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Associations between dyslipidaemia and pregnancy outcomes in the first complete cycle of IVF/ICSI: a real-world analysis

  • Tianli Yang
    Affiliations
    Reproductive Medicine Center, Xiangya Hospital of Central South University, Changsha Hunan, P.R. China

    Clinical Research Center for Women's Reproductive Health in Hunan Province, Changsha Hunan, P.R. China
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  • Jing Zhao
    Affiliations
    Reproductive Medicine Center, Xiangya Hospital of Central South University, Changsha Hunan, P.R. China

    Clinical Research Center for Women's Reproductive Health in Hunan Province, Changsha Hunan, P.R. China
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  • Qiong Zhang
    Affiliations
    Reproductive Medicine Center, Xiangya Hospital of Central South University, Changsha Hunan, P.R. China

    Clinical Research Center for Women's Reproductive Health in Hunan Province, Changsha Hunan, P.R. China
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  • Donge Liu
    Affiliations
    Reproductive Medicine Center, Xiangya Hospital of Central South University, Changsha Hunan, P.R. China

    Clinical Research Center for Women's Reproductive Health in Hunan Province, Changsha Hunan, P.R. China
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  • Nenghui Liu
    Affiliations
    Reproductive Medicine Center, Xiangya Hospital of Central South University, Changsha Hunan, P.R. China

    Clinical Research Center for Women's Reproductive Health in Hunan Province, Changsha Hunan, P.R. China
    Search for articles by this author
  • Yumei Li
    Affiliations
    Reproductive Medicine Center, Xiangya Hospital of Central South University, Changsha Hunan, P.R. China

    Clinical Research Center for Women's Reproductive Health in Hunan Province, Changsha Hunan, P.R. China
    Search for articles by this author
  • Zhongyuan Yao
    Affiliations
    Reproductive Medicine Center, Xiangya Hospital of Central South University, Changsha Hunan, P.R. China

    Clinical Research Center for Women's Reproductive Health in Hunan Province, Changsha Hunan, P.R. China
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  • Yeqing Zhang
    Affiliations
    Reproductive Medicine Center, Xiangya Hospital of Central South University, Changsha Hunan, P.R. China

    Clinical Research Center for Women's Reproductive Health in Hunan Province, Changsha Hunan, P.R. China
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  • Fen Tian
    Affiliations
    Reproductive Medicine Center, Xiangya Hospital of Central South University, Changsha Hunan, P.R. China

    Clinical Research Center for Women's Reproductive Health in Hunan Province, Changsha Hunan, P.R. China
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  • Tingting Liao
    Affiliations
    Reproductive Medicine Center, Xiangya Hospital of Central South University, Changsha Hunan, P.R. China

    Clinical Research Center for Women's Reproductive Health in Hunan Province, Changsha Hunan, P.R. China
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  • Hongying Tang
    Correspondence
    Corresponding authors.
    Affiliations
    Reproductive Medicine Center, Xiangya Hospital of Central South University, Changsha Hunan, P.R. China

    Clinical Research Center for Women's Reproductive Health in Hunan Province, Changsha Hunan, P.R. China
    Search for articles by this author
  • Yanping Li
    Correspondence
    Corresponding authors.
    Affiliations
    Reproductive Medicine Center, Xiangya Hospital of Central South University, Changsha Hunan, P.R. China

    Clinical Research Center for Women's Reproductive Health in Hunan Province, Changsha Hunan, P.R. China
    Search for articles by this author
Published:September 06, 2021DOI:https://doi.org/10.1016/j.rbmo.2021.08.030

      Abstract

      Research question

      Are there associations between dyslipidaemia and pregnancy outcomes in the first complete cycle of IVF/intracytoplasmic sperm injection (ICSI)?

      Design

      This long-term, retrospective real-world analysis involved 5030 infertile women who underwent a first complete IVF/ICSI cycle between January 2015 and October 2020. They were categorized into dyslipidaemia (n = 1903) and control (n = 3127) groups according to serum lipid concentrations before ovarian stimulation. Propensity score matching and multivariable logistic regression were used to control for confounding variables.

      Results

      In the raw cohort, women with dyslipidaemia had a significantly increased late miscarriage rate (P = 0.039), decreased term birth rate (P = 0.002) and decreased live birth rate (P = 0.005) compared with non-dyslipidaemic women. In the propensity score-matched cohort, the term birth rate (P = 0.038) and live birth rate (P = 0.044) were significantly lower in the dyslipidaemia group (n = 1686) than the controls (n = 1686). Multivariable logistic regression indicated that infertile women with dyslipidaemia (P = 0.026) and elevated serum total cholesterol concentrations (total cholesterol ≥5.20 mmol/l; P = 0.028) were significantly less likely to have a live birth. Rates of late miscarriage (P = 0.027), term birth (P = 0.003) and live birth (P = 0.010) differed significantly among women with normal, borderline increased and increased serum lipid concentrations. Compared with controls, women with increased serum lipid concentrations had a significantly higher late miscarriage rate, lower term birth rate and lower live birth rate. Women with increased serum lipid concentrations were significantly less likely than controls to have a live birth.

      Conclusions

      Dyslipidaemia, total cholesterol ≥5.20 mmol/l and degrees of elevated serum lipid concentrations are negatively associated with live birth rate in the first complete IVF/ICSI cycle in infertile women.

      Keywords

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      References

        • Alpha Scientists in Reproductive Medicine and ESHRE Special Interest Group of Embryology
        The Istanbul consensus workshop on embryo assessment: proceedings of an expert meeting.
        Hum. Reprod. 2011; 26: 1270-1283
        • Balen A.H.
        • Morley L.C.
        • Misso M.
        • Franks S.
        • Legro R.S.
        • Wijeyaratne C.N.
        • Stener-Victorin E.
        • Fauser B.C.
        • Norman R.J.
        • Teede H.
        The management of anovulatory infertility in women with polycystic ovary syndrome: an analysis of the evidence to support the development of global WHO guidance.
        Hum. Reprod. Update. 2016; 22: 687-708
        • Bellver J.
        • Pellicer A.
        • García-Velasco J.A.
        • Ballesteros A.
        • Remohí J.
        • Meseguer M.
        Obesity reduces uterine receptivity: clinical experience from 9,587 first cycles of ovum donation with normal weight donors.
        Fertil. Steril. 2013; 100: 1050-1058
        • Boots C.E.
        • Bernardi L.A.
        • Stephenson M.D.
        Frequency of euploid miscarriage is increased in obese women with recurrent early pregnancy loss.
        Fertil. Steril. 2014; 102: 455-459
        • Di Gregorio L.M.
        • Zambrotta E.
        • Di Guardo F.
        • Gulino F.A.
        • Musmeci G.
        • Capriglione S.
        • Angioli R.
        • Palumbo M.
        Effects of Body Mass Index and Biochemical Lipid Levels on Reproductive Outcomes during An Intracytoplasmic Sperm Injection: A Retrospective Study.
        Int. J. Fertil. Steril. 2019; 13: 190-195
        • Gao L.
        • Li M.
        • Wang Y.
        • Zeng Z.
        • Xie Y.
        • Liu G.
        • Li J.
        • Zhang B.
        • Liang X.
        • Wei L.
        • Yang X.
        Overweight and high serum total cholesterol were risk factors for the outcome of IVF/ICSI cycles in PCOS patients and a PCOS-specific predictive model of live birth rate was established.
        J. Endocrinol. Invest. 2020; 43: 1221-1228
        • Garrido M.M.
        • Kelley A.S.
        • Paris J.
        • Roza K.
        • Meier D.E.
        • Morrison R.S.
        • Aldridge M.D.
        Methods for constructing and assessing propensity scores.
        Health Serv. Res. 2014; 49: 1701-1720
        • He Y.
        • Lu Y.
        • Zhu Q.
        • Wang Y.
        • Lindheim S.R.
        • Qi J.
        • Li X.
        • Ding Y.
        • Shi Y.
        • Wei D.
        • Chen Z.J.
        • Sun Y.
        Influence of metabolic syndrome on female fertility and in vitro fertilization outcomes in PCOS women.
        Am. J. Obstet. Gynecol. 2019; 221 (138.e1-138.e12)
        • Hoeger K.M.
        • Dokras A.
        • Piltonen T.
        Update on PCOS: Consequences, Challenges, and Guiding Treatment.
        J. Clin. Endocrinol. Metab. 2021; 106: e1071-e1083
        • Hou Z.
        • Zhang Q.
        • Zhao J.
        • Xu A.
        • He A.
        • Huang X.
        • Xie S.
        • Fu J.
        • Xiao L.
        • Li Y.
        Value of endometrial echo pattern transformation after hCG trigger in predicting IVF pregnancy outcome: a prospective cohort study.
        Reprod. Biol. Endocrinol. 2019; 17: 74
        • Jamro E.L.
        • Bloom M.S.
        • Browne R.W.
        • Kim K.
        • Greenwood E.A.
        • Fujimoto V.Y.
        Preconception serum lipids and lipophilic micronutrient levels are associated with live birth rates after IVF.
        Reprod. Biomed. Online. 2019; 39: 665-673
        • Joint Committee for Guideline Revision
        2016 Chinese guidelines for the management of dyslipidemia in adults.
        J. Geriatr. Cardiol. 2018; 15: 1-29
        • Lainas T.G.
        • Sfontouris I.A.
        • Zorzovilis I.Z.
        • Petsas G.K.
        • Lainas G.T.
        • Alexopoulou E.
        • Kolibianakis E.M.
        Flexible GnRH antagonist protocol versus GnRH agonist long protocol in patients with polycystic ovary syndrome treated for IVF: a prospective randomised controlled trial (RCT).
        Hum. Reprod. 2010; 25: 683-689
        • Li X.
        • Ding W.
        • Liu J.Y.
        • Mao Y.D.
        • Huang J.
        • Wang W.
        • Ma X.
        [Effects of dyslipidemia on IVF/ICSI pregnancy outcome in patients with polycystic ovary syndrome].
        Zhonghua Fu Chan Ke Za Zhi. 2018; 53 (Chinese): 402-408
        • Liu F.
        • Jiang Q.
        • Sun X.
        • Huang Y.
        • Zhang Z.
        • Han T.
        • Shi Y.
        Lipid Metabolic Disorders and Ovarian Hyperstimulation Syndrome: A Retrospective Analysis.
        Front Physiol. 2020; 11491892
        • Liu H.H.
        • Li J.J.
        Aging and dyslipidemia: a review of potential mechanisms.
        Ageing Res. Rev. 2015; 19: 43-52
        • Melo A.S.
        • Rosa-e-Silva J.C.
        • Rosa-e-Silva A.C.
        • Poli-Neto O.B.
        • Ferriani R.A.
        • Vieira C.S.
        Unfavorable lipid profile in women with endometriosis.
        Fertil. Steril. 2010; 93: 2433-2436
        • Niu Z.
        • Ye Y.
        • Xia L.
        • Feng Y.
        • Zhang A.
        Follicular fluid cytokine composition and oocyte quality of polycystic ovary syndrome patients with metabolic syndrome undergoing in vitro fertilization.
        Cytokine. 2017; 91: 180-186
        • Palomba S.
        • Piltonen T.T.
        • Giudice L.C.
        Endometrial function in women with polycystic ovary syndrome: a comprehensive review.
        Hum. Reprod. Update. 2021; 27: 584-618
        • Pantasri T.
        • Robker R.L.
        • Wu L.L.
        • Norman R.J.
        Relationship between serum and follicular levels of glucose and lipids, oocyte lipids and in vitro fertilization (IVF) outcome.
        Hum. Reprod. 2013; 28 (SUPPL. 1(i233-i234)
        • Pugh S.J.
        • Schisterman E.F.
        • Browne R.W.
        • Lynch A.M.
        • Mumford S.L.
        • Perkins N.J.
        • Silver R.
        • Sjaarda L.
        • Stanford J.B.
        • Wactawski-Wende J.
        • et al.
        Preconception maternal lipoprotein levels in relation to fecundability.
        Hum. Reprod. 2017; 32: 1055-1063
        • Qi L.
        • Ding X.
        • Tang W.
        • Li Q.
        • Mao D.
        • Wang Y.
        Prevalence and Risk Factors Associated with Dyslipidemia in Chongqing, China.
        Int. J. Environ. Res. Public Health. 2015; 12: 13455-13465
        • Sam S.
        • Scoccia B.
        • Yalamanchi S.
        • Mazzone T.
        Metabolic dysfunction in obese Hispanic women with polycystic ovary syndrome.
        Hum. Reprod. 2015; 30: 1358-1364
        • Schisterman E.F.
        • Mumford S.L.
        • Browne R.W.
        • Barr D.B.
        • Chen Z.
        • Louis G.M.
        Lipid concentrations and couple fecundity: the LIFE study.
        J. Clin. Endocrinol. Metab. 2014; 99: 2786-2794
        • Sermondade N.
        • Huberlant S.
        • Bourhis-Lefebvre V.
        • Arbo E.
        • Gallot V.
        • Colombani M.
        • Fréour T.
        Female obesity is negatively associated with live birth rate following IVF: a systematic review and meta-analysis.
        Hum. Reprod. Update. 2019; 25: 439-451
        • Simon A.
        • Laufer N.
        Repeated implantation failure: clinical approach.
        Fertil. Steril. 2012; 97: 1039-1043
        • Teede H.J.
        • Misso M.L.
        • Costello M.F.
        • Dokras A.
        • Laven J.
        • Moran L.
        • Piltonen T.
        • Norman R.J.
        International PCOS Network. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome.
        Hum. Reprod. 2018; 33: 1602-1618
        • Tehrani F.R.
        • Erfani H.
        • Cheraghi L.
        • Tohidi M.
        • Azizi F.
        Lipid profiles and ovarian reserve status: a longitudinal study.
        Hum. Reprod. 2014; 29: 2522-2529
        • Vekic J.
        • Zeljkovic A.
        • Stefanovic A.
        • Jelic-Ivanovic Z.
        • Spasojevic-Kalimanovska V.
        Obesity and dyslipidemia.
        Metabolism. 2019; 92: 71-81
        • Verit F.F.
        • Yildiz Zeyrek F.
        • Zebitay A.G.
        • Akyol H.
        Cardiovascular risk may be increased in women with unexplained infertility.
        Clin. Exp. Reprod. Med. 2017; 44: 28-32
        • Wu B.
        Information presentation and consumer choice: Evidence from Assisted Reproductive Technology (ART) Success Rate Reports.
        Health Econ. 2019; 28: 868-883
        • Yang X.
        • Wu L.L.
        • Chura L.R.
        • Liang X.
        • Lane M.
        • Norman R.J.
        • Robker R.L.
        Exposure to lipid-rich follicular fluid is associated with endoplasmic reticulum stress and impaired oocyte maturation in cumulus-oocyte complexes.
        Fertil. Steril. 2012; 97: 1438-1443
        • Zhang Q.
        • Hao J.
        • Wang Y.
        • Xu B.
        • Zhao J.
        • Li Y.
        Clinical validation of pinopode as a marker of endometrial receptivity: a randomized controlled trial.
        Fertil. Steril. 2017; 108 (513-517.e2)
        • Zhu L.
        • Li Y.
        • Xu A.
        Influence of controlled ovarian hyperstimulation on uterine peristalsis in infertile women.
        Hum. Reprod. 2012; 27: 2684-2689

      Biography

      Yanping Li, MD, is a Professor and Doctoral Supervisor at Central South University, Changsha, and the Director of Reproductive Medicine Center, Xiangya Hospital, China. She performs more than 1000 IVF cycles per year with a clinical pregnancy rate of 54%. In addition, she conducts research on reproductive endocrinology and endometrial receptivity.
      Key message
      This study reveals that dyslipidaemia, especially an elevated total cholesterol level, is negatively associated with live birth rate in the first complete IVF/ICSI cycle in infertile women. Further multicentre clinical studies and laboratory experiments are required to provide strong evidence regarding this aspect.