【前沿传递】肥胖者减轻体重有助于提高试管婴儿的活产率

作者: Nathalie S, et al.

翻译：重庆医科大学附属第一医院 杨涓

译者简介：女，博士，重庆医科大学附属第一医院中西医结合科主治医师。毕业于天津中医药大学中西医结合妇科专业，现任重庆市医师协会风湿免疫科医师分会第一届委员会免疫相关生殖疾病学组委员，承担重庆市卫生局科研课题1项，发表SCI及CSCD论著数篇。擅长常见、多发风湿性疾病病的诊治，能够熟练处理风湿病危重症，擅长中西医结合妇科内分泌疾病及不孕症的诊治。

【摘要】

背景：在过去的三十年中，肥胖症的患病率在全球范围内呈上升趋势，尤其是在育龄妇女中。女性肥胖显然与自发生育力受损以及不良妊娠结局相关。文献中越来越多的证据表明，在体外受精（IVF）治疗后，肥胖也会导致不良的临床结果。然而，现有的研究在人群、群体定义和结果方面存在异质性，因此，阻碍了我们得出统一的结论。先前在2011年发表的meta分析表明，女性体重指数（BMI）升高对IVF结果的影响很小，但意义重大，但此后发表了许多研究，包括来自国家注册机构的大型队列研究，强调了更新了评论和meta分析的必要性。

目的：我们对现有文献进行系统的回顾和meta分析，旨在评估IVF后女性肥胖与活产率之间的关系。并按照排卵状态，卵母细胞来源，新鲜或冷冻的胚胎移植和周期等级进行亚组分析。

检索方法：使用以下关键词进行了系统回顾：“肥胖”，“体重指数”，“活产”，“ IVF”，“ ICSI”。检索了2007年1月1日至2017年11月30日期间在MEDLINE，EMBASE，Cochrane图书馆，Eudract和Clinicaltrial.gov中的相关文献。研究选择基于标题和摘要。检索了相关文章的全文，并由两名审稿人对其进行了评估。随后，使用纽卡斯尔-渥太华质量评估量表对患者的选择，可比性和结果评估进行质量评估。两名独立的评论者根据Cochrane方法进行了研究选择和数据提取。 

使用Review Manager软件对所有数据进行随机效应meta分析（整体分析），然后进行亚组分析。

结果：meta分析共纳入21项研究。与正常体重（BMI 18.5-24.9kg / m2）的女性相比，肥胖（BMI≥30kg / m2）的女性的IVF后活产率降低：风险比（RR）（95％CI）0.85（0.82– 0.87）。亚组分析表明，当肥胖与多囊卵巢综合征有关时，预后更差，不管卵母细胞来源如何（供体或非供体），都不能改变这个更差的结局。

结论：我们的meta分析清晰地显示，女性肥胖对IVF后的活产率存在负面影响和显着影响。通过改变生活方式或减肥手术减肥是否可以扭转这种有害作用还需要进一步评估。

附原文：

BACKGROUND: A worldwide increase in the prevalence of obesity has been observed in the past three decades, particularly in women of reproductive age. Female obesity has been clearly associated with impaired spontaneous fertility, as well as adverse pregnancy outcomes. Increasing evidence in the literature shows that obesity also contributes to adverse clinical outcomes following in vitro fertilization (IVF) procedures. However, the heterogeneity of the available studies in terms of populations, group definition and outcomes prevents drawing firm conclusions. A previous meta-analysis published in 2011 identified a marginal but significant negative effect of increased female body mass index (BMI) on IVF results, but numerous studies have been published since then, including large cohort studies from national registries, highlighting the need for an updated review and meta-analysis.OBJECTIVE AND RATIONALE: Our systematic review and meta-analysis of the available literature aims to evaluate the association of female obesity with the probability of live birth following IVF. Subgroup analyses according to ovulatory status, oocyte origin, fresh or frozen-embryo transfer and cycle rank were performed.SEARCH METHODS: A systematic review was performed using the following key words: (‘obesity’, ‘body mass index’, ‘live birth’, ‘IVF’, ‘ICSI’). Searches were conducted in MEDLINE, EMBASE, Cochrane Library, Eudract and clinicaltrial.gov from 01 January 2007 to 30 November 2017. Study selection was based on title and abstract. Full texts of potentially relevant articles were retrieved and assessed for inclusion by two reviewers. Subsequently, quality was assessed using the Newcastle-Ottawa Quality Assessment Scales for patient selection, comparability and assessment of outcomes. Two independent reviewers carried out study selection and data extraction according to Cochrane methods. Random-effect meta-analysis was performed using Review Manager software on all data (overall analysis), followed by subgroup analyses. OUTCOMES: A total of 21 studies were included in the meta-analysis. A decreased probability of live birth following IVF was observed in obese (BMI ≥ 30kg/m2) women when compared with normal weight (BMI 18.5–24.9kg/m2) women: risk ratio (RR) (95% CI) 0.85 (0.82–0.87). Subgroups analyses demonstrated that prognosis was poorer when obesity was associated with polycystic ovary syndrome, while the oocyte origin (donor or non-donor) did not modify the overall interpretation. WIDER IMPLICATIONS: Our meta-analysis clearly demonstrates that female obesity negatively and significantly impacts live birth rates following IVF. Whether weight loss can reverse this deleterious effect through lifestyle modifications or bariatric surgery should be further evaluated.

引自：

Nathalie S, Stéphanie H, Vanessa BL,etal. Female obesity is negatively associated with live birth rate following IVF: a systematic review and meta-analysis.Human Reproduction Update, 2019 Doi:10.1093/humupd/dmz011

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