P-639 Effect of preconceptional weight optimization on metabolic parameters and in vitro fertilization outcomes in infertile women with obesity

Abstract

Study question Does preconceptional weight loss improve metabolic parameters and IVF success rates in obese, infertile women? Summary answer Weight loss before IVF significantly improved metabolic markers, and 62.5% of those who reached target weight conceived through IVF, while 18.75% conceived spontaneously. What is known already The global rise in obesity significantly impacts female reproductive health. In Hungary, 22.7% of adult women are obese. Obesity contributes to metabolic and hormonal imbalances, negatively affecting fertility. Studies indicate that excess weight impairs in vitro fertilization (IVF) outcomes, although the benefits of weight loss remain debated. Research suggests that preconceptional weight reduction improves pregnancy rates, live birth rates, and reduces the number of IVF cycles needed. Lifestyle modification is the first-line treatment for obese, infertile women, particularly those with polycystic ovarian syndrome (PCOS). Exercise alone may also enhance fertility outcomes, as evidenced by recent clinical trials. Study design, size, duration A retrospective, single-center cohort study was conducted on infertile women with obesity (BMI>30 kg/m2) the Endocrinology Outpatient Clinic, Department of Medicine in cooperation with the Institute of Reproductive Medicine at the University of Szeged. Data collection was performed from January 1, 2020, to March 31, 2024 among women undergoing weight optimization before IVF treatment. There were no exclusion criteria for participation in the study. Participants/materials, setting, methods Comparisons of baseline clinical, laboratory, and biometric parameters of the infertile women with obesity (n = 58) were made with an age-matched control group (n = 45) with normal BMI, and within the group of infertile women (n = 16) both before and after the weight loss period, which included lifestyle modifications, dietary interventions, and liraglutide. The treatment of obesity, including pharmacological treatment, was carried out according to recent Hungarian guidelines. Primary outcomes were metabolic improvements and clinical pregnancy rates. Main results and the role of chance Infertile women with obesity (n = 58; age: 33.1 ± 5.42 years; BMI: 39.3 ± 6.90 kg/m²) had significantly higher systolic (136.8 ± 14.55 vs. 113.4 ± 13.87 mmHg; p < 0.001) and diastolic blood pressure (84.7 ± 11.98 vs. 69.4 ± 11.48 mmHg; p < 0.001) compared to controls (n = 45; age: 32.1 ± 7.67 years; BMI: 21.1 ± 2.02 kg/m²). They also exhibited a higher prevalence of metabolic disorders, including hypertension (0 vs. 17; p < 0.001), impaired glucose tolerance (0 vs. 16; p < 0.001), type 2 diabetes (0 vs. 5; p < 0.05), PCOS (5 vs. 32; p < 0.001), and hypothyroidism (0 vs. 17; p < 0.001). Laboratory tests revealed significant differences in glucose metabolism, lipid profile, liver function, and inflammatory markers. Following weight loss therapy with lifestyle and dietary changes combined with liraglutide, 16 patients reached the target weight reduction before IVF, with significant decreases in body weight (104.3 ± 16.64 vs. 89.1 ± 15.74 kg; p < 0.05) and BMI (38.5 ± 5.02 vs. 32.9 ± 5.20 kg/m²; p < 0.01). Among them, 8 conceived (5 through IVF, 3 spontaneously), 3 remained in IVF treatment, while 5 did not conceive. Limitations, reasons for caution The retrospective design, acknowledging that the program was a real-world intervention, and the small sample size limit generalizability. Variability in weight loss adherence and additional confounding factors may influence reproductive outcomes. Wider implications of the findings Preconceptional weight loss interventions could improve metabolic health and enhance fertility outcomes, potentially reducing the need for IVF in some obese, infertile women. Further research is needed to optimize strategies for weight management in reproductive medicine. Trial registration number No