Impact of Body Mass Index on Fertility Outcomes
Summary
Body mass index (BMI) exerts a profound influence on reproductive health, with both underweight and overweight statuses linked to suboptimal fertility outcomes. Elevated adiposity disrupts hormonal milieu—altering leptin, insulin and sex steroid levels—while promoting chronic inflammation and insulin resistance. These changes impair ovarian folliculogenesis, oocyte quality, endometrial receptivity and sperm parameters, contributing to prolonged time to pregnancy, reduced success rates of assisted reproductive technology (ART) and increased risk of miscarriage. Conversely, low BMI may be associated with ovulatory irregularities and marginally lower implantation rates. The global prevalence of abnormal weight magnifies its public health importance, underscoring the need for preconception weight management strategies, personalised ART protocols and integrative care to optimise fertility and improve birth outcomes.
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Impact of Body Mass Index on Fertility Outcomes publication trend
The graph below shows the total number of articles in impact of body mass index on fertility outcomes across all publications each year (not limited to Nature Index journals).
Technical terms
Body Mass Index (BMI): A measure of body fat calculated as weight in kilograms divided by the square of height in metres, used to categorise underweight, normal weight, overweight and obesity.
Assisted Reproductive Technology (ART): Clinical techniques, including in vitro fertilisation and intracytoplasmic sperm injection, employed to achieve pregnancy.
Endometrial receptivity: The physiological state of the uterine lining that permits embryo implantation, governed by hormonal, molecular and structural factors.
Anovulation: The absence of ovulation, a common cause of subfertility characterised by hormonal and metabolic disturbances, often exacerbated by obesity.
References
- When Weight Matters: How Obesity Impacts Reproductive Health and Pregnancy-A Systematic Review. Current Obesity Reports (2025).
- Attenuation of palmitic acid-induced lysyl oxidase overexpression in the ovary contributes to the improvement of ovulation in obesity by metformin. Human Reproduction Open (2024).
- Effects of preconception lifestyle intervention in infertile women with obesity: The FIT-PLESE randomized controlled trial. PLOS Medicine (2022).
- Effect of body mass index on pregnancy outcomes in a freeze-all policy: an analysis of 22,043 first autologous frozen-thawed embryo transfer cycles in China. BMC Medicine (2019).
- Role of hormonal and inflammatory alterations in obesity-related reproductive dysfunction at the level of the hypothalamic-pituitary-ovarian axis. Reproductive Biology and Endocrinology (2018).
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