1. Bea Jaye Warlick, RN, BSN N5033 Research in Nursing Dr. Marianne MatzoSpring 2011 Obesity and Infertility: A Research Proposal

2. Introduction As the most common chronic disease in the United States of America, overweight or obesity affects more than one third of all adults (Flegal, Carroll, Ogden, & Curtin, 2010). According to Dorland’s Medical Dictionary (1985) obesity is defined as an increase in body weight beyond the limitation of skeletal and physical requirement, as the result of an excessive accumulation of fat in the body.

3. Introduction “Obesity is associated with greater risks for adverse health outcomes across the reproductive spectrum, including higher rates of infertility” (Luke et al., 2011, p. 245). “Infertility affects an estimated 12% of women of reproductive age” (Luke et al., 2011, p. 246). The prevalence of obesity in women of reproductive age, and in the infertile population, continues to increase with recent recognition that abdominal obesity is associated with greater metabolic disturbances and reduced conception even in ovulating women (Malik, 2009).

4. Problem Statement Does obesity in reproductive age women, ≤ 35 years of age, effect pregnancy and live birth rates in in-vitro fertilization (IVF)?

5. Purpose The purpose of this nursing study is to evaluate the effect of obesity, using Body Mass Index (BMI) categories, on pregnancy rates among women undergoing IVF.

6. Hypothesis Obesity in reproductive aged women, less than or equal to 35 years of age, decreases pregnancy rates in in-vitro fertilization (IVF).

7. Theoretical Framework Definitions maintain optimal health and wellness Orem’s model is separated into three conceptual theories which include: self care, self care deficit and nursing system (Orem, 1985). Orem’s metaparadigm Obesity is the result of a combination of reduced exercise, changes in dietary composition, and increased caloric intake (Bellver et al., 2010) and defined by BMI ≥30 kg/m². Obesity is operationalized by BMI. Orem’s Self Care Practice Model

8. Research Design retrospective cohort study nonprobability, convenience (accidental) sampling method The study population will include 200 women of primary fertility age, ≤ 35 years of age, who will be undergoing their first cycle of in-vitro fertilization at Henry G. Bennett Fertility Institute between January 2009 and December 2011.

9. Inclusions Exclusions Patients with regular menstrual cycles (21-35 days) Patients that have had NO hormonal therapy for the last three months Patients that have had no systemic illnesses. Male patients Patients younger than 18 Patients with polycystic ovary syndrome (PCOS) Patients with severe endometriosis Cancelled IVF cycles Research Design

10. Data Collection Society for Assisted Reproductive Technology Clinic Online Reporting System (SART CORS) This database contains data collected and verified by the SART, and reported to the Centers for Disease Control in compliance with the Fertility Clinic Success Rate and Certification Act of 1992 (Wyden Act).

11. Instrumentation Body Mass Index (BMI) weight in kilograms divided by the square of the height in meters (kg/m2) predominant instrument that both medical clinicians and researchers use for classifying individuals into obesity categories

12. BMI Groups underweight (BMI < 18.5 kg/m2) normal weight (BMI 18.5-24.9 kg/m2) overweight (BMI 25-29.9 kg/m2) obese (BMI ≥ 30 kg/m2) normal weight women are the reference group.

13. BMI Chart

14. Statistical Methods One-tailed t-test 95% Power Moderate effect size 0.40 Significance level of 0.01 ANOVA Statistical significance p<0.05 SAS Software Version 9.1

15. Conclusions Patients desire conception as soon as possible Fertility can be negatively affected by obesity Obesity can increase risk of miscarriage Impaired pregnancy outcomes Increase patient awareness Educate patients Be supportive

16. References Bellver, J., Ayllion, Y., Ferrando, M., Melo, M., Goyri, E., Pellicer, A., Remohi, J., & Meseguer, M. (2010). Female obesity impairs in vitro fertilization outcome without affecting embryo quality. Fertility and Sterility, 93(2), 447-454. Burns, N. & Groves, S.K. (2009). The practice of nursing research: Appraisal, synthesis, and generation of evidence (6th ed.).St. Louis, Missouri: Saunders. Dorland's Illustrated Medical Dictionary (26th ed.). (1985). Philadelphia: W.B. Saunders Company. Flegal, K.M., Carroll, M.D., Ogden, C.L., & Curtin, L.R. (2010). Prevalence and trends in obesity among US adults, 1999-2008. J Am Med Association, 303, 235- 241. Hawkins, D. (2011, March 4). BMI weight ratio. Retrieved March 25, 2011, from http://www.livestrong.com/article/396934-bmi-weight-ratio/

17. Malik, S. (2009). Impact of obesity on female fertility and fertility treatment. British Journal of Midwifery, 17(7), 452-454. Martinuzzi, K., Ryan, S., Luna, M., & Copperman, A.B. (2008). Elevated body mass index (BMI) does not adversely affect in vitro fertilization outcome in young women. Journal of Assisted Reproduction and Genetics, 25, 169-175. McEwen, M., & Wills, E. M. (2011). Theoretical Basis for Nursing. Philadelphia: Lippincott Williams & Wilkins. Norman, R.J., Noakes, M., Wu, R., Davies, M.J., Moran, L., & Wang, J.X. (2004). Improving reproductive performance in overweight/obese women with effective weight management. Human Reproduction, 10, 267-280. Orem, D. E. (1985). Nursing Concepts of Practice (3rd ed.). New York: McGraw Hill. Smalley, K.J., Knerr, A.N., Kendrick, Z.V., Colliver, J.A., & Owen, O.E. (1990). Reassessment of body mass indices. American Journal of Clinical Nutrition, 52, 405-408. World Health Organization (WHO). (2011, March). Obesity and Overweight. Retrieved March 20, 2011, from http://www.who.int/mediacentre/factsheets/fs311/en/index.html