title: Complications and outcome of assisted reproduction technologies in overweight and obese women.
abstract: BACKGROUND
  Based on a presumed negative impact of overweight and obesity on reproductive capacity and pregnancy outcome, some national guidelines and clinicians have argued that there should be an upper limit for a woman's BMI to access assisted reproductive technologies (ART). However, evidence on the risk of complications or expected success rate of ART in obese women is scarce. We therefore performed a systematic review on the subject.
  
  
  METHODS
  We searched the literature for studies reporting on complications or success rates in overweight and obese women undergoing ART. Articles were scored on methodological quality. We calculated pooled odds ratios (ORs) to express the association between overweight and obesity on the one hand, and complications and success rates of ART on the other hand. We only pooled results if data were available per woman instead of per cycle or embryo transfer.
  
  
  RESULTS
  We detected 14 studies that reported on the association between overweight and complications during or after ART, of which 6 reported on ovarian hyperstimulation syndrome (OHSS), 7 on multiple pregnancies and 6 on ectopic pregnancies. None of the individual studies found a positive association between overweight and ART complications. The pooled ORs for overweight versus normal weight for OHSS, multiple pregnancy and ectopic pregnancy were 1.0 [95% confidence interval (CI) 0.77-1.3], 0.97 (95% CI 0.91-1.04) and 0.96 (95% CI 0.54-1.7), respectively. In 27 studies that reported on BMI and the success of ART, the pooled ORs for overweight versus normal weight on live birth, ongoing and clinical pregnancy following ART were OR 0.90 (95% CI 0.82-1.0), 1.01 (95% CI 0.75-1.4) and OR 0.94 (95% CI 0.69-1.3), respectively.
  
  
  CONCLUSIONS
  Data on complications following ART are scarce and therefore a registration system should be implemented in order to gain more insight into this subject. In the available literature, there is no evidence of overweight or obesity increasing the risk of complications following ART. Furthermore, they only marginally reduce the success rates. Based on the currently available data, overweight and obesity in itself should not be a reason to withhold ART.
authors.affiliation: Department of Obstetrics and Gynaecology, University Medical Centre Utrecht, Utrecht, The Netherlands. akoning3@umcutrecht.nl
authors.forename: A M H
authors.initials: AM
authors.lastname: Koning
authors.forename: M A Q
authors.initials: MA
authors.lastname: Mutsaerts
authors.forename: W K H
authors.initials: WK
authors.lastname: Kuchenbecker
authors.forename: W K H
authors.initials: WK
authors.lastname: Kuchenbecher
authors.forename: F J
authors.initials: FJ
authors.lastname: Broekmans
authors.forename: J A
authors.initials: JA
authors.lastname: Land
authors.forename: B W
authors.initials: BW
authors.lastname: Mol
authors.forename: A
authors.initials: A
authors.lastname: Hoek
mesh_terms: D000328:Adult; D015992:Body Mass Index; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000150:complications / Q000628:therapy*; D009765:Obesity / Q000150:complications*; D016471:Ovarian Hyperstimulation Syndrome / Q000209:etiology; D050177:Overweight / Q000150:complications*; D011247:Pregnancy; D018873:Pregnancy Rate; D011271:Pregnancy, Ectopic / Q000209:etiology; D011272:Pregnancy, Multiple; D027724:Reproductive Techniques, Assisted / Q000009:adverse effects*