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Effect of Body Mass Index on the Outcome of In-Vitro Fertilization/
Intracytoplasmic Sperm Injection in Women
Manish Banker, Dipesh Sorathiya, Sandeep Shah
Nova IVI Fertility, Pulse
Women’s Hospital,
Ahmedabad, Gujarat, India
Background: Obesity, a known epidemic, is a leading cause of various reproductive
disorders. Association of body mass index (BMI) with pregnancy outcomes, either
ovarian or endometrial, is controversial and least elucidated. Aim: This study aimed to
analyze the effect of BMI on in-vitro fertilization (IVF)/intracytoplasmic sperm
injection (ICSI) outcome in women using self-oocytes, embryos prepared from
donor oocytes (DE), or vitrified/frozen embryos (VE) obtained from both the SE
and DE groups. Materials and Methods: A 9-month retrospective study was
conducted on women undergoing IVF/ICSI. The women were grouped according
to the World Health Organization classification of BMI (<18.50, 18.50–24.99,
25.00–29.99, and ≥30.00 kg/m
2
). They were further subcategorized as SE, DE,
and VE groups. Ongoing pregnancy rate (OPR) was recorded as primary, whereas
pregnancy rate (PR), clinical PR (CPR), implantation rate (IR), and clinical abortion
rate (CAR) were secondary endpoints. Age, number of mature eggs, usable embryos,
and embryos transferred were also measured. The data were statistically analyzed
using chi-square and analysis of variance. P-value <0.05 was considered statistically
significant. Results: OPR was statistically insignificant across all the groups.
Secondary outcomes were statistically insignificant in all the groups except in VE,
where IR (P=0.008) and CAR (P=0.0002) were statically significant. Other
parameters were statistically insignificant among all the groups. However, in the
SE and VE groups, the mean age was statistically significant (SE, P=0.0001; VE,
P=0.0191). Conclusion: This study showed marginal/no effect of BMI on oocyte
quality/endometrial receptivity and, subsequently, on the pregnancy outcome.
However, well-designed, larger prospective studies are needed to clarify the role
of BMI in pregnancy outcome in women undergoing IVF/ICSI.
KEYWORDS:Assisted reproductive technology, BMI, clinical abortion rate,
implantation rate, obesity, ongoing pregnancy rate, pregnancy rate
INTRODUCTION
Obesity is one of the leading global risk factors
affecting both men as well as women.
[1]
The
prevalence of obesity has increased dramatically over
the past two decades. In the United States, about 66.7%
of women and 75% men of are overweight or obese; out of
which, nearly 50% of the women are of reproductive age,
and about 17% of their children are aged 2–19 years.
[2]
In
India, according to the National Family Health Survey
(NFHS), the percentage of ever-married overweight/obese
women (aged 15–49 years) has increased from 11% in
NFHS-2 to 15% in NFHS-3.
[3]
Obesity is usually assessed using body mass index
(BMI), which is calculated by dividing the weight (kg)
of a person with the square of her/his height (m
2
).
[4]
The
World Health Organization (WHO) considers a person as
obese if her/his BMI ≥30 kg/m
2
[Table 1].
[5]
Besides the
ABSTRACT
Address for correspondence: Dr. Dipesh Sorathiya, Associate
Consultant, Nova IVI Fertility, Pulse Women’s Hospital, 108, Swastik
Society, Navrangpura, Ahmedabad 380 009, Gujarat, India.
E-mail: drdipeshsorathiya@gmail.com
This is an open access article distributed under the terms of the Creative Commons
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tweak, and build upon the work noncommercially, as long as the author is
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For reprints contact: reprints@medknow.com
How to cite this article: Banker M, Sorathiya D, Shah S. Effect of Body
Mass Index on the Outcome of In-Vitro Fertilization/Intracytoplasmic
Sperm Injection in Women. J Hum Reprod Sci 2017;10:37-43.
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DOI:
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Original Article
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association of obesity with cardiovascular diseases,
diabetes, ortho-arthiritis, etc., a raised BMI is also
related with a high risk of reproductive complications in
women such as menstrual dysfunction, anovulation, and
infertility.
[6,7]
The women with a higher BMI also show a
lower conception rate and higher abortion rate (AR), and
they usually experience other
reproductive complications.
[8]
Alteration in the secretion
of pulsatile gonadotropin-releasing hormone (GnRH),
sex hormone-binding globulin levels, ovarian and
adrenal androgens, and luteinizing hormone might
be the probable reasons
for this dysfunction. Other mechanisms suggest an
increased serum and follicular fluid leptin concentration,
which in turn inhibits ovarian steroidogenesis. A decrease
in serum adiponectin levels might cause hyperandro-
genaemia.
[6,11,12]
However, mechanisms underlying the
adverse outcomes of raised BMI, whether ovarian or
endometrial, still remain to be fully elucidated.
In-vitro fertilization (IVF) and intracytoplasmic sperm
injection (ICSI) involve the process of embryo transfer
(ET) using embryos prepared from either self-oocytes
(SE), donated oocytes (DE), or vitrified/frozen embryos
(VE). Females using DE are generally incapable of
producing their own oocytes due to their advanced
age or other conditions leading to poor ovarian
reserve.
[13]
The vitrification of embryos plays an
important role in assisted reproduction technology
(ART) by offering the patients a prospect to take
more chances to conceive without undergoing another
fresh cycle.
[14,15]
It has been reported that women with BMI more than
35 kg/m
2
areathighriskduringART.
[4]
Therefore, many
prior studies have investigated the impact of raised BMI
on the pregnancy outcomes of IVF/ICSI but with
disparate results.
[16,17]
Some studies conducted on the
patients undergoing IVF/ICSI using DE reported the
negative impact of BMI, whereas others reported no
difference in the reproductive outcomes in obese and
normal DE recipients.
[18-20]
Similarly, there has been a
debate on the effect of BMI on IVF patients using
VE.
[21,22]
The present study was conducted to
investigate the effect of BMI on IVF/ICSI outcomes in
women using SE, DE, and VE to evaluate whether the
effect of BMI, if any, was due to oocyte quality or
endometrial receptivity.
MATERIALS AND METHODS
Patients
A retrospective study was conducted on women, who
underwent ICSI from March 1, 2015 to November 30,
2015. This study was approved by an Independent Ethics
Committee.
Data collection
The medical records of women were reviewed to
calculate their BMI as per formula, weight/height
2
(kg/
m
2
), on starting of the treatment. According to WHO
classification of BMI, the patients were divided into
four groups, that is, <18.50 kg/m
2
, 18.50–24.99 kg/m
2
,
25.00–29.99 kg/m
2
, and ≥30.00 kg/m
2
. They were
further categorized into three groups on the basis of the
type of embryo used for transfer, that is, SE, DE, and VE.
The ongoing pregnancy rate (OPR; the ratio of pregnancy
continuedbeyond12 weeksof pregnancytothe totalnumber
of women who have undergone ET) was the primary
outcome measure. The pregnancy rate [PR; the ratio of
patients with positive β-human chorionic gonadotropin
(β-hCG) to the total number of patients who underwent
ET], clinical pregnancy rate (CPR; the ratio of women with
sonographically confirmed gestation sac after 3 weeks of ET
to the total number of patients undergoing ET), implantation
rate (IR; the ratio of the number of gestational sacs observed
during sonography screening after 3 weeks of ET to the total
number of embryos transferred), and clinical abortion rate
(CAR; ratio between the number of abortions occurring
before 12 weeks of pregnancy to the total number of
sonographically confirmed pregnancies) were assessed as
secondary outcomes during the study.
The women in the SE groups were also assessed to calculate
their mean age, average mature (M II) oocytes, average
number of utilized embryos (the number of embryos for
transfer plus the number of embryos for freezing), and the
average number of embryos transferred. Only the mean age
and the average number of embryos transferred were
determined in the case of the DE group, because all the
patients received almost similar number of oocytes from
donors. In the VE group, only the parameters related to ET
and mean age were recorded.
Treatment protocol
SE group
The patients were stimulated from second day (D2) of
menstrual cycle with a flexible antagonist protocol. When
the majority of the follicles reached 17 mm, rec hCG
(250 μg) was used to trigger ovulation. The oocytes
retrieval procedure (OPU) was followed 35 h later under
general anesthesia. Luteal phase was supported by vaginal
Table 1: Categorization of obesity by body mass index
as per the World Health Organization
Category BMI (kg/m
2
)
Underweight <18.50
Normal range 18.50–24.99
Overweight 25.00–29.99
Obese ≥30.00
BMI =body mass index.
Banker, et al.: BMI and IVF/ICSI
38 Journal of Human Reproductive Sciences ¦Volume 10 ¦Issue 1 ¦January-March 2017
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micronized progesterone (400 mg) twice a day, 1 day after
OPU. ET was performed on D3 or D5, and a maximum of
two embryos were transferred. The surplus good quality
embryos were vitrified for future use.
DE group
Hormone replacement therapy (HRT) for the preparation
of endometrial lining was started from the second day of
menstrual cycle by increasing the dose of estradiol valerate
tablets from 4 mg to 8 mg per day. When endometrial
lining sized ≥8 mm, serum progesterone level was
measured. If the progesterone level was found to be
≤0.5 ng/ml, then on the day of donor oocytes retrieval,
vaginal micronized progesterone (400 mg) twice a day was
added. Subsequently, ET was performed on D3 or D5 with
a transfer of maximum two embryos. The surplus good
quality embryos were vitrified for future use. All the
donors were stimulated with flexible antagonist protocol
as in the SE group, but final oocyte maturation was
triggered with GnRH agonist.
VE group
HRT for endometrial lining preparation was started
from D2 of menstrual cycle by increasing the dose of
estradiol valerate tablets from 4 mg/day to 8 mg/day.
When the size of endometrial lining was found to be
≥8 mm, serum progesterone level was measured. If it
was found to be ≤0.5 ng/ml, then vaginal micronized
progesterone (400 mg) twice a day was added. A
maximum of two embryos were transferred 3 or 5 days
after starting the progesterone injection depending on the
stage at which the embryos were vitrified.
All the patients underwent serum β-hCG testing
14 days after the ET. If it was positive, the patients
underwent transvaginal sonography 1 week later for the
confirmation of pregnancy and the estimation of the
number of gestational sacs. All the patients were
followed up to 12 weeks of pregnancy at Nova IVI
Fertility center or at a referral doctor clinic, and the
outcomes were noted.
Statistical analysis
The study data were statistically analyzed using the
Statistical Package for the Social Sciences version 19
software (SPSS Inc., Chicago, IL, United States; IBM
Corp., Armonk, NY, United States). Age, number of
mature oocytes, usable embryos, and embryos
transferred were presented as mean ± SD. In all the
three groups, the association between BMI and OPR,
IR, CAR, CPR, and PR was analyzed using chi-square
test, whereas the effect of BMI on age and number of
embryos transferred was investigated using the analysis of
variance (ANOVA) procedure. In the SE and DE
groups, the ANOVA procedure was also used to
analyze the effect of BMI on a number of mature
oocytes retrieved and total usable embryos. A Pvalue
of <0.05 was considered statistically significant.
RESULTS
Patients
A total of 812, 665, and 1130 women underwent ET
using SE, DE, and VE, respectively. The women in
each group were divided into four categories as per
their BMI <18.50 kg/m
2
(n=108), 18.50–24.99 kg/m
2
(n=1048), 25.00–29.99 kg/m
2
(n=885), and ≥30.00 kg/
m
2
(n=566), respectively.
Data analysis
The demographic profile of women in SE, DE, and VE
is presented in Table 2. The pregnancy outcome
Table 2: Demographic profiling of women as per body mass index
Groups Variables BMI (kg/m
2
)P
<18.5 18.5–24.99 25–29.99 ≥30
SE Total patients 39.00 333.00 285.00 155.00 –
Mean age
!,#
29.57 ± 3.05 30.28 ± 3.66 31.07 ± 3.65 31.57 ± 3.46 0.0001
*,a
M II oocytes
#
7.72 ± 4.39 7.86 ± 4.29 8.32 ± 4.08 8.68 ± 4.34 0.1851
a
Usable embryos
#
3.42 ± 2.13 3.29 ± 1.85 3.41 ± 1.85 3.48 ± 1.95 0.7404
a
ET
#
1.81 ± 0.39 1.81 ± 0.39 1.79 ± 0.40 1.83 ± 0.38 0.8374
a
DE Total patients 26.00 262.00 222.00 155.00 –
Mean age
!,#
35.97 ± 5.68 36.53 ± 5.49 36.79 ± 5.41 37.56 ± 5.22 0.2200
a
M II oocytes
#
12.47 ± 2.63 11.84 ± 3.08 11.25 ± 2.87 11.59 ± 3.59 0.0823
a
Usable embryos
#
3.94 ± 1.58 4.20 ± 1.69 4.02 ± 1.68 3.94 ± 1.64 0.4139
a
ET
#
1.91 ± 0.29 1.86 ± 0.34 1.86 ± 0.35 1.86 ± 0.35 0.9000
a
VE Total patients 43.00 453.00 378.00 256.00 –
Mean age
!,#
32.08 ± 4.87 31.79 ± 5.19 32.63 ± 5.36 33.01 ± 5.54 0.0191
*,a
ET
#
1.90 ± 0.30 1.83 ± 0.37 1.84 ± 0.37 1.84 ± 0.36 0.5567
a
SE =the group of patients using self-oocytes, DE =the group of patients using donated oocytes, VE =the group of patients using vitrified
embryos.
#
Data presented as mean ± SD unless otherwise specified.
!
Years.
*
Statistically significant (P<0.05).
a
The ANOVA procedure.
Banker, et al.: BMI and IVF/ICSI
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measures of women as per BMI in all the groups are
presented in Table 3.
SE group
The mean age ranged between 29.57 and 31.57 years,
across the BMI categories with ≥30.00 kg/m
2
and
<18.50 kg/m
2
, being highest in ≥30.00 kg/m
2
group
(P=0.0001). The number of M II oocytes ranged from
7.72 to 8.68, being highest in ≥30.00 kg/m
2
BMI category.
The usable embryos and average number of ETs ranged
3.48–3.29 and 1.83–1.79, respectively. The number of
mature eggs, usable embryos, and embryos transferred
were insignificant among all the BMI groups [Table 2].
OPR was found to be highest in the BMI group ≥30.00 kg/
m
2
and lowest in the group with lowest BMI level
(<18.50 kg/m
2
). PR, CPR, and IR were highest in the
group with BMI ≥30.00 kg/m
2
; however, none of these
were statistically significant. Probably, the highest OPR
(47.10%) was observed in BMI category with ≥30.00 kg/
m
2
owing to a comparatively higher number of M II
oocytes and usable embryos in this group [Table 3].
However, neither M II oocytes (P=0.1851) nor OPR
(P=0.137) was significantly different among the
groups. CAR was highest (16.30%) in the category with
BMI ranging between 25.00 and 29.99 kg/m
2
, whereas the
lowest CAR (12.50%) was observed in the group with
BMI <18.50 kg/m
2
. However, it was found statistically
insignificant among all the groups.
DE group
The mean age ranged between 35.97 and 37.56 years, and
all the recipients received almost the same number of eggs
from donors, ranging 11.35–12.47. Usable embryos
ranged 3.94–4.20, whereas the range of average number
of embryos transferred was 1.86–1.91. All these three
parameters were found statistically insignificant [Table 2].
OPR was highest (50%) in the group with BMI
<18.50 kg/m
2
. The lowest OPR (39.35%) was found in
the group with BMI ≥30 kg/m
2
. However, this difference
among the groups was insignificant. PR, CPR, IR, and
CAR were highest (66.22, 62.16, 46.73, and 46.73%,
respectively) in the group with BMI ranging between
25.00 and 29.99 kg/m
2
. However, their difference
among the groups was insignificant. CAR was found
to be lowest (7.14%) in the lowest BMI category
(<18.50 kg/m
2
). It increased with increasing BMI but
was statistically not significant among the BMI groups
[Table 3].
VE group
The mean age ranged 32.08–33.01 years, being highest
in the group with BMI level ≥30.00 kg/m
2
(P=0.0191).
The average number of embryos transferred ranged
1.84–1.90 and were found to be statistically
insignificant across all the groups [Table 2].
The OPR (38.85%) was highest in the BMI category
ranging 18.50–24.99 kg/m
2
, but the difference among
Table 3: Pregnancy outcome measures in women as per body mass index
Groups Variables BMI (kg/m
2
)P
<18.5 18.5–24.99 25–29.99 ≥30
SE Total patients 39.00 333.00 285.00 155.00 –
OPR (%) 35.90 37.84 39.65 47.10 0.137
a
IR (%) 29.58 34.33 35.35 40.64 0.078
a
CAR (%) 12.50 20.25 16.30 14.12 0.4082
a
CPR (%) 41.03 47.45 47.37 54.84 0.159
a
PR (%) 41.03 52.55 51.93 56.77 0.374
a
DE Total patients 26.00 262.00 222.00 155.00 –
OPR (%) 50.00 42.75 48.65 39.35 0.185
a
IR (%) 40.00 38.73 46.73 39.93 0.691
a
CAR (%) 7.14 17.65 21.74 29.07 0.103
a
CPR (%) 53.85 51.91 62.16 55.48 0.378
a
PR (%) 61.54 58.02 66.22 58.06 0.492
a
VE Total patients 43.00 453.00 378.00 256.00 –
OPR (%) 27.91 38.85 32.01 32.81 0.0761
a
IR (%) 38.55 34.22 30.32 34.04 0.008
*,a
CAR (%) 52.00 16.59 27.54 31.15 0.0002
*,a
CPR (%) 58.14 46.58 44.18 47.66 0.076
a
PR (%) 65.12 52.32 52.12 55.08 0.158
a
SE =the group of patients using self-oocytes, DE =the group of patients using donated oocytes, VE =the group of patients using vitrified
embryos, OPR =ongoing pregnancy rate, IR =implantation rate, CAR =clinical abortion rate, CPR =clinical pregnancy rate,
PR =pregnancy rate.
*
Statistically significant (P<0.05).
a
Chi-square test.
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the various groups was insignificant. PR, CPR, CAR,
and IR were highest (65.12, 58.14, 52.00, and
38.55%, respectively) in the group with BMI <18.5 kg/
m
2
[Table 3]. Moreover, IR and CAR were found
statistically significant among the BMI groups
(P=0.008 and 0.0002, respectively).
DISCUSSION
Obesity is a highly prevalent medical condition
characterized by high BMI, that is, ≥30 kg/m
2
.
[23]
It is
associated with many diseases such as diabetes, hyper-
tension, hypothyroidism, and cardiovascular diseases.
[4]
Obesity also has a profound impact on the reproductive
health of women. It increases the risk of incidence of
infertility and related disorders in women by three times as
compared to women with normal BMI.
[24]
Many studies
also report a relationship between high BMI and female
sexual disorders including infertility.
[25-27]
The relationship between raised BMI and poor
reproductive outcomes is an ambiguous issue. Endo-
metrium and ovaries, alone or together, might result in
poor reproductive outcome in overweight/obese women.
Many studies suggest the effect of alteration in ovarian
response leading to significant changes in the follicular
fluid levels of insulin, lactate, C-reactive protein, and
androgens.
[28]
Though many extra-ovarian factors also
contribute to the adverse outcomes of pregnancy in
obese infertile women, the accurate mechanism is still
unclear.
The risks associated with obese women who conceive
naturally are similar to those who conceive with IVF.
[29,30]
However, the effect of obesity on ART is controversial due to
contradiction in the studies reported by various researchers. A
bunch of studies report poor pregnancy outcomes in obese
women undergoing ART.
[4,8,31]
As per studies, obesity
increases pregnancy risks in women undergoing ART.
They need a higher level of gonadotropins as compared to
women having normal BMI. The procedure to recover
oocytes is more tedious and challenging in an obese
woman. The number of oocytes retrieved during the IVF
of an obese woman is comparatively lesser than in a woman
with normal BMI. However, the quality of oocytes is
unaffected by variation in BMI. The increased risk of early
pregnancy loss is also observed in obese women.
[12]
Many
studies suggest that the pregnancy outcome followed by ART
is not influenced by BMI. However, they might require a high
dose of gonadotropin and a longer period of stimulation.
[17,31]
According to a systematic review and meta-analysis, a
decreased incidence of pregnancy is associated with raised
BMI in women undergoing IVF using SE. The authors also
suggested the use of DE, as the chance of attaining
pregnancy was found similar in the women with higher
as well as normal BMI levels.
[13]
However, the transfer of
VE is not recommended in cases with higher BMI range in
other studies.
[21,32]
The present study analyzed the effect of BMI on IVF-/
ICSI-related pregnancy outcomes. The effect of raised
BMI/obesity was observed on three groups, that is,
women using SE, DE, and VE for transfer or
implantation. OPR was assessed as the primary
endpoint in the study. Many studies have considered
OPR as one of the major outcomes to be measured for
the assessment of the success rate of ART. However, the
time period for the confirmation of pregnancy was
different.
[33-37]
The effect of BMI on OPR has always
been conflicted, because a deleterious impact of BMI on
OPR has been reported in the study conducted by Loveland
et al.,
[38]
whereas a study conducted by Madkour et al.
[33]
suggested no such association. The present study reports
an insignificant effect of BMI on OPR in all the three
groups.
The secondary outcomes, that is, CPR, PR, IR, and CAR
are important measures of successful pregnancy outcome
in ART.
[36]
There are contrasting reports on the effect of
BMI on CPR.
[38-41]
Similarly, an inconsistency in the
effect of BMI on PR has been observed in the previous
studies.
[42,43]
However, the current study reports an
insignificant impact of BMI on CPR and PR. IR and
CAR are important factors to determine the reproductive
outcome in IVF/ICSI. A decrease in IR is attributed to a
poor embryo quality and genetic abnormality in
embryos.
[44,45]
Some studies suggest a significant adverse
effect of obesity on IR, which is independent of embryo
quality, whereas others show no such association.
[29,38-41]
As per the study conducted by Styne-Gross et al.,
[20]
IR is
not affected by obesity in donor oocyte recipients. In the
present study, IR in the SE, DE, and VE groups was
highest in the categories with BMI level ≥30.00,
25.00–29.99, and <18.50 kg/m
2
, respectively. Moreover,
the difference among the BMI categories was found to be
statistically significant in the VE group (P=0.008).
However, no specific pattern could be observed.
Similarly, CAR was highest in the categories with BMI
levels18.50–24.99(SE), ≥30.00 (DE),and <18.50(VE) kg/
m
2
, respectively. Though no specific pattern was observed,
the difference among the BMI categories was found
statistically significant in only the VE group (P=0.0002).
The observed trend revealed an increased CAR in the
patients with abnormal BMI range, that is, <18.50 and
≥30.00 kg/m
2
, whereas a low CAR was observed in the
patients with normal BMI levels (18.50–29.99 kg/m
2
).
According to Veleva et al.,
[9]
underweight women
have an increased miscarriage risk, and approximately,
1.7-fold higher AR is found among hormonally
substituted Frozen embryo transfer (FET) in contrast with
the fresh cycles. A systematic review and meta-analysis on
Banker, et al.: BMI and IVF/ICSI
Journal of Human Reproductive Sciences ¦Volume 10 ¦Issue 1 ¦January-March 2017 41
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the association of pre-pregnancy underweight and
miscarriage by Balsells et al.
[10]
concluded that the
maternal underweight is related to a marginally increased
risk of clinical miscarriage. These might be the reasons for a
higher AR in the VE group. All other parameters in all the
groups were insignificant.
Oocytes number is essential to be measured for the
successful outcome of ARTs. A woman with raised
BMI might retrieve a lesser number of oocytes as
observed in previous studies.
[41,46,47]
A retrospective
cohort study conducted by Zhang et al.
[48]
reported a
retrieval of less oocytes from obese women as
compared to normal women. However, in the present
study, the SE group retrieved the highest average M II
oocytes (8.68 ± 4.34) in the BMI ≥30.00 kg/m
2
, whereas
the lowest average number of oocytes (7.72 ± 4.39) was
obtained in the lowest BMI range (<18.50 kg/m
2
).
However, the difference among the groups was
insignificant. The results indicated that the BMI does
not affect the number of oocytes retrieved. A study by
Sneed et al.
[49]
suggested that the chance of positive IVF
pregnancy declines steadily with age, whereas obesity
plays a limited or no role in older women. In the
present study, difference in mean age was found to be
significant in the SE as well as VE groups. In the SE group,
a trend was observed, where BMI was found to be
increasing with advancing age. However, the present
study did not present such a pattern. In the SE group,
the lowest mean age (29.57 ± 3.05 years), observed in
the patients with lowest BMI group (<18.50 kg/m
2
), did
not show best OPR, whereas a group with highest BMI and
a highest mean age (31.57 ± 3.46 years) presented highest
OPR. In case of the VE group, the mean age was almost
similar in all the groups ranging from 31.79 to 33.01 years.
The limitations of the present study include its
retrospective nature. The unequal distribution pattern
across BMI categories with the largest difference in the
VE group with 43 patients in BMI category with
<18.50 kg/m
2
and 453 in BMI ranging from 18.50 to
24.99 kg/m
2
could also affect the results. Uniformity in
sample size might help in omitting such differences and
disorganization of results. However, the study by Kilic
et al.
[50]
also supported that BMI does not have a strong
influence on successful outcome of pregnancy.
CONCLUSION
Overall, the OPR was found unaffected by BMI in any of
the three groups, which brought us to a conclusion that
BMI does not have any effect on oocyte quality or
endometrial receptivity. Hence, BMI does not affect the
chance of achieving pregnancy in infertile women
following IVF/ICSI. However, IR and CAR were found
to be statistically significant in the VE group presenting no
specific pattern. Therefore, more robust studies, with large
and comparable sample size, are needed to substantiate this
fact.
Acknowledgements
The authors acknowledge the staff of Nova IVI Fertility,
Pulse Women’s Hospital, and the patients. The authors
also acknowledge Knowledge Isotopes Pvt. Ltd. (www.
knowledgeisotopes.com) for their writing support.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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