 PCOS, obesity, and fertility treatment
PCOS, obesity, and fertility treatment
Issue 03: 5 Feb 2008
Source: Fertility and Sterility 2008;in press
The interaction of body mass index (BMI) and polycystic ovarian syndrome (PCOS), and their effects on the outcomes of fertility treatment, have been investigated in a new study.
Specialists from the University of Cincinnati College of Medicine, USA, conducted a small study of 94 fresh non-donor IVF-embryo transfer cycles, involving 86 women.
The women were divided into four groups based on BMI and the presence/absence of PCOS: 52 women were lean (defined as a BMI of 18.5-24.9 kg/m2) and without PCOS, six women were lean with PCOS, 18 women were obese (BMI 30 kg/m2 or higher) without PCOS, and 10 women were obese with PCOS. In a paper due to be published in the journal Fertility and Sterility, the researchers report the following key findings:
Lean PCOS versus lean non-PCOS
The women in the lean PCOS group were found to have had a significantly higher number of dominant follicles compared with women in the lean non-PCOS group (mean 12.2 versus 7.7, respectively). They also had significantly more retrieved oocytes (mean 22.2 versus 12.6, respectively) and significantly more frozen embryos (mean 5 versus 1.4, respectively).
Lean PCOS versus obese PCOS
Women in the lean PCOS group also had significantly more retrieved oocytes than women in the obese PCOS group (mean 22.2 versus 14.3, respectively), despite requiring fewer gonadotropin ampoules (mean 18.8 versus 29.2, respectively).
Obese non-PCOS versus obese PCOS
The women who were obese but without PCOS had better-grade day 3 embryos than obese women with PCOS, and had significantly fewer embryos transferred (mean 2.4 versus 2.9, respectively).
Obese non-PCOS versus lean non-PCOS
Women in the obese non-PCOS group had significantly more embryos frozen compared with women in the lean non-PCOS group (mean 3.2 versus 1.4, respectively).
The researchers found no significant differences between the four groups in any of the clinical outcomes measured (including the implantation rate, clinical pregnancy rate, and live birth rate), although there was a trend towards a lower implantation rate in the group of obese women with PCOS.
Discussing the results, the researchers note that the significant finding of increased gonadotropin use in the obese PCOS group, compared with the lean PCOS group, has financial implications. In addition, “the lower embryo quality and decreased rates of implantation in obese patients with PCOS may hint at more subtle clinically important outcomes, which could be the basis of a future study with larger patient numbers.”
Based on their study, they conclude that “that although patients with PCOS have more favourable IVF-embryo transfer cycle characteristics if they have a BMI in the lean rather than the obese range, clinical pregnancy rate and live birth rate are not significantly different.” However, they point out that their study was limited by insufficient power to show differences in the primary outcomes of clinical pregnancy rate and live birth rates.
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