Skip to main content

Effect of body mass index on the outcomes of controlled ovarian hyperstimulation in Chinese women with polycystic ovary syndrome: a multicenter, prospective, observational study

Journal of Assisted Reproduction and Genetics volume 34, pages 61–70 (2017)Cite this article

Abstract

Purpose

The purpose of the present study is to explore the influence of body mass index (BMI) on outcomes of in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) techniques in Chinese women with polycystic ovary syndrome (PCOS).

Methods

This was a multicenter, prospective, observational study that enrolled 800 subjects with PCOS from nine hospitals in China. Patients were categorized according to BMI categories: underweight, <18.5 kg/m2; normal, 19–23.9 kg/m2; overweight, 24–27.9 kg/m2; and obese, ≥28 kg/m2. Total recombinant follicle-stimulating hormone (rFSH) dose used, estradiol, and progesterone levels on human chorionic gonadotropin (hCG) day; implantation rate; and biochemical, clinical, and ongoing pregnancy rates were compared among BMI categories. Hormone levels (estradiol, follicle-stimulating hormone (FSH), LH, testosterone, and progesterone) were measured using electrochemiluminescence assays.

Results

Among the 774 subjects, 27.3 % were overweight and 8.1 % were obese. The rFSH dose used differed significantly among BMI categories (P < 0.001). The implantation rate was lower in obese subjects than that in normal-weight subjects (25.3 vs 45.7 %). Clinical pregnancy rate per transfer differed among BMI categories (P = 0.033), but there was no difference for biochemical (P = 0.327) and ongoing (P = 0.084) pregnancy rates. The miscarriage rate was similar among BMI categories.

Conclusions

More than one third of Chinese women with PCOS undergoing IVF/ICSI are overweight or obese. Elevated BMI is associated with reduced clinical pregnancy rate but similar ongoing pregnancy rates, suggesting that BMI has little impact on IVF outcomes.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1

References

  1. Franks S. Polycystic ovary syndrome. N Engl J Med. 1995;333(13):853–61. doi:10.1056/NEJM199509283331307.

    CAS  Article  PubMed  Google Scholar 

  2. Al-Azemi M, Omu FE, Omu AE. The effect of obesity on the outcome of infertility management in women with polycystic ovary syndrome. Arch Gynecol Obstet. 2004;270(4):205–10. doi:10.1007/s00404-003-0537-2.

    Article  PubMed  Google Scholar 

  3. Nugent D, Vandekerckhove P, Hughes E, Arnot M, Lilford R. Gonadotrophin therapy for ovulation induction in subfertility associated with polycystic ovary syndrome. Cochrane Database Syst Rev. 2000;4:CD000410. doi:10.1002/14651858.CD000410.

    Google Scholar 

  4. Levi Setti PE. The importance of consistent FSH delivery in infertility treatment. Reprod Biomed Online. 2006;12(4):493–9.

    Article  PubMed  Google Scholar 

  5. Sneed ML, Uhler ML, Grotjan HE, Rapisarda JJ, Lederer KJ, Beltsos AN. Body mass index: impact on IVF success appears age-related. Hum Reprod. 2008;23(8):1835–9. doi:10.1093/humrep/den188.

    Article  PubMed  Google Scholar 

  6. Expert Consultation WHO. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004;363(9403):157–63. doi:10.1016/S0140-6736(03)15268-3.

    Article  Google Scholar 

  7. Szilagyi A, Homoki J, Bellyei S, Szabo I. Hormonal and clinical effects of chronic gonadotropin-releasing hormone agonist treatment in polycystic ovary syndrome. Gynecol Endocrinol. 2000;14(5):337–41.

    CAS  Article  PubMed  Google Scholar 

  8. Imani B, Eijkemans MJ, Faessen GH, Bouchard P, Giudice LC, Fauser BC. Prediction of the individual follicle-stimulating hormone threshold for gonadotropin induction of ovulation in normogonadotropic anovulatory infertility: an approach to increase safety and efficiency. Fertil Steril. 2002;77(1):83–90.

    Article  PubMed  Google Scholar 

  9. Bureau. MoHDC. Chinese adult overweight and obese prevention and control guideline (on trial). 2002.

  10. He W, Li Q, Yang M, Jiao J, Ma X, Zhou Y, et al. Lower BMI cutoffs to define overweight and obesity in China. Obesity. 2015;23(3):684–91. doi:10.1002/oby.20995.

    Article  PubMed  Google Scholar 

  11. Oakkar EE, Stevens J, Truesdale KP, Cai J. BMI and all-cause mortality among Chinese and Caucasians: the People’s Republic of China and the Atherosclerosis Risk in Communities Studies. Asia Pac J Clin Nutr. 2015;24(3):472–9. doi:10.6133/apjcn.2015.24.3.12.

    CAS  PubMed  Google Scholar 

  12. Rich-Edwards JW, Spiegelman D, Garland M, Hertzmark E, Hunter DJ, Colditz GA, et al. Physical activity, body mass index, and ovulatory disorder infertility. Epidemiology. 2002;13(2):184–90.

    Article  PubMed  Google Scholar 

  13. Costa Justus JF, Ligocki Campos AC, Figueroa AL, Gomis R, Santo MA, Favero GM, et al. Early effect of bariatric surgery on the circadian rhythms of adipokines in morbidly obese women. Metab Syndr Relat Disord. 2015. doi:10.1089/met.2015.0051.

    PubMed  Google Scholar 

  14. Fedorcsak 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(11):2523–8. doi:10.1093/humrep/deh485.

    Article  PubMed  Google Scholar 

  15. Pasquali R, Pelusi C, Genghini S, Cacciari M, Gambineri A. Obesity and reproductive disorders in women. Hum Reprod Update. 2003;9(4):359–72.

    Article  PubMed  Google Scholar 

  16. Caillon H, Freour T, Bach-Ngohou K, Colombel A, Denis MG, Barriere P, et al. Effects of female increased body mass index on in vitro fertilization cycles outcome. Obes Res Clin Pract. 2015;9(4):382–8. doi:10.1016/j.orcp.2015.02.009.

    Article  PubMed  Google Scholar 

  17. Chen H, Wang WJ, Chen YZ, Mai MQ, Ouyang NY, Chen JH, et al. Effects of body mass index and age on the treatment of in vitro fertilization-embryo transfer among patients with non-polycystic ovarian syndrome. Zhonghua Liu Xing Bing Xue Za Zhi. 2010;31(5):567–71.

    CAS  PubMed  Google Scholar 

  18. Dokras A, Baredziak L, Blaine J, Syrop C, VanVoorhis BJ, Sparks A. Obstetric outcomes after in vitro fertilization in obese and morbidly obese women. Obstet Gynecol. 2006;108(1):61–9. doi:10.1097/01.AOG.0000219768.08249.b6.

    Article  PubMed  Google Scholar 

  19. Lashen H, Ledger W, Bernal AL, Barlow D. Extremes of body mass do not adversely affect the outcome of superovulation and in-vitro fertilization. Hum Reprod. 1999;14(3):712–5.

    CAS  Article  PubMed  Google Scholar 

  20. 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(1):63–70. doi:10.1097/AOG.0b013e31821fd360.

    Article  PubMed  Google Scholar 

  21. 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(12):973–7.

    PubMed  Google Scholar 

  22. Bu Z, Dai W, Guo Y, Su Y, Zhai J, Sun Y. Overweight and obesity adversely affect outcomes of assisted reproductive technologies in polycystic ovary syndrome patients. Int J Clin Exp Med. 2013;6(10):991–5.

    PubMed  PubMed Central  Google Scholar 

  23. Huang K, Liao X, Dong X, Zhang H. Effect of overweight/obesity on IVF-ET outcomes in Chinese patients with polycystic ovary syndrome. Int J Clin Exp Med. 2014;7(12):5872–6.

    PubMed  PubMed Central  Google Scholar 

  24. 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(1):88–93. doi:10.1016/j.ejogrb.2005.12.009.

    Article  PubMed  Google Scholar 

  25. Fedorcsak P, Dale PO, Storeng R, Tanbo T, Abyholm T. The impact of obesity and insulin resistance on the outcome of IVF or ICSI in women with polycystic ovarian syndrome. Hum Reprod. 2001;16(6):1086–91.

    CAS  Article  PubMed  Google Scholar 

  26. Maheshwari A, Stofberg L, Bhattacharya S. Effect of overweight and obesity on assisted reproductive technology—a systematic review. Hum Reprod Update. 2007;13(5):433–44. doi:10.1093/humupd/dmm017.

    CAS  Article  PubMed  Google Scholar 

  27. Ozekinci M, Seven A, Olgan S, Sakinci M, Keskin U, Akar ME, et al. Does obesity have detrimental effects on IVF treatment outcomes? BMC Womens Health. 2015;15:61. doi:10.1186/s12905-015-0223-0.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Singh N, Gupta P, Mittal S, Malhotra N. Correlation of body mass index with outcome of in vitro fertilization in a developing country. Arch Gynecol Obstet. 2012;285(1):259–63. doi:10.1007/s00404-011-2013-8.

    Article  PubMed  Google Scholar 

  29. Zander-Fox DL, Henshaw R, Hamilton H, Lane M. Does obesity really matter? The impact of BMI on embryo quality and pregnancy outcomes after IVF in women aged ≤38 years. Aust N Z J Obstet Gynaecol. 2012;52(3):270–6. doi:10.1111/j.1479-828X.2012.01453.x.

    Article  PubMed  Google Scholar 

  30. Zhang D, Zhu Y, Gao H, Zhou B, Zhang R, Wang T, et al. Overweight and obesity negatively affect the outcomes of ovarian stimulation and in vitro fertilisation: a cohort study of 2628 Chinese women. Gynecol Endocrinol. 2010;26(5):325–32. doi:10.3109/09513591003632100.

    Article  PubMed  Google Scholar 

  31. 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(2):447–54. doi:10.1016/j.fertnstert.2008.12.032.

    Article  PubMed  Google Scholar 

  32. Vilarino FL, Christofolini DM, Rodrigues D, de Souza AM, Christofolini J, Bianco B, et al. Body mass index and fertility: is there a correlation with human reproduction outcomes? Gynecol Endocrinol. 2011;27(4):232–6.

  33. Sathya A, Balasubramanyam S, Gupta S, Verma T. Effect of body mass index on in vitro fertilization outcomes in women. J Hum Reprod Sci. 2010;3(3):135–8. doi:10.4103/0974-1208.74155.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Schliep KC, Mumford SL, Ahrens KA, Hotaling JM, Carrell DT, Link M, et al. Effect of male and female body mass index on pregnancy and live birth success after in vitro fertilization. Fertil Steril. 2015;103(2):388–95. doi:10.1016/j.fertnstert.2014.10.048.

    Article  PubMed  Google Scholar 

  35. Vilarino FL, Bianco B, Christofolini DM, Barbosa CP. Impact of body mass index on in vitro fertilization outcomes. Rev Bras Ginecol Obstet. 2010;32(11):536–40.

    Article  PubMed  Google Scholar 

  36. Vural F, Vural B, Cakiroglu Y. The role of overweight and obesity in in vitro fertilization outcomes of poor ovarian responders. Biomed Res Int. 2015;2015:781543. doi:10.1155/2015/781543.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Zhang JJ, Feret M, Chang L, Yang M, Merhi Z. Obesity adversely impacts the number and maturity of oocytes in conventional IVF not in minimal stimulation IVF. Gynecol Endocrinol. 2015;31(5):409–13. doi:10.3109/09513590.2015.1014785.

    Article  PubMed  Google Scholar 

  38. Marquard KL, Stephens SM, Jungheim ES, Ratts VS, Odem RR, Lanzendorf S, et al. Polycystic ovary syndrome and maternal obesity affect oocyte size in in vitro fertilization/intracytoplasmic sperm injection cycles. Fertil Steril. 2011;95(6):2146–9. doi:10.1016/j.fertnstert.2010.10.026. 9 e1.

    Article  PubMed  Google Scholar 

  39. 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(5):532–8.

    CAS  Article  PubMed  Google Scholar 

  40. Robker RL. Evidence that obesity alters the quality of oocytes and embryos. Pathophysiology. 2008;15(2):115–21. doi:10.1016/j.pathophys.2008.04.004.

    CAS  Article  PubMed  Google Scholar 

  41. Provost MP, Acharya KS, Acharya CR, Yeh JS, Steward RG, Eaton JL, et al. Pregnancy outcomes decline with increasing body mass index: analysis of 239,127 fresh autologous in vitro fertilization cycles from the 2008–2010 Society for Assisted Reproductive Technology registry. Fertil Steril. 2015. doi:10.1016/j.fertnstert.2015.11.008.

    Google Scholar 

  42. Moragianni VA, Jones SM, Ryley DA. The effect of body mass index on the outcomes of first assisted reproductive technology cycles. Fertil Steril. 2012;98(1):102–8. doi:10.1016/j.fertnstert.2012.04.004.

    Article  PubMed  Google Scholar 

  43. Coyne K, Whigham LD, O’Leary K, Yaklic JK, Maxwell RA, Lindheim SR. Gestational carrier BMI and reproductive, fetal and neonatal outcomes: are the risks the same with increasing obesity? Int J Obes. 2015. doi:10.1038/ijo.2015.159.

    Google Scholar 

  44. Jungheim ES, Lanzendorf SE, Odem RR, Moley KH, Chang AS, Ratts VS. Morbid obesity is associated with lower clinical pregnancy rates after in vitro fertilization in women with polycystic ovary syndrome. Fertil Steril. 2009;92(1):256–61. doi:10.1016/j.fertnstert.2008.04.063.

    Article  PubMed  Google Scholar 

  45. Kupka MS, Gnoth C, Buehler K, Dahncke W, Kruessel JS. Impact of female and male obesity on IVF/ICSI: results of 700,000 ART-cycles in Germany. Gynecol Endocrinol. 2011;27(3):144–9. doi:10.3109/09513590.2010.487617.

    Article  PubMed  Google Scholar 

  46. Petanovski Z, Dimitrov G, Ajdin B, Hadzi-Lega M, Sotirovska V, Matevski V, et al. Impact of body mass index (BMI) and age on the outcome of the IVF process. Prilozi. 2011;32(1):155–71.

    CAS  PubMed  Google Scholar 

  47. Han AR, Kim HO, Cha SW, Park CW, Kim JY, Yang KM, et al. Adverse pregnancy outcomes with assisted reproductive technology in non-obese women with polycystic ovary syndrome: a case–control study. Clin Exp Reprod Med. 2011;38(2):103–8. doi:10.5653/cerm.2011.38.2.103.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Legge A, Bouzayen R, Hamilton L, Young D. The impact of maternal body mass index on in vitro fertilization outcomes. J Obstet Gynaecol Can. 2014;36(7):613–9.

    Article  PubMed  Google Scholar 

  49. Fedorcsak P, Storeng R, Dale PO, Tanbo T, Abyholm T. Obesity is a risk factor for early pregnancy loss after IVF or ICSI. Acta Obstet Gynecol Scand. 2000;79(1):43–8.

    CAS  Article  PubMed  Google Scholar 

  50. 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(3):714–26. doi:10.1016/j.fertnstert.2007.07.1290.

    Article  PubMed  Google Scholar 

  51. Krizanovska K, Ulcova-Gallova Z, Bouse V, Rokyta Z. Obesity and reproductive disorders. Sb Lek. 2002;103(4):517–26.

    CAS  PubMed  Google Scholar 

  52. van Swieten EC, van der Leeuw-Harmsen L, Badings EA, van der Linden PJ. Obesity and clomiphene challenge test as predictors of outcome of in vitro fertilization and intracytoplasmic sperm injection. Gynecol Obstet Investig. 2005;59(4):220–4. doi:10.1159/000084347.

    Article  Google Scholar 

  53. Qiao J, Lu G, Zhang HW, Chen H, Ma C, Olofsson JI, et al. A randomized controlled trial of the GnRH antagonist ganirelix in Chinese normal responders: high efficacy and pregnancy rates. Gynecol Endocrinol. 2012;28(10):800–4. doi:10.3109/09513590.2012.665103.

    CAS  Article  PubMed  Google Scholar 

Download references

Acknowledgments

This study was supported by Merck Serono Co., Ltd. (Grant number EMR700623-530). We thank Wenfeng Chen (principal biostatistician) from Global Biostatistics & Epidemiology, Merck Serono (Beijing) Pharmaceutical R&D Co., Ltd. In addition, we thank all the staffs from research centers for their assistance.

Author information

Affiliations

  1. Center for Reproductive Medicine, Shandong University, Jinan, China

    Yan Sheng & Zijiang Chen

  2. Reproductive & Genetic Hospital CITIC-Xiangya, Changsha, China

    Guangxiu Lu

  3. Jiangsu Province Hospital, Nanjing, China

    Jiayin Liu

  4. The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China

    Xiaoyan Liang

  5. The First People’s Hospital of Yunnan Province, Kunming, China

    Yanping Ma

  6. The First Hospital of Lanzhou University, Lanzhou, China

    Xuehong Zhang

  7. Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China

    Songying Zhang

  8. The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China

    Yingpu Sun

  9. Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China

    Yun Sun

  10. Merck Serono Co., Ltd, Beijing, China

    Wenfeng Chen & Wenhui Fang

Authors
  1. Yan Sheng
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Guangxiu Lu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jiayin Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Xiaoyan Liang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yanping Ma
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Xuehong Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Songying Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yingpu Sun
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Yun Sun
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Wenfeng Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Wenhui Fang
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Zijiang Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Zijiang Chen.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the ethics committees of the participating hospitals.

Informed consent

All study subjects were fully informed as to the nature of the study and provided written consent for inclusion.

Additional information

Capsule Elevated body mass index is associated with reduced clinical pregnancy rate but similar ongoing pregnancy rates.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Table S1

(DOCX 16 kb)

Table S2

(DOCX 16 kb)

Table S3

(DOCX 18 kb)

Table S4

(DOCX 16 kb)

Table S5

(DOCX 18 kb)

Table S6

(DOCX 17 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Sheng, Y., Lu, G., Liu, J. et al. Effect of body mass index on the outcomes of controlled ovarian hyperstimulation in Chinese women with polycystic ovary syndrome: a multicenter, prospective, observational study. J Assist Reprod Genet 34, 61–70 (2017). https://doi.org/10.1007/s10815-016-0830-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10815-016-0830-1

Keywords

  • Polycystic ovary syndrome
  • In vitro fertilization
  • Intracytoplasmic sperm injections
  • Body mass index
  • Pregnancy rate