Intra-patient analysis of individual weight gain or loss between IVF cycles: cycle now and transfer later
Authors: Fouks Yuval , Vaughan Denis A , Neuhausser Werner , Cohen Yoni , Penzias Alan S , Sakkas Denny 
Published: November 2023

Abstract

STUDY QUESTION
What is the impact of clinically significant weight change on outcomes related to IVF cycle performance?

SUMMARY ANSWER
While individual weight loss did not significantly impact ovarian response to stimulation or other cycle outcome parameters in our study, some positive associations were found for individual weight gain.

WHAT IS KNOWN ALREADY
The role of weight-change in patients undergoing IVF has been largely studied by comparing weight loss in different cohorts of patients stratified by a static BMI. Specifically, obesity has been extensively studied in relation to its negative effects on assisted or unassisted conception outcomes and ovulatory function. Previous research has shown conflicting results, while BMI, which is commonly used as a marker of obesity, may not accurately reflect the underlying factors affecting fertility in obese patients.

STUDY DESIGN, SIZE, DURATION
This study utilized a retrospective within-patient repeated measurement analysis design to assess the impact of weight change on IVF outcomes in cycles where all embryos were cryopreserved at the blastocyst stage for transfer at a later date.

PARTICIPANTS/MATERIALS, SETTING, METHODS
The study was conducted at an academically affiliated fertility center. The data included 961 women who underwent at least two IVF cycles between December 2014 and June 2020, with documented short-term weight gain (n = 607) or weight loss (n = 354) within 1 year from their initial IVF cycle. Multivariable generalized estimating equations (GEE) and generalized linear mixed models (GLMM) were employed to assess associations between weight change and outcomes across cycles.

MAIN RESULTS AND THE ROLE OF CHANCE
The multivariable models indicated that weight loss did not show any significant associations with the numbers of oocytes retrieved, or mature oocytes, the fertilization rate or the blastulation rate. However, weight gain demonstrated a minor positive association with the number of oocytes retrieved in both GEE models (coefficient: 0.01, 95% CI: 0.00–0.01) and GLMM models (0.01, 95% CI: 0.01–0.00). There was also a potential increase in the fertilization rate with weight gain, as indicated by a positive coefficient in both GEE models (coefficient: 0.01, 95% CI: 0.00–0.02) and GLMM models (coefficient: 0.01, 95% CI: 0.00–0.01). However, the association between weight gain and the embryo blastulation rate was not statistically significant in any model.

LIMITATIONS, REASONS FOR CAUTION
This study focused on cycle performance parameters instead of reproductive outcomes, which restricted our ability to evaluate the impact of weight change on cumulative live birth rates. Additionally, the study did not account for variables such as stimulation protocols, potentially introducing confounding factors and limiting the generalizability of the results.

WIDER IMPLICATIONS OF THE FINDINGS
Although obesity is associated with adverse obstetrical risks, there is less evidence of adverse reproductive outcomes in IVF cycles. We therefore recommend that an IVF cycle should not be delayed due to weight, so that the patient is not adversely affected by increasing age. The IVF cycle should aim to freeze all embryos, so that embryo transfer can then occur after weight loss, so as to limit the recognized obstetrical risks.

STUDY FUNDING/COMPETING INTEREST(S)
The study was not funded and there were no competing interests.

TRIAL REGISTRATION NUMBER
N/A.