Article| Volume 42, ISSUE 2, P366-374, February 2021

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Reproductive and obstetric outcomes in mildly and significantly underweight women undergoing IVF

Published:October 23, 2020DOI:


      Research question

      What is the impact of low body mass index (BMI) on live birth rates and obstetric outcomes in infertile women treated with IVF and fresh embryo transfer?


      This was a retrospective cohort study of infertile patients in an academic hospital setting who underwent their first oocyte retrieval with planned autologous fresh embryo transfer between 1 January 2012 and 31 December 2018. The primary study outcome was live birth rate. Secondary outcomes were IVF treatment and delivery outcomes. Underweight patients were stratified into a significantly underweight group (body mass index [BMI] <17.5 kg/m2) and a mildly underweight group (BMI 17.5–18.49 kg/m2), and were compared with a normal-weight group (BMI 18.5–24.9 kg/m2).


      A total of 5229 patients were included (significantly underweight, 76; mildly underweight, 231; normal weight, 4922), resulting in 4798 embryo transfers. After oocyte retrieval, there were no significant differences between groups for total oocytes, mature oocyte yield and number of supernumerary blastocysts cryopreserved. Among women who had an embryo transfer, there were no significant differences in the live birth rates in significantly (31.0%, odds ratio [OR] 0.67, confidence interval [0.95, CI] 0.40–1.13) and mildly (37.7%, OR 0.95, CI 0.73–1.33) underweight patients compared with normal-weight patients (35.9%). Additionally, there were no statistically significant increased risks of preterm delivery, Caesarean delivery or a low birthweight (<2500 g) neonate.


      Mildly and significantly underweight infertile women have similar pregnancy and live birth rates to normal-weight patients after IVF treatment. In addition, underweight patients do not have an increased risk of preterm delivery (<37 weeks), Caesarean delivery or a low birthweight neonate.

      Key words

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        • Bellver J.
        In vitro fertilization in underweight women: focus on obstetric outcome.
        Fertility and Sterility. 2020; 113 (Elsevier): 323-324
        • Chavarro JE
        • Rich-Edwards JW
        • Rosner BA
        • Willett WC
        Diet and Lifestyle in the Prevention of Ovulatory Disorder Infertility.
        Obstetrics & Gynecology. 2007; 110: 1050-1058
        • Cheung LP
        • Lam PM
        • Lok IH
        • Chiu TT
        • Yeung SY
        • Tjer CC
        • Haines CJ
        GnRH antagonist versus long GnRH agonist protocol in poor responders undergoing IVF: a randomized controlled trial.
        Hum. Reprod. 2005; 20: 616-621
        • Crosignani PG
        • Bianchedi D
        • Riccaboni A
        • Vegetti W
        Management of anovulatory infertility.
        Hum. Reprod. 1999; 14 (Oxford Academic): 108-119
        • Dragisic KG
        • Davis OK
        • Fasouliotis SJ
        • Rosenwaks Z
        Use of a luteal estradiol patch and a gonadotropin-releasing hormone antagonist suppression protocol before gonadotropin stimulation for in vitro fertilization in poor responders.
        Fertil. Steril. 2005; 84: 1023-1026
        • Fedorcsák P
        • Dale PO
        • Storeng R
        • Ertzeid G
        • Bjercke S
        • Oldereid N
        • Omland AK
        • Åbyholm T
        • Tanbo T
        Impact of overweight and underweight on assisted reproduction treatment.
        Hum. Reprod. 2004; 19 (Oxford Academic): 2523-2528
        • Gesink Law DC
        • Maclehose RF
        • Longnecker MP
        Obesity and time to pregnancy.
        Hum. Reprod. 2007; 22 (Oxford Academic): 414-420
        • 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.
        Fertility and Sterility. 2016; 106: 1742-1750
        • Li C
        • Zhu N
        • Zeng L
        • Dang S
        • Zhou J
        • Pei L
        • Watson V
        • Chen T
        • Wang D
        • Yan H
        Effect of maternal pre-pregnancy underweight and average gestational weight gain on physical growth and intellectual development of early school-aged children.
        Sci. Rep. 2018; 8 ([Internet])
        • Li Y
        • Yang D
        • Zhang Q
        Impact of overweight and underweight on IVF treatment in Chinese women.
        Gynecological Endocrinology. 2010; 26 (Taylor & Francis): 416-422
        • Nohr EA
        • Vaeth M
        • Rasmussen S
        • Ramlau-Hansen CH
        • Olsen J
        Waiting time to pregnancy according to maternal birthweight and prepregnancy BMI.
        Hum. Reprod. 2009; 24 (Oxford Academic): 226-232
        • Pereira N
        • Petrini AC
        • Lekovich JP
        • Schattman GL
        • Rosenwaks Z
        Comparison of perinatal outcomes following fresh and frozen-thawed blastocyst transfer.
        International Journal of Gynecology & Obstetrics. 2016; 135: 96-100
        • Pereira N
        • Reichman DE
        • Goldschlag DE
        • Lekovich JP
        • Rosenwaks Z
        Impact of elevated peak serum estradiol levels during controlled ovarian hyperstimulation on the birth weight of term singletons from fresh IVF-ET cycles.
        J. Assist. Reprod. Genet. 2015; 32: 527-532
        • Provost MP
        • Acharya KS
        • Acharya CR
        • Yeh JS
        • Steward RG
        • Eaton JL
        • Goldfarb JM
        • Muasher SJ
        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: 663-669
        • Provost MP
        • Acharya KS
        • Acharya CR
        • Yeh JS
        • Steward RG
        • Eaton JL
        • Goldfarb JM
        • Muasher SJ
        Pregnancy outcomes decline with increasing recipient body mass index: an analysis of 22,317 fresh donor/recipient cycles from the 2008-2010 Society for Assisted Reproductive Technology Clinic Outcome Reporting System registry.
        Fertil. Steril. 2016; 105: 364-368
        • Ramlau-Hansen CH
        • Thulstrup AM
        • Nohr EA
        • Bonde JP
        • Sørensen TIA
        • Olsen J
        Subfecundity in overweight and obese couples.
        Hum. Reprod. 2007; 22 (Oxford Academic): 1634-1637
        • Rasmussen KM
        • Abrams B
        • Bodnar LM
        • Butte NF
        • Catalano PM
        • Siega-Riz AM
        Recommendations for Weight Gain During Pregnancy in the Context of the Obesity Epidemic.
        Obstet. Gynecol. 2010; 116: 1191-1195
        • Rich-Edwards JW
        • Goldman MB
        • Willett WC
        • Hunter DJ
        • Stampfer MJ
        • Colditz GA
        • Manson JE
        Adolescent body mass index and infertility caused by ovulatory disorder.
        American Journal of Obstetrics and Gynecology. 1994; 171: 171-177
        • Rich-Edwards JW
        • Spiegelman D
        • Garland M
        • Hertzmark E
        • Hunter DJ
        • Colditz GA
        • Willett WC
        • Wand H
        • Manson JE
        Physical Activity, Body Mass Index, and Ovulatory Disorder Infertility.
        Epidemiology. 2002; 13: 184-190
        • 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: 421-439
        • Shah DK
        • Missmer SA
        • Berry KF
        • Racowsky C
        • Ginsburg ES
        Effect of obesity on oocyte and embryo quality in women undergoing in vitro fertilization.
        Obstet. Gynecol. 2011; 118: 63-70
        • Singh N
        • Gupta P
        • Mittal S
        • Malhotra N
        Correlation of body mass index with outcome of in vitro fertilization in a developing country.
        Arch. Gynecol. Obstet. 2012; 285: 259-263
        • Surrey ES
        • Bower J
        • Hill DM
        • Ramsey J
        • Surrey MW
        Clinical and endocrine effects of a microdose GnRH agonist flare regimen administered to poor responders who are undergoing in vitro fertilization.
        Fertil. Steril. 1998; 69: 419-424
        • Tummon IS
        • Daniel SA
        • Kaplan BR
        • Nisker JA
        • Yuzpe AA
        Randomized, prospective comparison of luteal leuprolide acetate and gonadotropins versus clomiphene citrate and gonadotropins in 408 first cycles of in vitro fertilization.
        Fertil. Steril. 1992; 58: 563-568
        • Veeck LL
        • Zaninovic N.
        An Atlas of Human Blastocysts.
        CRC Press, New York2003
        • Wise LA
        • Rothman KJ
        • Mikkelsen EM
        • Sørensen HT
        • Riis A
        • Hatch EE
        An internet-based prospective study of body size and time-to-pregnancy.
        Hum. Reprod. 2010; 25: 253-264
        • Xiong Y
        • Liu Y
        • Qi Y
        • Liu C
        • Wang J
        • Li L
        • Zou K
        • Tan J
        • Sun X
        Association between prepregnancy subnormal body weight and obstetrical outcomes after autologous in vitro fertilization cycles: systematic review and meta-analysis.
        Fertility and Sterility. 2020; 113 (344-353.e2)
        • Yarali H
        • Esinler İ
        • Polat M
        • Bozdag G
        • Tiras B
        Antagonist/letrozole protocol in poor ovarian responders for intracytoplasmic sperm injection: a comparative study with the microdose flare-up protocol.
        Fertility and Sterility. 2009; 92: 231-235
        • Zanardo V
        • Mazza A
        • Parotto M
        • Scambia G
        • Straface G
        Gestational weight gain and fetal growth in underweight women.
        Ital. J. Pediatr. 2016; 42 ([Internet])


      Phillip Romanski graduated medical school from the University of Central Florida, Orlando, FL, USA, and completed his obstetrics and gynaecology Residency at the Brigham & Women's Hospital and Massachusetts General Hospital, Boston, MA. He is currently a Clinical Fellow in reproductive endocrinology and infertility at Weill Cornell Medical College, New York, NY.
      Key Message
      Mildly and significantly underweight infertile women had similar pregnancy and live birth rates to normal-weight women. Additionally, underweight patients did not have an increased risk of preterm delivery, Caesarean delivery or low birthweight neonates. These findings support the suggestion that underweight patients have similar IVF treatment outcomes to normal-weight patients.