The combined impact of maternal age and body mass index on cumulative live birth following in vitro fertilization
Autor: | Elizabeth S. Ginsburg, Randi H. Goldman, Ann M. Thomas, Chloe Zera, Leslie V. Farland |
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Rok vydání: | 2019 |
Předmět: |
Adult
Infertility medicine.medical_specialty Time Factors Pregnancy Rate medicine.medical_treatment Fertilization in Vitro Reproductive technology Overweight Severity of Illness Index Body Mass Index Obesity Maternal 03 medical and health sciences 0302 clinical medicine Pregnancy Weight Loss medicine Humans Mass index Sperm Injections Intracytoplasmic 030212 general & internal medicine Proportional Hazards Models Retrospective Studies 030219 obstetrics & reproductive medicine In vitro fertilisation Obstetrics business.industry Age Factors Obstetrics and Gynecology Embryo Transfer medicine.disease Embryo transfer Abortion Spontaneous Female Preconception Care medicine.symptom Live birth business Live Birth Body mass index Maternal Age |
Zdroj: | American Journal of Obstetrics and Gynecology. 221:617.e1-617.e13 |
ISSN: | 0002-9378 |
Popis: | Background It is critical to evaluate the combined impact of age and body mass index on the cumulative likelihood of live birth following in vitro fertilization, as achieving a lower body mass index before infertility treatment often is recommended for women with overweight and obesity. It is important to consider whether achieving a particular body mass index, thus resulting in an older age at in vitro fertilization cycle start, is beneficial or harmful to the likelihood of live birth. Objectives To evaluate the combined impact of age and body mass index on the cumulative live birth rate following in vitro fertilization to inform when delaying in vitro fertilization treatment to achieve a lower body mass index may be beneficial or detrimental to the likelihood of live birth. Study Design This is a retrospective study using linked fresh and cryopreserved/frozen cycles from January 2014 to December 2015 from the Society for Reproductive Technology Clinic Outcome Reporting System, representing >90% of in vitro fertilization cycles performed in the United States. The primary outcome was live birth as measured by cumulative live birth rate. Secondary outcomes included implantation rate, clinical pregnancy rate, and miscarriage rate. Poisson and logistic regression were used to calculate risk and odds ratios with 95% confidence intervals to determine differences in implantation, clinical pregnancy, and miscarriage, as appropriate, among first fresh in vitro fertilization cycles compared across age (years) and body mass index (kg/m2) categories. Cox regression was used to calculate hazard ratios with 95% confidence intervals to determine differences in the cumulative live birth rate using fresh plus linked frozen embryo transfer cycles. Results There were 51,959 first fresh cycles using autologous eggs and 16,067 subsequent frozen embryo transfer cycles. There were 21,395 live births, for an overall cumulative live birth rate of 41.2% per cycle start. The implantation rate, clinical pregnancy rate, and cumulative live birth rate decreased with increasing body mass index and age, and the miscarriage rate increased with increasing body mass index and age (linear trend P Conclusions Age-related decline in fertility has a greater impact than body mass index on the cumulative live birth rate at older ages, suggesting that taking time to achieve lower body mass index before in vitro fertilization may be detrimental for older women with overweight or obesity. Delaying conception to lose weight before in vitro fertilization should be informed by the combination of age and body mass index. |
Databáze: | OpenAIRE |
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