The LIFESTYLE study: costs and effects of a structured lifestyle program in overweight and obese subfertile women to reduce the need for fertility treatment and improve reproductive outcome. A randomised controlled trial.
BACKGROUND
In the Netherlands, 30% of subfertile women are overweight or obese, and at present there is no agreement on fertility care for them. Data from observational and small intervention studies suggest that reduction of weight will increase the chances of conception, decrease pregnancy complications and improve perinatal outcome, but this has not been confirmed in randomised controlled trials. This study will assess the cost and effects of a six-months structured lifestyle program aiming at weight reduction followed by conventional fertility care (intervention group) as compared to conventional fertility care only (control group) in overweight and obese subfertile women. We hypothesize that the intervention will decrease the need for fertility treatment, diminish overweight-related pregnancy complications, and will improve perinatal outcome.


METHODS
Multicenter randomised controlled trial in subfertile women (age 18-39 year) with a body mass index between 29 and 40 kg/m2. Exclusion criteria are azoospermia, use of donor semen, severe endometriosis, premature ovarian failure, endocrinopathies or pre-existent hypertensive disorders.In the intervention group the aim is a weight loss of at least 5% to10% in a six-month period, to be achieved by the combination of a diet, increase of physical activity and behavioural modification. After six months, in case no conception has been achieved, these patients will start fertility treatment according to the Dutch fertility guidelines. In the control group treatment will be started according to Dutch fertility guidelines, independently of the patient's weight.


METHODS
The primary outcome measure is a healthy singleton born after at least 37 weeks of gestation after vaginal delivery. Secondary outcome parameters including pregnancy outcome and complications, percentage of women needing fertility treatment, clinical and ongoing pregnancy rates, body weight, quality of life and costs.Data will be analysed according to the intention to treat principle, and cost-effectiveness analysis will be performed to compare the costs and health effects in the intervention and control group.


CONCLUSIONS
The trial will provide evidence for costs and effects of a lifestyle intervention aiming at weight reduction in overweight and obese subfertile women and will offer guidance to clinicians for the treatment of these patients.


BACKGROUND
Dutch Trial Register NTR1530.
Mutsaerts
Meike A Q
MA
Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. m.a.q.mutsaerts@og.umcg.nl
Groen
Henk
H
ter Bogt
Nancy C W
NC
Bolster
Johanna H T
JH
Land
Jolande A
JA
Bemelmans
Wanda J E
WJ
Kuchenbecker
Walter K H
WK
Hompes
Peter G A
PG
Macklon
Nick S
NS
Stolk
Ronald P
RP
van der Veen
Fulco
F
Maas
Jacques W M
JW
Klijn
Nicole F
NF
Kaaijk
Eugenie M
EM
Oosterhuis
Gerrit J E
GJ
Bouckaert
Peter X J M
PX
Schierbeek
Jaap M
JM
van Kasteren
Yvonne M
YM
Nap
Annemiek W
AW
Broekmans
Frank J
FJ
Brinkhuis
Egbert A
EA
Koks
Carolien A M
CA
Burggraaff
Jan M
JM
Blankhart
Adrienne S
AS
Perquin
Denise A M
DA
Gerards
Marie H
MH
Mulder
Robert J A B
RJ
Gondrie
Ed T C M
ET
Mol
Ben W J
BW
Hoek
Annemieke
A
D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D004032:Diet; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000209:etiology / Q000517:prevention & control / Q000628:therapy*; D008019:Life Style; D009043:Motor Activity; D009765:Obesity / Q000150:complications* / Q000517:prevention & control / Q000628:therapy*; D050177:Overweight / Q000150:complications / Q000517:prevention & control / Q000628:therapy; D011247:Pregnancy; D011248:Pregnancy Complications / Q000209:etiology / Q000517:prevention & control; D011256:Pregnancy Outcome; D015431:Weight Loss / Q000502:physiology; D055815:Young Adult