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Hum. Reprod. Advance Access originally published online on February 15, 2008
Human Reproduction 2008 23(4):878-884; doi:10.1093/humrep/den017
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© The Author 2008. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

High and low BMI increase the risk of miscarriage after IVF/ICSI and FET

Zdravka Veleva1, Aila Tiitinen2, Sirpa Vilska3, Christel Hydén-Granskog2, Candido Tomás4, Hannu Martikainen1 and Juha S. Tapanainen1,5

1 Department of Obstetrics and Gynecology, University of Oulu, PO Box 5000, Oulu FIN-90014, Finland 2 Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Helsinki, Finland 3 Infertility Clinic, Family Federation of Finland, Helsinki, Finland 4 AVA Clinic, Tampere, Finland

5 Correspondence address. Tel: +358-8-3153172; Fax: +358-8-3154310; E-mail: juha.tapanainen{at}oulu.fi

BACKGROUND: The extremes of BMI are associated with an increased risk of miscarriage both in spontaneously conceived pregnancies and after fertility treatment. The aim of the present study was to study the effect of BMI on miscarriage rate (MR) in fresh IVF/ICSI, and in spontaneous and hormonally substituted frozen-thawed embryo (FET) cycles.

METHODS: Analysis was carried out on 3330 first pregnancy cycles, performed during the years 1999–2004, of which 2198 were fresh, 666 were spontaneous and 466 were hormonally substituted FET cycles. A categorical, a linear and a quadratic models of the effect of BMI on miscarriage were studied by logistic regression. Factors related to patient characteristics, protocol and embryo parameters were also examined.

RESULTS: MR was higher in hormonally substituted FET (23.0%), compared with the fresh cycles (13.8%) and spontaneous FET (11.4%, P < 0.0001). Multivariate logistic regression revealed that the relationship between BMI and the risk of miscarriage is not linear but quadratic (U-shaped) (P = 0.01), indicating a higher risk of miscarriage in underweight and obese women. Hormonal substitution for FET was also associated with a 1.7-fold higher MR, compared with the fresh cycles (P = 0.002, 95% confidence interval 1.2–2.3).

CONCLUSIONS: Obese and underweight women have an increased risk of miscarriage, and hormonally substituted FET is associated with an even higher MR.

Key words: obesity/underweight/miscarriage/IVF/ICSI/frozen-thawed embryo transfer

Submitted on July 30, 2007; resubmitted on October 25, 2007; accepted on November 21, 2007.


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Z. Veleva, P. Karinen, C. Tomas, J. S. Tapanainen, and H. Martikainen
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