Advanced Fertility Center of Chicago ivf

Influence of Body Mass Index, BMI on IVF Outcome

Research presentation by Ellen Gibbons of the Advanced Fertility Center of Chicago at the 2008 Annual Meeting of the American Society for Reproductive Medicine

Gibbons E, Potgieter A, Bailey J, Sherbahn, R: Influence of BMI on number of eggs retrieved and day of transfer. 64th Annual Meeting of the American Society for Reproductive Medicine, San Francisco, CA, November, 2008.

Introduction

The goal of this study was to evaluate some aspects of the possible effect of BMI, body mass index, on in vitro fertilization outcomes.


Materials and Methods

  • This was a retrospective study of 1,150 IVF stimulation cycles in women under the age of 40 using their own eggs from January 2003 through July 2007.

  • The cases were clustered into two groups according to their BMI of under 30 or over 30.

  • Patients that had 4 or more good quality embryos on day 3 were cultured to day 5 for transfer.

  • Assessments were made for the average antral follicle count, number of eggs, rates of implantation, clinical pregnancy, live birth, miscarriage, day 3 and day 5 embryo transfer, and IVF cycle cancellation.

  • Statistical analysis was performed by the t-test and Fishers exact test when appropriate.

Results

  • The average number of antral follicles (23.1 vs. 19.6, p <0.002) and eggs retrieved (10.5 vs. 9.4, p<0.004) were significantly higher in the group with increased BMI.

  • The rate of having a day 5 transfer was significantly higher in the increased BMI group (69.2% vs. 59.3%, p<0.02).

  • There were no significant differences between the two BMI groups regarding the other variables studied.

BMI <30 (%)

AVERAGE # ANTRALS
(� Standard Deviation)

19.6 � 14.0 SD

AVERAGE # EGGS

9.4 � 4.7 SD

IMPLANTATION RATE

725/1816 (39.9%)

CLINICAL PREGNANCY RATE PER ET

545/889 (61.3%)

LIVE BIRTH RATE PER ET

462/889 (52.0%)

MISCARRIAGE RATE

79/545 (14.5%)

CANCELLATION RATE

41/967 (4.2%)

PROPORTION HAVING DAY 3 ET

362/889 (40.7%)

PROPORTION HAVING DAY 5 ET

527/889 (59.3%)

RATE OF DAY 3 ET & 2 GOOD EMBRYOS

207/362 (57.2%)

RATE OF DAY 5 ET & 2 GOOD EMBRYOS

255/527 (48.4%)

BMI >30 (%)

AVERAGE # ANTRALS
(� Standard Deviation)

23.1 � 15.1 SD

AVERAGE # EGGS

10.5 � 4.5 SD

IMPLANTATION RATE

128/349 (36.7%)

CLINICAL PREGNANCY RATE PER ET

106/169 (62.7%)

LIVE BIRTH RATE PER ET

82/169 (48.5%)

MISCARRIAGE RATE

22/106 (20.8%)

CANCELLATION RATE

13/183 (7.1%)

PROPORTION HAVING DAY 3 ET

52/169 (30.8%)

PROPORTION HAVING DAY 5 ET

117/169 (69.2%)

RATE OF DAY 3 ET & 2 GOOD EMBRYOS

34/52 (65.4%)

RATE OF DAY 5 ET & 2 GOOD EMBRYOS

55/117 (47.0%)

STATISTICS

AVERAGE # ANTRALS
(� Standard Deviation)

p<0.002

AVERAGE # EGGS

p <0.004

IMPLANTATION RATE

NS

CLINICAL PREGNANCY RATE PER ET

NS

LIVE BIRTH RATE PER ET

NS

MISCARRIAGE RATE

NS

CANCELLATION RATE

NS

PROPORTION HAVING DAY 3 ET

p<0.02

PROPORTION HAVING DAY 5 ET

p<0.02

RATE OF DAY 3 ET & 2 GOOD EMBRYOS

NS

RATE OF DAY 5 ET & 2 GOOD EMBRYOS

NS

BMI <30 (%)

BMI >30 (%)

STATISTICS

AVERAGE # ANTRALS
(� Standard Deviation)

19.6 � 14.0 SD

23.1 � 15.1 SD

p<0.002

AVERAGE # EGGS

9.4 � 4.7 SD

10.5 � 4.5 SD

p <0.004

IMPLANTATION RATE

725/1816 (39.9%)

128/349 (36.7%)

NS

CLINICAL PREGNANCY RATE PER ET

545/889 (61.3%)

106/169 (62.7%)

NS

LIVE BIRTH RATE PER ET

462/889 (52.0%)

82/169 (48.5%)

NS

MISCARRIAGE RATE

79/545 (14.5%)

22/106 (20.8%)

NS

CANCELLATION RATE

41/967 (4.2%)

13/183 (7.1%)

NS

PROPORTION HAVING DAY 3 ET

362/889 (40.7%)

52/169 (30.8%)

p<0.02

PROPORTION HAVING DAY 5 ET

527/889 (59.3%)

117/169 (69.2%)

p<0.02

RATE OF DAY 3 ET & 2 GOOD EMBRYOS

207/362 (57.2%)

34/52 (65.4%)

NS

RATE OF DAY 5 ET & 2 GOOD EMBRYOS

255/527 (48.4%)

55/117 (47.0%)

NS

NS = not statistically significant

Antrals by BMI Day 3 vs. day 5 transfer by BMI
Average antral follicle count by BMI group
Rate of day 3 vs. day 5 transfer by BMI group
BMI and number of IVF eggs

Graph shows number of eggs retrieved with IVF by age and BMI group


Summary

  • Women with a higher BMI had significantly more antral follicles and eggs retrieved and a higher likelihood of having a day 5 transfer.

  • However, there was no difference between the BMI groups for clinical pregnancy, miscarriage, or live birth rates.

  • It is possible that the higher number of eggs and higher chance for a day 5 transfer is due to a higher incidence of polycystic ovarian syndrome, PCOS, in women with�  BMI > 30.

  • Overall in our program, day 5 pregnancy and live birth rates are significantly higher as compared to day 3 transfers.

  • Therefore, because there was a higher rate of day 5 transfer in the obese group but not a corresponding increase in implantation, clinical pregnancy, or live birth rates we speculate that either embryo viability or uterine receptivity may be compromised in obese women.

  • Because the embryo transfer procedure can be more difficult in obese women, there could also be a loss of efficiency related to the difficulty of the transfer process.

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