Does Metabolic Status Associate With IVF Outcomes in Women Within Similar Body Mass Index Category: Evidence From a Large Cohort Study

ABSTRACT Objectives Whether diverse metabolic statuses within a similar body mass index (BMI) category associate with different in vitro fertilization (IVF) outcomes. Design A retrospective cohort study. Setting Wenzhou, Zhengjiang Province, China. Population This retrospective cohort study prescreened 16 458 women who underwent their first IVF and fresh embryo transfer cycle between January 2010 and December 2021. Methods Metabolic status was assessed using the National Cholesterol Education Program–Adult Treatment Panel III criteria. Patients were then categorized into six groups: metabolically healthy normal weight, metabolically unhealthy normal weight, metabolically healthy overweight, metabolically unhealthy overweight, metabolically healthy obese, and metabolically unhealthy obese. Main Outcome Measures The primary outcome was live birth rate. Results Regarding live birth, rates in normal weight women were initially lower for metabolically unhealthy normal weight versus metabolically healthy normal weight (44.6% vs. 48.6%), but this was not significant after multivariate adjustment. In obese women, live birth rates were similar between metabolically unhealthy obese and metabolically healthy obese (41.5% vs. 43.9%), with no adjusted difference. For secondary outcomes, metabolically unhealthy normal weight patients had lower biochemical pregnancy rates than metabolically healthy normal weight (OR: 0.86, 95% CI: 0.76–0.98); high blood pressure was a significant risk factor for this outcome in metabolically unhealthy normal weight (OR: 0.84, 95% CI: 0.72–0.98). Conclusion Our findings indicated that different cardio‐metabolic risk factors but a similar BMI category may have limited adverse effects on live birth rate.