{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T09:52:59Z","timestamp":1773395579143,"version":"3.50.1"},"reference-count":36,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T00:00:00Z","timestamp":1773273600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Does maternal body mass index (BMI) influence embryo morphokinetics in fresh embryo transfer cycles, and how does this relate to clinical outcomes and obstetric complications? Methods: A retrospective cohort study was conducted on 2238 fresh embryo transfer (ET) cycles, categorized into four BMI groups: underweight, normal weight, overweight, and obese. Baseline characteristics, stimulation parameters, hormonal profiles, morphokinetic data, and pregnancy and delivery outcomes were analyzed. Results: Higher BMI was associated with more anovulatory infertility and greater endometrial thickness. Peak estradiol and estradiol-to-oocyte ratios declined progressively with increasing BMI, despite preserved oocyte yield and embryo quality scores. Interestingly, the underweight group exhibited a significantly distinct biphasic morphokinetics developmental pattern compared with the overweight and obese groups. Pregnancy rates, including clinical and live birth, did not differ significantly across BMI groups. However, obese women had markedly higher cesarean section rates (51.9% vs. ~25\u201328% in other groups) and a non-significant trend toward more gestational diabetes. Other perinatal outcomes, such as preeclampsia and preterm birth, were not significantly different. Conclusions: In fresh IVF cycles, a higher BMI does not impair pregnancy achievement but is linked to altered hormonal response and increased obstetric risk, particularly cesarean delivery. These findings highlight the importance of preconception counseling and targeted obstetric management for women with elevated BMI undergoing fresh ET.<\/jats:p>","DOI":"10.3390\/jcm15062182","type":"journal-article","created":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T08:26:19Z","timestamp":1773390379000},"page":"2182","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Beyond the Scale: Effects of Maternal Obesity on Embryo Morphokinetics and IVF Outcomes"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-6710-2746","authenticated-orcid":false,"given":"Nir","family":"Roguin","sequence":"first","affiliation":[{"name":"Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be\u2019er Sheva 8410501, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Medeia","family":"Michaeli","sequence":"additional","affiliation":[{"name":"IVF Unit, Department of Obstetrics & Gynecology, Hillel Yaffe Medical Center, Hadera 3810101, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Diana","family":"Polotov","sequence":"additional","affiliation":[{"name":"IVF Unit, Department of Obstetrics & Gynecology, Hillel Yaffe Medical Center, Hadera 3810101, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7785-4202","authenticated-orcid":false,"given":"Einat","family":"Shalom-Paz","sequence":"additional","affiliation":[{"name":"IVF Unit, Department of Obstetrics & Gynecology, Hillel Yaffe Medical Center, Hadera 3810101, Israel"},{"name":"Ruth and Bruce Rappaport Faculty of Medicine, The Technion-Israel Institute of Technology, Haifa 3200003, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Vahratian, A. (2008). Prevalence of Overweight and Obesity among Women of Childbearing Age: Results from the 2002 National Survey of Family Growth. Matern. Child Health J., 13.","DOI":"10.1007\/s10995-008-0340-6"},{"key":"ref_2","unstructured":"American Society for Reproductive Medicine (ASRM) (2025, August 07). Obesity and Reproduction: A Committee Opinion (2021). Available online: https:\/\/www.asrm.org\/practice-guidance\/practice-committee-documents\/obesity-and-reproduction-a-committee-opinion-2021\/."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1109","DOI":"10.1007\/s10815-019-01456-3","article-title":"Maternal body mass index affects embryo morphokinetics: A time-lapse study","volume":"36","author":"Bartolacci","year":"2019","journal-title":"J. Assist. Reprod. Genet."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1016\/j.ogc.2012.09.002","article-title":"Obesity and Reproductive Function","volume":"39","author":"Jungheim","year":"2012","journal-title":"Obstet. Gynecol. Clin. North. Am."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"3171","DOI":"10.1007\/s43032-021-00631-1","article-title":"Obesity Affects Endometrial Receptivity by Displacing the Window of Implantation","volume":"28","author":"Bellver","year":"2021","journal-title":"Reprod. Sci."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1030","DOI":"10.1016\/j.fertnstert.2013.01.089","article-title":"Selection of high potential embryos using time-lapse imaging: The era of morphokinetics","volume":"99","author":"Herrero","year":"2013","journal-title":"Fertil. Steril."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Minasi, M.G., Greco, P., Varricchio, M.T., Barillari, P., and Greco, E. (2020). The clinical use of time-lapse in human-assisted reproduction. Ther. Adv. Reprod. Health, 14.","DOI":"10.1177\/2633494120976921"},{"key":"ref_8","unstructured":"BMI|CDC (2025, August 13). Adult BMI Categories, Available online: https:\/\/www.cdc.gov\/bmi\/adult-calculator\/bmi-categories.html."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Al-Inany, H.G., Youssef, M.A., Ayeleke, R.O., Brown, J., Lam, W.S., and Broekmans, F.J. (2016). Gonadotrophin-releasing hormone antagonists for assisted reproductive technology. Cochrane Database Syst. Rev., 2016.","DOI":"10.1002\/14651858.CD001750.pub4"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1093\/humrep\/15.3.526","article-title":"Ovarian stimulation with HMG: Results of a prospective randomized phase III European study comparing the luteinizing hormone-releasing hormone (LHRH)-antagonist cetrorelix and the LHRH-agonist buserelin","volume":"15","author":"Albano","year":"2000","journal-title":"Hum. Reprod."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"840","DOI":"10.1016\/j.fertnstert.2017.01.017","article-title":"Obesity and female infertility: Potential mediators of obesity\u2019s impact","volume":"107","author":"Broughton","year":"2017","journal-title":"Fertil. Steril."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"4588","DOI":"10.1210\/jc.2017-01474","article-title":"Estrogen metabolism in abdominal subcutaneous and visceral adipose tissue in postmenopausal women","volume":"102","author":"Tikkanen","year":"2017","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"\u0160i\u0161ljagi\u0107, D., Bla\u017eeti\u0107, S., Heffer, M., Vranje\u0161 Dela\u0107, M., and Muller, A. (2024). The Interplay of Uterine Health and Obesity: A Comprehensive Review. Biomedicines, 12.","DOI":"10.3390\/biomedicines12122801"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Pandey, S., Pandey, S., Maheshwari, A., and Bhattacharya, S. (2010). The impact of female obesity on the outcome of fertility treatment. J. Hum. Reprod. Sci., 3.","DOI":"10.4103\/0974-1208.69332"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Arias, A., Quiroz, A., Santander, N., Morselli, E., and Busso, D. (2022). Implications of High-Density Cholesterol Metabolism for Oocyte Biology and Female Fertility. Front. Cell Dev. Biol., 10.","DOI":"10.3389\/fcell.2022.941539"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Zhou, X., Mo, Z., Li, Y., Huang, L., Yu, S., Ge, L., Hu, Y., Shi, S., Zhang, L., and Wang, L. (2022). Oleic acid reduces steroidogenesis by changing the lipid type stored in lipid droplets of ovarian granulosa cells. J. Anim. Sci. Biotechnol., 13.","DOI":"10.1186\/s40104-021-00660-5"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"R79","DOI":"10.1530\/REP-18-0583","article-title":"Obesity induces ovarian inflammation and reduces oocyte quality","volume":"158","author":"Snider","year":"2019","journal-title":"Reproduction"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"George, K., and Kamath, M. (2010). Fertility and age. J. Hum. Reprod. Sci., 3.","DOI":"10.4103\/0974-1208.74152"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1038\/332459a0","article-title":"Human gene expression first occurs between the four- and eight-cell stages of preimplantation development","volume":"332","author":"Braude","year":"1988","journal-title":"Nature"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1093\/molehr\/gat026","article-title":"Maternal obesity, infertility and mitochondrial dysfunction: Potential mechanisms emerging from mouse model systems","volume":"19","author":"Grindler","year":"2013","journal-title":"Mol. Hum. Reprod."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Sigal, E., Shavit, M., Atzmon, Y., Aslih, N., Bilgory, A., Estrada, D., Michaeli, M., Rotfarb, N., Abu-Raya, Y.S., and Meisel-Sharon, S. (2024). Excess Weight Impairs Oocyte Quality, as Reflected by mtDNA and BMP-15. Cells, 13.","DOI":"10.3390\/cells13221872"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1071\/RD11904","article-title":"The impact of obesity on oocytes: Evidence for lipotoxicity mechanisms","volume":"24","author":"Wu","year":"2012","journal-title":"Reprod. Fertil. Dev."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1530\/REP-11-0484","article-title":"Metabolism of the preimplantation embryo: 40 Years on","volume":"143","author":"Leese","year":"2012","journal-title":"Reproduction"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"909","DOI":"10.1095\/biolreprod.110.084145","article-title":"Beta-oxidation is essential for mouse oocyte developmental competence and early embryo development","volume":"83","author":"Dunning","year":"2010","journal-title":"Biol. Reprod."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"3531","DOI":"10.1093\/humrep\/des350","article-title":"BMI-related metabolic composition of the follicular fluid of women undergoing assisted reproductive treatment and the consequences for oocyte and embryo quality","volume":"27","author":"Valckx","year":"2012","journal-title":"Hum. Reprod."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1095\/biolreprod.115.134080","article-title":"Morphokinetic Evaluation of Embryo Development in a Mouse Model: Functional and Molecular Correlates","volume":"94","author":"Weinerman","year":"2016","journal-title":"Biol. Reprod."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1458","DOI":"10.1016\/j.fertnstert.2012.07.1135","article-title":"Limited implantation success of direct-cleaved human zygotes: A time-lapse study","volume":"98","author":"Rubio","year":"2012","journal-title":"Fertil. Steril."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Younes, G., Kugelman, N., Blais, I., Lahav-Baratz, S., Assaf, W., Koifman, M., Skvirsky, S., Segev, Y., Wiener-Magnazi, Z., and Oron, G. (2025). Does obesity affect embryo development and quality? A retrospective analysis. Reprod. Biomed. Online, 51.","DOI":"10.1016\/j.rbmo.2024.104753"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Hamm, R.F., Teefey, C.P., Dolin, C.D., Durnwald, C.P., Srinivas, S.K., and Levine, L.D. (2021). Risk of Cesarean Delivery for Women with Obesity Using a Standardized Labor Induction Protocol. Am. J. Perinatol., 38.","DOI":"10.1055\/s-0041-1732459"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Abraham, T., and Romani, A.M.P. (2022). The Relationship between Obesity and Pre-Eclampsia: Incidental Risks and Identification of Potential Biomarkers for Pre-Eclampsia. Cells, 11.","DOI":"10.3390\/cells11091548"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1016\/j.orcp.2021.07.005","article-title":"The association of general obesity, central obesity and visceral body fat with the risk of gestational diabetes mellitus: Evidence from a systematic review and meta-analysis","volume":"15","author":"Alwash","year":"2021","journal-title":"Obes. Res. Clin. Pract."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Liu, K., Chen, Y., Tong, J., Yin, A., Wu, L., and Niu, J. (2022). Association of maternal obesity with preterm birth phenotype and mediation effects of gestational diabetes mellitus and preeclampsia: A prospective cohort study. BMC Pregnancy Childbirth, 22.","DOI":"10.1186\/s12884-022-04780-2"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/j.fertnstert.2006.05.064","article-title":"Relationship between endometrial thickness and embryo implantation, based on 1,294 cycles of in vitro fertilization with transfer of two blastocyst-stage embryos","volume":"87","author":"Richter","year":"2007","journal-title":"Fertil. Steril."},{"key":"ref_34","first-page":"6351","article-title":"Endometrial thickness is a good predictor of clinical pregnancy and live birth rates in fresh and frozen-thawed embryo transfer cycles","volume":"27","year":"2023","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Montano, L., Raimondo, S., Piscopo, M., Ricciardi, M., Guglielmino, A., Chamayou, S., Gentile, R., Gentile, M., Rapisarda, P., and Oliveri Conti, G. (2025). First evidence of microplastics in human ovarian follicular fluid: An emerging threat to female fertility. Ecotoxicol. Environ. Saf., 291.","DOI":"10.1016\/j.ecoenv.2025.117868"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Raimondo, S., Gentile, M., Esposito, G., Gentile, T., Ferrara, I., Crescenzo, C., Palmieri, M., Cuomo, F., De Filippo, S., and Lettieri, G. (2021). Could Kallikrein-Related Serine Peptidase 3 Be an Early Biomarker of Environmental Exposure in Young Women?. Int. J. Environ. Res. Public. Health, 18.","DOI":"10.3390\/ijerph18168833"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/6\/2182\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T08:51:05Z","timestamp":1773391865000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/6\/2182"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,12]]},"references-count":36,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["jcm15062182"],"URL":"https:\/\/doi.org\/10.3390\/jcm15062182","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,12]]}}}