Cited by 111Assisted Reproductive Technology and Twin PregnancyPrenatal Screening and DiagnosticsReproductive Health and Technologies

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Female obesity increases the risk of miscarriage of euploid embryos

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Cozzolino, Mauro, García-Velasco, Juan Antonio, Meseguer, Marcos, Pellicer, Antonio, Bellver, Jose·2021·Fertility and Sterility

DOI 10.1016/j.fertnstert.2020.09.139

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Abstract

Objective To determine whether female body mass index (BMI) is associated with an increased risk of miscarriage after euploid embryo transfer. Design A retrospective, observational, multicenter cohort study. Setting University-affiliated in vitro fertilization center. Patient(s) In this study, 3,480 cycles of in vitro fertilization with preimplantation genetic testing for aneuploidy (PGT-A) in the blastocyst stage and euploid embryo transfer were divided into four groups according to patient BMI. Intervention(s) In vitro fertilization with PGT-A. Main outcome measure(s) The primary outcome was the miscarriage rate, which included both biochemical and clinical miscarriages. Secondary outcomes were implantation, pregnancy, clinical pregnancy, and live birth rates. Result(s) Cycles were divided into four groups according to BMI (kg/m 2): underweight (<18.5; n = 155), normal weight (18.5-24.9; n = 2,549), overweight (25-29.9; n = 591), and obese (≥30; n = 185). The number of PGT-A cycles per patient was similar in the four groups. Fertilization rate, day of embryo biopsy, technique of chromosomal analysis, number of euploid embryos, number of transferred embryos, and method of endometrial preparation for embryo transfer were similar in the four BMI groups. Miscarriage rates were significantly higher in women with obesity compared to women with normal weight, mainly due to a significant increase in the clinical miscarriage rates. Live birth rates also were lower in women with obesity. Obesity in women and day 6 trophectoderm biopsy were found to influence the reduced live birth rate. Conclusion(s) Women with obesity experience a higher rate of miscarriage after euploid embryo transfer than women with a normal weight, suggesting that other mechanisms than aneuploidy are responsible for this outcome.

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“6,21,22 A displacement of implantation window in obese women undergoing artificial endometrial preparation has recently been described and may be related to increased risk of miscarriage observed following embryo transfers.”
Impact of Body Fat Distribution and Insulin Sensitivity on In Vitro Fertilization Outcomes: A Prospective Observational Study
Carosso, A. R., Revelli, A., Ruffa, A., Carosso, M., Contangelo, G., Benedetto, C., & Gennarelli, G. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14113848 · Cited by 2
Male obesity impairs early embryonic development and increases miscarriage risk in oocyte donation cycles
Quintana-Vehí, A., Miguel-Escalada, I., Scaraboto, D., Zambelli, F., Mataró, D., Zamora, M. J., Oliver‐Bonet, M., Pujol, A., Rodríguez-Aranda, A., & Popovic, M. (2025) · Fertility and Sterility · doi:10.1016/j.fertnstert.2025.09.035 · Cited by 2
Effect of overweight and obesity on live birth rate in single euploid frozen embryo transfers
Ruiz, F. J., Lawrenz, B., Kalafat, E., Ata, B., Liñán, A., Elkhatib, I., Melado, L., & Fatemi, H. M. M. (2024) · Reproductive BioMedicine Online · doi:10.1016/j.rbmo.2024.104443 · Cited by 2
Impact of GnRH Agonist Pretreatment on Frozen-Thawed Embryo Transfer Outcomes of Overweight/Obese Women Undergoing Hormone Replacement Therapy
Huang, Z., Liao, Y., Xie, Q., Deng, Y., Chen, H., Wan, X., Tian, L., Xia, L., Zhao, Y., & Huang, J. (2025) · Drug Design Development and Therapy · doi:10.2147/dddt.s551326 · Cited by 2
Applying Scientific Rationale to the Current Perceptions and Explanations of Massage and Miscarriage in the First Trimester
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Effect of time since vasectomy on live birth rate of TESE‒ICSI egg donation cycles and male‐related prognostic factors
Hervás, I., Pellegrini, L., Valls-González, L., Juliá, M. G., Navarro‐Gomezlechon, A., Rivera‐Egea, R., Mossetti, L., Jabaloyas, J. M. M., & Garrido, N. (2024) · Andrology · doi:10.1111/andr.13697 · Cited by 1
“Is less well-studied than the effect of female obesity on the probabilityof conception, 44,45 but has been associated with reduced semen quality, inflammation, and oxidative stress, altering sperm potential.”
Elevated luteinizing hormone levels during the artificial endometrial preparation cycle do not impact pregnancy outcomes in patients undergoing single vitrified-warmed blastocyst transfer
Jeon, H., Lee, W. S., & Kim, J. W. (2024) · Human Fertility · doi:10.1080/14647273.2024.2424336 · Cited by 1
“However, in contrast to previous studies (Bellver, 2022; Cozzolino et al., 2021; Sermondade et al., 2019), our study showed that BMI and age did not significantly affect pregnancy outcomes.”
Semaglutide and metformin improve menstrual cyclicity in overweight/obese women with polycystic ovary syndrome: a randomized trial
Zhang, W., Xue, J., Wang, J., Ni, D., Zhou, W., Wang, B., Shi, J., & Wang, A. (2026) · Metabolism and Target Organ Damage · doi:10.20517/mtod.2025.210 · Cited by 1
Obesity is associated with an increased risk of early pregnancy loss after euploid frozen embryo transfer
Whitehead, C. V., Lefebvre, K. M., & Seli, E. U. (2026) · Fertility and Sterility · doi:10.1016/j.fertnstert.2026.04.016 · Cited by 1
Maternal body mass index and periconception growth and development: a systematic review
Bruin, R. J. D., van Duijn, L., Rousian, M., Baart, E., Laven, J. S. E., Willemsen, S. P., Theunissen, R. S. , & Rousian, M. (2026) · Reproductive BioMedicine Online · doi:10.1016/j.rbmo.2026.105829 · Cited by 1
Relationship of morphology and chromatin integrity of sperm in aneuploid blastocyst development: embryos fertilized with sperm diagnosed with teratozoospermia
Estuardo, L. I. J., Vargas-Hernández, V. M., Carlos, D.-M., Giovani, P.-P. J., de Jesús, Á.-P. F., Omar, A.-C. J., Daniela, Á.-R., Héctor, T.-C., Stéphanie, L.-E. M., de Jesús, V.-C. T., et al. (2023) · Obstetrics & Gynecology International Journal · doi:10.15406/ogij.2023.14.00706 · Cited by 1
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Chuisaca, F. M. G., & Peláez, A. G. B. (2024) · Journal of Population Therapeutics and Clinical Pharmacology · doi:10.53555/jptcp.v31i2.4239 · Cited by 1
SARS-CoV-2 infection in IVF-conceived early pregnancy and the risk of miscarriage: a matched retrospective cohort study
Xu, J., Mao, D., Liu, C.-L., & Sun, L. (2024) · Human Reproduction Open · doi:10.1093/hropen/hoae024 · Cited by 1
“Moreover, the individuals we included in our study were of comparatively younger ages, reasonable BMI, and the majority of them lacked a history of miscarriage.”
BackgroundInfluential
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Malpica, P. A. C., Flórez, I. X., Martínez-Torres, J., Medina, N. A. Z., Lee-Osorno, B. I., & Laguado, M. F. J. (2021) · Revista Investigación en Salud Universidad de Boyacá · doi:10.24267/23897325.602
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Authors: Cozzolino, M., García-Velasco, J. A., Meseguer, M., Pellicer, A., & Bellver, J.
Affiliations: Universidad Rey Juan Carlos (ES)
IVIRMA Global (ES)
Corresponding author: Cozzolino, Mauro
ORCID: Cozzolino, Mauro
García-Velasco, Juan Antonio
Meseguer, Marcos
Venue: Fertility and Sterility
Publisher: Elsevier BV
Published: 2021-06
Volume: 115
Issue: 6
Pages: 1495-1502
ISSN: 0015-0282 (ISSN-L)
DOI: 10.1016/j.fertnstert.2020.09.139
OpenAlex: W3108144574
Cited by: 111
References: 32
Citations by year: 2026: 8 · 2025: 20 · 2024: 36 · 2023: 21 · 2022: 18 · 2021: 8
FWCI: 11.29
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
www.elsevier.com/open-access/userlicense/1.0/ (vor, 365 d)
Locations: Fertility and Sterility (publishedVersion)
PubMed (publishedVersion)
Repository of Digital Objects for Teaching Research and Culture (University of Valencia) (submittedVersion)
Funders: Merck
Gedeon Richter
Topics: Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Assisted Reproductive Technology and Twin Pregnancy
Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Prenatal Screening and Diagnostics
Health Sciences › Medicine › Reproductive Medicine › Reproductive Health and Technologies
Keywords: female obesity, body mass index, miscarriage, euploid embryo transfer, preimplantation genetic testing for aneuploidy, blastocyst, live birth rate, clinical pregnancy, implantation rate
MeSH terms: Abortion, Spontaneous, Gestational Weight Gain, Pregnancy in Obesity, Obesity, Maternal, Aneuploidy, Blastocyst, Embryo Transfer, Female, Fertilization in Vitro, Genetic Testing, Humans, Infertility, Embryo Implantation, Pregnancy, Retrospective Studies, Risk Factors, Spain, Body Mass Index, Treatment Outcome, Risk Assessment, Pregnancy Rate, Preimplantation Diagnosis, Live Birth

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Female obesity increases the risk of miscarriage of euploid embryos

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