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Randomized Trial of a Lifestyle Program in Obese Infertile Women

Published on May 19, 2016in The New England Journal of Medicine70.67
· DOI :10.1056/NEJMoa1505297
Meike Mutsaerts8
Estimated H-index: 8
(UG: University of Groningen),
Anne M. van Oers4
Estimated H-index: 4
(UG: University of Groningen)
+ 28 AuthorsAnnemieke Hoek34
Estimated H-index: 34
(UG: University of Groningen)
Sources
Abstract
BackgroundSmall lifestyle-intervention studies suggest that modest weight loss increases the chance of conception and may improve perinatal outcomes, but large randomized, controlled trials are lacking. MethodsWe randomly assigned infertile women with a body-mass index (the weight in kilograms divided by the square of the height in meters) of 29 or higher to a 6-month lifestyle intervention preceding treatment for infertility or to prompt treatment for infertility. The primary outcome was the vaginal birth of a healthy singleton at term within 24 months after randomization. ResultsWe assigned women who did not conceive naturally to one of two treatment strategies: 290 women were assigned to a 6-month lifestyle-intervention program preceding 18 months of infertility treatment (intervention group) and 287 were assigned to prompt infertility treatment for 24 months (control group). A total of 3 women withdrew consent, so 289 women in the intervention group and 285 women in the control group were included in ...
  • References (32)
  • Citations (77)
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References32
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#1Richard S. Legro (Heilongjiang University of Chinese Medicine)H-Index: 74
#2Xiaoke WuH-Index: 21
Last. Ben Willem J. MolH-Index: 74
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Clinical trials testing infertility treatments often do not report on the major outcomes of interest to patients and clinicians and the public (such as live birth) nor on the harms, including maternal risks during pregnancy and fetal anomalies. This is complicated by the multiple participants in infertility trials which may include a woman (mother), a man (father), and result in a third individual if successful, their offspring (child), who is also the desired outcome of treatment. The primary o...
51 CitationsSource
#1Marie Ng (UW: University of Washington)H-Index: 26
#2Thomas R. Fleming (UW: University of Washington)H-Index: 76
Last. Emmanuela Gakidou (UW: University of Washington)H-Index: 49
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Summary Background In 2010, overweight and obesity were estimated to cause 3·4 million deaths, 3·9% of years of life lost, and 3·8% of disability-adjusted life-years (DALYs) worldwide. The rise in obesity has led to widespread calls for regular monitoring of changes in overweight and obesity prevalence in all populations. Comparable, up-to-date information about levels and trends is essential to quantify population health effects and to prompt decision makers to prioritise action. We estimate th...
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#1Dagfinn Aune (Imperial College London)H-Index: 41
#2Ola Didrik Saugstad (Oslo University Hospital)H-Index: 69
Last. Serena Tonstad (LLU: Loma Linda University)H-Index: 2
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Importance Evidence suggests that maternal obesity increases the risk of fetal death, stillbirth, and infant death; however, the optimal body mass index (BMI) for prevention is not known. Objective To conduct a systematic review and meta-analysis of cohort studies of maternal BMI and risk of fetal death, stillbirth, and infant death. Data Sources The PubMed and Embase databases were searched from inception to January 23, 2014. Study Selection Cohort studies reporting adjusted relative risk (RR) ...
230 CitationsSource
498 CitationsSource
#2Harry J.M. GroenH-Index: 70
Last. E va Corpeleijn (UMCG: University Medical Center Groningen)H-Index: 29
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Objective To compare the means and changes over time of intra-abdominal fat (IAF) and subcutaneous abdominal fat (SAF) measured by abdominal ultrasound (US) and computerized tomography (CT). Design and Methods Prospective cohort study of 53 women with obesity and infertility undergoing a lifestyle program. Results The Pearson's correlation between IAF measurement by US compared to CT was good at baseline, month 3 and 6 (all r ≥ 0.72). The correlation of SAF measurement by US compared to CT was r...
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#1Adolfo Correa (UMMC: University of Mississippi Medical Center)H-Index: 51
#2Jessica Marcinkevage (Emory University)H-Index: 6
The growing number of obese women worldwide has many implications for the reproductive health outcomes of mothers and their children. Specifically, prepregnancy obesity has been associated with certain major birth defects. Provided here is a summary of the most recent and comprehensive meta-analysis of reports of associations between prepregnancy obesity and birth defects, along with an update that includes a brief overview of reports of similar associations published since that meta-analysis. T...
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#1Sven Cnattingius (KI: Karolinska Institutet)H-Index: 85
#2Eduardo VillamorH-Index: 44
Last. Fredrik Granath (KI: Karolinska Institutet)H-Index: 62
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Importance Preterm birth is a leading cause of infant mortality, morbidity, and long-term disability, and these risks increase with decreasing gestational age. Obesity increases the risk of preterm delivery, but the associations between overweight and obesity and subtypes of preterm delivery are not clear. Objective To study the associations between early pregnancy body mass index (BMI) and risk of preterm delivery by gestational age and by precursors of preterm delivery. Design, Setting, and Pa...
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#1Meike Mutsaerts (UMCG: University Medical Center Groningen)H-Index: 8
Last. Annemieke Hoek (UMCG: University Medical Center Groningen)H-Index: 34
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What are the dropout rates in lifestyle intervention programs (LIPs) for overweight and obese infertile women and can intervention- or patient-related baseline factors associated with dropout be identified in these women? The median dropout rate was 24 in overweight and obese infertile women who participated in a LIP; clinical useful intervention or patient-related factors associated with dropout could not be identified. Overweight and obese infertile women might improve their chance of concepti...
32 CitationsSource
#1L Vrebosch (Katholieke Universiteit Leuven)H-Index: 1
#2Sarah Bel (Katholieke Universiteit Leuven)H-Index: 4
Last. Roland Devlieger (Katholieke Universiteit Leuven)H-Index: 42
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The number of women of reproductive age undergoing bariatric surgery, including laparoscopic adjustable gastric banding (LAGB), has increased in recent years. The objective of this study was to list both maternal and neonatal outcomes in pregnancies in obese women (BMI ≥ 30 kg/m2) after LAGB and compare them with pregnancies in obese or normal weight women without LAGB. Studies showed a lower incidence of gestational diabetes, pregnancy-induced hypertension (PIH), pre-eclampsia, caesarean sectio...
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#1I.M. CustersH-Index: 9
Last. Pieternel SteuresH-Index: 20
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BACKGROUND: We recently reported that treatment with intrauterine insemination and controlled ovarian stimulation (IUI-COS) did not increase ongoing pregnancy rates compared with expectant management (EM) in couples with unexplained subfertility and intermediate prognosis of natural conception. Long-term cost-effectiveness of a policy of initial EM is unknown. We investigated whether the recommendation not to treat during the first 6 months is valid, regarding the long-term effectiveness and cum...
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Cited By77
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#1Hellas Cena (UNIPV: University of Pavia)H-Index: 15
#2Luca Chiovato (UNIPV: University of Pavia)H-Index: 49
Last. Rossella E. Nappi (UNIPV: University of Pavia)H-Index: 43
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CONTEXT: Obesity is responsible for an increased risk of sub-fecundity and infertility. Obese women show poorer reproductive outcomes regardless of the mode of conception, and higher body mass index (BMI) is associated with poorer fertility prognosis. Polycystic ovary syndrome (PCOS) is one of the leading causes of infertility, and many women with PCOS are also overweight or obese. EVIDENCE ACQUISITION: The aim of the present narrative review is to describe the mechanisms responsible for the dev...
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#1Sophie BrouilletH-Index: 9
#2Guilaine Boursier (University of Montpellier)H-Index: 5
Last. Samir Hamamah (University of Montpellier)H-Index: 38
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BACKGROUND A dynamic balance between pro- and anti-inflammatory factors contributes to regulating human female reproduction. Chronic low-grade inflammation has been detected in several female reproductive conditions, from anovulation to embryo implantation failure. C-reactive protein (CRP) is a reliable marker of inflammation that is extensively used in clinical practice. Recent studies quantified CRP in the serum of infertile women undergoing ART and suggested its potential for the prediction o...
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#1C Dupont (University of Paris)H-Index: 9
#2Philippe Aegerter (French Institute of Health and Medical Research)H-Index: 41
Last. Emmanuel Cosson (Sorbonne)H-Index: 25
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Infertility is defined as the inability to conceive after 12 months of unprotected intercourse. It affects approximately one in six couples seeking pregnancy in France or western countries. Many lifestyle factors of the couples’ pre and peri-conceptional environment (weight, diet, alcohol, tobacco, coffee, drugs, physical activity, stress, sleep…) have been identified as risk factors for infertility in both males and females. The high prevalence rates of unhealthy diets and lifestyles in the rep...
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#1Macie L. Champion (UAB: University of Alabama at Birmingham)H-Index: 1
#2Lorie M. Harper (UAB: University of Alabama at Birmingham)H-Index: 16
Gestational weight gain is a modifiable risk factor for adverse perinatal outcomes. After the Institute of Medicine (IOM) released updated recommendations for gestational weight gain in 2009, a multitude of studies were released examining the recommendations, particularly for women with obesity. As the obesity epidemic continues, many physicians are interested in minimizing gestational weight gain for all women. Our aim was to review the evidence for the association of gestational weight gain an...
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#1Kai-Lun Hu (PKU: Peking University)H-Index: 3
#2Fen-Ting Liu (PKU: Peking University)H-Index: 1
Last. Jie Qiao (PKU: Peking University)H-Index: 40
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Abstract Research question What are the optimal values of maternal age and body mass index (BMI), paternal age and BMI, number of oocytes retrieved, and serum AMH levels for the cumulative live birth rate (CLBR) in in vitro fertilization and embryo transfer (IVF-ET)? Design This retrospective cohort study included 9,494 women who underwent their first IVF-ET cycle between January 2017 and July 2018. The primary outcome was the CLBR within one complete cycle. Results The CLBR was significantly lo...
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#1Roberto Matorras (UPV/EHU: University of the Basque Country)H-Index: 1
#2Antonia Exposito (UPV/EHU: University of the Basque Country)H-Index: 1
Last. Maria Begoña Ruiz-Larrea (UPV/EHU: University of the Basque Country)H-Index: 1
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Objective To ascertain whether the oocytes of women who are obese or overweight have a different fatty acid (FA) profile than women with normal weight. Design Prospective case-control study. Setting Two IVF centers. Patient(s) A total of 205 women undergoing IVF and intracytoplasmic sperm injection (ICSI) were included in the study, totaling 922 oocytes. Intervention(s) The unfertilized and the immature oocytes from the women who underwent IVF/ICSI were subjected to FA analysis with capillary ga...
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Source
#1Kay NeumannH-Index: 3
#2Georg GriesingerH-Index: 23
Bereits 1721 wurde durch Antonio Vallisneri, einem Mediziner, Wissenschaftler und Naturforscher aus Padua, das polyzystische Ovarsyndrom (PCOS) anhand auffallend groser Ovarien bei einer verheirateten, infertilen Frau beschrieben. 1935 berichteten Stein und Leventhal von Zyklusunregelmasigkeiten und Hirsutismus bei einer Gruppe von Frauen mit grosen sowie mit einer hohen Anzahl an Follikeln versehenen Ovarien. Als Therapie wurde im Jahre 1948 von Stein und Leventhal eine chirurgische Keilresekti...
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#1Jing Li (Zhengzhou University)H-Index: 5
#2Xiaocong Liu (Zhengzhou University)
Last. Yihong Guo (Zhengzhou University)H-Index: 10
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Background: Polycystic ovary syndrome (PCOS) patients have a better ovarian reserve and age-related improvement in endocrine disturbances than non-PCOS patients. The effects of age on in vitro fertilization (IVF) treatment outcomes associated with cumulative live birth rate (CLBR) remain unclear. Objectives: To study the effect of age on CLBR after the first ovarian stimulation in IVF in PCOS patients. Method: This retrospective cohort study included 3,502 PCOS patients and 18,596 patients with ...
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#1Marjolein M. van den Tweel (LUMC: Leiden University Medical Center)H-Index: 1
#2Nicole F. Klijn (LUMC: Leiden University Medical Center)H-Index: 3
Last. Leoni A. Louwé (LUMC: Leiden University Medical Center)H-Index: 10
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AbstractThis retrospective cohort study examines the association between previous mode of delivery and subsequent live birth rate in women who become pregnant after in vitro fertilization (IVF) or ...
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