The impact of BMI on the clinical outcomes of patients undergoing long-term IVF/ICSI treatment in the follicular phase / 中国医师杂志

ABSTRACT

Objective:To investigate the effect of body mass index (BMI) on the first in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) treatment for young women of childbearing age (20-35 years old) with tubal factor infertility.Methods:A retrospective analysis was conducted on the clinical data of 747 patients who underwent assisted reproductive technology (IVF/ICSI) treatment for the first time at the Reproductive Medicine Center of the First People′s Hospital of Changde City from January 1, 2019 to September 30, 2021. The patients were aged 20-35 years old and all received controlled ovarian hyperstimulation treatment using a long-term follicular protocol. Patients were divided into four groups based on their BMI values during physical examinations before assisted pregnancy treatment: the weight loss group [body mass index (BMI)<18.5 kg/m 2 in 72 cases], the normal weight group (18.5 kg/m 2≤BMI<24 kg/m 2 in 455 cases), the super recombination group (24 kg/m 2≤BMI<28 kg/m 2 in 161 cases), and the obesity group (BMI≥28 kg/m 2 in 59 cases). The differences in relevant indicators during controlled ovarian hyperstimulation treatment and pregnancy outcomes after fresh embryo transfer were analyzed among each group. Resultsl:There were no statistically significant differences in age, infertility years, primary/secondary infertility ratio, basal follicle stimulating hormone levels, and sinus follicle count among the lean, normal weight, overweight, and obese groups (all P>0.05). There were no statistically significant differences in the duration of gonadotropin (Gn) administration, the number of follicles with a diameter of ≥14 mm on the trigger day, the level of estrogen on the trigger day, the number of retrieved eggs, the number of double pronuclei, the rate of cyst formation, the rate of transplantation, and the rate of whole embryo cryopreservation among the four groups (all P>0.05). The total amount of Gn was found to be (2 374.5±892.5)U in the lean group, (2 643.8±1 213.5)U in the normal weight group, (2 950.5±1 156.5)U in the super recombinant group, and (2 949.8±1 030.5)U in the obese group, with a statistically significant difference ( P=0.001). The number of excellent embryos was (3.06±2.50) in the lean group, (2.96±2.16) in the normal weight group, (2.45±1.96) in the super recombinant group, and (2.39±2.03) in the obese group, with a statistically significant difference ( P=0.015). The embryo free rate among the four groups significantly increased with increasing BMI, and the difference was statistically significant ( P=0.039). There was no statistically significant difference in the number of embryos transferred, biochemical pregnancy rate, clinical pregnancy rate, embryo implantation rate, multiple pregnancy rate, early abortion rate, mid-term abortion rate, and live birth rate among the four groups (all P>0.05). Conclusions:In patients with simple tubal factor infertility who receive long-term follicular phase assisted fertilization treatment, an increase in BMI can significantly increase the dosage of Gn, reduce the number of excellent embryos, and increase the rate of no embryos. Although there is currently no statistical difference in various indicators of pregnancy outcomes after fresh embryo transfer among different BMI groups, there is a risk of an increase in early or mid-term miscarriage rates as BMI increases.