Weight management interventions before IVF in overweight and obese women: a scoping review

Abstract Background Overweight and obesity are associated with reduced fertility outcomes in assisted reproduction. This scoping review maps available evidence on pre-IVF weight management interventions. Methods We searched PubMed/MEDLINE (2008–2025) for studies evaluating weight management interventions (dietary, exercise, pharmacological, surgical) before or during IVF in women with BMI ≥ 25 kg/m². We included randomized controlled trials, quasi-experimental studies, and cohorts with interventions. Two reviewers independently screened records and extracted data on interventions and outcomes. Supplementary searches included reference screening and citation tracking. Results From 230 records, 19 studies met inclusion criteria: 17 evaluating IVF-specific outcomes — lifestyle or dietary interventions ( n = 10), pharmacological therapies ( n = 3), and bariatric surgery ( n = 4) — and 2 examining preconception interventions before other ART modalities included exclusively to inform implementation challenges. Weight loss was achieved across intervention categories, though the magnitude varied substantially. Improvements in reproductive outcomes were inconsistent. Some studies reported improved pregnancy rates following lifestyle interventions, while well-designed trials showed no significant differences despite weight reduction. Orlistat showed no reproductive benefit; GLP-1 agonist combination therapy showed preliminary promise in PCOS. Bariatric surgery produced substantial weight loss but inconsistent live birth outcomes. High attrition rates (> 20%), treatment delays, and variable adherence were common challenges. Conclusions Pre-IVF weight management interventions demonstrate substantial outcome heterogeneity. While weight loss is achievable, reproductive benefits are inconsistent. Evidence does not support rigid BMI cutoffs. Clinical decisions should be individualized. Future research should identify predictive factors and optimize intervention protocols.