title: Infertility treatment outcome in sub groups of obese population.
abstract: BACKGROUND
  Obesity is a common disorder with a negative impact on IVF treatment outcome. It is not clear whether morbidly obese women (BMI >= 35 kg/m2) respond to treatment differently as compared to obese women (BMI = 30-34.9 kg/m2) in IVF. Our aim was to compare the outcome of IVF or ICSI treatments in obese patients to that in morbidly obese patients.
  
  
  METHODS
  This retrospective cohort study was conducted in a tertiary care centre. Patients inclusion criteria were as follows; BMI >or= 30, age 20-40 years old, first cycle IVF/ICSI treatment with primary infertility and long follicular pituitary down regulation protocol.
  
  
  RESULTS
  A total of 406 obese patients (group A) and 141 morbidly obese patients (group B) satisfied the inclusion criteria. Average BMI was 32.1 +/- 1.38 kg/m2 for group A versus 37.7 +/- 2.99 kg/m2 for group B. Patient age, cause of infertility, duration of stimulation, fertilization rate, and number of transferred embryos were similar in both groups. Compared to group A, group B had fewer medium size and mature follicles (14 vs. 16), fewer oocytes collected (7 vs. 9) and required higher doses of HMG (46.2 vs. 38.5 amps). There was also a higher cancellation rate in group B (28.3% vs. 19%) and lower clinical pregnancy rate per started cycle (19.9% vs. 28.6%).
  
  
  CONCLUSIONS
  In a homogenous infertile and obese patient population stratified according to their BMI, morbid obesity is associated with unfavorable IVF/ICSI cycle outcome as evidenced by lower pregnancy rates. It is recommended that morbidly obese patients undergo appropriate counseling before the initiation of this expensive and invasive therapy.
authors.affiliation: Reproductive Medicine, Department of Obstetrics & Gynecology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia. kawartani@kfshrc.edu.sa
authors.forename: Khalid A
authors.initials: KA
authors.lastname: Awartani
authors.forename: Samar
authors.initials: S
authors.lastname: Nahas
authors.forename: Saad H
authors.initials: SH
authors.lastname: Al Hassan
authors.forename: Mashael A
authors.initials: MA
authors.lastname: Al Deery
authors.forename: Serdar
authors.initials: S
authors.lastname: Coskun
mesh_terms: D000328:Adult; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D007247:Infertility, Female / Q000150:complications* / Q000628:therapy*; D009767:Obesity, Morbid / Q000150:complications*; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D020554:Sperm Injections, Intracytoplasmic; D055815:Young Adult