Fertility treatment in obese women

Overweight and obesity are increasing worldwide. This has major adverse consequences for health in general and fertility in women in particular. With the increasing number of women in reproductive age being obese, there is also an increasing need for fertility treatment. And with more pregnant women being obese, the amount of pregnancy complications will also continue to increase. In the USA, women with a body mass index (BMI) ≥ 35 kg/m² most frequently sought medical attention to become pregnant, but received surgical fertilityrelated services least frequent. Assisted reproductive technology (ART) is restricted worldwide beyond a certain BMI, ranging from 25 to 40 kg/m². In the Netherlands several fertility centres have a BMI limit, mostly around 30-35 kg/m². This restriction is based on different arguments from safety for the woman to risk for the future child. This thesis studies several aspects of reproductive problems in overweight and obese women. We address the (cost) effectiveness and safety of fertility treatment in overweight and obese women, the effectiveness of lifestyle intervention in obese women who suffer from subfertility, and we discuss ethical issues regarding fertility treatment in obese women

Economic consequences of overweight and obesity in infertility: a framework for evaluating the costs and outcomes of fertility care

Overweight and obesity are an epidemic in Western society, and have a strong impact on fertility. We studied the consequences of overweight and obesity with respect to fecundity, costs of fertility treatment and pregnancy outcome in subfertile women. We searched the literature for systematic reviews and large studies reporting on the effect of weight on both fecundity and pregnancy outcome in subfertile women. We collected data on costs of treatment with ovulation induction, intrauterine insemination and in vitro fertilization, as well as costs of pregnancy complications. We calculated, for ovulatory and anovulatory women separately, the number of expected pregnancies, complications and costs in a hypothetical cohort of 1000 normal weight, overweight and obese women each. In our hypothetical cohort of 1000 women, compared with women with normal weight, live birth was decreased by 14 and 15% (from 806 live births to 692 and 687 live births) in overweight and obese anovulatory women, respectively, for ovulatory women it was decreased by 22 and 24% (from 698 live births to 546 and 531 live births), respectively. These outcomes were associated with an increase in the number of complications and associated costs leading to cost per live birth in anovulatory overweight and obese women were 54 and 100% higher than their normal weight counterparts, for ovulatory women they were 44 and 70% higher, respectively. Overweight and obese subfertile women have a reduced probability of successful fertility treatment and their pregnancies are associated with more complications and higher costs