Which BMI conditions are associated with disrupted ovulation and lower ART live birth rates?

• A. Obesity and underweight status can disrupt ovulation, reduce response to stimulation, increase miscarriage risk, and lower live birth rates in ART.
• B. BMI has no impact on fertility.
• C. Only obesity affects fertility.
• D. Higher BMI improves outcomes.

Answer: (A)

Extrema of BMI—both obesity and being underweight—disrupt ovulation and worsen outcomes with assisted reproductive technology. Obesity often brings insulin resistance and high insulin levels that increase ovarian androgen production, impair follicle development, and contribute to anovulation or irregular cycles. In ART, this leads to a poorer ovarian response (needing more meds, sometimes fewer oocytes retrieved), potential issues with oocyte quality, and a higher risk of miscarriage; endometrial receptivity can also be affected, lowering implantation and live birth rates.

Being underweight can suppress the hypothalamic-pituitary-ovarian axis due to energy deficit, reducing GnRH pulsatility and lowering LH/FSH, which disrupts ovulation. In ART cycles, underweight status is linked to poorer stimulation responses, more cycle cancellations, and lower pregnancy and live birth rates.

That’s why this option correctly captures that both ends of the BMI spectrum are associated with disrupted ovulation and lower ART live birth rates. The other statements misstate the relationship: BMI does influence fertility; it’s not true that only obesity affects fertility; and higher BMI does not improve ART outcomes.