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Is It Good Practice/Ethical to Set a Max BMI Before IVF?

  • Joseph O. Doyle
  • Nicole Doyle
  • Alan H. DeCherney
Chapter

Abstract

If current trends continue, almost 40% of the world’s population will be obese by 2030 (Kelly et al., Int J Obes 32:1431–1437, 2008). Obesity is now recognized as a chronic disease, and we need to consider how to approach and optimize this condition in parallel with fertility treatments. When evaluating the ethics of a BMI threshold prior to IVF, we must consider the impact of obesity on overall health, fertility, pregnancy, the postpartum period, and our responsibility as providers to prioritize maternal and fetal well-being within the ethical framework of autonomy, nonmaleficence, beneficence, and justice.

Keywords

Obesity Body mass index BMI Ethics Moral Autonomy Nonmaleficence Beneficence Justice Fertility Assisted reproductive technology ART In vitro fertilization IVF 

References

  1. 1.
    Flegal KM, Carroll MD, Ogden CL, Johnson CL. Prevalence and trends in obesity among US adults, 1999-2000. JAMA. 2002;288:1723–7.CrossRefPubMedGoogle Scholar
  2. 2.
    Flegal KM, Kruszon-Moran D, Carroll MD, Fryar CD, Ogden CL. Trends in obesity among adults in the United States, 2005 to 2014. JAMA. 2016;315:2284–91.CrossRefGoogle Scholar
  3. 3.
    North American Association for the Study of Obesity NH, Lung, and Blood Institute, National Institute fo Health. The practical guide: identification, evaluation, and treatment of overweight and obesity in adults. 2000.Google Scholar
  4. 4.
    Deurenberg P, Yap M, van Staveren WA. Body mass index and percent body fat: a meta analysis among different ethnic groups. Int J Obes Relat Metab Disord. 1998;22:1164–71.CrossRefPubMedGoogle Scholar
  5. 5.
    Razak F, Anand SS, Shannon H, et al. Defining obesity cut points in a multiethnic population. Circulation. 2007;115:2111–8.CrossRefPubMedGoogle Scholar
  6. 6.
    Story M, French S. Food advertising and marketing directed at children and adolescents in the US. Int J Behav Nutr Phys Act. 2004;1:3.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    The Surgeon General’s call to action to prevent and decrease overweight and obesity. 2001. http://www.surgeon-general.gov/topics/obesity.
  8. 8.
    Prevention CfDCa. Adult obesity facts. https://www.cdc.gov/obesity/data/adult.html
  9. 9.
    Kelly T, Yang W, Chen CS, Reynolds K, He J. Global burden of obesity in 2005 and projections to 2030. Int J Obes. 2008;32:1431–7.CrossRefGoogle Scholar
  10. 10.
    Awartani KA, Nahas S, Al Hassan SH, Al Deery MA, Coskun S. Infertility treatment outcome in sub groups of obese population. Reprod Biol Endocrinol. 2009;7:52.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Polotsky AJ, Hailpern SM, Skurnick JH, Lo JC, Sternfeld B, Santoro N. Association of adolescent obesity and lifetime nulliparity—the study of women’s health across the nation (SWAN). Fertil Steril. 2010;93:2004–11.CrossRefPubMedGoogle Scholar
  12. 12.
    Story M, French S. Food advertising and marketing directed at children and adolescents in the US. Int J Behav Nutr Phys Act. 2004;1:3. Published online 2004 Feb 10. PMCID: PMC416565. PMID: 15171786.  https://doi.org/10.1186/1479-5868-1-3.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Catalano PM. Management of obesity in pregnancy. Obstet Gynecol. 2007;109:419–33.CrossRefPubMedGoogle Scholar
  14. 14.
    Ozanne SE. Epigenetic signatures of obesity. N Engl J Med. 2015;372:973–4.CrossRefPubMedGoogle Scholar
  15. 15.
    Oken E, Taveras EM, Kleinman KP, Rich-Edwards JW, Gillman MW. Gestational weight gain and child adiposity at age 3 years. Am J Obstet Gynecol. 2007;196:322e1–8.CrossRefGoogle Scholar
  16. 16.
    Baptiste-Roberts K, Nicholson WK, Wang NY, Brancati FL. Gestational diabetes and subsequent growth patterns of offspring: the national collaborative perinatal project. Matern Child Health J. 2012;16:125–32.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Oken E, Levitan EB, Gillman MW. Maternal smoking during pregnancy and child overweight: systematic review and meta-analysis. Int J Obes. 2008;32:201–10.CrossRefGoogle Scholar
  18. 18.
    Baker JL, Michaelsen KF, Sorensen TI, Rasmussen KM. High prepregnant body mass index is associated with early termination of full and any breastfeeding in Danish women. Am J Clin Nutr. 2007;86:404–11.CrossRefPubMedGoogle Scholar
  19. 19.
    Bodnar LM, Siega-Riz AM, Cogswell ME. High prepregnancy BMI increases the risk of postpartum anemia. Obes Res. 2004;12:941–8.CrossRefPubMedGoogle Scholar
  20. 20.
    Molyneaux E, Poston L, Ashurst-Williams S, Howard LM. Obesity and mental disorders during pregnancy and postpartum: a systematic review and meta-analysis. Obstet Gynecol. 2014;123:857–67.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Sasson IE, Vitins AP, Mainigi MA, Moley KH, Simmons RA. Pre-gestational vs gestational exposure to maternal obesity differentially programs the offspring in mice. Diabetologia. 2015;58:615–24.CrossRefPubMedGoogle Scholar
  22. 22.
    Nomura Y, Lambertini L, Rialdi A, et al. Global methylation in the placenta and umbilical cord blood from pregnancies with maternal gestational diabetes, preeclampsia, and obesity. Reprod Sci. 2014;21:131–7.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Saben JL, Boudoures AL, Asghar Z, et al. Maternal metabolic syndrome programs mitochondrial dysfunction via germline changes across three generations. Cell Rep. 2016;16:1–8.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Kilpelainen TO, Qi L, Brage S, et al. Physical activity attenuates the influence of FTO variants on obesity risk: a meta-analysis of 218,166 adults and 19,268 children. PLoS Med. 2011;8:e1001116.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Mitchell JA, Church TS, Rankinen T, Earnest CP, Sui X, Blair SN. FTO genotype and the weight loss benefits of moderate intensity exercise. Obesity (Silver Spring). 2010;18:641–3.CrossRefGoogle Scholar
  26. 26.
    Bateson P, Barker D, Clutton-Brock T, et al. Developmental plasticity and human health. Nature. 2004;430:419–21.CrossRefPubMedGoogle Scholar
  27. 27.
    Practice Committee of the American Society for Reproductive Medicine. Obesity and reproduction: a committee opinion. Fertil Steril. 2015;104:1116–26.CrossRefGoogle Scholar
  28. 28.
    Gesink Law DC, Maclehose RF, Longnecker MP. Obesity and time to pregnancy. Hum Reprod. 2007;22:414–20.CrossRefPubMedGoogle Scholar
  29. 29.
    van der Steeg JW, Steures P, Eijkemans MJ, et al. Obesity affects spontaneous pregnancy chances in subfertile, ovulatory women. Hum Reprod. 2008;23:324–8.CrossRefPubMedGoogle Scholar
  30. 30.
    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
  31. 31.
    Gaskins AJ, Rich-Edwards JW, Missmer SA, Rosner B, Chavarro JE. Association of fecundity with changes in adult female weight. Obstet Gynecol. 2015;126:850–8.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Wise LA, Rothman KJ, Mikkelsen EM, Sorensen HT, Riis A, Hatch EE. An internet-based prospective study of body size and time-to-pregnancy. Hum Reprod. 2010;25:253–64.CrossRefPubMedGoogle Scholar
  33. 33.
    Ramlau-Hansen CH, Thulstrup AM, Nohr EA, Bonde JP, Sorensen TI, Olsen J. Subfecundity in overweight and obese couples. Hum Reprod. 2007;22:1634–7.CrossRefPubMedGoogle Scholar
  34. 34.
    Souter I, Baltagi LM, Kuleta D, Meeker JD, Petrozza JC. Women, weight, and fertility: the effect of body mass index on the outcome of superovulation/intrauterine insemination cycles. Fertil Steril. 2011;95:1042–7.CrossRefPubMedGoogle Scholar
  35. 35.
    Fedorcsak P, Dale PO, Storeng R, et al. Impact of overweight and underweight on assisted reproduction treatment. Hum Reprod. 2004;19:2523–8.CrossRefPubMedGoogle Scholar
  36. 36.
    Luke B, Brown MB, Missmer SA, et al. The effect of increasing obesity on the response to and outcome of assisted reproductive technology: a national study. Fertil Steril. 2011;96:820–5.CrossRefPubMedGoogle Scholar
  37. 37.
    MacKenna A, Schwarze JE, Crosby JA, Zegers-Hochschild F. Outcome of assisted reproductive technology in overweight and obese women. JBRA Assist Reprod. 2017;21:79–83.PubMedPubMedCentralGoogle Scholar
  38. 38.
    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
  39. 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;15:532–8.CrossRefPubMedGoogle Scholar
  40. 40.
    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
  41. 41.
    Petersen GL, Schmidt L, Pinborg A, Kamper-Jorgensen M. The influence of female and male body mass index on live births after assisted reproductive technology treatment: a nationwide register-based cohort study. Fertil Steril. 2013;99:1654–62.CrossRefPubMedGoogle Scholar
  42. 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;98:102–8.CrossRefPubMedGoogle Scholar
  43. 43.
    Provost MP, Acharya KS, Acharya CR, et al. Pregnancy outcomes decline with increasing recipient body mass index: an analysis of 22,317 fresh donor/recipient cycles from the 2008-2010 Society for Assisted Reproductive Technology Clinic Outcome Reporting System registry. Fertil Steril. 2016;105:364–8.CrossRefPubMedGoogle Scholar
  44. 44.
    Luke B, Brown MB, Stern JE, et al. Female obesity adversely affects assisted reproductive technology (ART) pregnancy and live birth rates. Hum Reprod. 2011;26:245–52.CrossRefPubMedGoogle Scholar
  45. 45.
    Rittenberg V, Seshadri S, Sunkara SK, Sobaleva S, Oteng-Ntim E, El-Toukhy T. Effect of body mass index on IVF treatment outcome: an updated systematic review and meta-analysis. Reprod Biomed Online. 2011;23:421–39.CrossRefPubMedGoogle Scholar
  46. 46.
    Machtinger R, Combelles CM, Missmer SA, Correia KF, Fox JH, Racowsky C. The association between severe obesity and characteristics of failed fertilized oocytes. Hum Reprod. 2012;27:3198–207.CrossRefPubMedGoogle Scholar
  47. 47.
    Jensen TK, Andersson AM, Jorgensen N, et al. Body mass index in relation to semen quality and reproductive hormones among 1,558 Danish men. Fertil Steril. 2004;82:863–70.CrossRefPubMedGoogle Scholar
  48. 48.
    Kort HI, Massey JB, Elsner CW, et al. Impact of body mass index values on sperm quantity and quality. J Androl. 2006;27:450–2.CrossRefPubMedGoogle Scholar
  49. 49.
    Hammoud AO, Wilde N, Gibson M, Parks A, Carrell DT, Meikle AW. Male obesity and alteration in sperm parameters. Fertil Steril. 2008;90:2222–5.CrossRefPubMedGoogle Scholar
  50. 50.
    Alshahrani S, Ahmed AF, Gabr AH, Abalhassan M, Ahmad G. The impact of body mass index on semen parameters in infertile men. Andrologia. 2016;48:1125–9.CrossRefPubMedGoogle Scholar
  51. 51.
    Dupont C, Faure C, Sermondade N, et al. Obesity leads to higher risk of sperm DNA damage in infertile patients. Asian J Androl. 2013;15(5):622.CrossRefPubMedPubMedCentralGoogle Scholar
  52. 52.
    Sallmen M, Sandler DP, Hoppin JA, Blair A, Baird DD. Reduced fertility among overweight and obese men. Epidemiology. 2006;17:520–3.CrossRefPubMedGoogle Scholar
  53. 53.
    Nguyen RH, Wilcox AJ, Skjaerven R, Baird DD. Men’s body mass index and infertility. Hum Reprod. 2007;22:2488–93.CrossRefPubMedGoogle Scholar
  54. 54.
    Campbell JM, Lane M, Owens JA, Bakos HW. Paternal obesity negatively affects male fertility and assisted reproduction outcomes: a systematic review and meta-analysis. Reprod Biomed Online. 2015;31:593–604.CrossRefPubMedGoogle Scholar
  55. 55.
    Soubry A, Guo L, Huang Z, et al. Obesity-related DNA methylation at imprinted genes in human sperm: results from the TIEGER study. Clin Epigenetics. 2016;8:51.CrossRefPubMedPubMedCentralGoogle Scholar
  56. 56.
    Boots C, Stephenson MD. Does obesity increase the risk of miscarriage in spontaneous conception: a systematic review. Semin Reprod Med. 2011;29:507–13.CrossRefPubMedGoogle Scholar
  57. 57.
    Lashen H, Fear K, Sturdee DW. Obesity is associated with increased risk of first trimester and recurrent miscarriage: matched case-control study. Hum Reprod. 2004;19:1644–6.CrossRefPubMedGoogle Scholar
  58. 58.
    Boots CE, Bernardi LA, Stephenson MD. Frequency of euploid miscarriage is increased in obese women with recurrent early pregnancy loss. Fertil Steril. 2014;102:455–9.CrossRefPubMedGoogle Scholar
  59. 59.
    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
  60. 60.
    Aagaard-Tillery KM, Flint Porter T, Malone FD, et al. Influence of maternal BMI on genetic sonography in the FaSTER trial. Prenat Diagn. 2010;30:14–22.PubMedGoogle Scholar
  61. 61.
    Salihu HM, Dunlop AL, Hedayatzadeh M, Alio AP, Kirby RS, Alexander GR. Extreme obesity and risk of stillbirth among black and white gravidas. Obstet Gynecol. 2007;110:552–7.CrossRefPubMedGoogle Scholar
  62. 62.
    Persson M, Johansson S, Villamor E, Cnattingius S. Maternal overweight and obesity and risks of severe birth-asphyxia-related complications in term infants: a population-based cohort study in Sweden. PLoS Med. 2014;11:e1001648.CrossRefPubMedPubMedCentralGoogle Scholar
  63. 63.
    Robinson HE, O’Connell CM, Joseph KS, McLeod NL. Maternal outcomes in pregnancies complicated by obesity. Obstet Gynecol. 2005;106:1357–64.CrossRefPubMedGoogle Scholar
  64. 64.
    Salihu HM, Lynch O, Alio AP, Liu J. Obesity subtypes and risk of spontaneous versus medically indicated preterm births in singletons and twins. Am J Epidemiol. 2008;168:13–20.CrossRefPubMedGoogle Scholar
  65. 65.
    Usha Kiran TS, Hemmadi S, Bethel J, Evans J. Outcome of pregnancy in a woman with an increased body mass index. BJOG. 2005;112:768–72.CrossRefPubMedGoogle Scholar
  66. 66.
    Denison FC, Price J, Graham C, Wild S, Liston WA. Maternal obesity, length of gestation, risk of postdates pregnancy and spontaneous onset of labour at term. BJOG. 2008;115:720–5.CrossRefPubMedPubMedCentralGoogle Scholar
  67. 67.
    Wolfe KB, Rossi RA, Warshak CR. The effect of maternal obesity on the rate of failed induction of labor. Am J Obstet Gynecol. 2011;205:128.e1–7.CrossRefGoogle Scholar
  68. 68.
    Weiss JL, Malone FD, Emig D, et al. Obesity, obstetric complications and cesarean delivery rate—a population-based screening study. Am J Obstet Gynecol. 2004;190:1091–7.CrossRefPubMedGoogle Scholar
  69. 69.
    Hibbard JU, Gilbert S, Landon MB, et al. Trial of labor or repeat cesarean delivery in women with morbid obesity and previous cesarean delivery. Obstet Gynecol. 2006;108:125–33.CrossRefPubMedGoogle Scholar
  70. 70.
    Chu SY, Kim SY, Schmid CH, et al. Maternal obesity and risk of cesarean delivery: a meta-analysis. Obes Rev. 2007;8:385–94.CrossRefPubMedGoogle Scholar
  71. 71.
    Leth RA, Uldbjerg N, Norgaard M, Moller JK, Thomsen RW. Obesity, diabetes, and the risk of infections diagnosed in hospital and post-discharge infections after cesarean section: a prospective cohort study. Acta Obstet Gynecol Scand. 2011;90:501–9.CrossRefPubMedGoogle Scholar
  72. 72.
    Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37.CrossRefPubMedGoogle Scholar
  73. 73.
    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
  74. 74.
    Sim KA, Dezarnaulds GM, Denyer GS, Skilton MR, Caterson ID. Weight loss improves reproductive outcomes in obese women undergoing fertility treatment: a randomized controlled trial. Clin Obes. 2014;4:61–8.CrossRefPubMedGoogle Scholar
  75. 75.
    Legro RS, Dodson WC, Kris-Etherton PM, et al. Randomized controlled trial of preconception interventions in infertile women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2015;100:4048–58.CrossRefPubMedPubMedCentralGoogle Scholar
  76. 76.
    Legro RS, Dodson WC, Kunselman AR, et al. Benefit of delayed fertility therapy with preconception weight loss over immediate therapy in obese women with PCOS. J Clin Endocrinol Metab. 2016;101:2658–66.CrossRefPubMedPubMedCentralGoogle Scholar
  77. 77.
    Johansson K, Cnattingius S, Naslund I, et al. Outcomes of pregnancy after bariatric surgery. N Engl J Med. 2015;372:814–24.CrossRefPubMedGoogle Scholar
  78. 78.
    Teitelman M, Grotegut CA, Williams NN, Lewis JD. The impact of bariatric surgery on menstrual patterns. Obes Surg. 2006;16:1457–63.CrossRefPubMedGoogle Scholar
  79. 79.
    Escobar-Morreale HF, Botella-Carretero JI, Alvarez-Blasco F, Sancho J, San Millan JL. The polycystic ovary syndrome associated with morbid obesity may resolve after weight loss induced by bariatric surgery. J Clin Endocrinol Metab. 2005;90:6364–9.CrossRefPubMedGoogle Scholar
  80. 80.
    Press. TLBJFCOU. Principles of biomedical ethics. 7th ed. New York; Oxford: Oxford University Press; 2013.Google Scholar
  81. 81.
    Ethics Committee of the American Society for Reproductive Medicine. Electronic address Aao, Ethics Committee of the American Society for Reproductive Medicine. Provision of fertility services for women at increased risk of complications during fertility treatment or pregnancy: an ethics committee opinion. Fertil Steril. 2016;106:1319–23.CrossRefGoogle Scholar
  82. 82.
    ACOG Practice Bulletin No 156: obesity in pregnancy. Obstet Gynecol. 2015;126:e112–26.Google Scholar
  83. 83.
    Wax J, Minkoff H, Johnson A, et al. Consensus report on the detailed fetal anatomic ultrasound examination: indications, components, and qualifications. J Ultrasound Med. 2014;33:189–95.CrossRefPubMedGoogle Scholar
  84. 84.
    Donofrio MT, Moon-Grady AJ, Hornberger LK, et al. Diagnosis and treatment of fetal cardiac disease: a scientific statement from the American Heart Association. Circulation. 2014;129:2183–242.CrossRefPubMedGoogle Scholar
  85. 85.
    Legro RS. Effects of obesity treatment on female reproduction: results do not match expectations. Fertil Steril. 2017;107:860–7.CrossRefPubMedGoogle Scholar
  86. 86.
    Kiddy DS, Hamilton-Fairley D, Bush A, et al. Improvement in endocrine and ovarian function during dietary treatment of obese women with polycystic ovary syndrome. Clin Endocrinol. 1992;36:105–11.CrossRefGoogle Scholar
  87. 87.
    Muktabhant B, Lawrie TA, Lumbiganon P, Laopaiboon M. Diet or exercise, or both, for preventing excessive weight gain in pregnancy. Cochrane Database Syst Rev. 2015.  https://doi.org/10.1002/14651858.CD007145.pub3.
  88. 88.
    Swinburn B, Egger G, Raza F. Dissecting obesogenic environments: the development and application of a framework for identifying and prioritizing environmental interventions for obesity. Prev Med. 1999;29:563–70.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Joseph O. Doyle
    • 1
  • Nicole Doyle
    • 2
  • Alan H. DeCherney
    • 2
  1. 1.Shady Grove Fertility Reproductive Science CenterRockvilleUSA
  2. 2.Reproductive Endocrinology and Infertility Fellowship ProgramEunice Kennedy Shriver National Institute of Child Health and Human DevelopmentBethesdaUSA

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