Patients with a body mass index of ≥45 kg/m² can safely undergo oocyte retrievals and anticipate similar assisted reproductive technology outcomes

Objective: To compare anesthesia and assisted reproductive technology (ART) outcomes in patients with a body mass index (BMI) of 40–44.9 kg/m² with those with a BMI of ≥45 kg/m² because these patients are often excluded from care. Design: Retrospective cohort study. Subjects: All patients with a BMI of ≥40 kg/m² undergoing oocyte retrieval for ART from January 2018 to 2023 from one academic fertility clinic and one private fertility clinic. Exposure: A BMI of ≥45 kg/m² compared with a BMI of 40–44.9 kg/m². Main Outcome Measures: The primary outcome was anesthesia complications at the time of retrieval. Demographic data, cycle specific information, medical comorbidities, BMI at retrieval, length of oocyte retrieval, ART and anesthesia complications, laboratory data, and pregnancy rates were recorded. Results: A total of 98 patients with a BMI of ≥40 kg/m² undergoing oocyte retrieval were identified for the study: 56 patients with a BMI from 40 to 44.9 kg/m² and 42 patients with a BMI of ≥45 kg/m². Demographics were not statistically significantly different between both groups, except that more patients with a BMI of 40–44.9 kg/m² identified as White (73% vs. 60%) or Black (9% vs. 0). All patients were successfully managed with intravenous sedation and did not require higher level of sedation or care. The mean surgical duration was longer in patients with a BMI of ≥45 kg/m² than in those with a BMI of 40–44.9 kg/m² (26.8 minutes [standard deviation, 13 minutes] vs. 22.3 minutes [standard deviation, 8.4 minutes]). Most patients (93%) did not experience any anesthesia complication. The only adverse anesthesia complication in both groups was oxygen desaturation of <90%, which did not differ by cohort even when adjusting for age. There was no difference in the number of mature oocytes retrieved, day 5/6 blastocysts, the number of euploid embryos, or clinical pregnancy, miscarriage, or live birth rates. Conclusion: Body mass index is commonly used as a threshold for access to ART. When using intravenous sedation, patients with a BMI of ≥45 kg/m² have similar ART outcomes with few anesthesia or ART complications compared with those with a BMI of 40–44.9 kg/m². With appropriate counseling and preoperative preparation, patients with a BMI of ≥45 kg/m² can safely undergo oocyte retrieval.