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Published in: Journal of Assisted Reproduction and Genetics 6/2019

01-06-2019 | Fertility | Assisted Reproduction Technologies

Body mass index restrictions in fertility treatment: a national survey of OB/GYN subspecialists

Authors: Angela S. Kelley, Sylvia E. Badon, Michael S. M. Lanham, Senait Fisseha, Molly B. Moravek

Published in: Journal of Assisted Reproduction and Genetics | Issue 6/2019

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Abstract

Purpose

To explore the attitudes of reproductive endocrinology and infertility (REI) and maternal–fetal medicine (MFM) subspecialists regarding the necessity and appropriateness of body mass index (BMI) cutoffs for women seeking fertility treatment.

Methods

Members of the Society for Reproductive Endocrinology and Infertility (SREI) and the Society for Maternal Fetal Medicine (SMFM) were invited to participate in a survey querying their knowledge of existing institutional or clinic BMI policies and personal opinions regarding upper and lower BMI cutoffs for a range of fertility treatments, including oral ovulation agents, gonadotropins, and in vitro fertilization.

Results

Respondents included 398 MFMs and 201 REIs. The majority of REI and MFM providers agreed with upper limit BMI cutoffs (72.5% vs 68.2%, p = 0.29), but REIs were twice as likely to support lower limit BMI restrictions compared to MFMs (56.2% vs 28.4%, p < 0.0001). Those who supported upper BMI restrictions were more likely to be female and report existing institutional BMI cutoffs. The majority of respondents (99.3%) believed that an official statement to guide clinicians should be issued by a national professional organization.

Conclusions

Although practice patterns widely vary, the majority of REIs and MFMs believe that there should be a BMI cutoff above which women should not be offered immediate fertility treatment. Furthermore, there is a reported need for a written statement by a national professional organization to guide clinical practice and to ensure that OB/GYN subspecialists are providing consistent, fair, and safe recommendations to infertile women at the extremes of BMI.
Literature
1.
go back to reference Johnson NB, Hayes LD, Brown K, Hoo EC, Ethier KA. Centers for Disease Control and Prevention (CDC). CDC National Health Report: leading causes of morbidity and mortality and associated behavioral risk and protective factors—United States, 2005-2013. MMWR Suppl. 2014;63:3–27.PubMed Johnson NB, Hayes LD, Brown K, Hoo EC, Ethier KA. Centers for Disease Control and Prevention (CDC). CDC National Health Report: leading causes of morbidity and mortality and associated behavioral risk and protective factors—United States, 2005-2013. MMWR Suppl. 2014;63:3–27.PubMed
2.
go back to reference Kent S, Fusco F, Gray A, Jebb SA, Cairns BJ, Mihaylova B. Body mass index and healthcare costs: a systematic literature review of individual participant data studies. Obes Rev. 2017;18:869–79.CrossRefPubMed Kent S, Fusco F, Gray A, Jebb SA, Cairns BJ, Mihaylova B. Body mass index and healthcare costs: a systematic literature review of individual participant data studies. Obes Rev. 2017;18:869–79.CrossRefPubMed
3.
go back to reference Ogden CL, Carroll MD, Fryar CD, Flegal KM. Prevalence of obesity among adults and youth: United States, 2011-2014. NCHS Data Brief. 2015;1–8. Ogden CL, Carroll MD, Fryar CD, Flegal KM. Prevalence of obesity among adults and youth: United States, 2011-2014. NCHS Data Brief. 2015;1–8.
4.
go back to reference Persson M, Cnattingius S, Villamor E, Söderling J, Pasternak B, Stephansson O, et al. Risk of major congenital malformations in relation to maternal overweight and obesity severity: cohort study of 1.2 million singletons. BMJ. 2017;357:j2563.CrossRefPubMedPubMedCentral Persson M, Cnattingius S, Villamor E, Söderling J, Pasternak B, Stephansson O, et al. Risk of major congenital malformations in relation to maternal overweight and obesity severity: cohort study of 1.2 million singletons. BMJ. 2017;357:j2563.CrossRefPubMedPubMedCentral
5.
go back to reference Torloni MR, Betrán AP, Daher S, Widmer M, Dolan SM, Menon R, et al. Maternal BMI and preterm birth: a systematic review of the literature with meta-analysis. J Matern Fetal Neonatal Med. 2009;22:957–70.CrossRefPubMed Torloni MR, Betrán AP, Daher S, Widmer M, Dolan SM, Menon R, et al. Maternal BMI and preterm birth: a systematic review of the literature with meta-analysis. J Matern Fetal Neonatal Med. 2009;22:957–70.CrossRefPubMed
6.
go back to reference American College of Obstetricians and Gynecologists. ACOG Committee opinion no. 549: obesity in pregnancy. Obstet Gynecol. 2013;121:213–7.CrossRef American College of Obstetricians and Gynecologists. ACOG Committee opinion no. 549: obesity in pregnancy. Obstet Gynecol. 2013;121:213–7.CrossRef
7.
go back to reference Scott-Pillai R, Spence D, Cardwell CR, Hunter A, Holmes VA. The impact of body mass index on maternal and neonatal outcomes: a retrospective study in a UK obstetric population, 2004-2011. BJOG. 2013;120:932–9.CrossRefPubMed Scott-Pillai R, Spence D, Cardwell CR, Hunter A, Holmes VA. The impact of body mass index on maternal and neonatal outcomes: a retrospective study in a UK obstetric population, 2004-2011. BJOG. 2013;120:932–9.CrossRefPubMed
8.
go back to reference Joy S, Istwan N, Rhea D, Desch C, Stanziano G. The impact of maternal obesity on the incidence of adverse pregnancy outcomes in high-risk term pregnancies. Am J Perinatol. 2009;26:345–9.CrossRefPubMed Joy S, Istwan N, Rhea D, Desch C, Stanziano G. The impact of maternal obesity on the incidence of adverse pregnancy outcomes in high-risk term pregnancies. Am J Perinatol. 2009;26:345–9.CrossRefPubMed
9.
go back to reference Lynch AM, Hart JE, Agwu OC, Fisher BM, West NA, Gibbs RS. Association of extremes of prepregnancy BMI with the clinical presentations of preterm birth. Am J Obstet Gynecol. 2014;210:428.e1–9.CrossRef Lynch AM, Hart JE, Agwu OC, Fisher BM, West NA, Gibbs RS. Association of extremes of prepregnancy BMI with the clinical presentations of preterm birth. Am J Obstet Gynecol. 2014;210:428.e1–9.CrossRef
10.
go back to reference Mahutte N, Kamga-Ngande C, Sharma A, Sylvestre C. Obesity and reproduction. J Obstet Gynaecol Can. 2018;40:950–66.CrossRefPubMed Mahutte N, Kamga-Ngande C, Sharma A, Sylvestre C. Obesity and reproduction. J Obstet Gynaecol Can. 2018;40:950–66.CrossRefPubMed
11.
go back to reference Brewer CJ, Balen AH. The adverse effects of obesity on conception and implantation. Reproduction. 2010;140:347–64.CrossRefPubMed Brewer CJ, Balen AH. The adverse effects of obesity on conception and implantation. Reproduction. 2010;140:347–64.CrossRefPubMed
12.
go back to reference Kominiarek MA, Jungheim ES, Hoeger KM, Rogers AM, Kahan S, Kim JJ. American Society for Metabolic and Bariatric Surgery position statement on the impact of obesity and obesity treatment on fertility and fertility therapy endorsed by the American College of Obstetricians and Gynecologists and the Obesity Society. Surg Obes Relat Dis. 2017;13:750–7.CrossRefPubMed Kominiarek MA, Jungheim ES, Hoeger KM, Rogers AM, Kahan S, Kim JJ. American Society for Metabolic and Bariatric Surgery position statement on the impact of obesity and obesity treatment on fertility and fertility therapy endorsed by the American College of Obstetricians and Gynecologists and the Obesity Society. Surg Obes Relat Dis. 2017;13:750–7.CrossRefPubMed
13.
go back to reference Davies MJ. Evidence for effects of weight on reproduction in women. Reprod BioMed Online. 2006;12:552–61.CrossRefPubMed Davies MJ. Evidence for effects of weight on reproduction in women. Reprod BioMed Online. 2006;12:552–61.CrossRefPubMed
14.
go back to reference Practice Committee of the American Society for Reproductive Medicine. Definitions of infertility and recurrent pregnancy loss. Fertil Steril. 2008;89:1603.CrossRef Practice Committee of the American Society for Reproductive Medicine. Definitions of infertility and recurrent pregnancy loss. Fertil Steril. 2008;89:1603.CrossRef
15.
go back to reference Provost MP, Acharya KS, Acharya CR, Yeh JS, Steward RG, Eaton JL, et al. Pregnancy outcomes decline with increasing body mass index: analysis of 239,127 fresh autologous in vitro fertilization cycles from the 2008-2010 Society for Assisted Reproductive Technology registry. Fertil Steril. 2016;105:663–9.CrossRefPubMed Provost MP, Acharya KS, Acharya CR, Yeh JS, Steward RG, Eaton JL, et al. Pregnancy outcomes decline with increasing body mass index: analysis of 239,127 fresh autologous in vitro fertilization cycles from the 2008-2010 Society for Assisted Reproductive Technology registry. Fertil Steril. 2016;105:663–9.CrossRefPubMed
16.
go back to reference Kawwass JF, Kulkarni AD, Hipp HS, Crawford S, Kissin DM, Jamieson DJ. Extremities of body mass index and their association with pregnancy outcomes in women undergoing in vitro fertilization in the United States. Fertil Steril. 2016;106:1742–50.CrossRefPubMed Kawwass JF, Kulkarni AD, Hipp HS, Crawford S, Kissin DM, Jamieson DJ. Extremities of body mass index and their association with pregnancy outcomes in women undergoing in vitro fertilization in the United States. Fertil Steril. 2016;106:1742–50.CrossRefPubMed
17.
go back to reference Rittenberg V, Seshadri S, Sunkara SK, Sobaleva S, Oteng-Ntim E, El-Toukhy T. Effect of body mass index on IVF treatment outcome: an updated systematic review and meta-analysis. Reprod BioMed Online. 2011;23:421–39.CrossRefPubMed Rittenberg V, Seshadri S, Sunkara SK, Sobaleva S, Oteng-Ntim E, El-Toukhy T. Effect of body mass index on IVF treatment outcome: an updated systematic review and meta-analysis. Reprod BioMed Online. 2011;23:421–39.CrossRefPubMed
18.
go back to reference Sarais V, Pagliardini L, Rebonato G, Papaleo E, Candiani M, Viganò P. A comprehensive analysis of body mass index effect on in vitro fertilization outcomes. Nutrients. 2016;8:109.CrossRefPubMedPubMedCentral Sarais V, Pagliardini L, Rebonato G, Papaleo E, Candiani M, Viganò P. A comprehensive analysis of body mass index effect on in vitro fertilization outcomes. Nutrients. 2016;8:109.CrossRefPubMedPubMedCentral
19.
go back to reference MacKenna A, Schwarze JE, Crosby JA, Zegers-Hochschild F. Outcome of assisted reproductive technology in overweight and obese women. JBRA Assist Reprod. 2017;21:79–83.PubMedPubMedCentral MacKenna A, Schwarze JE, Crosby JA, Zegers-Hochschild F. Outcome of assisted reproductive technology in overweight and obese women. JBRA Assist Reprod. 2017;21:79–83.PubMedPubMedCentral
20.
go back to reference Luke B, Brown MB, Missmer SA, Bukulmez O, Leach R, Stern JE, et al. The effect of increasing obesity on the response to and outcome of assisted reproductive technology: a national study. Fertil Steril. 2011;96:820–5.CrossRefPubMed Luke B, Brown MB, Missmer SA, Bukulmez O, Leach R, Stern JE, et al. The effect of increasing obesity on the response to and outcome of assisted reproductive technology: a national study. Fertil Steril. 2011;96:820–5.CrossRefPubMed
21.
go back to reference Veleva Z, Tiitinen A, Vilska S, Hydén-Granskog C, Tomás C, Martikainen H, et al. High and low BMI increase the risk of miscarriage after IVF/ICSI and FET. Hum Reprod. 2008;23:878–84.CrossRefPubMed Veleva Z, Tiitinen A, Vilska S, Hydén-Granskog C, Tomás C, Martikainen H, et al. High and low BMI increase the risk of miscarriage after IVF/ICSI and FET. Hum Reprod. 2008;23:878–84.CrossRefPubMed
22.
go back to reference Dayan N, Spitzer K, Laskin CA. A focus on maternal health before assisted reproduction: results from a pilot survey of Canadian IVF medical directors. J Obstet Gynaecol Can. 2015;37:648–55.CrossRefPubMed Dayan N, Spitzer K, Laskin CA. A focus on maternal health before assisted reproduction: results from a pilot survey of Canadian IVF medical directors. J Obstet Gynaecol Can. 2015;37:648–55.CrossRefPubMed
23.
go back to reference Kaye L, Sueldo C, Engmann L, Nulsen J, Benadiva C. Survey assessing obesity policies for assisted reproductive technology in the United States. Fertil Steril. 2016;105:703–706.e2.CrossRefPubMed Kaye L, Sueldo C, Engmann L, Nulsen J, Benadiva C. Survey assessing obesity policies for assisted reproductive technology in the United States. Fertil Steril. 2016;105:703–706.e2.CrossRefPubMed
24.
go back to reference Zachariah M, Fleming R, Acharya U. Management of obese women in assisted conception units: a UK survey. Hum Fertil. 2006;9:101–5.CrossRef Zachariah M, Fleming R, Acharya U. Management of obese women in assisted conception units: a UK survey. Hum Fertil. 2006;9:101–5.CrossRef
25.
go back to reference Practice Committee of American Society for Reproductive Medicine. Recommendations for reducing the risk of viral transmission during fertility treatment with the use of autologous gametes: a committee opinion. Fertil Steril. 2013;99:340–6.CrossRef Practice Committee of American Society for Reproductive Medicine. Recommendations for reducing the risk of viral transmission during fertility treatment with the use of autologous gametes: a committee opinion. Fertil Steril. 2013;99:340–6.CrossRef
26.
go back to reference Phelan SM, Burgess DJ, Yeazel MW, Hellerstedt WL, Griffin JM, van Ryn M. Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. Obes Rev. 2015;16:319–26.CrossRefPubMedPubMedCentral Phelan SM, Burgess DJ, Yeazel MW, Hellerstedt WL, Griffin JM, van Ryn M. Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. Obes Rev. 2015;16:319–26.CrossRefPubMedPubMedCentral
28.
go back to reference Ethics Committee of the American Society for Reproductive Medicine. Disparities in access to effective treatment for infertility in the United States: an Ethics Committee opinion. Fertil Steril. 2015;104:1104–10.CrossRef Ethics Committee of the American Society for Reproductive Medicine. Disparities in access to effective treatment for infertility in the United States: an Ethics Committee opinion. Fertil Steril. 2015;104:1104–10.CrossRef
29.
go back to reference Quinn M, Fujimoto V. Racial and ethnic disparities in assisted reproductive technology access and outcomes. Fertil Steril. 2016;105:1119–23.CrossRefPubMed Quinn M, Fujimoto V. Racial and ethnic disparities in assisted reproductive technology access and outcomes. Fertil Steril. 2016;105:1119–23.CrossRefPubMed
30.
go back to reference Mutsaerts MAQ, van Oers AM, Groen H, Burggraaff JM, Kuchenbecker WKH, Perquin DAM, et al. Randomized trial of a lifestyle program in obese infertile women. N Engl J Med. 2016;374:1942–53.CrossRefPubMed Mutsaerts MAQ, van Oers AM, Groen H, Burggraaff JM, Kuchenbecker WKH, Perquin DAM, et al. Randomized trial of a lifestyle program in obese infertile women. N Engl J Med. 2016;374:1942–53.CrossRefPubMed
Metadata
Title
Body mass index restrictions in fertility treatment: a national survey of OB/GYN subspecialists
Authors
Angela S. Kelley
Sylvia E. Badon
Michael S. M. Lanham
Senait Fisseha
Molly B. Moravek
Publication date
01-06-2019
Publisher
Springer US
Published in
Journal of Assisted Reproduction and Genetics / Issue 6/2019
Print ISSN: 1058-0468
Electronic ISSN: 1573-7330
DOI
https://doi.org/10.1007/s10815-019-01448-3

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