• Rehana Rehman
  • Zahir Hussain
  • Naveed Faraz


Background: The incidence of obesity in women of reproductive age group has encountered problemsof infertility with frequent referral to reproductive clinics. In order to know whether increase in bodymass index (BMI) is associated with poor reproductive outcome, current study was aimed to relatewomen’s BMI, estradiol (E2) levels, and clinic pregnancy rates after intra cytoplasmic sperm injection(ICSI). Methods: Quasi experimental design of 323 women was conducted from June 2010 till August2011. Women were grouped on the basis of BMI; Group A, BMI <18 (underweight); Group B, BMI18–22.9 (normal weight); Group C, BMI 23–25.9 (overweight); and Group D, BMI ≥26 (obese).Procedure of ICSI commenced by down regulation of ovaries followed by controlled ovarianstimulation. Oocyte pickup was done 36 hours after ovulation induction by hCG, eggs fertilised in vitrowere graded and only blastocysts were transferred. Serum samples of basal E2, peak E2 (day of hCGadministration) and mid-luteal E2 (7 days after egg collection) measured by ELISA were compared inall BMI groups. Pregnancy outcome of these was categorised as: no conception β-hCG <5 mIU/ml,preclinical abortion with β-hCG >5 mIU/ml, no cardiac activity on transvaginal scan (TVS) and clinicalpregnancy with β-hCG >5 mIU/ml and cardiac activity on trans-vaginal scan. Results: Obese womenwith BMI ≥26 had lowest basal, peak and mid-luteal E2 with minimum clinical pregnancy ratescompared to rest of the groups. Conclusion: A high BMI is associated with decreased E2 levels in allphases of ovarian cycle and has a negative impact on pregnancy outcome.Keywords: Intra-cytoplasmic sperm injection, Body mass Index, Estradiol, Obesity, Infertility


Koning AMH, Mustsaerts MAQ, Kuchenbecher WKH,

Broekmans FJ, Land JA, Mol BW, et al.Complications and

outcome of assisted reproduction technologies in overweight and

obese women. Hum Reprod 2012;27(2):457–67.

Chavarro JE, Ehrich S, Colaci D, Wright DL, Toth TL, Petrozza

JC, et al. Body Mass Index and short term weight change in

relation to treatment outcomes in women undergoing assisted

reproduction. Fertil Steril 2012;98(1):109–16.

Psychoyos A. Hormonal control of ovo implantation. Vitam

Horm 1973;3:205–25.

Gruber I, Just A, Briner M, Losch A. Serum estradiol/

progesterone ratio on day of embryo transfer may predict

reproductive outcome following controlled ovarian hyperstimulation and in vitro fertilization. J Exp Clin Assist Reprod


Elnashar AM, Gamal I, Aboul-Enein. Endometrial receptivity.

Middle East Fertil Soc J.2004; 9(1): 10-24.

Simon C, Piquette GN, Frances A, Polan ML. Localization of

interleukin-1 type I receptor and interleukin-1 beta in human

endometrium throughout the menstrual cycle. J Clin Endocrinol

Metab 1993;77:549–55.

Bentin LU, Sjogren A, Nilsson L, Hamberger L, Larson JF, Horn

T. Presence of uterine pinopodes at the embryo–endometrial

interface during human implantation in vitro. Hum Reprod


Snehalatha C, Viswanatha NV, Ramachandran A. Cut off values

for normal anthropometric variables in Asian Indian adults.

Diabetes Care 2003;26:1380–4.

Esinler I, Gurkan B, Hakan Y. Impact of isolated obesity on ICSI

outcome. Reprod Bio Med Online 2008;17(4):583–7.

Fedorcsak P, Dale PO, Storeng R, Ertzeid G, Bjercke S, Oldereid

N, et al. Impact of overweight and underweight on assisted

reproduction treatment. Hum Reprod 2004;19:2523–28.

Phophong P, Massimo DR, Khadum I, Meo F, Serhal P. Basal

b-estradiol did not correlate with ovarian response and in vitro

fertilization treatment outcome. Fertil Steril 2000;74:1133–6.

Aktan E, Bozkurt K, Ozer D, Yucebilgin S, Karadadas N, Bilgin

O. The effect of mid luteal estradiol level on the outcome of

ICSI-ET cycles .Arch Gynecol Obstet 2004;269:134–8

Kondapalli LA, Molinaro TA, Sammel MD, Dokras A. A

decrease in serum estradiol levels after human chorionic

gonadotrophin administration predicts significantly lower clinical

pregnancy and live birth rates in vitro fertilization cycles. Hum

Reprod 2012;27:2690–7.

Tworoger SS, Eliassen AH, Missmer SA, Baer H, Rich-dwards J,

Michels KB, Barbieri RL, Dowsett M, Hankinson SE. Birth

weight and body size throughout life in relation to sex hormones

and prolactin concentrations in pre-menopausal women. Cancer

Epidemiol Biomarkers Prev 2006;15:2494–2501.

Abd Ali ZAU, Al-Zaidi MS. The Association between Body

Mass Index, Lipid Profile and Serum Estradiol Levels in a

Sample of Iraqi Diabetic Premenopausal Women. Oman Med J