Enhancing ART success in overweight and obese women: Current strategies and novel evidence-based approaches

Background Female obesity is frequently associated with suboptimal reproductive outcomes in patients undergoing assisted reproductive technologies (ART). This scoping review evaluated traditional and emerging strategies, protocol modifications, and biomarkers aimed at improving ART outcomes in overweight and obese women. Methods A comprehensive PubMed literature search (January 1, 2015–April 23, 2025) identified studies focusing on overweight and obese women undergoing ART. Studies evaluating underweight women or paternal obesity were excluded. Results A total of 50 studies (33 observational and 17 randomized controlled trials) were included. The impact of weight loss interventions was evaluated in 14 studies. Weight loss ≥10% or >5 kg or that achieved after bariatric surgery was associated with improved ART outcomes. Adjunct therapies (N=5) such as micronutrient supplementation (e.g., folate, vitamin B12) demonstrated potential benefits with respect to ovulation, pregnancy, and live birth rates. While overweight or obese women required higher gonadotropin dosages and longer stimulation cycles (N=10), weight loss was associated with decreased gonadotropin consumption and improved ART outcomes. The use of letrozole (N=6), alone or in combination with other stimulation protocols, appeared to increase live birth rates and reduce the risk of miscarriages. Finally, biomarker analyses (N=15) suggested that lipid profiles, reproductive hormones, and inflammatory markers may serve as predictors of ART outcomes. Conclusion Interventions achieving greater degrees of weight loss, adjunct therapies, and letrozole-based protocols may improve ART outcomes, including pregnancy and live birth rates, in overweight and obese women. Personalized treatment protocols, biomarkers, and multidisciplinary approaches are essential for optimizing ART success in this population.