الفهرس 
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Abstract
Obesity has been associated with menstrual irregularities, chronic anovulation, infertility, and poor outcomes in women undergoing in vitro fertilization.
Different obesity markers has been utilized for obesity description , and our hypothesis is to test the predictor level of those on fresh ICSI cycle outcome in infertile women without polycystic ovary syndrome .We included 91 patients in this prospective cohort study.
Those markers are: (1) Clinical assessment of BMI and waist circumference .The latter subdivided the cohort to 2 groups of women; the first group included women with central obesity (central obesity as a surrogate for increased adiposity markers) which means waist circumference equal to or more than 80 cm and the second group comprised women without central obesity. (2) Laboratory testing and calculation of visceral adiposity index VAI , lipid accummulation product LAP, homeostatic model assessment for insulin resistance HOMAIR , those were tested from serum sample at baseline evaluation of the patients. Then assessment of leptin level in follicular fluid sample obtained on ovum pick up day. (3) lastly sonographic measurment of subcutaneous fat and preperitoneal fat thickness to calculate the novel body fat index BFI.
Our Time frame for repoting the outcomes was one fresh cycle. The primary endpoint is : Live birth , defined as delivery of a live baby 28 weeks of gestation or over, which is the standard definition in Egypt. Secondary outcomes were : Clinical pregnancy, Multiple pregnancy, Ectopic pregnancy/ Miscarriage, Maturation index ,fertilization rate, implantation rate.
Our results summarized as : The Median age of enrolled women was 30 years with more than half of the cohort (54.9%) were in their thirties. They sought ICSI secondary to male factor in 41.8% of women and to unexplained factor in 36.3% of women. The median BMI of the study participants was 30 , and approximately half of them were obese (n=47; 51.6%). Based on waist circumference and HOMA-IR, 57 (62.6%) women had central obesity, and 47 (51.6%) women show insulin resistance.
Women with central obesity had higher median BMI, significantly higher preperitoneal fat thickness , subcutaneous fat thickness and Body Fat Index. Visceral Adiposity Index and Lipid Accummulation Product were also significantly higher in women with central obesity , although, there is no difference in insulin resistance between both groups . Also there is no difference in follicular fluid leptin with mean level in women without central obesity 17854.4 pg/ml (17.8 ng/ml) and in women with central obesity is 19965.1 pg/ml (19.9 ng/ml).
As regard laboratory outcomes, maturation index , fertilization rate, implantation rate, % of women who had good quality embryo transferes, and % of women who cryopreserve embryos were not different between both groups.
As regard clinical outcomes, Statistically there is no difference in live birth rate between patients with and without central obesity which is 28.8% and 33.3% respectively.
Receiver Operating characteristic curve (ROC) analysis and logistic regression were used to evaluate the predictability of the different obesity measures for having a live birth. None of them was found predictor to LB in the cohort studied in the current study.
The present work could not find evidence that a correlation exists between follicular fluid leptin and having a live birth after ICSI cycles. Also, live birth did not differ between leptin tertiles. Among tested adiposity measures, the only maker that has been correlated to follicular fluid leptin level was insulin resistance.