Obesity and IVF outcomes - EMBΡΥO ART肥胖与IVF结局的维护ΡΥO艺术.pptVIP

obesity and pregnancy rates BMI 30 vs 20-30: lower pregnancy rates Maheshwari et al, 2007 OBESITY AND IVF - 2010 E. MAKRAKIS obesity and pregnancy rates Maheshwari et al, 2007 OW and OB women face a reduced likelihood of pregnancy theory of inverted U: low BMI has similar detrimental effect on pregnancy rates Metwally et al, 2007 no effect of BMI on clinical pregnancy rates Martinuzzi et al, 2008 trend to lower implantation and ongoing pregnancy rates in PCOS patients with high BMI Sneed et al, 2008 analysis of the interaction BMIxAGE effect on pregnancy rates in younger ages (35 years) BMI has a significant negative impact on implantation, pregnancy, and livebirth rates it may be reasonable to delay treatment in younger women and recommend weight loss OBESITY AND IVF - 2010 E. MAKRAKIS obesity and pregnancy rates in obese: lower implantation, pregnancy, livebirth rates Bellver et al, 2009 in overweight: lower implantation, pregnancy, livebirth rates raising BMI by 1 unit: odds for pregnancy decrease by 0.98 reducing BMI by 1 unit: odds for pregnancy increase by 1.19 OBESITY AND IVF - 2010 E. MAKRAKIS difficult embryotransfers (ET)? ET under ultrasound guidance improves pregnancy rates proven [Cochrane Review, 2007] the quality of visualization correlates with pregnancy rates if excellent/good: 41.5% - if fair/poor: 16.7% [Wood et al,2000] in obese: difficulty to see the air-bubble of the catheter and tendency for blood in the catheter tip [Martinuzzi et al, 2008] impaired oocyte-embryo quality? impaired endometrial receptivity? mechanisms for reduced pregnancy rates tip of external catheter sheath placement of embryos OBESITY AND IVF - 2010 E. MAKRAKIS obesity and oocyte quality Carrel et al, 2001 fewer metaphase II (MII) oocytes in BMI≥30 vs. BMI 20-30 Whittemer et al, 2000 fewer metaphase II (MII) oocytes in BMI≥25 vs. BMI 20-25 fewer mature oocytes by nuclear assessment in BMI≥40 Dokras et al, 2006 Balaban et al, 2006 negati