Body composition and reproductive outcomes: a scoping review
Caroline de Oliveira Martini, Manoela Teixeira da Silva, Eduardo Pandolfi Passos, Luciana Verçoza Viana
Abstract
Objectives: Infertility affects more than 48 million couples worldwide. Body composition could interfere in fertility rates in Assisted Reproductive Techniques (ART). Our study aims to assess body composition and reproductive outcomes in women, men and couples undergoing ART. Methods: A scoping review was conducted under review registry https://osf.io/xthdr. Studies evaluating body composition and reproductive outcomes in ART by methods other than weight and Body Mass Index (BMI) in men, women and couples, published until February 2025, were included. The main review question was: “What is known in the literature about the relation between body composition and reproductive outcomes in women, men and couples undergoing ART?” Results: From 5,122 studies, only 17 (8.905 participants) addressed the main question. Studies included women (n=12), men (n=1), and couples (n=4). In women, Waist Circumference (WC) was associated with lower rates of implantation (4 studies) but not pregnancy (5 studies). Moreover, Percentage of Body Fat (%BF) was inversely related to pregnancy (3 studies). Conclusions: Central obesity, measured by WC, seems to be related to poorer ART outcomes. More studies are necessary to evaluate the effect of body composition on ART outcomes.
Keywords
References
1. Zegers-Hochschild F, Adamson GD, Mouzon J, Ishihara O, Mansour R, Nygren K, et al. International Committee for Monitoring Assisted Reproductive Technology (ICMART) and the World Health Organization (WHO) revised glossary of ART terminology, 2009. Fertil Steril. 2009;92(5):1520-4. https://doi.org/10.1016/j.fertnstert.2009.09.009. PMid:19828144.
2. Mascarenhas MN, Flaxman SR, Boerma T, Vanderpoel S, Stevens GA. National, regional, and global trends in infertility prevalence since 1990: a systematic analysis of 277 health surveys. PLoS Med. 2012;9(12):e1001356. https://doi.org/10.1371/journal. pmed.1001356. PMid:23271957.
3. Kushnir VA, Barad DH, Albertini DF, Darmon SK, Gleicher N. Systematic review of worldwide trends in assisted reproductive technology 2004-2013. Reprod Biol Endocrinol. 2017;15(1):6. https://doi.org/10.1186/s12958-016-0225-2. PMid:28069012.
4. Vander Borght M, Wyns C. Fertility and infertility: definition and epidemiology. Clin Biochem. 2018;62:2-10. https://doi.org/10.1016/j. clinbiochem.2018.03.012. PMid:29555319.
5. Leisegang K, Sengupta P, Agarwal A, Henkel R. Obesity and male infertility: mechanisms and management. Andrologia. 2021;53(1):e13617. https://doi.org/10.1111/and.13617. PMid:32399992.
6. Amsiejiene A, Drasutiene G, Usoniene A, Tutkuviene J, Vilsinskaite S, Barskutyte L. The influence of age, body mass index, waistto-hip ratio and anti-Mullerian hormone level on clinical pregnancy rates in ART. Gynecol Endocrinol. 2017;33(Suppl 1):41-3. https://doi.org/10.1080/09513590.2017.1399692. PMid:29264991.
7. Sharma R, Biedenharn KR, Fedor JM, Agarwal A. Lifestyle factors and reproductive health: taking control of your fertility. Reprod Biol Endocrinol. 2013;11(1):66. https://doi.org/10.1186/1477-7827-11-66. PMid:23870423.
8. Bray GA. Determining body composition in adults. UptoDate. 2015;10(18):1-10.
9. Christofolini J, Maria Christofolini D, Zaia V, Bianco B, Barbosa CP. Body fat distribution influences ART outcomes. Gynecol Endocrinol. 2020;36(1):40-3. https://doi.org/10.1080/09513590.2019.1630609. PMid:31210070
10. Mushtaq R, Pundir J, Achilli C, Naji O, Khalaf Y, El-Toukhy T. Effect of male body mass index on assisted reproduction treatment outcome: an updated systematic review and meta-analysis. Reprod Biomed Online. 2018;36(4):459-71. https://doi.org/10.1016/j. rbmo.2018.01.002. PMid:29452915.
11. Xiong YQ, Liu YM, Qi YN, Liu CR, Wang J, Li L, et al. Association between prepregnancy subnormal body weight and obstetrical outcomes after autologous in vitro fertilization cycles: systematic review and meta-analysis. Fertil Steril. 2020;113(2):344-353.e2. https://doi.org/10.1016/j.fertnstert.2019.09.025. PMid:32106988.
12. Kim JG, Juneau CR, Landis J, Morin SJ, Neal SA, Scott RT. ABC trial: Appraisal of body content. How percent body fat (%BF) compares to body mass index (BMI) in evaluating infertile couples. Fertil Steril. 2017;107(3):e39-40. https://doi.org/10.1016/j. fertnstert.2017.02.075.
13. Peters M, Godfrey CM, McInerney P, Soares CB, Khalil H, Parker D. The Joanna Briggs Institute reviewers’ manual 2015: methodology for JBI scoping reviews. Adelaide: Joanna Briggs Institute; 2015. 24 p.
14. Page MJ, Moher D. Evaluations of the uptake and impact of the Preferred Reporting Items for Systematic reviews and MetaAnalyses (PRISMA) statement and extensions: a scoping review. Syst Rev. 2017;6(1):263. https://doi.org/10.1186/s13643-017- 0663-8. PMid:29258593.
15. Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;169(7):467-73. https://doi.org/10.7326/M18-0850. PMid:30178033.
16. Li Y, Lin H, Pan P, Yang D, Zhang Q. Impact of central obesity on women with polycystic ovary syndrome undergoing in vitro fertilization. Biores Open Access. 2018;7(1):116-22. https://doi.org/10.1089/biores.2017.0040. PMid:30083428.
17. Li MC, Mínguez-Alarcón L, Arvizu M, Chiu Y-H, Ford JB, Williams PL, et al. Waist circumference in relation to outcomes of infertility treatment with assisted reproductive technologies. Am J Obstet Gynecol. 2019;220(6):578.e1-13. https://doi.org/10.1016/j. ajog.2019.02.013. PMid:30763543.
18. Setti A, Halpern G, Braga D, Figueira R, Iaconelli A Jr, Borges E Jr. Association between parental anthropometric measures and the outcomes of intracytoplasmic sperm injection cycles. J Assist Reprod Genet. 2019;36(3):461-71. https://doi.org/10.1007/ s10815-018-1381-4. PMid:30515618.
19. Ferreira A, Ferreira R, Sousa AP, Moura-Ramos M, Cortesão P, Costa AL, et al. Adverse effect of higher waist circumference in assisted reproductive technology outcomes. Eur Gynecol Obstet. 2020;2(1):36-41.
20. Makhlouf AA, Ali MK, Abdelmagied AM, Habib DM, Badran E, El-Nashar IM, et al. Effect of abdominal fat on intracytoplasmic sperm injection cycles: preliminary results. Fertil Steril. 2020;114(3):e482. https://doi.org/10.1016/j.fertnstert.2020.08.1383.
21. Kim J, Patounakis G, Juneau C, Morin S, Neal S, Bergh P, et al. The Appraisal of Body Content (ABC) trial: Increased male or female adiposity does not significantly impact in vitro fertilization laboratory or clinical outcomes. Fertil Steril. 2021;116(2):444- 52. https://doi.org/10.1016/j.fertnstert.2020.12.037. PMid:33581854.
22. Hansen KR, He AL, Styer AK, Wild RA, Butts S, Engmann L, et al. Predictors of pregnancy and live-birth in couples with unexplained infertility after ovarian stimulation-intrauterine insemination. Fertil Steril. 2016;105(6):1575-1583.e2. https://doi.org/10.1016/j. fertnstert.2016.02.020. PMid:26949110.
23. Kim JG, Juneau CR, Morin SJ, Neal SA, Franasiak JM, Patounakis G, et al. ABC trial (assessment of body content): body composition in couples undergoing IVF predicts outcomes when body mass index alone does not. Fertil Steril. 2017;108(3):e103. https://doi. org/10.1016/j.fertnstert.2017.07.315.
24. Bustillo M, Collazo I, Palmerola KL, Gerkowicz SA, Eisermann J, Hendon N, et al. Obesity and mitoscore: determinant of art success? Fertil Steril. 2020;114(3):e430-1. https://doi.org/10.1016/j.fertnstert.2020.08.1250.
25. Hassab ZS, Al-Musawi BJ, Almohaidi AMS. Evaluation hormonal state in iraqi infertility females under in-vitro fertilization program. Indian J Forensic Med Toxicol. 2021;15(4):437-44. https://doi.org/10.37506/ijfmt.v15i4.16741.
26. Bian H, Mínguez-Alarcón L, Salas-Huetos A, Bauer D, Williams PL, Souter I, et al. Male waist circumference in relation to semen quality and partner infertility treatment outcomes among couples undergoing infertility treatment with assisted reproductive technologies. Am J Clin Nutr. 2022;115(3):833-42. https://doi.org/10.1093/ajcn/nqab364. PMid:34734234.
27. Svensson H, Einarsson S, Olausson D, Kluge L, Bergh C, Edén S, et al. Inflammatory and metabolic markers in relation to outcome of in vitro fertilization in a cohort of predominantly overweight and obese women. Sci Rep. 2022;12(1):13331. https://doi. org/10.1038/s41598-022-17612-2. PMid:35922472.
28. Yao Y, Liu W, Zhang X, Su N, Huang L, Nong Y, et al. Normal weight obesity is associated with lower AFC and adverse IVF outcomes. Front Endocrinol. 2024;15:1332995. https://doi.org/10.3389/fendo.2024.1332995. PMid:38455649.
29. Özelçi R, Aldemir O, Dilbaz S, Dilbaz B, Başer E, Kahyaoğlu İ, et al. Impact of metabolic syndrome on female fertility and in vitro fertilization outcomes in PCOS women. Reprod Biomed Online. 2023;47:103462. https://doi.org/10.1016/j.rbmo.2023.103462.
30. Klipstein S. Weighing the options: a patient-centered approach to timing embryo transfer in women with obesity. Fertil Steril. 2022;117(4):790-1. https://doi.org/10.1016/j.fertnstert.2022.01.035. PMid:35256190
31. Skoracka K, Ratajczak AE, Rychter AM, Dobrowolska A, Krela-Kaźmierczak I. Female fertility and the nutritional approach: the most essential aspects. Adv Nutr. 2021;12(6):2372-86. https://doi.org/10.1093/advances/nmab068. PMid:34139003.
32. Sundaram R, Mumford SL, Buck Louis GM. Couples’ body composition and time-to-pregnancy. Hum Reprod. 2017;32(3):662-8. https://doi.org/10.1093/humrep/dex001. PMid:28158570
33. Ke J, Feng Y, Chen Z. Association between waist circumference and female infertility in the United States. PLoS One. 2023;18(12):e0295360. https://doi.org/10.1371/journal.pone.0295360. PMid:38117771.
34. Poretsky L, Cataldo NA, Rosenwaks Z, Giudice LC. The insulin-related ovarian regulatory system in health and disease. Endocr Rev. 1999;20(4):535-82. https://doi.org/10.1210/edrv.20.4.0374. PMid:10453357.
35. Pasquali R, Gambineri A. Metabolic effects of obesity on reproduction. Reprod Biomed Online. 2006;12(5):542-51. https://doi. org/10.1016/S1472-6483(10)61179-0. PMid:16790096.
36. Brewer CJ, Balen AH. The adverse effects of obesity on conception and implantation. Reproduction. 2010;140(3):347-64. https:// doi.org/10.1530/REP-09-0568. PMid:20395425.
37. Jain A, Polotsky AJ, Rochester D, Berga SL, Loucks T, Zeitlian G, et al. Pulsatile luteinizing hormone amplitude and progesterone metabolite excretion are reduced in obese women. J Clin Endocrinol Metab. 2007;92(7):2468-73. https://doi.org/10.1210/jc.2006- 2274. PMid:17440019.
38. He Y, Lu Y, Zhu Q, Wang Y, Lindheim SR, Qi J, et al. Influence of metabolic syndrome on female fertility and in vitro fertilization outcomes in PCOS women. Am J Obstet Gynecol. 2019;221(2):138.e1-12. https://doi.org/10.1016/j.ajog.2019.03.011. PMid:30910544.
39. Osadchuk LV, Kleshchev MA, Osadchuk AV. Association of overweight and obesity with semen parameters and metabolic and hormonal status in young men. Bull Exp Biol Med. 2023;175(6):744-8. https://doi.org/10.1007/s10517-023-05937-5. PMid:37978149.
40. Foucaut A-M, Faure C, Julia C, Czernichow S, Levy R, Dupont C. Sedentary behavior, physical inactivity and body composition in relation to idiopathic infertility among men and women. PLoS One. 2019;14(4):e0210770. https://doi.org/10.1371/journal. pone.0210770. PMid:31017887.
41. Kirchengast S, Huber J. Body composition characteristics and fat distribution patterns in young infertile women. Fertil Steril. 2004;81(3):539-44. https://doi.org/10.1016/j.fertnstert.2003.08.018. PMid:15037399.
Submitted date:
06/29/2025
Accepted date:
11/01/2025
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