Age and body mass index as factors of female infertility and negative results of assisted reproductive technologies

Ruziguli A., Rukhliada N.N.

Department of Obstetrics and Gynecology, Saint Petersburg State Pediatric Medical University, Ministry of Health of Russia, Saint Petersburg, Russia
To improve the effectiveness of assisted reproductive technologies is a key problem in modern medicine. Therapeutic approaches to reducing the likelihood of not getting pregnant are inevitably associated with infertility-related risk factors. Women with good reproductive health mostly become mothers naturally, apart from being influenced by the male factor or resorting to medical decisions through personal reasons. Among the standard risk factors that lead to a decrease in the effectiveness of assisted reproductive technologies, there are obesity and late reproductive age. The paper considers the mechanisms for the negative effects of these features of the anamnesis and the ways to reduce/overcome their harmful effects on pregnancy. An analysis of information sources has identified the possibilities of increasing the effectiveness of the onset and preservation of induced pregnancy in the presence of the above risk factors. It has been found that it is necessary to organize a comprehensive preparation of a woman's health before reproductive intervention in order to normalize weight and the hormone background. Only a change in lifestyle and consolidation of new behavior can significantly reduce the negative impact of obesity on a woman's reproductive health. Treatment should be performed taking into account concomitant diseases, in particular diabetes mellitus, polycystic ovary syndrome, etc. The successes of pharmacological treatment for obesity in reducing the level of influence of infertility and in increasing the effectiveness of assisted reproductive technologies are analyzed separately.
Conclusion. It has been found that there are very few drugs that can be used to correct weight during pregnancy when planning due to side effects. Before planning a pregnancy at late reproductive age, there is a need for exhaustive analysis of the female reproductive system, including an evaluation of the ability to ovulate and the state of the endometrium. Exogenous hormonal background correction must be done. The negative effect of obesity or late reproductive age depends on many individual characteristics of the patient's history. Therefore, whether there is a prevalence of the influence of one or another factor in their combination remains unresolved and causes discussion.


body mass index
late reproductive age
assisted reproductive technologies


  1. Иакашвили С.Н., Самчук П.М. Особенности течения и исход одноплодной беременности, наступившей после экстракорпорального оплодотворения и переноса эмбриона, в зависимости от фактора бесплодия. Современные проблемы науки и образования. 2017; 3: 50. [Iakashvili S.N., Samchuk P.M. Тhe course of pregnancy and delivery, was the result of in vitro fertilization and embryo transfer. Sovremennye problemy nauki i obrazovaniya/Modern problems of science and education. Surgery. 2017; 3: 50. (in Russian)].
  2. Андреева Е.Н., Абсатарова Ю.С., Шереметьева Е.В., Фурсенко В.А. Ожирение и репродуктивная функция у женщин: эпигенетические и сомато-психологические особенности. Ожирение и метаболизм. 2019; 16(2): 9-15. [Andreeva E.N., Absatarova Yu.S., Sheremetyeva E.V., Fursenko V.A. Obesity and reproductive function of women: epigenetic and somato-psychological features. Ozhirenie i metabolizm/Obesity and metabolism. 2019; 16(2): 9-15. (in Russian)]. doi: 10.14341/omet10113.
  3. Пинхасов Б.Б. Патогенетические особенности первичного ожирения и его типов у женщин репродуктивного возраста. Международный эндокринологический журнал. 2011; 8: 13-26. [Pinhasov B.B. Pathogenetic features of primary obesity and its types in women of reproductive age. Mezhdunarodnyj endokrinologicheskij zhurnal/International Journal of Endocrinology. 2011; 8: 13-26. (in Russian)].
  4. Setji T.L., Brown A.J. Polycystic ovary syndrome: update on diagnosis and treatment. Am. J. Med. 2014; 127(10): 912-9.
  5. Karacan E., Caglar G.S., Gürsoy A.Y., Yilmaz M.B. Body satisfaction and eating attitudes among girls and young women with and without polycystic ovary syndrome. J. Pediatr. Adolesc. Gynecol. 2014; 27(2): 72-7.
  6. Butterworth J., Deguara J., Borg C.M. Bariatric surgery, polycystic ovary syndrome, and infertility. J. Obes. 2016; 2016: 1871594.
  7. Shehata M. Effect of female increased body mass index on intracytoplasmic sperm injection outcome. Sci. J. Al-Azhar Med. Fac. Girls. 2017; 1(1): 36-41.
  8. Григорян О.Р., Михеев Р.К., Андреева Е.Н., Дедов И.И. Овариальный резерв у женщин с ожирением. Ожирение и метаболизм. 2019; 16(3): 69-75. [Grigoryan O.R., Mikheev R.K., Andreeva E.N., Dedov I.I. Ovarian reserve in obese women. Obesity and metabolism. 2019; 16(3): 69-75. (in Russian)].
  9. Teede H.J., Misso M.L., Costello M.F., Dokras A., Laven J., Moran L. et al. International PCOS Network. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Hum. Reprod. 2018; 33(9): 1602-18.
  10. Foroozanfard F., Rafiei H., Samimi M., Gilasi H.R., Gorjizadeh R., Heidar Z. et al. The effects of dietary approaches to stop hypertension diet on weight loss, anti-Müllerian hormone and metabolic profiles in women with polycystic ovary syndrome: a randomized clinical trial. Clin. Endocrinol. (Oxf). 2017; 87(1): 51-8.
  11. Guenard F., Deshaies Y., Cianflone K., Kral J.G., Marceau P., Vohl M.C. Differential methylation in glucoregulatory genes of offspring born before vs. after maternal gastrointestinal bypass surgery. Proc. Natl. Acad. Sci. USA. 2013; 110(28): 11439-44.
  12. Timmermans S., Steegers-Theunissen R.P., Vujkovic M., den Breeijen H., Russcher H., Lindemans J. et al. The Mediterranean diet and fetal size parameters: the Generation R Study. Br. J. Nutr. 2012; 108(8): 1399-409.
  13. Dante G., Vaccaro V., Facchinetti F. Use of progestagens during early pregnancy. Facts Views Vis. Obgyn. 2013; 5(1): 66-71.
  14. Boudet-Berquier J., Salanave B., Desenclos J.C., Castetbon K. Sociodemographic factors and pregnancy outcomes associated with prepregnancy obesity: effect modification of parity in the nationwide Epifane birth-cohort. BMC Pregnancy Childbirth. 2017; 17(1): 273.
  15. Chen C.P. Prenatal findings and the genetic diagnosis of fetal overgrowth disorders: Simpson-Golabi-Behmel syndrome, Sotos syndrome, and Beckwith-Wiedemann syndrome. Taiwan. J. Obstet. Gynecol. 2012; 51(2): 186-91.
  16. Hou M., Chu Z., Liu T., Lv H., Sun L., Wang B. et al. A high-fat maternal diet decreases adiponectin receptor-1 expression in offspring. J. Matern. Neonatal Med. 2015; 28(2): 216-21.
  17. Frias A.E., Grove K.L. Obesity: a transgenerational problem linked to nutrition during pregnancy. Semin. Reprod. Med. 2012; 30(6): 472-8.
  18. Shen M., Chaudhry S.H., MacFarlane A.J., Gaudet L., Smith G.N., Rodger M.A. et al. Serum and red-blood-cell folate demonstrate differential associations with BMI in pregnant women. Public Health Nutr. 2016; 19(14): 2572-9.
  19. Diefenbach K., Trummer D., Ebert F., Lissy M., Koch M., Rohde B. EE-drospirenone-levomefolate calcium versus EE-drospirenone + folic acid: folate status during 24 weeks of treatment and over 20 weeks following treatment cessation. Int. J. Womens Health. 2013; 5: 149-63. 10.2147/IJWH.S37254.
  20. Vannuccini S., Clifton V.L., Fraser I.S., Taylor H.S., Critchley H., Giudice L.C. et al. Infertility and reproductive disorders: impact of hormonal and inflammatory mechanisms on pregnancy outcome. Hum. Reprod. Update. 2016; 22(1): 104-15.
  21. Practice Committee of the American Society for Reproductive Medicine. The clinical relevance of luteal phase deficiency: a committee opinion. Fertil. Steril. 2012; 98(5): 1112-7.
  22. Keum N., Greenwood D.C., Lee D.H., Kim R., Aune D., Ju W. et al. Adult weight gain and adiposity-related cancers: a dose-response meta-analysis of prospective observational studies. J. Natl. Cancer Inst. 2015; 107(2): djv088.
  23. Benedetto C., Salvagno F., Canuto E.M., Gennarelli G. Obesity and female malignancies. Best Pract. Res. Clin. Obstet. Gynaecol. 2015; 29(4): 52840.
  24. Gottschau M., Kjaer S.K., Jensen A., Munk C., Mellemkjaer L. Risk of cancer among women with polycystic ovary syndrome: a Danish cohort study. Gynecol. Oncol. 2015; 136(1): 99-103.
  25. Shafiee M.N., Khan G., Ariffin R., Abu J., Chapman C., Deen S., Nunns D., Barrett D.A., Seedhouse C., Atiomo W. Preventing endometrial cancer risk in polycystic ovarian syndrome (PCOS) women: could metformin help? Gynecol. Oncol. 2014; 132(1): 248-53.
  26. Anveden Å., Taube M., Peltonen M., Jacobson P., Andersson-Assarsson J.C., Sjöholm K. et al. Long-term incidence of female-specific cancer after bariatric surgery or usual care in the Swedish Obese Subjects Study. Gynecol. Oncol. 2017; 145(2): 224-9.
  27. Махмадалиева М.Р., Коган И.Ю., Ниаури Д.А., Мекина И.Д., Гзгзян А.М. Влияние избытка массы тела и ожирения на эффективность программ вспомогательных репродуктивных технологий. Журнал акушерства и женских болезней. 2018; 67(2): 32-9. [Mahmadalieva M.R., Kogan I.Yu., Niauri D.A., Mekina I.D., Gzgzyan A.M. The effect of excess body weight and obesity on the effectiveness of assisted reproductive technologies programs. Zhurnal akusherstva i zhenskih boleznej/Journal of obstetrics and womens’s diseases. 2018; 67(2): 32-9. (in Russian)].
  28. Аншина М.Б., Подзолкова Н.М., Колода Ю.А., Шамугия Н.Л., Смирнова А.А., Абляева Э.Ш. Особенности индукции суперовуляции у пациенток с избыточной массой тела и ожирением. Проблемы репродукции. 2009; 15(1): 65-9. [Anshina M.B., Podzolkova N.M., Koloda Yu.A., SHamugiya N.L., Smirnova A.A., Ablyaeva E.Sh. Features of induction of superovulation in patients with overweight and obesity. Problemy reprodukcii/Reproduction problems. 2009; 15(1): 65-9. (in Russian)].
  29. Tomic V., Tomic J., Klaic D.Z., Kasum M., Kuna K. Oral dydrogesterone versus vaginal progesterone gel in the luteal phase support: randomized controlled trial. Eur. J. Obstet. Gynecol. Reprod. Biol. 2015; 186: 4953. 10.1016/j.ejogrb.2014.11.002.
  30. Salehpour S., Tamimi M., Saharkhiz N. Comparison of oral dydrogesterone with suppository vaginal progesterone for luteal-phase support in in vitro fertilization (IVF): a randomized clinical trial. Iran. J. Reprod. Med. 2013; 11(11): 913-8.
  31. Khoei H.H., Dehdehi L., Moloudizargari M., Baninameh Z., Rezaie-Chamani S., Conti G.O. et al. Female obesity and clinical outcomes of assisted reproductive technologies (ART): an updated systematic review and meta-analysis. Int. J. Med. Res. Health Sci. 2016; 5(11): 157-70.
  32. Practice Committee of the American Society for Reproductive Medicine. Obesity and reproduction: a committee opinion. Fertil. Steril. 2015; 104(5): 1116-26.
  33. Khairy M., Rajkhowa K. Effect of obesity on assisted reproductive treatment outcomes and its management: a literature review. Obstet. Gynaecol. 2017; 19(1): 47-54.
  34. Бейк Е.П., Сыркашева А.Г., Долгушина Н.В. Эффективность программ вспомогательных репродуктивных технологий у пациенток позднего репродуктивного возраста. Гинекология. 2018; 20(1): 109-12. [Bejk E.P., Syrkasheva A.G., Dolgushina N.V. The effectiveness of assisted reproductive technology programs in patients of late reproductive age. Ginekologiya/Gynecology. 2018; 20(1): 109-12. (in Russian)].
  35. Ермоленко К.С., Радзинский В.Е., Рапопорт С.И. Современное состояние проблемы реализации фертильной функции женщин позднего репродуктивного возраста. Клиническая медицина. 2016; 94(1): 10-5. [Ermolenko K.S., Radzinsky V.E., Rapoport S.I. The current state of the problem of the implementation of the fertile function of women of late reproductive age. Klinicheskaya medicina/Clinical Medicine. 2016; 94(1): 10-5. (in Russian)].
  36. Kasum M., Radakovic B., Simunic V., Orešković S. Preovulatory progesterone rise during ovarian stimulation for IVF. Gynecol. Endocrinol. 2013; 29(8): 7448.
  37. Reiter R.J., Tan D.X., Korkmaz A., Rosales-Corral S.A. Melatonin and stable circadian rhythms optimize maternal, placental and fetal physiology. Hum. Reprod. Update. 2014; 20(2): 293-307.
  38. Tamura H., Takasaki A., Taketani T., Tanabe M., Lee L., Tamura I. et al. Melatonin and female reproduction. J. Obstet. Gynaecol. Res. 2014; 40(1): 1-11.
  39. Shi L., Li N., Bo L., Xu Z. Melatonin and hypothalamic-pituitary-gonadal axis. Curr. Med. Chem. 2013; 20(15): 2017-31. 10.2174/09298673113209990114.
  40. Bhatti P., Mirick D.K., Davis S. The impact of chronotype on melatonin levels among shift workers. Occup. Environ. Med. 2014; 71(3): 195-200.

Received 30.10.2020

Accepted 16.11.2020

About the Authors

Abuduwaili Ruziguli, postgraduate student, Department of Obstetrics and Gynecology, St. Petersburg State Pediatric Medical University, Ministry of Health of Russia.
Tel.: +7(911)817-55-35. E-mail: 194100, Russia, St. Petersburg, Litovskaya str., 2.
Nikolai N. Rukhliada, Dr. Med. Sci., Head of the Department of Obstetrics and Gynecology, St. Petersburg State Pediatric Medical University, Ministry of Health of Russia. Tel.: +7(911)817-55-35. E-mail: 194100, Russia, St. Petersburg, Litovskaya str., 2.

For citation: Ruziguli A., Rukhliada N.N. Age and body mass index as factors of female infertility and negative results of assisted reproductive technologies.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2021; 2: 21-26 (in Russian)

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