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 Table of Contents  
Year : 2022  |  Volume : 9  |  Issue : 1  |  Page : 130-131

Morbidly obese women seeking to undergo IVF/ICSI treatment can be made eligible by engaging them in a weight-loss program that incorporates physical activity

Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy

Date of Submission15-Oct-2021
Date of Acceptance13-Jan-2022
Date of Web Publication23-Mar-2022

Correspondence Address:
Dr. Chidiebere Emmanuel Okechukwu
Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro, 5 - 00185 Rome.
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/mgmj.mgmj_76_21

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How to cite this article:
Okechukwu CE. Morbidly obese women seeking to undergo IVF/ICSI treatment can be made eligible by engaging them in a weight-loss program that incorporates physical activity. MGM J Med Sci 2022;9:130-1

How to cite this URL:
Okechukwu CE. Morbidly obese women seeking to undergo IVF/ICSI treatment can be made eligible by engaging them in a weight-loss program that incorporates physical activity. MGM J Med Sci [serial online] 2022 [cited 2022 May 17];9:130-1. Available from: http://www.mgmjms.com/text.asp?2022/9/1/130/340592

Dear Editor,

Morbid obesity in adults is defined as having a body mass index (BMI) of 40 or more and a high proportion of body fat. Obesity is connected to reproductive problems and can impair a woman’s menstrual cycle. Thus, morbidly obese women are more likely to require fertility treatment than those with a healthy BMI.[1] Various countries have their fertility treatment guidelines. However, many fertility clinics in most countries in the world do not provide assisted reproductive technology (ART) treatment for morbidly obese women. Nevertheless, it is important to explain to morbidly obese women that weight reduction and healthy weight loss maintenance will boost their chances of becoming pregnant with fewer complications through in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) treatment and to encourage them to do so through regular physical activity (PA) and diet modification. PA before IVF and ICSI cycles increased pregnancy and live birth rates, possibly by lowering body fat percentage.[1]

Women with a BMI ≥ 25 kg/m2 had a lower chance of pregnancy following IVF and had an increased miscarriage rate compared to women with a BMI ≤ 25 kg/m2.[2] One study showed an increase in miscarriages among women with a BMI ≥ 30 kg/m2 following ART.[3] Obese women undergoing ART may require an increase and longer doses of ovarian stimulation medication, and usually have fewer or more immature eggs to retrieve or more contradicted cycles, and they have an increased risk of bleeding, damage to nearby organs, and anesthesia associated complications during surgery or egg retrieval.[4],[5],[6]

Weight management is important in the prevention and treatment of infertility, and PA is an essential aspect of a weight management program. Engaging in PA before undergoing IVF and ICSI cycles was significantly associated with improved reproductive outcomes in obese patients with infertility, regardless of body weight loss.[7] According to the American College of Sports Medicine, engaging in moderate-intensity aerobic exercise for at least 30 min/day for 5 days/week ≥ 150 min/week may improve weight loss when combined with moderate diet restriction.[8],[9] However, engaging in PA ≥ 250 min/week was associated with considerable weight loss and healthy weight loss maintenance.[8] Resistance/strength training involving each major muscle group (60%–70% of the one-repetition maximum at moderate-to-vigorous intensity, at least 10–15 repetitions for 2–3 days/week) should be performed to increase the loss of fat mass and improve neuromuscular performance using strength training equipment.[9] PA carried out for at least one hour, three times per week, improved rates of implantation and pregnancy and reduced the risk of miscarriage among women undergoing ICSI.[10] physically active Women are likely to have successful implantation and live birth because regular PA improves body composition.[11]

In summary, female obesity is associated with adverse ART outcomes. This was demonstrated in several studies examined in systematic reviews and meta-analyses, which revealed that female obesity negatively affects live birth rates following IVF/ICSI cycles.[2],[3],[12] Instead of rejecting female fertility treatment based on severe obesity, it is preferable to enroll morbidly obese women seeking IVF/ICSI treatment in a weight loss program involving a regular and supervised PA routine, preferable 3–6 months before undergoing ART treatment. Moreover, being physically active by engaging in a regular, moderate to vigorous-intensity aerobic and resistance exercise routine, achieving a decrease in weight, and maintaining a healthy weight positively influences ART outcomes in women. Behavior change strategies can be used to improve the motivation to engage in PA and exercise adherence in obese women before commencing ART. Further studies are required to determine the optimal dose of PA (intensity, duration, and frequency) that can be tailored and prescribed for overweight and obese women 12–24 weeks before commencing ART treatment, to achieve healthy weight loss. Moreover, exercise combined with dietary modification, intermittent energy restriction, and a once-daily dose of liraglutide 3.0 mg subcutaneous injection may be more effective in accelerating and maintaining healthy weight loss among morbidly obese women with or without diabetes mellitus (type 1 and 2) before undergoing IVF and ICSI treatment cycles.[13] On the contrary, bariatric surgery, and postbariatric surgery dietary and lifestyle interventions may also be considered for morbidly obese women.[14]

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Conflicts of interest

There are no conflicts of interest.

  References Top

Rao M, Zeng Z, Tang L Maternal physical activity before IVF/ICSI cycles improves clinical pregnancy rate and live birth rate: A systematic review and meta-analysis. Reprod Biol Endocrinol 2018;16:11.  Back to cited text no. 1
Maheshwari A, Stofberg L, Bhattacharya S Effect of overweight and obesity on assisted reproductive technology: A systematic review. Hum Reprod Update 2007;13:433-44.  Back to cited text no. 2
Supramaniam PR, Mittal M, McVeigh E, Lim LN The correlation between raised body mass index and assisted reproductive treatment outcomes: A systematic review and meta-analysis of the evidence. Reprod Health 2018;15:34.  Back to cited text no. 3
Pandey S, Pandey S, Maheshwari A, Bhattacharya S The impact of female obesity on the outcome of fertility treatment. J Hum Reprod Sci 2010;3:62-7.  Back to cited text no. 4
Robson SJ, Norman RJ It is ethical to recommend against assisted reproductive treatment for women with a high body mass index. Aust N Z J Obstet Gynaecol 2017;57:575-8.  Back to cited text no. 5
Lamon AM, Habib AS Managing anesthesia for cesarean section in obese patients: Current perspectives. Local Reg Anesth 2016;9:45-57.  Back to cited text no. 6
Palomba S, Falbo A, Valli B, Morini D, Villani MT, Nicoli A, et al. Physical activity before IVF and ICSI cycles in infertile obese women: An observational cohort study. Reprod Biomed Online 2014;29:72-9.  Back to cited text no. 7
Donnelly JE, Blair SN, Jakicic JM, Manore MM, Rankin JW, Smith BK; American College of Sports Medicine. American college of sports medicine position stand: Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults. Med Sci Sports Exerc 2009;41:459-71.  Back to cited text no. 8
Garber CE, Blissmer B, Deschenes MR, Franklin BA, Lamonte MJ, Lee IM, et al; American College of Sports Medicine. American college of sports medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: Guidance for prescribing exercise. Med Sci Sports Exerc 2011;43:1334-59.  Back to cited text no. 9
Ferreira RC, Halpern G, Figueira RC, Braga DP, Iaconelli A Jr, Borges E Jr. Physical activity, obesity and eating habits can influence assisted reproduction outcomes. Womens Health (Lond) 2010;6:517-24.  Back to cited text no. 10
Kucuk M, Doymaz F, Urman B Effect of energy expenditure and physical activity on the outcomes of assisted reproduction treatment. Reprod Biomed Online 2010;20:274-9.  Back to cited text no. 11
Sermondade N, Huberlant S, Bourhis-Lefebvre V, Arbo E, Gallot V, Colombani M, et al. Female obesity is negatively associated with live birth rate following IVF: A systematic review and meta-analysis. Hum Reprod Update 2019;25:439-51.  Back to cited text no. 12
Okechukwu CE Healthy weight loss maintenance with exercise, liraglutide, or both combined. N Engl J Med 2021;385:572-3.  Back to cited text no. 13
Masood A, Alsheddi L, Alfayadh L, Bukhari B, Elawad R, Alfadda AA Dietary and lifestyle factors serve as predictors of successful weight loss maintenance postbariatric surgery. J Obes 2019;2019:7295978.  Back to cited text no. 14


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