{"title":"Obesity and morbid obesity are associated with reductions in live birth rate and increased miscarriage rate after frozen embryo transfer.","authors":"Patricia Xu, Lauren Tetelbaun, Alexa Setteducate, Mindy Lowy, Eliana Felder, Martin Keltz","doi":"10.1007/s10815-026-04054-2","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>Obesity is associated with poor in-vitro fertilization (IVF) outcomes, with limited data on patients with BMI ≥ 40 kg/m<sup>2</sup>. This study assessed BMI's impact on frozen embryo transfer (FET) outcomes.</p><p><strong>Methods: </strong>A retrospective cohort study (2017-2024) of 1,424 FETs from 889 patients, stratified by BMI: normal (18.5-24.9), overweight (25.0-29.9), obese (30.0-39.9), morbidly obese (≥ 40). Primary outcome was live birth rate per transfer (LBR). Secondary outcomes include clinical intrauterine pregnancy (CIUPR), miscarriage rates (MR), and proportion achieving ≥ 1 live birth. Outcomes were adjusted for age, AMH, FSH, PCOS, tubal infertility, and race.</p><p><strong>Results: </strong>LBR decreased with increasing BMI for all transfers (53.5%, 52.8%, 42.5%, 30.8%, p < 0.001) and single elective euploid transfers (SEETs) (54.2%, 57.8%, 44.5%, 32.3%, p < 0.001). CIUPR showed the same pattern (58.0%, 59.5%, 50.4%, 39.7%; p < 0.001 all transfers; 58.6%, 63.1%, 51.0%, 40.3%; p < 0.001 SEETs), as did the proportion of patients achieving at least one birth (72.9%, 68.3%, 65.8%, 51.1%; p = 0.020). MR significantly increased with BMI (7.4%, 11.2%, 15.2%, 22.6%, p<0.001) for all transfers but not for SEETs (7.5%, 8.4%, 12.8%, 20.0%; p = 0.169). Each one-unit increase in BMI was associated with a 3% reduction in odds of live birth (aOR 0.969, 95% CI 0.951-0.987, p<0.001).</p><p><strong>Conclusion: </strong>Increasing BMI is associated with lower LBR and CIUPR, following FET, including SEETs. MR increased with BMI for all FETs, with a similar but non-significant gradient among SEETs. This highlights the importance of considering BMI when counseling patients, particularly those with morbid obesity.</p>","PeriodicalId":15246,"journal":{"name":"Journal of Assisted Reproduction and Genetics","volume":" ","pages":""},"PeriodicalIF":2.8000,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Assisted Reproduction and Genetics","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s10815-026-04054-2","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"GENETICS & HEREDITY","Score":null,"Total":0}
引用次数: 0
Abstract
Purpose: Obesity is associated with poor in-vitro fertilization (IVF) outcomes, with limited data on patients with BMI ≥ 40 kg/m2. This study assessed BMI's impact on frozen embryo transfer (FET) outcomes.
Methods: A retrospective cohort study (2017-2024) of 1,424 FETs from 889 patients, stratified by BMI: normal (18.5-24.9), overweight (25.0-29.9), obese (30.0-39.9), morbidly obese (≥ 40). Primary outcome was live birth rate per transfer (LBR). Secondary outcomes include clinical intrauterine pregnancy (CIUPR), miscarriage rates (MR), and proportion achieving ≥ 1 live birth. Outcomes were adjusted for age, AMH, FSH, PCOS, tubal infertility, and race.
Results: LBR decreased with increasing BMI for all transfers (53.5%, 52.8%, 42.5%, 30.8%, p < 0.001) and single elective euploid transfers (SEETs) (54.2%, 57.8%, 44.5%, 32.3%, p < 0.001). CIUPR showed the same pattern (58.0%, 59.5%, 50.4%, 39.7%; p < 0.001 all transfers; 58.6%, 63.1%, 51.0%, 40.3%; p < 0.001 SEETs), as did the proportion of patients achieving at least one birth (72.9%, 68.3%, 65.8%, 51.1%; p = 0.020). MR significantly increased with BMI (7.4%, 11.2%, 15.2%, 22.6%, p<0.001) for all transfers but not for SEETs (7.5%, 8.4%, 12.8%, 20.0%; p = 0.169). Each one-unit increase in BMI was associated with a 3% reduction in odds of live birth (aOR 0.969, 95% CI 0.951-0.987, p<0.001).
Conclusion: Increasing BMI is associated with lower LBR and CIUPR, following FET, including SEETs. MR increased with BMI for all FETs, with a similar but non-significant gradient among SEETs. This highlights the importance of considering BMI when counseling patients, particularly those with morbid obesity.
期刊介绍：
The Journal of Assisted Reproduction and Genetics publishes cellular, molecular, genetic, and epigenetic discoveries advancing our understanding of the biology and underlying mechanisms from gametogenesis to offspring health. Special emphasis is placed on the practice and evolution of assisted reproduction technologies (ARTs) with reference to the diagnosis and management of diseases affecting fertility. Our goal is to educate our readership in the translation of basic and clinical discoveries made from human or relevant animal models to the safe and efficacious practice of human ARTs. The scientific rigor and ethical standards embraced by the JARG editorial team ensures a broad international base of expertise guiding the marriage of contemporary clinical research paradigms with basic science discovery. JARG publishes original papers, minireviews, case reports, and opinion pieces often combined into special topic issues that will educate clinicians and scientists with interests in the mechanisms of human development that bear on the treatment of infertility and emerging innovations in human ARTs. The guiding principles of male and female reproductive health impacting pre- and post-conceptional viability and developmental potential are emphasized within the purview of human reproductive health in current and future generations of our species.
The journal is published in cooperation with the American Society for Reproductive Medicine, an organization of more than 8,000 physicians, researchers, nurses, technicians and other professionals dedicated to advancing knowledge and expertise in reproductive biology.
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