Patients with a body mass index ≥45 kg/m2 can safely undergo oocyte retrievals and anticipate similar assisted reproductive technology outcomes.

Abstract

OBJECTIVE To compare anesthesia and assisted reproductive technology (ART) outcomes in patients with a body mass index (BMI) of 40-44.9kg/m2 to those with a BMI ≥45kg/m2 as these patients are often excluded from care. DESIGN Retrospective cohort study SUBJECTS: All patients with a BMI ≥40kg/m2 undergoing oocyte retrieval for ART from January 2018-2023 from one academic fertility clinic and one private fertility clinic. EXPOSURE BMI ≥45kg/m2 compared to a BMI of 40-44.9kg/m2. MAIN OUTCOME MEASURES The primary outcome was anesthesia complications at the time of retrieval. Demographic data, cycle specific information, medical comorbidities, BMI at retrieval, length of oocyte retrieval, ART and anesthesia complications, laboratory data, and pregnancy rates were recorded. RESULTS A total of 98 patients with a BMI ≥40kg/m2 undergoing oocyte retrieval were identified for the study, 56 patients with a BMI from 40-44.9kg/m2 and 42 patients with a BMI ≥45kg/m2. Demographics were not statistically different between both groups, except more patients with a BMI 40-44.9 kg/m2 identified as White (73% vs 60%) or Black (9% vs 0%), p=0.03. All patients were successfully managed with intravenous sedation and did not require higher level of sedation or care. Mean surgical duration was longer for patients with a BMI ≥45 kg/m2 than in those with a with a BMI 40-44.9 kg/m2 (26.8min, SD 13min vs. 22.3min, SD 8.4min, p=0.04). Most patients (93%) did not experience any anesthesia complication. The only adverse anesthesia complication in both groups was oxygen desaturation <90%, which did not differ by cohort even when adjusting for age. There was no difference in the number of mature oocytes retrieved, day 5/6 blastocysts, the number of euploid embryos, clinical pregnancy, miscarriage or live birth rates. CONCLUSION BMI is commonly used as a threshold for access to ART. When using intravenous sedation, patients with BMI ≥45 kg/m2 have similar ART outcomes with few anesthesia or ART complications in comparison to patients with a BMI of 40-44.9 kg/m2. With appropriate counseling and preoperative preparation, patients with a BMI ≥45 kg/m2 can safely undergo oocyte retrieval.