Multidisciplinary management of severe obesity in women undergoing assisted reproduction: an integrated model linking obesity and fertility centers

Abstract Objective Obesity is a well-established risk factor for infertility in both men and women. In the setting of medically assisted reproduction (MAR), it is associated with lower conception rates and an increased risk of adverse outcomes. This study aimed to assess the impact of structured nutritional management on conception rates and reproductive outcomes in individuals with severe obesity undergoing MAR, within an integrated care pathway between a Center for Obesity Management (COM) and a MAR center. Design Observational study involving individuals with severe obesity who wish to begin a MAR program. Methods A total of 108 women with a body mass index (BMI) 35 kg/m², referred from the MAR center to the COM, were included. Participants underwent a structured nutritional intervention at the COM before initiating MAR treatment. The primary outcome was eligibility for MAR treatment. Secondary outcomes included weight loss achieved during the intervention, pregnancy rates, and pregnancy outcomes. Results Following nutritional management, 60% (n=65) of participants were approved to begin MAR treatment. The average weight loss was –5.1% (7.0) across the study population and 6.7% (8.1) among those approved for MAR. A total of 39 pregnancies were confirmed, 33.3% (n=13) of which occurred spontaneously. Of these, 30.8% (n=12) resulted in live births, and 23.1% (n=9) were ongoing at the end of the follow-up period. Conclusions Nutritional management before MAR treatment is associated with weight loss and favourable fertility outcomes in individuals with severe obesity. These findings highlight the value of an integrated care pathway for this population.