Impact of Bodyweight and Lifestyle on IVF Outcome

Box 1.

Deleterious Effects Described in Obese Women Undergoing IVF

Healy DL, Trounson AO, Andersen AN. Female infertility: causes and treatment. Lancet 343, 1539-1544 (1994).
Boivin J, Bunting L, Collins JA, Nygren KG. International estimates of infertility prevalence and treatment-seeking: potential need and demand for infertility medical care. Hum. Reprod. 22, 1506-1512 (2007).
Broekmans FJ, Knauff EA, te Velde ER, Macklon NS, Fauser BC. Female reproductive ageing: current knowledge and future trends. Trends Endocrinol. Metab. 18, 58-65 (2007).
Auger J, Kunstmann JM, Czyglik F, Jouannet P. Decline in semen quality among fertile men in Paris during the past 20 years. N. Engl. J. Med. 332, 281-285 (1995).
Jensen TK, Carlsen E, Jorgensen N et al. Poor semen quality may contribute to recent decline in fertility rates. Hum. Reprod. 17, 1437-1440 (2002).
Rich-Edwards JW, Spiegelman D, Garland M et al. Physical activity, body mass index and ovulatory disorder infertility. Epidemiology 13, 184-190 (2002).
Davies M. Evidence for effects of weight on reproduction in women. Reprod. Biomed. Online 12, 552-561 (2006).
Hassan MA, Killick SR. Negative lifestyle is associcated with a significant reduction in fecundity. Fertil. Steril. 81, 384-392 (2004).
Cwikel J, Gidron Y, Sheiner E. Psychological interactions with infertility among women. Eur. J. Obstet. Gynecol. Reprod. Biol. 117, 126-131 (2004).
Bisanti L, Olsen J, Basso O, Thonneau P, Karmaus W; European Study Group on Infertility and Subfecundity. Shift work and subfecundity: a European multicenter study. J. Occup. Environ. Med. 38, 352-358 (1996).
Magnusdottir EV, Thorsteinsson T, Thorsteindottir S, Heimisdottir M, Olafsdottir K. Persistent organochlorines, sedentary occupation, obesity and human male subfertility. Hum. Reprod. 20, 208-215 (2005).
Jensen TK, Hjollund HI, Henriksen TB et al. Does moderate alcohol consumption affect fertility? Follow up study among couples planning first pregnancy. BMJ 317, 505-510 (1998).
Grodstein F, Goldman MB, Ryan L, Cramer DW. Relation of female infertility to consumption of caffeinated beverages. Am. J. Epidemiol. 137, 1353-1360 (1993).
Mueller BA, Daling JR, Weiss NS, Moore DE. Recreational drug use and the risk of primary infertility. Epidemiology 1, 195-200 (1990).
Tielemans E, van Kooij R, Looman C, Burdorf A, te Velde E, Heederik D. Paternal occupational exposures and embryo implantation rates after IVF. Fertil. Steril. 74, 690-695 (2000).
Younglai EV, Holloway AC, Foster WG. Environmental and occupational factors affecting fertility and IVF success. Hum. Reprod. Update 11, 43-57 (2005).
Soares SR, Melo MA. Cigarette smoking and IVF. Expert Rev. Obstet. Gynecol. 3(4), 555-563 (2008).
Norman R, Clark A. Obesity and reproductive disorders: a review. Reprod. Fertil. Dev. 10, 55-63 (1998)
Jokela M, Kivimäki M, Elovainio M, Viikari J, Raitakari OT, Keltikangas-Järvinen L. Body mass index in adolescence and number of children in adulthood. Epidemiology 18, 599-606 (2007).
Winter E, Wang J, Davies M, Norman R. Early pregnancy loss following assisted reproductive technology treatment. Hum. Reprod. 17, 3220-3223 (2002).
Bolumar F, Olsen J, Rebagliato M, Sáez-Lloret I, Bisanti L. Body mass index and delayed conception: a European Multicenter Study on Infertility and Subfecundity. Am. J. Epidemiol. 151, 1072-1079 (2000).
Grodstein F, Goldman MB, Cramer DW. Body mass index and ovulatory infertility. Epidemiology 5, 247-250 (1994).
The ESHRE Capri Workshop Group. Nutrition and reproduction in women. Hum. Reprod. Update 12, 193-207 (2006).
Roth D, Grazi R, Lobel S. Extremes of body mass index do not affect first-trimester pregnancy outcome in patients with infertility. Am. J. Obstet. Gynecol. 188, 1169-1170 (2003).
Fedocksák P, Dale P, Storeng R et al. Impact of overweight on assisted reproduction treatment. Hum. Reprod. 11, 2523-2528 (2004).
Kelly- Weeder S, Cox CL. The impact of lifestyle risk factors on female infertility. Womens Health 44, 1-23 (2006).
Bellver J, Melo MA, Bosch E, Serra V, Remohí J, Pellicer A. Obesity and poor reproductive outcome: the potential role of the endometrium. Fertil. Steril. 88, 446-451 (2007).
• Largest study on obesity and IVF outcome with donated ova; highlights the potential role of the endometrium on the poor reproductive performance of overweight/ obese women from a clinical point of view.
Franks S. Genetic and environmental origins of obesity relevant to reproduction. Reprod. Biomed. Online 12, 526-531 (2006).
Mühlhaüsler BS. Programming of appetiteregulating neural network: a link between maternal overnutrition and the programming of obesity? J. Endocrinol. 19, 67-72 (2006).
Norman R, Noakes M, Wu R, Davies MJ, Moran L, Wang JX. Improving reproductive performance in overweight/obese women with effective weight management. Hum. Reprod. Update 10, 267-280 (2004).
•• Excellent review on weight management strategies for the improvement of reproductive performance in overweight/ obese women.
World Health Organization. Preventing and managing the global epidemic. Report of the World Health Organization on obesity. WHO, Geneva, Switzerland (1997).
Helsehurst N, Ells LJ, Simpson H, Batterham A, Wilkinson J, Summerbell CD. Trends in maternal obesity incidence rates, demographic predictors, and health inequalities in 36821 women over a 15.year period. BJOG 114, 187.194 (2007).
• Recent epidemiological data regarding the high and increasing prevalence of obesity in young women in developed countries.
Calle EE, Thun MJ, Petrelli JM, Rodriguez C, Heath CW Jr. Body mass index and mortality in a prospective cohort of U.S. adults. N. Engl. J. Med. 341, 1097.1105 (1999).
Bellver J, Busso C, Pellicer A, Remohi J, Simon C. Obesity and assisted reproductive technology outcomes. Reprod. Biomed. Online 12, 562.568 (2006).
Gambineri A, Pelusi C, Viccenati V, Pagotto U, Pasquali R. Obesity and polycystic ovarian syndrome. Int. J. Obes. Relat. Metab. Disord. 26, 883.896 (2002).
Rich-Edwards JW, Goldman MB, Willet WC et al. Adolescent body mass index and infertility caused by ovulatory disorder. Am.J. Obstet. Gynaecol. 171, 171.177 (1994).
Zaadastra BM, Seidell JC, Van Noord PA et al. Fat and female fecundity: prospective study of effect of body fat distribution on conception rates. BMJ 306, 484.487 (1993).
Crosignani PG, Ragni G, Parazzini F, Wyssling H, Lombroso G, Perotti L. Anthropometric indicators and response to gonadotrophin for ovulation induction. Hum. Reprod. 9, 420.423 (1994).
Wass P, Waldenstrom U, Rossner S, Hellberg D. An android body fat distribution in females impairs the pregnancy rate of in-vitro fertilisationembryo transfer. Hum. Reprod. 12, 2057.2060 (1997).
Moran LJ, Norman RJ. The obese patient with infertility: a practical approach to diagnosis and treatment. Nutr. Clin. Care 5, 290.297 (2002).
Pasquali R, Pelusi C, Genghini S, Cacciari M, Gambineri A. Obesity and reproductive disorders in women. Hum. Reprod. Update 4, 359.372 (2003).
Budak E, Fernández M, Bellver J, Cerveró A, Simón C, Pellicer A. Interactions of the hormones leptin, ghrelin, adiponectin, resistin and PYY3-36 with the reproductive system. Fertil. Steril. 85, 1563-1581 (2006).
•• Extensive review that summarizes the effects of hormones secreted from adipose tissue and gastrointestinal tract on several reproductive functions.
Pasquali R, Gambineri A. Metabolic effects of obesity on reproduction. Reprod. Biomed. Online 12, 542-551 (2006).
Gesink Law DC, Maclehose RF, Longnecker MP. Obesity and time to pregnancy. Hum. Reprod. 22, 414-420 (2007).
Poretsky L, Cataldo NA, Rosenwaks Z, Giudice L. The insulin-related ovarian regulatory system in health and disease. Endocr. Rev. 20, 535-582 (1999).
Moschos S, Chan JL, Mantzoros CS. Leptin and reproduction: a review. Fertil. Steril. 77, 433-444 (2002).
Fertlisch K, Sator M, Gruber D, Rücklinger E, Gruber CJ, Huber JC. Body mass index, follicle-stimulating hormone and their predictive value in in vitro fertilization. J. Assist. Reprod. Genet. 12, 431-436 (2004).
van der Steeg JW, Steures P, Eijkemans MJC et al. Obesity affects spontaneous pregnancy chances in subfertile, ovulatory women. Hum. Reprod. 23, 324-328 (2008).
Homburg R, Orvieto R, Bar-Hava I, Ben-Rafael Z. Serum levels of insulin-like growth factor-1, IGF binding protein-1 and insulin and the response to human menopausal gonadotrophins in women with polycystic ovary syndrome. Hum. Reprod. 11, 716-719 (1996).
Mulders AG, Laven JS, Eijkemans MJ, Hughes EG, Fauser BC. Patient predictors for outcome of gonadotrophin ovulation induction in women with normogonadotropic anovulatory infertility: a meta-analysis. Hum. Reprod. Update 9, 429-449 (2003).
Al-Azemi M, Omu FE, Omu AE. The effect of obesity on the outcome of infertility management in women with polycystic ovary syndrome. Arch. Gynecol. Obstet. 270, 205-210 (2004).
Dodson WC, Kunselman AR, Legro RS. Association of obesity with treatment outcomes in ovulatory infertile women undergoing superovulation and intrauterine insemination. Fertil. Steril. 86, 642-646 (2006).
Balen AH, Platteau P, Andersen AN et al. The influence of body weight on response to ovulation induction with gonadotrophins in 335 women with World Health Organization group II anovulatory infertility. BJOG 113, 1195-1202 (2006).
White DM, Polson DW, Kiddy D et al. Induction of ovulation with low-dose gonadotrophins in polycystic ovary syndrome: an analysis of 109 pregnancies in 225 women. J. Clin. Endocrinol. Metab. 81, 3821-3824 (1996).
Fedorcksák P, Dale P, Storeng R, Tanbo T, Abyholm T. The impact of obesity and insulin resistance on the IVF or ICSI in women with polycystic ovarian syndrome. Hum. Reprod. 6, 1086-1091 (2001).
Loveland JB, McClamrock HD, Malinow AM, Sharara FI. Increased body mass index has a deleterious effect on in vitro fertilization outcome. J. Assist. Reprod. Genet. 18, 382-386 (2001).
Wittemer C, Ohl J, Bailly M, Bettahar- Lebugle K, Nisand I. Does body mass index of infertile women have an impact on IVF procedure and outcome? J. Assist. Reprod. Genet. 17, 547-552 (2000).
Loh S, Wang JX, Mattheus CD. The influence of body mass index, basal FSH and age on the response to gonadotrophin stimulation in non-polycystic ovarian syndrome patients. Hum. Reprod. 17, 1207-1211 (2002).
Mulders AG, Laven JS, Imani B, Eijkemans MJ, Fauser BC. IVF outcome in anovulatory infertility (WHO group 2) - including polycystic ovary syndrome - following previous unsuccessful ovulation induction. Reprod. Biomed. Online 7, 50-58 (2003).
van Swieten E, Leew-Harmsen L, Badings E, van der Linden PJQ. Obesity and clomiphene challenge test as predictors of outcome of in vitro fertilization and intracytoplasmic sperm injection. Gynecol. Obstet. Invest. 59, 220-224 (2005).
Kably-Ambe A, Barrón-Vallejo J, Limón- Luque L. Effect of body mass index and follicular synchrony in the ovarian response to ovulation induction with menotropins. Int. J. Fertil. 44, 156-159 (1999).
Carrell DT, Jones KP, Peterson CM, Aoki V, Emery BR, Campbell BR. Body mass index is inversely related to intrafollicular hCG concentrations, embryo quality and IVF outcome. Reprod. Biomed. Online 3, 109-111 (2001).
Nichols J, Crane M, Higdon H, Miller P; Boone W. Extremes of body mass index reduce in vitro fertilization pregnancy rates. Fertil. Steril. 79, 645-657 (2003).
Lashen H, Ledger W, Bernal AL, Barlow D. Extremes of body mass do not adversely affect the outcome of superovulation and in-vitro fertilization. Hum. Reprod. 14, 712.715 (1999).
Sodestrom-Antilla V, Foudila T, Hovatta O. A randomized comparative study of highly purified follicle stimulating hormone and human menopausal gonadotrophin for ovarian hyperstimulation in an oocyte donation programme. Hum. Reprod. 11, 1864.1170 (1996).
Fridstrom M, Sjoblom P, Pousette A, Hillensjo T. Serum FSH levels in women with polycystic ovary syndrome during ovulation induction using down-regulation and urofollitropin. Eur. J. Endocrinol. 136, 488.492 (1997).
Hillier SG. The Parkes lecture: controlled ovarian stimulation in women. J. Reprod. Fertil. 120, 201.210 (2000).
Imani B, Eijkemans MJ, Faessen GH, Bouchard P, Giudice LC, Fauser BC. Prediction of the follicle stimulating hormone threshold for gonadotrophin induction of ovulation in normogonadotropic anovulatory infertility: an approach to increase safety and efficiency. Fertil. Steril. 7, 83.90 (2002).
Zachow RJ, Magoffin DA. Direct intraovarian effects of leptin: impairment of synergistic action of insulin-like growth factor-I in follicle-stimulating hormonedependent estradiol-17 ƒÀ production by rat ovarian granulosa cells. Endocrinology 138, 847.850 (1997).
Agarwal SK, Vogel K, Weitsman SR, Magoffin DA. Leptin antagonizes the insulin-like growth factor-I augmentation of steroidogenesis in granulosa and teca cells of the human ovary. J. Clin. Endocrinol. Metab. 84, 1072.1076 (1999).
Fedorcsak P, Storeng R, Dale PO et al. Leptin and leptin binding activity in the preovuatory follicle of polycystic ovary syndrome patients. Scand. J. Clin. Lab. Invest. 60, 649.655 (2000).
Lewis CG, Warnes GM, Wang XJ, Matthews CD. Failure of body mass index or body weight to influence markedly the response to ovarian hyperstimulation in normal cycling women. Fertil. Steril. 53, 1097.1099 (1990).
Fedorcsak P, Storeng R, Dale PO, Tanbo T, Abyholm T. Impaired insulin action on granulosa-lutein cells in women with polycystic ovary syndrome and insulin resistance. Gynaecol. Endocrinol. 14, 327.336 (2000).
Kawamura K, Sato N, Fukuda J et al. Leptin promotes the development of mouse preimplantation embryos in vitro. Endocrinology 143, 1922-1931 (2002).
Fedorcsák P, Storeng R. Effects of leptin and leukemia inhibitory factor on preimplantation development and STAT3 signaling of mouse embryos in vitro. Biol. Reprod. 69, 1531-1538 (2003).
Castellucci M, De Matteis R, Meisser A et al. Leptin modulates extracellular matrix molecules and metalloproteinases: possible implications for trophoblast invasion. Mol. Hum. Reprod. 6, 951-958 (2000).
Alfer J, Muller-Schottle F, Cassen-Linke I et al. The endometrium as a novel target for leptin: differences in fertility and subfertility. Mol. Hum. Reprod. 6, 595-601 (2000).
Gonzalez RR, Caballero-Campo P, Jasper M et al. Leptin and leptin receptor are expressed in the human endometrium and endometrial leptin secretion is regulated by the human blastocyst. J. Clin. Endocrinol. Metab. 58, 4883-4888 (2000).
Dechaud H, Anahory T, Reyftmann L, Loup V, Hamamah S, Hedon B. Obesity does not adversely affect results in patients who are undergoing in vitro fertilization and embryo transfer. Eur. J. Obstet. Gynecol. Reprod. Biol. 127, 88-93 (2006).
Dokras A, Baredziak L, Blaine J, Syrop C, Van Voorhis BJ, Sparks A. Obstetric outcomes after in vitro fertilization in obese and morbidly obese women. Obstet. Gynecol. 108, 61-69 (2006).
Ku SY, Kim SD, Jee BC et al. Clinical efficacy of body mass index as predictor of in vitro fertilization and embryo transfer outcomes. J. Korean. Med. Sci. 21, 300-303 (2006).
Wang J, Davies M, Norman R. Body mass and probability of pregnancy during assisted reproduction treatment: retrospective study. BMJ 321, 1320-1321 (2000).
Maheshwari A, Stofberg L, Bhattacharya S. Effect of overweight and obesity on assisted reproductive technology - a systematic review. Hum. Reprod. Update 13, 433-444 (2007).
•• Recent systematic review that shows a lower pregnancy rate and increased miscarriage rate following IVF in overweight and obese women.
Hamilton-Fairley D, Kiddy D, Watson H, Paterson C, Franks S. Association of moderate obesity with a poor pregnancy outcome in women with polycystic ovary syndrome treated with low dose gonadotrophin. BJOG 99, 128-131 (1992).
Lashen H, Fear H, Sturdee D. Obesity is associated with increased risk of first trimester and recurrent miscarriage: matched case control study. Hum. Reprod. 19, 1644-1646 (2004).
Ramsay JE, Greer I, Sattar N. Obesity and reproduction. BMJ 333, 1159-1162 (2006).
Fedorcsak P, Storeng R, Dale P, Tanbo T, Abyholm T. Obesity is a risk factor for early pregnancy loss after IVF or ICSI. Acta Obstet. Gynecol. Scand. 79, 43-48 (2000).
Wang JX, Davies M, Norman RJ. Obesity increases the risk of spontaneous abortion during infertility treatment. Obes. Res. 10, 551-554 (2002).
Bussen S, Sütterlin M, Steck T. Endocrine abnormalities during the follicular phase in women with recurrent spontaneous abortion. Hum. Reprod. 14, 18-20 (1999).
Cano F, Garcia-Velasco JA, Millet A, Remohí J, Simón C, Pellicer A. Oocyte quality in polycystic ovaries revisited: identification of a particular subgroup of women. J. Assist. Reprod. Genet. 14, 254-261 (1997).
Wang J, Davies M, Norman R. Polycystic ovarian syndrome and the risk of spontaneous abortion following assisted reproductive technology treatment. Hum. Reprod. 16, 2606-2609 (2001).
Hall F, Neubert A. Obesity and pregnancy. Obstet. Gynaecol. Surv. 4, 253-260 (2005).
Bellver J, Pellicer A. Impact of obesity on spontaneous abortion. Am. J. Obstet. Gynecol. 190, 293-294 (2004).
Linsten A, Pasker-de Jong P, de Boer E et al. Effects of subfertility cause, moking and body weight on the success rate of IVF. Hum. Reprod. 20, 1867-1875 (2005).
Metwally M, Ong KJ, Ledger WL, Li TC. Does high body mass index increase the risk of miscarriage after spontaneous and assisted conception? A meta-analysis of the evidence. Fertil. Steril. PMID: 18068166 (2007) (Epub ahead of print).
• Recent meta-analysis that shows an increased risk of miscarriage in obese women undergoing assisted reproduction.
Orvieto R, Ben-Rafael Z, Ashkenazi J et al. Outcome of pregnancies derived from assisted reproductive technologies: IVF versus ICSI. J. Assist. Reprod. Genet. 17, 385-387 (2000).
Valbuena D, Jasper M, Remohí J, Pellicer A, Simón C. Ovarian stimulation and endometrial receptivity. Hum. Reprod. 14, 107-111 (1999).
Andreasen R, Andersen M, Schantz A. Obesity and pregnancy. Acta Obstet. Gynecol. Scand. 83, 1022-1029 (2004).
Linné Y. Effects of obesity on women’s reproduction and complications during pregnancy. Obes. Rev. 5, 137-143 (2004).
Waller DK, Mills JL, Simpson JP et al. Are obese women at higher risk for producing malformed offspring? Am. J. Obstet. Gynaecol. 170, 541-548 (1994).
Watkins ML, Rasmussen SA, Honein MA, Botto LD, Moore CA. Maternal obesity and risk for birth defects. Pediatrics 111, 1152-1158 (2003).
Werler MM, Louik C, Shapiro S, Mitchell AA. Prepregnant weight in relation to risk of neural tube defects. JAMA 275, 1089-2092 (1996).
Wolfe HM, Sokol RJ, Martier SM, Zador IE. Maternal obesity: a potential source of error in sonographic prenatal diagnosis. Obstet. Gynecol. 76, 339-342 (1990).
Motjabai R. Body mass index and serum folate in childbearing age women. Eur. J. Epidemiol. 19, 1029-1036 (2004).
Callaway LK, Prins JB, Chang AM, McIntyre HD. The prevalence and impact of overweight and obesity in an Australian obstetric population. Med. J. Aust. 184, 56-59 (2006).
Catalano PM. Management of obesity in pregnancy. Obstet. Gynecol. 109, 419-433 (2007).
•• Interesting review about the risks and management of obesity during pregnancy.
Chan CC, Ng EH, Chan MM et al. Bioavailability of hCG after intramuscular or subcutaneous injection in obese and non-obese women. Hum. Reprod. 18, 2294-2297 (2003).
Krizanovská K, Ulcová- Gallová Z, Bouse V, Rokyta C. Obesity and reproductive disorders. Sb. Lek. 103, 517-526 (2002).
Metwally M, Cutting R, Tipton A, Skull J, Ledger WL, Li TC. Effect of increased body mass index on oocyte and embryo quality in IVF patients. Reprod. Biomed. Online 15, 532-538 (2007).
Ertzeid G, Storeng R. Adverse effects of gondotrophin treatment on pre- and postimplantation development in mice. J. Reprod.Fertil. 96, 649-655 (1992).
Ertzeid G, Storeng R, Lyberg T. Treatment with gondotrophins impaired implantation and fetal development in mice. J. Assist. Reprod. Genet. 10, 286-291 (1993).
Katagiri S, Moon YS, Yuen BH. The role for the uterin insulin-like gowth factor I in early embryonic loss after superovulation in the rat. Fertil. Steril. 65, 426-36 (1996).
Horcajadas JA, Riesewijk A, Polman J et al. Effect of controlled ovarian hyperstimulation in IVF on endometrial gene expression profiles. Mol. Hum. Reprod. 11, 195-205 (2005).
Simón C, Oberyé J, Bellver J et al. Similar endometrial development in oocyte donors treated with either high- or standard-dose GnRH antagonist compared with treatment with a GnRH agonist or in natural cycles. Hum. Reprod. 20, 3318- 3327 (2005).
Jansen RP. Spontaneous abortion incidence in the treatment of infertility. Am. J. Obstet. Gynaecol. 143, 451-473 (1982).
Jensen TK, Andersson AM, Jorgensen N et al. Body mass index in relation to semen quality and reproductive hormones among 1558 Danish men. Fertil. Steril. 82, 863-870 (2004).
Koloszar S, Fejes I, Zavaczki Z, Daru J, Pal A. Effect of body weight on sperm concentration in normozoospermic males. Arch. Androl. 51, 299-304 (2005).
Nguyen RHN, Wilcox AJ, Skjaerven R, Baird D. Men’s body mass index and infertility. Hum. Reprod. 22, 2488-2493 (2007).
Ramlau-Hansen CH, Thulstrup AM, Nohr EA, Bonde JP, Sorensen TIA, Olsen J. Subfecundity in overweight and obese couples. Hum. Reprod. 22, 1634-1637 (2007).
Metwally M, Tuckerman EM, Laird SM, Ledger WL, Li TC. Impact of high body mass index on endometrial morphology and function in the peri-implantation period in women with recurrent miscarriage. Reprod. Biomed. Online 14, 328-334 (2007).
Bellver J, Rossal L, Bosch E et al. Obesity and the risk of spontaneous abortion after oocyte donation. Fertil. Steril. 79, 1136-1140 (2003).
Wattanakumtornkul S, Damario M, Hall S, Thornhill AR, Tummon IS. Body mass index and uterine receptivity in the oocyte donation model. Fertil. Steril. 80, 336-340 (2003).
Styne-Gross A, Elkind-Hirsch K, Scott R. Obesity does not impact implantation rates or pregnancy outcome in women attempting conception through oocyte donation. Fertil. Steril. 83, 1629-1634 (2005).
Tummon I, Hall S, Thornhill A, Wattanakumtornkul S, Damario M. Reply to: BMI - the fragility of fertility. Fertil. Steril. 81, 727-8 (2004).
Soares SR, Troncoso C, Bosch E et al. Age and uterine receptiveness: predicting the outcome of oocyte donation cycles. J. Clin. Endocrinol. Metab. 90, 4399- 4404 (2005).
Bellver J, Bosch E, Remohí J, Pellicer A. Evidence-based medicine is gaining momentum. Fertil. Steril. 84, 1555-1556 (2005).
Huber-Buchholz MM, Carey DG, Norman RJ. Restoration of reproductive potential by lifestyle modification in obese polycystic ovary syndrome: role of insulin sensitivity and luteinizing hormone. J. Clin. Endocrinol. Metab. 84, 1470-1474 (1999).
Pasquali R, Antenucci D, Casimirri F, Venturoli S, Paradisi R. Clinical and hormonal characteristics of obese amenorrheic, hyperandrogenic women before and after weight loss. J. Clin. Endocrinol. Metab. 68, 173-179 (1989).
Moran LJ, Noakes M, Clifton PM, Tomlinson L, Norman RJ. Dietary composition in restoring reproductive and metabolic physiology in overweight women with polycystic ovary syndrome. J. Clin. Endocrinol. Metab. 88, 812-819 (2003).
Kiddy DS, Hamilton-Fairley D, Bush A et al. Improvement on endocrine and ovarian function during dietary treatment of obese women with polycystic ovary syndrome. Clin. Endocrinol. (Oxf.) 36, 105-111 (1992).
Clark AM, Ledger W, Galletley C et al. Weight loss results in significant improvement in pregnancy and ovulation rates in anovulatory obese women. Hum. Reprod. 10, 2705-2712 (1995).
Moran LJ, Norman RJ. The obese patient with infertility: a practical approach to diagnosis and treatment. Nutr. Clin. Care 5, 290-297 (2002).
Clark AM, Thornley B, Tomlinson L, Galletley C, Norman RJ. Weight loss in obese infertile women results in improvement in reproductive outcome for all forms of fertility treatment. Hum. Reprod. 13, 1502-1505 (1998).
Metwally M, Li TC, Ledger WL. The impact of obesity on female reproductive function. Obes. Rev. 8, 515-523 (2007).
Pirwany IR, Yates RW, Cameron IT, Fleming R. Effects of the insulin sensitizing drug metformin on ovarian function, follicular growth and ovulation rate in obese women with oligomenorrhoea. Hum. Reprod. 14, 2963-2968 (1999).
Harbone LR, Sattar N, Norman JE, Fleming R. Metformin and weight loss in obese women with polycystic ovary syndrome: comparison of doses. J. Clin. Endocrinol. Metab. 90, 4593-4598 (2005).
Tang T, Glanville J, Hayden CJ, White D, Barth JH, Balen AH. Combined lifestyle modification and metformin in obese patients with polycystic ovary syndrome. A randomized, placebo-controlled, doublebind multicentre study. Hum. Reprod. 21, 80-89 (2006).
Pasquali R, Gambineri A, Biscotti D et al. Effect of long-term treatment with metformin added to hypocaloric diet on body composition, fat distribution, and androgen and insulin levels in abdominally obese women with and without the polycystic ovary syndrome. J. Clin. Endocrinol. Metab. 85, 2767-2774 (2000).
Maciel GA, Soares Jr JM, Alves da Motta EL, Abi Haidar M, de Lima GR, Baracat EC. Nonobese women with polycystic ovary syndrome respond better than obese women to treatment with metformin. Fertil. Steril. 81, 355-60 (2004).
Moll E, Bossuyt PM, Korevaar JC, Lambalk CB, van der Veen F. Effect of clomiphene citrate plus metformin and clomiphene citrate plus placebo on induction of ovulation in women with newly diagnosed polycystic ovary syndrome: randomised double blind clinial trial. BMJ 332, 1485 (2006).
Legro RS, Barnhart HX, Schlaff WD et al. Clomiphene, metformin, or both for infertility in the polycystic ovary syndrome. N. Engl. J. Med. 356, 551-566 (2007).
Moll E, van der Veen F, van Wely M. The role of metformin in polycystic ovary syndrome: a systematic review. Hum. Reprod. Update 13, 527-537 (2007).
Deitel M, Stone E, Kassam HA, Wilk Ej, Sutherland DJ. Gynecologic-obstetric changes after loss of massive excess weight following bariatric surgery. J. Am. Coll. Nutr. 7, 147-153 (1988).
Bilenka B, Ben-Shlomo I, Cozacov C, Gold CH, Zohar S. Fertility, miscarriage and pregnancy after vertical banded gastroplasty operation for morbid obesity. Acta Obstet. Gynecol. Scand. 74, 42-44 (1995).
Steinbrook R. Surgery for severe obesity. N. Engl. J. Med. 350, 1454-1460 (2004).
Mehri ZO. Weight loss by bariatric surgery and subsequent fertility. Fertil. Steril. 87, 430-432 (2007).
• Literature appraisal regarding the role of bariatric surgery in the management of the morbidly obese infertile patient.
Flum DR, Salem L, Elrod JA, Dellinger EP, Cheadle A, Chan L. Early mortality among Medicare beneficiaries undergoing bariatric surgical procedures. J. Am. Med. Assoc. 294, 1903-1908 (2005).
Patel JA, Colella JJ, Esaka E, Patel NA, Thomas RL. Improvement in infertility and pregnancy outcomes after weight loss surgery. Med. Clin. North. Am. 91, 515-528 (2007).
Sheiner E, Menes TS, Silverberg D et al. Pregnancy outcome of patients with gestational diabetes mellitus following bariatric surgery. Am. J. Obstet. Gynecol. 194, 431-435 (2006).
Klonoff-Cohen H. Female and male lifestyle habits and IVF: what is known and unknown. Hum. Reprod. Update 11, 180-204 (2005).
Smeenk JMJ, Verhaak CM, Eugster A, van Minnen A, Zielhuis GA, Braat DDM. The effect of anxiety and depression on the outcome of in-vitro fertilisation. Hum. Reprod. 16, 1420-1423 (2001).
Smeenk JMJ, Verhaak CM, Vingerhoets AJJM et al. Stress and outcome success in IVF: the role of self-reports and endocrine variables. Hum. Reprod. 20, 991-996 (2005).
Schommer NC, Hellhammer DH, Kirschbaum C. Dissociation between reactivity of the hypothalamus-pituitary- adrenal axis and the sympathetic-adrenal- medullary system to repeated psychosocial stress. Psychosom. Med. 3, 450-460 (2003).
Boivin J, Takefman J. Stress levels across stages of in vitro fertilization in subsequently pregnant and nonpregnant women. Fertil. Steril. 64, 802-810 (1995).
Luppa P, Muller B, Jacob K et al. Variations of steroid hormone metabolites in serum and urine in polycystic ovary syndrome after nafarelin stimulation: evidence for an altered corticoid excretion. J. Clin. Endocrinol. Metab. 80, 280-288 (1995).
Schenker JG, Meirow D, Schenker E. Stress and human reproduction. Eur. J. Obstet. Gyn. Reprod. Biol. 45, 1-8 (1992).
Michael AE, Cooke BA. A working hypothesis for the regulation of steroidogenesis and germ cell development in the gonads by glucocorticoids and 11 β-hydroxysteroid dehydrogenase (11 βHSD). Moll. Cell. Endocrinol. 100, 55-63 (1994).
Lewicka S, von Hagens C, Hettinger U et al. Cortisol and cortisone in human follicular fluid and serum and the outcome of IVF treatment. Hum. Reprod. 18, 1613-1617 (2003).
Csemiczky G, Landgren BM, Collins A. The influence of stress and state anxiety on the outcome of IVF-treatment; psychological and endocrinological assessment of Swedish women entering IVF-treatment. Acta Obstet. Gynecol. Scand. 79, 113-118 (2000).
Gallinelli A, Roncaglia R, Matteo ML, Ciaccio I, Volpe A, Facchinetti F. Immunological changes and stress are associated with different implantation rates in patients undergoing in vitro fertilizationembryo transfer. Fertil. Steril. 76, 85-91 (2001).
Wischmann TH. Psychogenic infertility - myths and facts. J. Assist. Reprod. Genet. 20, 485-494 (2003).
de Klerk C, Hunfeld HAN, Heijnen EMEW et al. Low negative affect prior to treatment is associated with a decreased chance of live birth from a first IVF cycle. Hum. Reprod. 23, 112-116 (2008).
Klonoff-Cohen H, Chu E, Natarajan L, Sieber W. A prospective study of stress among women undergoing in vitro fertilization or gamete intrafallopian transfer. Fertil. Steril. 76, 675-687 (2001).
Lintsen AM, Veerhak C, Eijkemans MJ, Braat DD. The prognostic value of psychological factors on the outcome of IVF. Hum. Reprod. 21, i71 (2006).
Anderheim L, Holter H, Bergh C, Möller A. Does psychological stress affect the outcome of in vitro fertilization? Hum. Reprod. 20, 2969-2975 (2005).
Cooper BC, Gerber JR, McGettrick AL, Johnson JV. Perceived infertility-related stress correlates with in vitro fertilization outcome. Fertil. Steril. 88, 714-717 (2007).
Panagopoulou E, Vedhara K, Gaintarzti C, Tarlatzis B. Emotionally expressive doping reduces pregnancy rates in patients undergoing in vitro fertilization. Fertil. Steril. 86, 672-677 (2006).
Su HI, Barnhart KT. Lifestyle and environmental risk factors for infertility. Exp. Rev. Obstet. Gynecol. 1, 215-229 (2006).
Becker U, Tonnesen H, Kass-Claesson N, Gluud C. Menstrual disturbances and fertility in chronic alcoholic women. Drug Alcohol Depend. 24, 75-82 (1989).
Grodstein F, Goldman MB, Cramer DW. Infertility in women and moderate alcohol use. Am. J. Public Health 84, 1429-1432 (1994).
Klonoff-Cohen H, Lam-Kruglick MA, Gonzalez C. Effects of maternal and paternal alcohol consumption on the success rates of in vitro fertilization and gamete intrafallopian transfer. Fertil. Steril. 79, 330-339 (2003).
Kaufman MH. The teratogenic effects of alcohol following exposure during pregnancy, and its influence on the chromosome constitution of the preovulatory egg. Alcohol 32, 113-128 (1997).
Fazakas-Todea I. The effect of ethanol upon early development in mice and rats. XX. The effect of chronic biparental beer intake in mice upon early implantation events. Rom. J. Morphol. Embryol. 41, 7-12 (1995).
Stanton CK, Gray RH. Effects of caffeine on delayed conception. Am. J. Epidemiol. 142, 1322-1329 (1995).
Wilcox A, Weinberg C, Baird D. Caffeinated beverages and decreased fertility. Lancet 2, 1453-1456 (1988).
Klonoff-Cohen H, Bleha J, Lam-Kruglick P. A prospective study of the effects of female and male caffeine consumption on the reproductive end points of IVF and gamete intra-Fallopian transfer. Hum. Reprod. 17, 1746-1754 (2002).
Hatch EE, Bracken MB. Association of delayed conception with caffeine consumption. Am. J. Epidemiol. 138, 1082-1092 (1993).
Bolumar F, Olsen J, Rebagliato M, Bisanti L; European Study Group on Infertility Subfecundity. Caffeine intake and delayed conception: a European multicenter study on infertility and subfecundity. Am. J. Epidemiol. 145, 324-334 (1997).
Parazzini F, Chatenoud L, Benzi G et al. Coffee and alcohol intake, smoking and risk of multiple pregnancy. Hum. Reprod. 11, 2306-2309 (1996).
Marshburn PB, Sloan CS, Hammond MG. Semen quality and association with coffee drinking, cigarette smoking, and ethanol consumption. Fertil. Steril. 52, 162-165 (1989).
Hammitt DG, Bedja E, Rogers PR, Syrop CH, Donovan JF, Williamson RA. Comparison of motility stimulants for cryopreserved human semen. Fertil. Steril. 52, 495-502 (1989).
Santos IS, Victoria CG, Huttly S, Morris S. Caffeine intake and pregnancy outcomes: a meta-analytic review. Cadernos de Sude Publica 14, 523-530 (1998).
Higdon JV, Frei B. Coffee and health: a review of recent human research. Crit. Rev. Food. Sci. Nutr. 46, 101-123 (2006).
Klonoff-Cohen H, Natarajan L, Chen RV. A prospective study of the effects of female and male marijuana use on in vitro fertilization (IVF) and gamete intrafallopian transfer (GIFT) outcomes. Am. J. Obstet. Gynecol. 194, 369-376 (2006).
Taylor AH, Ang C, Bell SC, Konje JC. The role of the endocannabinoid system in gametogenesis, implantation and early pregnancy. Hum. Reprod. Update 13, 501-513 (2007).
Viveros MP, Llorente R, Moreno E, Marco EM. Behavioral and neuroendocrine effects of cannabinoids in critical development periods. Behav. Pharmacol. 16, 353-362 (2005).
Frank DA, Zuckerman BS, Amaro H et al. Cocaine use during pregnancy: prevalence and correlates. Pediatrics 82, 888-895 (1988).
Ness RB, Grisso JA, Hirschinger N et al. Cocaine and tobacco use and the risk of spontaneous abortion. N. Engl. J. Med. 340, 333-339 (1999).
Joesoef MR, Beral V, Aral SO, Rolfs RT, Cramer DW. Fertility and use of cigarettes, alcohol, marijuana, and cocaine. Ann. Epidemiol. 3, 592-594 (1993).
Kaufmann RA, Savoy-Moore RT, Sacco AG, Subramanian MG. The effect of cocaine on oocyte development and the follicular microenvironment in the rabbit. Fertil. Steril. 54, 921-926 (1990).
Little BB, Shell LM, Trimmer KJ et al. Peripartum cocaine use and adverse pregnancy outcome. Am. J. Hum. Biol. 11, 598-602 (1999).
International Obesity Task Force and European Association for the Study of Obesity. Obesity in Europe. The case for action. London. www.iotf.org (2002).
National survey on drug use and health (2003). www.oas.samhsa.gov/nhsda.htm

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Alcohol

Alcohol is widely consumed all over the globe. In the USA, for example, a report carried out in 2004 found that 50% of the population over the age of 12 years and 11% of pregnant women consumed alcohol, while 7% of the population were heavy drinkers.^[168] Different studies have established a relationship between moderate-to-severe alcohol intake and infertility in both men and women and poor obstetric outcome, in a dose-dependent manner.^[12,169-171]

However, only one study has explored female and male alcohol consumption as a primary risk factor for IVF.^[171] In this study of 221 couples with female infertility, the percentage of drinkers was high (20-40% for women and 40-60% for men). Female alcohol consumption was associated with a 13% (95% CI: 2-23%) decrease in the number of eggs aspirated for one additional drink (12 g alcohol) per day consumed during the year before the IVF or GIFT attempt was performed; an increase in the risk of failing to achieve a pregnancy by 2.86-times (95% CI: 0.99-8.24) and 4.14-times (95% CI: 0.91-18.92) with consumption 1 month or 1 week before the procedure, respectively; and an increase in the risk of miscarriage by 2.21-times (95% CI: 1.09-4.49) with consumption 1 week before the procedure. For men, despite no apparent alteration in sperm quality, one additional drink per day increased the risk of not achieving a live birth by 2.28 (95% CI: 1.08-4.80) to 8.32 (95% CI: 1.82-37.97), depending on the time period. Beer consumption also affected live births (OR: 5.49-45.64). These results were partially due to the increased risk of miscarriage by 2.70- to 38.04-times for men who drank in the month before and during the IVF or GIFT procedure.

Taking into account the lack of studies regarding alcohol and IVF outcome and the small number of participants that continue to consume alcohol around the time of the ART treatment, the conclusions obtained in this work should be considered with caution. However, it seems that alcohol intake, especially in high doses and near the time of conception, could impair both oocyte and sperm quality and, subsequently, embryo competence and the final result of the IVF treatment. In mice, exposure to alcohol has been shown to induce chromosome segregation errors in the ovulated cycle, producing aneuploid embryos after fertilization with a considerably high chance of spontaneous abortion during the first trimester of pregnancy.^[172] Similarly, chronic biparental beer intake in mice had a noxious effect on implantation, manifested by delayed attachment of blastocysts, absence of decidual reaction and desynchronization of the implantation process.^[173]

Until the medical literature provides more evidence about this relationship, reducing alcohol intake or better ceasing consumption is most certainly to be recommended to couples undergoing ART, particularly for more than 1 month before the attempt in order to maximize the chances of success. This modification of habits should be maintained during pregnancy to increase the chances of a healthy live born.