עודף משקל והשרשת עוברים

עודף משקל, בעיקר בנשים עם תנגוד לאינסולין, משפיע על המערכת ההורמונאלית, כך שעקב עליה ברמות ההורמונים האנדרוגניים (הזכריים) בגוף, תיתכן השפעה שלילית גם על ההשרשה. ההשפעה מתבטאת בהמשך בנטיה גם להפלות עצמוניות לאחר טיפולי פריון. Obesity is a risk factor for early pregnancy loss after IVF or ICSI. Fedorcsak P, Storeng R, Dale PO, Tanbo T, Abyholm T. Acta Obstet Gynecol Scand 2000 Jan;79(1):43-8 Department of Obstetrics and Gynecology, National Hospital, University of Oslo, Norway. BACKGROUND: Experience with polycystic ovary syndrome shows that insulin resistance is related to early pregnancy loss. This association was examined by comparing pregnancy outcome in obese and lean women. METHODS: A cohort of 383 patients conceiving after in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) was studied. Ovarian stimulation was achieved by GnRHa and FSH or hMG (n=362), by FSH or hMG alone (n=16), or by clomiphene citrate and FSH or hMG (n=5). Luteal phase was supported with progesterone. Pregnancies were defined by >10 IU/l plasma beta-hCG on day 14. Ultrasound scan on week 6 and week 12 confirmed fetal viability. RESULTS: Lean group (body mass index [BMI] or =25 kg/m2; n=79) were established. Obese patients had fewer oocytes collected (median: 8 vs 10 p=0.03), they had higher abortion rate during the first 6 weeks (22% vs 12%; p=0.03) and lower live-birth rate (63% vs 75%; p=0.04). The relative risk of abortion before week 6 was 1.77 (95% CI: 1.05 to 2.97). Multivariate logistic regression analysis revealed that obesity and low oocyte count were independently associated with spontaneous abortion. In the obese group, low oocyte number was associated with a more profound increase in the risk of abortion than among lean patients. The effect of age, history of past pregnancies, or infertility diagnosis on the probability of miscarriage were not significant. CONCLUSIONS: Obesity is an independent risk factor for early pregnancy loss. This risk is, in part, related to the lower number of collected oocytes in obese women. Obesity increases the risk of spontaneous abortion during infertility treatment. Wang JX, Davies MJ, Norman RJ. Obes Res 2002 Jun;10(6):551 Reproductive Medicine Unit, Department of Obstetrics and Gynaecology, University of Adelaide, The Queen Elizabeth Hospital, Woodville, Australia. [email protected] OBJECTIVE: This study examines the relationship between body mass and the risk of spontaneous abortion in a large cohort of patients who received infertility treatment. RESEARCH METHODS AND PROCEDURES: This is a retrospective study using data on pregnancies (n = 2349) achieved after treatment in a tertiary medical center from 1987 to 1999. One pregnancy per subject was included, and the subjects were stratified into five body mass groups based on body mass index (BMI): underweight, or =35 kg/m(2). Logistical regression analysis was used. RESULTS: The overall incidence of spontaneous abortion was 20% (476 of 2349). The effect of BMI on the risk of spontaneous abortion was significant after adjusting for several independent risk factors. Compared with the reference group (BMI 18.5 to 24.9 kg/m(2)), underweight women had a similar risk of spontaneous abortion, whereas there was progressive increase of risk in overweight, obese, and very obese groups (p < 0.05, p < 0.01, and p < 0.001, respectively). DISCUSSION: Of all known risk factors for spontaneous abortion, the control of obesity has great significance because it is noninvasive, potentially modifiable, possibly amenable to low cost, and self-manageable by patients. This study established a positive relationship between BMI and the risk of spontaneous abortion in women who became pregnant after assisted reproductive technology treatment.