Abstract
PURPOSE: Obesity is increasingly at the center of modern international healthcare systems. This is a position statement of the Italian Society of Fertility and Sterility and Reproductive Medicine (SIFES-MR) aimed at evaluating the impact of female overweight on infertility in order to improve fertility outcomes, including Assisted Reproductive technology (ART) treatments. METHODS: The SIFES-MR writing group for this position statement was composed by Italian reproductive physicians, embryologists, and scientists with expertise in fertility evaluation, assisted reproduction technologies, and laboratory quality management. The positions stated are based on consensus by the authors, who met over a six-month period. The consensus emerged after thorough review of pertinent literature and standards concerning the impact of female overweight, complemented by extensive dialogue and discussion among the authors. Additionally, input from society members was considered, leading to revisions and eventual approval by the SIFES-MR governing council. RESULTS: An increasing number of women affected by overweight and infertility accessing to ART treatments are expected in the future. A comprehensive counseling since the first access to infertility care is mandatory and should promote weight restoration, with the aim to improve the likelihood of spontaneous unassisted conception. Careful preconceptional evaluation of obese women is strongly encouraged for counseling purpose and comorbidities should be corrected by a multidisciplinary approach before spontaneous or medically assisted conception. Indeed, female obesity is responsible for high-risk pregnancies, with potential consequences in infants and during childhood. When in vitro fertilization is indicated, the risk of venous thromboembolism exacerbated by controlled ovarian stimulation should be assessed. CONCLUSIONS: Before IVF, different therapeutic approaches and expectant management to reduce overweight could be offered, and the age-related algorithm herein proposed by SIFES may represent an interesting tool for a better personalization of infertility care in these women. The treatment of infertility cannot ignore the correct management of female overweight, given the serious consequences that this condition can have on the outcomes of pregnancies and future generations. IVF specialists should tailor access and modalities of IVF treatment to this class of high-risk women.