You are leaving Medscape Education
Cancel Continue
Log in to save activities Your saved activities will show here so that you can easily access them whenever you're ready. Log in here CME & Education Log in to keep track of your credits.

Box 1.  

Deleterious Effects Described in Obese Women Undergoing IVF

Impact of Bodyweight and Lifestyle on IVF Outcome: Five-year View


Five-year View

The methodology for studying the implication of lifestyle factors on IVF outcome needs to be improved. A thorough evaluation of the most important IVF outcomes, such as healthy live birth rate and neonatal characteristics, is essential. Moreover, studies should consider lifetime versus procedural timing of a lifestyle habit, as well as its quantity, frequency, duration and coexistence with other habits. Future studies should include a comparison group, consider the male lifestyle and adjust for potentially confounding factors, as those related to the ovarian stimulation procedure. They should have a longitudinal design, adequate sample sizes and a thorough follow-up. Metabolites of the substances under investigation should be analyzed throughout the procedure in order to obtain more reliable conclusions.

Future studies about psychological stress and IVF should measure plasma and follicular levels of stress hormones such as prolactin and cortisol to clarify the role of these hormonal mechanisms, and determine the neuroendocrine and physiological pathways that mediate effects on IVF outcomes.

Prospective trials analyzing the effect of under/overweight and reproduction are difficult to perform. One feasible approach is to carry out randomized trials that evaluate weight management measures and the subsequent beneficial effect on the reproductive outcome. In the field of basic research, new criteria for assessing embryos based on their morphology or on their products (e.g., by proteomics or metabolomics) could help to ascertain the negative effect of the endocrine and metabolic environment in which embryos develop in women with altered bodyweight and composition. On other hand, gene expression analysis of the endometrium using microarray technology is a promising option for correlating clinical findings regarding implantation.

Based on current findings, weight reduction through diet and exercise, and often helped by psychological support, is advisable in all obese patients. Only in refractory cases should appetite suppressants and bariatric surgery be considered. Antiobesity drugs that act on the central melacortin pathway or endocannabinoid receptor are now being developed, and perhaps the combination of several drugs could lead to effective antiobesity strategies in the future, with positive consequences for the field of reproduction. Obesity is also increasingly suffered among children. Interventions in the early life may have a great impact on adult health. Long-term follow-up of childhood obesity and the impact of early interventions for weight reduction on the adult manifestation of reproductive disease are awaited.

  • Print