Abstract
BackgroundOverweight and obesity affect millions of people globally, which has also serious implications for reproduction. For example, treatment outcomes after in vitro fertilisation (IVF) are worse in women with a high body mass index (BMI). However, the impact of maternal BMI on embryo quality is inconclusive. Our main aim is to study associations between preconceptional maternal BMI and morphokinetic parameters of preimplantation embryos and predicted implantation potential. In addition, associations with clinical IVF outcomes are investigated.MethodsFrom a tertiary hospital, 268 women undergoing IVF or IVF with intracytoplasmic sperm injection (ICSI) were included; 143 normal weight, 79 overweight and 46 obese women. The embryos of these women were cultured in the EmbryoScope, a time-lapse incubator. The morphokinetic parameters of preimplantation embryos and predicted implantation potential, assessed by the KIDScore algorithm were longitudinally evaluated as primary and secondary outcomes, respectively. The tertiary outcomes included clinical outcomes, i.e., fertilization, implantation and live birth rate.ResultsAfter adjustment for patient- and treatment-related factors, we demonstrated in 938 embryos that maternal BMI is negatively associated with the moment of pronuclear appearance (βtPNa -0.070 h (95%CI -0.139, -0.001), p = 0.048), pronuclear fading (βtPNf -0.091 h (95%CI -0.180, -0.003), p = 0.043 and the first cell cleavage (βt2 -0.111 h (95%CI -0.205, -0.016), p = 0.022). Maternal BMI was not significantly associated with the KIDScore and tertiary clinical treatment outcomes. In embryos from couples with female or combined factor subfertility, the impact of maternal BMI was even larger (βtPNf -0.170 h (95%CI -0.293, -0.047), p = 0.007; βt2 -0.199 h (95%CI -0.330, -0.067), p = 0.003). Additionally, a detrimental impact of BMI per point increase was observed on the KIDScore (β -0.073 (se 0.028), p = 0.010).ConclusionsHigher maternal BMI is associated with faster early preimplantation development. In couples with female or combined factor subfertility, a higher BMI is associated with a lower implantation potential as predicted by the KIDScore. Likely due to power issues, we did not observe an impact on clinical treatment outcomes. However, an effect of faster preimplantation development on post-implantation development is conceivable, especially since the impact of maternal BMI on pregnancy outcomes has been widely demonstrated.
Highlights
Overweight and obesity affect millions of people of all ages, genders, ethnicities and income levels [1]
The main aim of this study is to investigate the hypothesis that a high maternal body mass index (BMI) is detrimentally associated with preimplantation embryo quality, as assessed by developmental time-lapse parameters and predicted implantation potential (KIDScore)
Summary of findings This study aimed to investigate the hypothesis that an elevated BMI in women undergoing in vitro fertilisation (IVF)/intracytoplasmic sperm injection (ICSI) treatment has a detrimental impact on 1) preimplantation morphokinetic parameters until day 3 of development, 2) predicted implantation potential and 3) pre- and posttransfer clinical treatment outcomes
Summary
Overweight and obesity affect millions of people of all ages, genders, ethnicities and income levels [1]. Surplus energy is stored as fat, which leads to a disruption of numerous physiological processes on endocrine, immune and vascular levels [4]. This explains why an elevated body mass index (BMI) is associated with various non-communicable diseases, such as diabetes type 2 and cancer [5, 6]. Obesity and overweight increase the risk of non-communicable diseases, and can impact reproduction [7]. Overweight and obesity are likely overrepresented in women receiving fertility treatment, such as in vitro fertilization (IVF) [11]. Treatment outcomes after in vitro fertilisation (IVF) are worse in women with a high body mass index (BMI).
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