Abstract
Obesity is a well-known risk factor for infertility, and nonpharmacological treatments are recommended as effective and safe, but evidence is still lacking on whether nonpharmacological interventions improve fertility in overweight or obese women. The aim of this study was to systematically assess the current evidence in the literature and to evaluate the impact of nonpharmacological interventions on improving pregnancy-related outcomes in overweight or obese infertile women. Seven databases were searched for randomized controlled trials (RCTs) of nonpharmacological interventions for infertile women with overweight or obesity through August 16, 2019 with no language restriction. A meta-analysis was conducted of the primary outcomes. A total of 21 RCTs were selected and systematically reviewed. Compared to the control group, nonpharmacological interventions significantly increased the pregnancy rate (relative risk (RR), 1.37; 95% CI, 1.04–1.81; p = 0.03; I2 = 58%; nine RCTs) and the natural conception rate (RR, 2.17, 95% CI, 1.41–3.34; p = 0.0004; I2 = 19%, five RCTs). However, they had no significant effect on the live birth rate (RR, 1.36, 95% CI, 0.94–1.95; p=0.10, I2 = 65%, eight RCTs) and increased the risk of miscarriage (RR: 1.57, 95% CI, 1.05–2.36; p = 0.03; I2 = 0%). Therefore, nonpharmacological interventions could have a positive effect on the pregnancy and natural conception rates, whereas it is unclear whether they improve the live birth rate. Further research is needed to demonstrate the integrated effects of nonpharmacological interventions involving psychological outcomes, as well as pregnancy-related outcomes.
Highlights
Infertility is a major health concern that affects 8–12% of couples of childbearing age who are trying to conceive worldwide [1]
The key questions for the systematic literature review were based on the Populations, Intervention, Comparison, Outcome, and Study Design (PICOSD) framework as follows: (1) The subjects were overweight or obese adult women (with a body mass index (BMI) of at least 25 kg/m2) who were diagnosed with infertility, were undergoing or scheduled to undergo infertility procedures, or were referred to infertility clinics and were actively trying to conceive (P). (2) The nonpharmacological interventions included diet; exercise; weight control programs; alternative complementary therapies; psychosocial interventions; cognitive behavioral programs; nursing interventions; and combinations thereof
The initial electronic database search resulted in 6046 articles (386 in Ovid MEDLINE, 1614 in EMbase, 3802 in the Cochrane Library, 152 in CINAHL, 58 in the Web of Science, 5 in PsycINFO, and 29 in KoreaMed) related to nonpharmacological interventions for overweight/obesity or infertility
Summary
Infertility is a major health concern that affects 8–12% of couples of childbearing age who are trying to conceive worldwide [1]. Overweight and obesity are well-known risk factors for infertility that can increase the likelihood of maternal and fetal/neonatal adverse outcomes (e.g., gestational hypertension, pre-eclampsia, perinatal depression, fetal defects, and perinatal mortality) [2,3]. The mechanisms through which obesity contributes to infertility include hormonal changes, menstrual disorders, and ovulatory disorders [4,5]. The majority of women with ovulatory disorders have polycystic ovary syndrome (PCOS), and a significant proportion of women with polycystic ovary symptom (PCOS) are obese [6]. With the increasing prevalence of infertility in obese women, it is becoming increasingly common for women to seek assisted reproductive treatment in order to become pregnant [7]. Overweight and obese women have poor reproductive outcomes for assisted conception techniques such as ovulation
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