Weight reduction intervention for obese infertile women prior to IVF: A randomized controlled trial
Open accessAbstract
STUDY QUESTION: Does an intensive weight reduction programme prior to IVF increase live birth rates for infertile obese women? SUMMARY ANSWER: An intensive weight reduction programme resulted in a large weight loss but did not substantially affect live birth rates in obese women scheduled for IVF. WHAT IS ALREADY KNOWN: Among obese women, fertility and obstetric outcomes are influenced negatively with increased risk of miscarriage and a higher risk of maternal and neonatal complications. A recent large randomized controlled trial found no effect of lifestyle intervention on live birth in infertile obese women. STUDY DESIGN, SIZE, DURATION: A prospective, multicentre, randomized controlled trial was performed between 2010 and 2016 in the Nordic countries. In total, 962 women were assessed for eligibility and 317 women were randomized. Computerized randomization with concealed allocation was performed in the proportions 1:1 to one of two groups: weight reduction intervention followed by IVF-treatment or IVF-treatment only. One cycle per patient was included. PARTICIPANTS/MATERIALS, SETTING, METHODS: Nine infertility clinics in Sweden, Denmark and Iceland participated. Women under 38 years of age planning IVF, and having a BMI ≥30 and <35 kg/m2 were randomized to two groups: an intervention group (160 patients) with weight reduction before IVF, starting with 12 weeks of a low calorie liquid formula diet (LCD) of 880 kcal/day and thereafter weight stabilization for 2-5 weeks, or a control group (157 patients) with IVF only. MAIN RESULTS AND ROLE OF CHANCE: In the full analysis set (FAS), the live birth rate was 29.6% (45/152) in the weight reduction and IVF group and 27.5% (42/153) in the IVF only group. The difference was not statistically significant (difference 2.2%, 95% CI: 12.9 to -8.6, P = 0.77). The mean weight change was -9.44 (6.57) kg in the weight reduction and IVF group as compared to +1.19 (1.95) kg in the IVF only group, being highly significant (P < 0.0001). Significantly more live births were achieved through spontaneous pregnancies in the weight reduction and IVF group, 10.5% (16) as compared to the IVF only group 2.6% (4) (P = 0.009). Miscarriage rates and gonadotropin dose used for IVF stimulation did not differ between groups. Two subgroup analyses were performed. The first compared women with PCOS in the two randomized groups, and the second compared women in the weight reduction group reaching BMI ≤ 25 kg/m2 or reaching a weight loss of at least five BMI units to the IVF only group. No statistical differences in live birth rates between the groups in either subgroup analysis were found. LIMITATIONS, REASON FOR CAUTION: The study was not powered to detect a small increase in live births due to weight reduction and was not blinded for the patients or physician. Further, the intervention group had a longer time to achieve a spontaneous pregnancy, but were therefore slightly older than the control group at IVF. The study only included women with a BMI lower than 35 kg/m2. WIDER IMPLICATIONS OF THE FINDINGS: The study suggests that weight loss for obese women (BMI: 30-34.9 kg/m2) may not rectify the outcome in IVF cycles, although a significant higher number of spontaneous conceptions occurred in the weight loss group. Also, the study suggests that intensive weight reduction with LCD treatment does not negatively affects the results. STUDY FUNDING/COMPETING INTEREST(S): The study was funded by Sahlgrenska University Hospital (ALFGBG-70 940), Merck AB, Solna, Sweden (an affiliate of Merck KGaA, Darmstadt, Germany), Impolin AB, Hjalmar Svensson Foundation and Jane and Dan Olsson Foundation. Dr Thurin-Kjellberg reports grants from Merck, non-financial support from Impolin AB, during the conduct of the study, and personal fees from Merck outside the submitted work. Dr Friberg reports personal fees from Ferring, Merck, MSD, Finox and personal fees from Studentlitteratur, outside the submitted work. Dr Englund reports personal fees from Ferring, and non-financial support from Merck, outside the submitted work. Dr Bergh reports and has been reimbursed for: writing a newsletter twice a year (Ferring), lectures (Ferring, MSD, Merck), and Nordic working group meetings (Finox). Dr Karlström reports lectures (Ferring, Finox, Merck, MSD) and Nordic working group meetings (Ferring). Ms Kluge, Dr Einarsson, Dr Pinborg, Dr Klajnbard, Dr Stenlöf, Dr Larsson, Dr Loft and Dr Wistrand have nothing to disclose. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov number, NCT01566929. TRIAL REGISTRATION DATE: 23-03-2012. DATE OF FIRST PATIENT'S ENROLMENT: 05-10-2010.
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In overweight women undergoing assisted reproduction technologies, weight loss does not significantly differ in pregnancy rates compared to control.
“However, in the group of overweight women who underwent assisted reproduction technologies (ARTs), such as in vitro fertilization (IVF), there was no significant difference in pregnancy rates between women who achieved weight loss and the control group [70].”
From Mediterranean Diet as an Antioxidant: The Impact on Metabolic Health and Overall Wellbeing (2021) · cites this paper as [70]
In overweight women, weight loss before insemination increases spontaneous pregnancy rate compared to no weight loss.
“According to a study by Einarsson et al., overweight women who lost weight before insemination had an increased spontaneous pregnancy rate compared to overweight women who did not lose weight.”
From Mediterranean Diet as an Antioxidant: The Impact on Metabolic Health and Overall Wellbeing (2021) · cites this paper as [70]
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Cellular Stress Responses in Oocytes: Molecular Changes and Clinical Implications
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Weight Cycling in Women: Adaptation or Risk?
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- Authors
- Einarsson, S., Bergh, C., Friberg, B., Pinborg, A., Klajnbard, A., Karlström, P.-O., Kluge, L., Larsson, I., Loft, A., Mikkelsen-Englund, A.-L., Stenlöf, K., Wistrand, A., & Thurin-Kjellberg, A.
- Affiliations
- University of Gothenburg (SE)
- Sahlgrenska University Hospital (SE)
- Skåne University Hospital (SE)
- Hvidovre Hospital (DK)
- Herlev Hospital (DK)
- Karolinska University Hospital (SE)
- Copenhagen University Hospital (DK)
- Örebro University Hospital (SE)
- ORCID
- Venue
- Human Reproduction
- Publisher
- Oxford University Press (OUP)
- Published
- 2017-06-29
- Volume
- 32
- Issue
- 8
- Pages
- 1621-1630
- ISSN
- 0268-1161 (ISSN-L)
- 1460-2350
- OpenAlex
- W2729389999
- Cited by
- 181
- References
- 34
- Citations by year
- 2026: 9 · 2025: 21 · 2024: 20 · 2023: 28 · 2022: 36 · 2021: 26 · 2020: 20 · 2019: 11 · 2018: 7 · 2017: 2 · 2015: 1
- FWCI
- 12.71
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Human Reproduction (publishedVersion)
- PubMed (publishedVersion)
- Lund University Publications (Lund University) (submittedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (submittedVersion)
- Funders
- Merck KGaA
- Gentofte Hospital
- Herlev Hospital
- Örebro Universitet
- Stiftelsen Handlanden Hjalmar Svenssons
- Rigshospitalet
- Sahlgrenska Universitetssjukhuset (70940, ALFGBG-70940)
- Universitetssjukhuset Örebro
- Hvidovre Hospital
- Skånes universitetssjukhus
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Reproductive Health and Technologies
- Health Sciences › Medicine › Reproductive Medicine › Ovarian function and disorders
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Assisted Reproductive Technology and Twin Pregnancy
- Keywords
- obesity, weight loss, in vitro fertilization, infertility, live birth rate, spontaneous conception, assisted reproduction outcomes, lifestyle intervention, body mass index, miscarriage
- MeSH terms
- Adult, Birth Rate, Female, Fertilization in Vitro, Humans, Infertility, Female, Obesity, Ovulation Induction, Pregnancy, Pregnancy Outcome, Prospective Studies, Weight Loss, Treatment Outcome, Live Birth
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