The effect of body mass index on the ovulation induction response

S rastućom prevalencijom pretilosti u Europi i svijetu, sve će više žena povišenog indeksa tjelesne mase (ITM) biti kandidatkinje za metode asistirane reprodukcije (MAR). Još je uvijek nedovoljno poznato kako povišen indeks tjelesne mase utječe na fertilitet žene, a posebice na ishode MAR. Brojna su istraživanja provedena na tu temu dala oprečne rezultate, a mijenjaju li povišen ili snižen ITM reprodukcijske ishode, posebice u vidu lošijih ishoda u pretilih žena, predmet je rasprave. Cilj rada bio je sustavno pretražiti istraživanja objavljena u literaturi u zadnjih 10 godina, analizirati njihove rezultate i napisati pregled dosadašnjih spoznaja o ovoj temi. U odabranim radovima, ishodi vezani uz indukciju ovulacije i odgovor ovarija na stimulaciju, primjenu MAR kao i tijek trudnoće i poroda uspoređivani su između skupina žena različitog ITM. Iako neki to rezultatima osporavaju, većina se autora slaže da postoji progresivno pogoršanje gotovo svih reprodukcijskih ishoda s porastom ITM. Patofiziološki mehanizam u podlozi nedovoljno je jasan, promjene osjetljivosti ovarija, kvalitete jajne stanice i receptivnosti endometrija smatraju se potencijalnim uzrokom, a konačna će se objašnjenja tražiti u budućim studijama. Zaključno, žene s povišenim ITM trebalo bi poticati na redukciju tjelesne mase prije primjenjivanja MAR, a narednim istraživanjima pokušati definirati smjernice liječenja te ciljane skupine, kao i poželjan ITM prije početka liječenja, s ciljem postizanja optimalnog odgovora ovarija na stimulaciju, kao i trudnoće i poroda sa što manje komplikacija.With the growing prevalence of obesity across Europe and the world, the number of women with a higher body mass index (BMI) who are in need of assisted reproductive technology (ART) treatment is expected to increase. The effect of an increased BMI on female fertility and especially on ART outcomes is still unknown. Numerous studies on this subject have yielded conflicting results and the association between lower or higher BMIs and reproductive outcomes, especially the deleterious effect of a higher BMI, is debatable. The aim of this study was to conduct a systematic review of the literature published in the last ten years, analyze the results, and write a review of the present knowledge on this subject. Ovarian response to ovulation induction and ART treatment results along with the course of pregnancy and labor were the reproductive outcomes compared among different BMI groups. Most authors concluded that progressive worsening of almost all reproductive outcomes is noticed with increasing BMI, although there were some who disagreed. Altered ovarian stimulation sensitivity and reduced oocyte quality as well as endometrial receptivity could be the potential causes, but the exact underlying pathophysiological mechanism is still unknown. In conclusion, women with raised BMI should be advised to reduce body weight before ART treatment, and future investigations should be focused on defining guidelines for this specific group of patients, as well as desirable pre-treatment BMI, in order to achieve optimal ovarian stimulation response and also pregnancy and labor with less complications