Journal of Assisted Reproduction and Genetics

, Volume 32, Issue 9, pp 1299–1304 | Cite as

Increased body mass index negatively impacts blastocyst formation rate in normal responders undergoing in vitro fertilization

  • Ioanna A. ComstockEmail author
  • Sun Kim
  • Barry Behr
  • Ruth B. Lathi
Reproductive Physiology and Disease



The aim of this study is to investigate the effect of female BMI and metabolic dysfunction on blastocyst formation rate.


This was a retrospective cohort study that was performed in an academic center for reproductive medicine. Patients who were normal weight, overweight with metabolic dysfunction, or obese who had ≥6 oocytes retrieved in a fresh IVF cycle were included in the study. The blastocyst formation rate was calculated from the number of ≥5 cell embryos on day 3 observed in culture until day 5 or day 6. Only good quality blastocysts were included in the calculation as defined by a morphologic grade of 3BB or better.


The blastocyst formation rate was significantly better in the normal-weight controls versus overweight/obese patients (57.2 versus 43.6 %, p < 0.007). There was no difference in blastocyst formation between the patients with a BMI 25–29.9 kg/m2 with metabolic dysfunction and those with a BMI ≥30 kg/m2.


The maternal metabolic environment has a significant impact on embryo quality as measured by blastocyst formation. A decreased blastocyst formation rate is likely a significant contributor to poorer reproductive outcomes in overweight and obese women with infertility.


Obesity Blastocyst IVF outcome Metabolic dysfunction Embryo quality 


Ethical approval

“All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.”

Conflict of interest

The authors declare that they have no competing interests.


  1. 1.
    Flegal KM, Carroll MD, Kit BK, Ogden CL. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999–2010. J Am Med Assoc. 2012;307(5):491–7.CrossRefGoogle Scholar
  2. 2.
    National Institutes of Health. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults—the evidence report. Obes Res. 1998;6 Suppl 2:51S–209.Google Scholar
  3. 3.
    Rich-Edwards JW, Golman MB, Willett WC, Hunter DJ, Stampfer MJ, Colditz GA, et al. Adolescent body mass index and infertility caused by ovulatory disorder. Am J Obstet Gynecol. 1994;171:171–7.CrossRefPubMedGoogle Scholar
  4. 4.
    Metwally M, Ong KJ, Ledger WL, Li TC. Does high body mass index increase the risk of miscarriage after spontaneous and assisted conception? A meta-analysis of the evidence. Fertil Steril. 2008;90:714–26.CrossRefPubMedGoogle Scholar
  5. 5.
    Catalano PM, Ehrenberg HM. The short- and long-term implications of maternal obesity on the mother and her offspring. BJOG. 2006;113:1126–33.CrossRefPubMedGoogle Scholar
  6. 6.
    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;301:636–50.CrossRefPubMedGoogle Scholar
  7. 7.
    Wittemer C, Ohl J, Bailly M, Bettahar-Lebugle K, Nisand I. Does body mass index of infertile women have an impact on IVF procedure and outcome? J Assist Reprod Genet. 2000;17:547–52.PubMedCentralCrossRefPubMedGoogle Scholar
  8. 8.
    Spandorfer SD, Kump L, Goldschlag D, Brodkin T, Davis OK, Rosenwaks Z. Obesity and in vitro fertilization: negative influences on outcome. J Reprod Med. 2004;49:973–7.PubMedGoogle Scholar
  9. 9.
    Maheshwari A, Stofberg L, Bhattacharya S. Effect of overweight and obesity on assisted reproductive technology—a systematic review. Hum Reprod Update. 2007;13:433–44.CrossRefPubMedGoogle Scholar
  10. 10.
    Carrell DT, Jones KP, Peterson CM, Aoki V, Emery BR, Campbell BR. Body mass index is inversely related to intrafollicular HCG concentrations, embryo quality and IVF outcome. Reprod Biomed Online. 2001;3:109–11.CrossRefPubMedGoogle Scholar
  11. 11.
    Metwally M, Cutting R, Tipton A, Skull J, Ledger WL, Li TC. Effect of increased body mass index on oocyte and embryo quality in IVF patients. Reprod Biomed Online. 2007;15:532–8.CrossRefPubMedGoogle Scholar
  12. 12.
    Wang JX, Davies M, Norman RJ. Body mass and probability of pregnancy during assisted reproduction treatment: retrospective study. BMJ. 2000;321:1320–1.PubMedCentralCrossRefPubMedGoogle Scholar
  13. 13.
    Fedoresak P, Dale PO, Storeng R, Ertzeid G, Bjercke S, Oldereid N, et al. Impact of overweight and underweight on assisted reproduction treatment. Hum Reprod. 2004;19:2523–8.CrossRefGoogle Scholar
  14. 14.
    Lintsen AM, Pasker-de Jong PC, de Boer EJ, Burger CW, Jansen CAM, Braat DDM, et al. Effects of subfertility cause, smoking and body weight on the success rate of IVF. Hum Reprod. 2005;20:1867–75.CrossRefPubMedGoogle Scholar
  15. 15.
    Dechaud H, Anahory T, Reyftmann L, Loup V, Hamamah S, Hedon B. Obesity does not adversely affect results in patients who are undergoing in vitro fertilization and embryo transfer. Eur J Obstet Gynecol Reprod Biol. 2006;127:88–93.CrossRefPubMedGoogle Scholar
  16. 16.
    Shah DK, Missmer SA, Berry KF, Racowsky C, Ginsburg ES. Effect of obesity on oocyte and embryo quality in women undergoing in vitro fertilization. Obstet Gynecol. 2011;118:63–70.CrossRefPubMedGoogle Scholar
  17. 17.
    WHO. Obesity: preventing and managing the global epidemic. Report of a WHO consultation on obesity. Geneva: World Health Organization; 1999.Google Scholar
  18. 18.
    McLaughlin T, Allison G, Abbasi F, Lamendola C, Reavan G. Prevalence of insulin resistance and associated cardiovascular disease risk factors among normal weight, overweight, and obese individuals. Metabolism. 2004;53:495–9.CrossRefPubMedGoogle Scholar
  19. 19.
    Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril. 2004;81:19–25.Google Scholar
  20. 20.
    Bellver J, Ayllon Y, Ferrando M, Melo M, Goyri E, Pellicer A, et al. Female obesity impairs in vitro fertilization outcome without affecting embryo quality. Fertil Steril. 2010;93:447–54.CrossRefPubMedGoogle Scholar
  21. 21.
    Vilarino F, Christofolini D, Rodrigues D, de Souza A, Christofolini J, Bianco B, et al. Body mass index and fertility: is there a correlation with human reproduction outcomes? Gynecol Endocrinol. 2011;27:232–6.CrossRefPubMedGoogle Scholar
  22. 22.
    Purcell SH, Moley KH. The impact of obesity on egg quality. J Assist Reprod Genet. 2011;28:517–24.PubMedCentralCrossRefPubMedGoogle Scholar
  23. 23.
    Wu LL, Norman RJ, Robker RL. The impact of obesity on oocytes: evidence for lipotoxicity mechanisms. Reprod Fertil Dev. 2011;24:29–34.CrossRefPubMedGoogle Scholar
  24. 24.
    Jungheim ES, Schoeller EL, Marquard KL, Louden ED, Schaffer JE, Moley KH. Diet-induced obesity model: abnormal oocytes and persistent growth abnormalities in the offspring. Endocrinology. 2010;151:4039–46.PubMedCentralCrossRefPubMedGoogle Scholar
  25. 25.
    Luzzo KM, Wang Q, Purcell SH, Chi M, Jimenez PT, Grindler N, et al. High fat diet induced developmental defects in the mouse: oocyte meiotic aneuploidy and fetal growth retardation/brain defects. PLoS One. 2012;7, e49217.PubMedCentralCrossRefPubMedGoogle Scholar
  26. 26.
    Wu LL, Dunning KR, Yang X, Russell DL, Lane M, Norman RJ, et al. High-fat diet causes lipotoxicity responses in cumulus-oocyte complexes and decreased fertilization rates. Endocrinology. 2010;151:5438–45.CrossRefPubMedGoogle Scholar
  27. 27.
    Herrero J, Tejera A, Albert C, Vidal C, de los Santos MJ, Mesequer MA. Time to look back: analysis of morphokinetic characteristics of human embryo development. Fertil Steril. 2013;100:1602–9.CrossRefPubMedGoogle Scholar
  28. 28.
    Leary C, Leese HJ, Sturmey RG. Human embryos from overweight and obese women display phenotypic and metabolic abnormalities. Hum Reprod. 2015;30:122–32.CrossRefPubMedGoogle Scholar
  29. 29.
    Wang JX, Davies MJ, Norman RJ. Obesity increases the risk of spontaneous abortion during infertility treatment. Obes Res. 2002;10:551–4.CrossRefPubMedGoogle Scholar
  30. 30.
    Rittenberg V, Sobaleva S, Ahmad A, Oteng-Ntim E, Bolton V, Khalaf Y, et al. Influence of BMI on risk of miscarriage after single blastocyst transfer. Hum Reprod. 2011;26:2642–50.CrossRefPubMedGoogle Scholar
  31. 31.
    Clark AM, Thornley B, Tomlinson L, Galletley C, Norman RJ. Weight loss in obese infertile women results in improvement in reproductive outcome for all forms of fertility treatment. Hum Reprod. 1998;13:1502–5.CrossRefPubMedGoogle Scholar
  32. 32.
    Ehrmann DA, Liljenquist DR, Kasza K, Azziz R, Legro RS, Ghazzi MN. Prevalence and predictors of the metabolic syndrome in women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2006;91:48–53.CrossRefPubMedGoogle Scholar
  33. 33.
    Kort JD, Winget C, Kim SH, Lathi RB. A retrospective cohort study to evaluate the impact of meaningful weight loss on fertility outcomes in an overweight population with infertility. Fertil Steril. 2014;101:1400–3.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Ioanna A. Comstock
    • 1
    Email author
  • Sun Kim
    • 2
  • Barry Behr
    • 1
  • Ruth B. Lathi
    • 1
  1. 1.Obstetrics and Gynecology—Reproductive Endocrinology and InfertilityStanford Hospital and ClinicsPalo AltoUSA
  2. 2.Medical EndocrinologyStanford Hospital and ClinicsPalo AltoUSA

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