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Qual o impacto do IMC da mulher nos desfechos reprodutivos dos tratamentos de inseminação intrauterina?
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Autores
Orientador(es)
Resumo(s)
Introdução
A infertilidade é uma condição de elevada prevalência mundial, com diferentes etiologias. A Inseminação Intrauterina (IIU) coloca-se como primeira opção terapêutica para casais com infertilidade inexplicada de curta duração ou fator masculino ligeiro.
Entre os fatores de risco associados à infertilidade, pela sua potencial reversibilidade, destaca-se o Índice de Massa Corporal (IMC) feminino aumentado, reconhecido pela Organização Mundial da Saúde (OMS) como um problema de saúde pública major.
Apesar disto, o impacto do IMC na taxa de sucesso da IIU não se encontra ainda totalmente estabelecido.
Objetivo
Avaliar se existe associação entre o IMC feminino e os desfechos reprodutivos após IIU.
Material e Métodos
Estudo retrospetivo através da consulta da base de dados da Unidade de Medicina da Reprodução (UMR) do Hospital de Santa Maria (HSM), que incluiu 2319 ciclos de IIU realizados entre 1 de janeiro de 2012 e 31 de dezembro de 2022.
O desfecho primário do estudo foi a taxa de gravidez clínica. O desfecho secundário foi a taxa de nado-vivo.
Resultados
Registaram-se 272 gravidezes clínicas (11,7%), das quais em 256 foi possível averiguar o desfecho final; obteve-se uma taxa de nado-vivo de 8,2% (n = 191).
Uma maior probabilidade de gravidez clínica, com significado estatístico, obteve-se para menor idade feminina (p= 0,02) e presença de mais de 1 folículo com tamanho superior a 16 mm (p = 0,002).
ii
A maior probabilidade de nado-vivo, com significado estatístico, obteve-se para menor idade feminina (p>= 0,001) e menor IMC (p = 0,02). O IMC manteve significado quando ajustado para a idade [OR 0,93 (IC 95% 0,88-0,99), p=0,035].
Conclusões
Na nossa amostra, um maior IMC feminino não demonstrou associação significativa com a diminuição da taxa de gravidez clínica após IIU, mas associou-se a menor taxa de nado-vivo. Estes resultados reforçam a importância de estratégias de modificações de estilos de vida prévias à gravidez.
Introduction Infertility is a highly prevalent condition worldwide, with different causes. Intrauterine Insemination (IUI) is considered as the primary therapeutic option for couples with unexplained infertility of short duration or mild male factor. The elevated female Body Mass Index (BMI) gains importance among the risk factors associated with infertility, due to its potential for being reversed. This condition has been recognized by the World Health Organization (WHO) as a major public health problem. However, the impact of BMI on the success rate of IUI is not yet fully established. Objective To evaluate whether there is an association between female BMI and reproductive outcomes after IUI. Materials and Methods A retrospective study was conducted by revising the database of the Unidade de Medicina da Reprodução (UMR) of Hospital de Santa Maria (HSM), which included 2319 IUI performed between January 1, 2012, and December 31, 2022. Primary outcome of the study was the clinical pregnancy rate. Secondary outcome was the live-birth rate. Results A total of 272 clinical pregnancies were recorded (11.7%), with complete follow up for 256; the live-birth rate was 8.2% (n = 191). A higher probability of clinical pregnancy, with statistical significance, was associated with younger female age (p=0.02) and the presence of more than one follicle measuring 16 mm or more (p=0.002). iv A higher probability of live birth, with statistical significance, was associated with younger female age (p<0.001) and lower BMI (p=0.02). The statistical significance for BMI was maintained after adjusting for age [OR 0.93 (95% CI 0.88-0.99), p=0.035]. Conclusions In our sample, a higher female BMI did not show a significant association with a lower clinical pregnancy rate after IUI, but it was associated with a lower rate of live birth. These results reinforce the importance of improving lifestyle prior to pregnancy.
Introduction Infertility is a highly prevalent condition worldwide, with different causes. Intrauterine Insemination (IUI) is considered as the primary therapeutic option for couples with unexplained infertility of short duration or mild male factor. The elevated female Body Mass Index (BMI) gains importance among the risk factors associated with infertility, due to its potential for being reversed. This condition has been recognized by the World Health Organization (WHO) as a major public health problem. However, the impact of BMI on the success rate of IUI is not yet fully established. Objective To evaluate whether there is an association between female BMI and reproductive outcomes after IUI. Materials and Methods A retrospective study was conducted by revising the database of the Unidade de Medicina da Reprodução (UMR) of Hospital de Santa Maria (HSM), which included 2319 IUI performed between January 1, 2012, and December 31, 2022. Primary outcome of the study was the clinical pregnancy rate. Secondary outcome was the live-birth rate. Results A total of 272 clinical pregnancies were recorded (11.7%), with complete follow up for 256; the live-birth rate was 8.2% (n = 191). A higher probability of clinical pregnancy, with statistical significance, was associated with younger female age (p=0.02) and the presence of more than one follicle measuring 16 mm or more (p=0.002). iv A higher probability of live birth, with statistical significance, was associated with younger female age (p<0.001) and lower BMI (p=0.02). The statistical significance for BMI was maintained after adjusting for age [OR 0.93 (95% CI 0.88-0.99), p=0.035]. Conclusions In our sample, a higher female BMI did not show a significant association with a lower clinical pregnancy rate after IUI, but it was associated with a lower rate of live birth. These results reinforce the importance of improving lifestyle prior to pregnancy.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2023
Palavras-chave
IMC feminino Infertilidade feminina Inseminação intrauterina Taxa de nado-vivo Taxa de gravidez clínica Obstetrícia