized according to BMI cut-off values proposed by the World Health Organization for Asian populations: normal weight (BMI < 23 kg/m2), overweight (BMI: 23–24.9 kg/m2), and obesity (BMI ≥ 25 kg/m2). The effect of BMI on clinical and embryological outcomes was evaluated by descriptive statistics and logistic regression models with confounders adjusted. The dose-response relationship between BMI as a continuous variable and IVF outcomes is also explored.

Interventions

no

Results

Increasing BMI was associated with significantly lower numbers of total oocytes retrieved, metaphase II oocytes, two pronuclear (2PN) zygotes, and good-quality embryos among women with PCOS. Patients with PCOS with a BMI ≥ 23 kg/m2 had significantly lower live birth rates (41.9% vs. 49.1%; adjusted odds ratio [aOR], 0.75; 95% confidence interval [CI], 0.57–0.97) and implantation rates (35.8% vs. 43.9%; aOR, 0.76; 95% CI, 0.61–0.93) than those with normal BMI. Moreover, BMI showed a non-linear relationship (p for nonlinearity <0.001) with the number of 2PN zygotes with the curve becoming steeper as BMI surpassed 22.4 kg/m2.

Conclusions

Patients with PCOS with a BMI ≥ 23 kg/m2 have lower live birth rates than those with a BMI < 23 kg/m2. Defining obesity and overweight with ethnicity-specific BMI cut-offs may help to improve IVF outcomes among PCOS patients.

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Fig. 1: Flow chart of participants selection for this study.
Fig. 2: Association between BMI and embryological outcomes.
Fig. 3: Association between BMI and pregnancy outcomes.

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Data availability

The data that support the findings of this study will be made available from the corresponding author upon reasonable request.

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Acknowledgements

The authors thank all the Department of Assisted Reproduction of Women’s Hospital staff for their support and cooperation.

Funding

National Key R&D Program of China (2021YFC2700100), National Natural Science Foundation of China (81974228), and Key R&D Program of Zhejiang (2021C03G2013079).

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Authors and Affiliations

  1. Department of Reproductive Endocrinology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, China

    Ruimin Zhao, Xinyun Yang, Long Cui, Lefeng Wang & Yinghui Ye

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  1. Ruimin Zhao
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  2. Xinyun Yang
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  3. Long Cui
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  4. Lefeng Wang
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Contributions

YY was responsible for conceptualization, funding acquisition, project administration, and editing. RZ was responsible for data curation, investigation, and writing-Original draft preparation. XY contributed to extracting and analyzing data and validation of results. LC was responsible for the election of methodology and software. Lefeng Wang contributed to interpreting results and providing feedback on the manuscript.

Corresponding author

Correspondence to Yinghui Ye.

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Zhao, R., Yang, X., Cui, L. et al. Overweight and obesity determined by body mass index criteria for Asian populations adversely affect assisted reproductive outcomes among Chinese women with polycystic ovary syndrome. Int J Obes 48, 394–402 (2024). https://doi.org/10.1038/s41366-023-01430-1

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