Round-Table: role of life habits and environment on ovarian stimulation strategies

Abstract

The Round-Table Discussion of the ART: Personalized Approaches to Improve Outcomes symposium focused on the role of lifestyle habits and environment on reproductive strategies. Claus Yding Andersen from Copenhagen, Denmark, reviewed the impact of being overweight (body mass index [BMI] = 25 29.9) or obese (BMI 30) on fertility and ovarian stimulation strategies. Evidence has shown that being overweight increases the risk of anovulatory infertility (Rich-Edwards et al., 2002). Although it is not completely understood how obesity increases the risk of anovulation, being overweight has been associated with an altered secretion of pulsatile gonadotropin-releasing hormone (GnRH), altered sex hormone-binding globulin (SHBG) concentrations, enhanced levels of both ovarian and adrenal androgens, and enhanced luteinizing-hormone (LH) secretion. A recent systematic review examined the effect of being overweight or obese on ART outcomes. Women with a BMI of 25 or more had a lower chance of pregnancy following IVF, required more exogenous FSH, had fewer numbers of oocytes retrieved and higher miscarriage rates compared to women with a BMI of less than 25 (Maheshwari et al., 2007). Another recent review from Australia concluded that the chance of pregnancy is reduced by 50% in overweight women compared to women with a normal BMI (Anderson et al., 2010). Weight loss appears to have a positive effect on ART outcomes. A prospective study that examined the effect of a 6-month weight loss program that included both dietary modifications and exercise in obese infertile women found that women who completed the program lost an average of 10.2 kg. Approximately