Environnement et grossesse : impact de l’obésité.

Obesity and overweight have a recognized impact on spontaneous fertility and the chances of success of assisted reproductive technique (ART), with a decrease in pregnancy and birth rates. Although the positive effect of weight loss on the chances of success of ART remains poorly demonstrated, weight loss is associated with an improvement in menstrual cycles, a better rate of spontaneous pregnancy, and has an interest in reducing the level of maternal-fetal risk in the event of pregnancy. Nevertheless, it implies deferring the management of the infertile couple, and must therefore be justified either by its action on the improvement of spontaneous fertility or the chances of pregnancy after ART, or on the improvement of the comorbidities. The indications for management must therefore be discussed in a multidisciplinary manner and early in the patient’s life : 1/ obstetrical preconception consultation to discuss the maternal-fetal risks of pregnancy according to BMI and comorbidities, 2/ consultation in reproductive medicine to define the cause of infertility and the technical possibilities of ART, and 3/ preconception consultation with a nutritionist doctor to determine the possibilities of weight loss and how to obtain it according to the necessary weight objective, and then an follow up of the pregnant woman. The weight objectives must be discussed early in the process, taking into account the age of the patients, especially after 35 years. [ABSTRACT FROM AUTHOR]