The DOI matches its Crossref record; 32 of the 32 references it cites were found in a registry or an index.
Female obesity increases the risk of miscarriage of euploid embryos
Open accessAbstract
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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“Among women undergoing ART there are greater rates of miscarriage with obesity. 40 , 41”
From Overweight, obesity and excessive weight gain in pregnancy as risk factors for adverse pregnancy outcomes: A narrative review (2022) · cites this paper as [41]
Citations
Cites
Smith, K. B., & Smith, M. S. (2016) · Primary Care Clinics in Office Practice · doi:10.1016/j.pop.2015.10.001 · Cited by 620
Subfecundity in overweight and obese couples
Ramlau‐Hansen, C. H., Thulstrup, A. M., Nohr, E. A., Bonde, J. P., Sørensen, T. I. A., & Olsen, J. (2007) · Human Reproduction · doi:10.1093/humrep/dem035 · Cited by 520
Maternal metabolism and obesity: modifiable determinants of pregnancy outcome
Nelson, S. M., Matthews, P., & Poston, L. (2009) · Human Reproduction Update · doi:10.1093/humupd/dmp050 · Cited by 372
Effects of maternal obesity on placental function and fetal development
Howell, K. R., & Powell, T. L. (2016) · Reproduction · doi:10.1530/rep-16-0495 · Cited by 370
Does Obesity Increase the Risk of Miscarriage in Spontaneous Conception: A Systematic Review
Boots, C. E., & Stephenson, M. D. (2011) · Seminars in Reproductive Medicine · doi:10.1055/s-0031-1293204 · Cited by 354
García-Velasco, J. A., Domingo, J., Cobo, A. C., Martínez, M., Carmona, L., & Pellicer, A. (2013) · Fertility and Sterility · doi:10.1016/j.fertnstert.2013.02.004 · Cited by 252
Self-citationTarrade, A., Panchenko, P., Junien, C., & Gabory, A. (2015) · Journal of Experimental Biology · doi:10.1242/jeb.110320 · Cited by 251
Bellver, J., Pellicer, A., García-Velasco, J. A., Ballesteros, A., Remohi, J. A., & Meseguer, M. (2013) · Fertility and Sterility · doi:10.1016/j.fertnstert.2013.06.001 · Cited by 235
Self-citationHuman embryos from overweight and obese women display phenotypic and metabolic abnormalities
Leary, C., Leese, H. J., & Sturmey, R. G. (2014) · Human Reproduction · doi:10.1093/humrep/deu276 · Cited by 223
Bellver, J., Martínez-Conejero, J. A., Labarta, E., Alamá, P., de Melo, M. A. B., Remohi, J. A., Pellicer, A., & Horcajadas, J. A. (2011) · Fertility and Sterility · doi:10.1016/j.fertnstert.2011.03.021 · Cited by 203
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Karimi, R., Hadavi, F., & Jafarabadi, M. N. (2024) · Archives of Gynecology and Obstetrics · doi:10.1007/s00404-024-07895-3
Obesogenic diet alters decidual differentiation and cell-cell communication in the mouse uterusPreprint
Koksal, B., Bellissimo, C. J., Jazwiec, P. A., Sloboda, D. M., & Beristain, A. G. (2025) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/2025.08.13.670199
Wei, M., Wei, Q., Xu, X., Liu, S., Zhao, X., Zeng, Z., Dai, Y., Ainiwaer, P., & Zhang, J. (2025) · International Journal of Women s Health · doi:10.2147/ijwh.s548360
“22 Tang et al 23 demonstrated through mouse experiments that maternal obesity can induce meiotic defects in oocytes, leading to abnormal chromosomal recombination.”
Obesity, women’s reproductive health, and demography. a contemporary perspective on the problem
Adamyan, L. V., Avetisyan, J. S., Seregina, V. Y., Pivazyan, L. G., Mailova, K. S., Osipova, A. A., & Stepanian, A. A. (2025) · Russian Journal of Human Reproduction · doi:10.17116/repro2025310516
Mitchell, E., & Simmons, H. (2022) · Pharmaceutical Sciences and Drug Design · doi:10.51847/fcjg30dmrj
The predictive value of anti-Müllerian hormone on embryo quality in PGT-A cycles analysis
Ni, M., Zhang, H., Sun, J., Zhu, G., Xing, S., Zheng, A., Pu, Y., Liao, G., Ding, J., Meng, Q., et al. (2025) · Frontiers in Endocrinology · doi:10.3389/fendo.2025.1645593
“However, high BMI also can lead to an increased risk of miscarriage after euploid embryo transfer (24), these women trying to become pregnant should be advised weight reduction before pregnancy.”
Guan, M., Yu, H., Feng, J., Zhu, M., Wang, Y. X., Ge, H., Shi, B., Lu, F., Yu, J., Gao, Z., et al. (2026) · Reproductive Biology and Endocrinology · doi:10.1186/s12958-026-01531-2
“Overweight and obese patients demonstrate higher miscarriage rates, likely attributable to an abnormal uterine environment exacerbated by obesity-associated inflammation [18, 19].”
Özkara, G., Yelke, H. K., Cetinkaya, C. P., Colakoglu, Y. K., & Kahraman, S. (2026) · Archives of Gynecology and Obstetrics · doi:10.1007/s00404-026-08468-2
“While many studies report superior outcomes with Day 5 embryos [17, 20, 27, 28, 30, 42, 43], others suggest comparable outcomes in euploid cohorts [5, 15, 18, 33].”
InfluentialAssociation between body roundness index and pregnancy outcomes of IVF
Fang, Y., Yang, Y., Li, N., Zou, J., Niu, Y., Zhao, D., Liao, S., Liu, Y., Chen, Z., & Wei, D. (2026) · Human Reproduction Open · doi:10.1093/hropen/hoag068
“…has suggested that higher BMI among women is associated with poorer IVF outcomes, including higher cycle cancellation rates, increased risk of miscarriage and, consequently, lower live birth rates (Sermondade et al. , 2019; Cozzolino et al. , 2021; Fabozzi et al. , 2024; Ren et al. , 2025).”
Preconception maternal body mass index and offspring sex ratio in intrauterine insemination cycles
Wang, C., Liu, D., Shi, J., Zhang, Z., Kirshenbaum, M., & Cai, H. (2026) · Journal of Assisted Reproduction and Genetics · doi:10.1007/s10815-026-04022-w
Xu, P., Tetelbaun, L., Setteducate, A., Lowy, M., Felder, E., & Keltz, M. D. (2026) · Journal of Assisted Reproduction and Genetics · doi:10.1007/s10815-026-04054-2
Metadata
- 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
- Venue
- Fertility and Sterility
- Publisher
- Elsevier BV
- Published
- 2021-06
- Volume
- 115
- Issue
- 6
- Pages
- 1495-1502
- ISSN
- 0015-0282 (ISSN-L)
- 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
- 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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