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Abstract
Obesity is an epidemic not only in the United States and developed countries but also in developing countries. It replaces the more traditional healthcare concerns including under-nutrition and infectious diseases as one of the most significant causes of ill health. World wide over a billion adults and children are overweight and some experts have predicted that the current generation of children are likely to have shorter life than their parents because of obesity. The obesity epidemic is related to an environment that encourages eating more food with little exercise.
Obesity leads to many complications that increase mortality and morbidity rate as cardiovascular diseases, cerebrovascular disease, type II diabetes, sleep apnoea syndrome, gastrointestinal diseases, arthritis and cancer.
Obesity affects gynaecology and reproduction causing menstrual disturbances,hirsutism, and infertility and may lead to pregnancy loss (miscarriage). It also leads to obstetric complications, these complications may be related to obesity alone or to polycystic ovary syndrome (PCOS), which is often associated:between one third to a half of PCOS patients are obese.
With increasing the prevalence of obesity, more women seeking ART as atreatment for infertility are obese. The data regarding the impact of obesity on pregnancy outcomes after ART are conflicting. Obesity thought to affects IVF results in different ways and through different mechanisms starting from oocytes retrieval until the end of pregnancy.
As obese women with high body mass index have been reported to affect the endometrium, as claimed in a study, which compared android and gynecoid body fat distribution, it is found that, the pregnancy rate decreased with an android body fat distribution. This might be due to hormonal changes that altered the endometrium, as obese women, especially those with upper segment fat distribution have more oestrogen receptors on their endometrium, this may be a result of inadequate progesterone action as well as the action of other steroid precursors or hormones like androgen, oestrogen and insulin.
In obese women with PCOS many theories try to explain the pathogenesis of pregnancy loss such as higher secretion of luteinizing hormone, increase of androgen production and hyper insulinemia.
In several studies, obesity is an independent risk factor for maternal complication as it reported to be associated with high miscarriage rates in natural conception, those obtained through ovulation induction and those obtained by IVF and ICS, these miscarriage include preclinical, clinical as well as recurrent miscarriage and all this may be due to poor oocyte and embryo quality.
It also has been reported that obesity increase the risk of foetal defect such as the central nervous system anomaly as neural tube defect; great vessels anomalies,ventral wall defects and intestinal anomalies, this has been reported to be due to low serum folic acid levels that present in obese patient with a body mass index more than 30.
Obesity also have been associated with many maternal complications such as hypertension, pre-eclampsia, gestational diabetes, thromboembolism, urinary tract infection, foetal macrosomia, preterm labour and delivery, sudden and unexplained intrauterine death, operative vaginal deliveries, anaesthetic and surgical complications, postpartum haemorrhage, postoperative wound infection and dehiscence and endomyometritis in the puerperium, it is also associated with eighteen percent of obstetric causes of maternal death and about eighty percent of anaesthesia related death.
In this study we found that there was increase in cancellation rate with increased BMI P=0.0001,also that fertilization rate increases with increase in BMI 0.0001, but there was no association between implantation rate, total pregnancy, ongoing pregnancy and clinical pregnancy rate and BMI.
We also found that there was decrease in implantation rate with advanced maternal age P=0.022, endometriosis P=0.032, male factor infertility P=0.019and cumulative OPU P=0.0001 but the implantation rate increase with ICSI treatment P=0.0001 and with history of previous birth P=0.006, implantation rate decrease with increase in maternal age more than 40 Y; P=0.011.
Obesity (BMI) has upward trend in biochemical pregnancy, clinical pregnancy loss, total pregnancy loss but without significant difference except in blighted ovum P=0.011.
We also found that PCOS patients had high total miscarriage and biochemical pregnancy rate when compared with the non-PCOS patients on the first ART pregnancy. Both clinical pregnancy loss and foetal heart loss was about to be significant.
Obese PCOS had high miscarriage rate when compared with obese non-PCOS P=0.004