Fit-for-Fertility Program Boosts Births, Is Cost-Effective 

Miriam E. Tucker

April 08, 2021

Incorporation of a nonintensive fitness intervention for women with obesity into a standard fertility treatment program could be cost-effective, a new analysis finds.

Financial data for the Canadian Fit-for-Fertility program were presented March 20 at the virtual ENDO 2021: The Endocrine Society Annual Meeting by Matea Belan, PhD, of the division of endocrinology at the University of Sherbrooke, Quebec, Canada.

Women with obesity and infertility are typically advised to lose 5% to 10% of their body weight as first-line fertility treatment, as doing so has been shown to increase rates of ovulation and pregnancy. But most established fertility treatment programs don't incorporate organized lifestyle modification interventions, Belan explained during a press briefing.

"Mostly they're just given general advice, not resources. It's up to the woman to seek help for lifestyle. Our idea is to give them access to intervention that's integrated into the setting of a fertility clinic," she said.

Primary results from the Fit-for-Fertility program, including significant weight loss and a 40% increased live birth rate at 18 months compared with standard fertility treatment, were presented at ENDO 2019 and reported at the time by Medscape Medical News.

In the new analysis, the cost in Canadian dollars per additional newborn achieved with the Fit-for-Fertility program was similar to the willingness-to-pay for in vitro fertilization (IVF) from a health system perspective.

The final goal, lead investigator Jean-Patrice Baillargeon, MD, told Medscape Medical News, "would be to convince stakeholders, and mainly the provincial government, to cover the costs of our lifestyle program. This would not be more costly than funding IVF, but [would provide] more long-term benefits for the whole family and the offspring."

Asked to comment, Chloe A. Zera, MD, told Medscape Medical News that she supports the idea in principle, but is concerned that in the US healthcare system women don't always have access to fertility and obesity treatments to begin with.

"There's a huge equity issue. People with Medicaid don't necessarily get coverage for IVF...Even many commercially insured people are paying out of pocket, which can be $10,000 to $15,000 for a cycle just for the medications, so the cost to patients on the individual level is huge," said Zera, who is associate professor of obstetrics, gynecology and reproductive biology at Harvard Medical School, Boston, Massachusetts.

She added: "I'm prolifestyle modification. I'm also proequity in health care delivery so I would want to make sure that the way it's delivered incorporates that as a consideration...Is that money better spent on primary prevention of obesity and access to basic services and basic reproductive health care for everybody?"

Primary Results: Improvements in Overall and Spontaneous Pregnancy Rates

The study included 130 women with infertility and a body mass index ≥ 30 kg/m2 (mean 40 kg/m2), of whom 65 were randomized to the Fit-for-Fitness program and 65 to standard fertility treatment that did not include a lifestyle intervention, although those women could consult professionals on their own. The women in the lifestyle intervention group had to stop medical fertility treatments for the first 6 months but could use them thereafter while the controls continued to use them throughout.  

Based on motivational interviewing, the program focused on womens' individual likes and dislikes, experiences, and perceived capacities, aiming to improve healthful habits gradually and with "low intensity" so as to maintain them in the long run.

The program combined individual sessions with a nutritionist and kinesiologist every 6 weeks and 12 mandatory group sessions. The women were asked to reduce their total caloric intake by about 500 calories/day but weren't asked to change their diets. They were also advised to increase physical activity by about 150 minutes/week.

"We want to keep it sustainable in time, so they don't have a relapse when they become pregnant, and to help the newborn and spouse too. It's about improving and maintaining habits," Belan explained during the briefing.

At 6 months, mean weight changes were –3.4% versus –0.89% for the intervention versus control groups (P = .003).

"What is important for women with obesity and infertility is to improve their lifestyle, both physical activity and nutrition, even if the weight loss is minimal," noted Baillargeon, professor of medicine, health sciences research and physiology, also at the University of Sherbrooke.

A total of 46 intervention and 52 control patients finished the 18-month study. Pregnancies occurred in 61% of the intervention group versus 39% of the controls, while spontaneous pregnancies — among those not using medical fertility treatments — occurred in 33.3% versus 12.3% (P = .009).

The primary outcome, live births at 18 months, occurred in 51.0% of the intervention group versus 36.8% of controls, which wasn't a statistically significant difference, but was "highly clinically significant," Belan said.

Cost Per Additional Newborn Similar to IVF

Costs (in Canadian dollars) considered in the analysis included those related to the management of infertility, obesity, pregnancy, and childbirth. The incremental cost-effectiveness ratios (ICERs), a standard cost-effectiveness measure, per live birth were $24,393 from a societal perspective, $12,633 for the health system, and $5,980 for the patient.

Because the $12,633 health system cost per additional newborn with the Fit-for-Fertility program is similar to the health system's willingness-to-pay for IVF of up to $15,000, a lifestyle intervention could be considered cost-efficient compared with the standard of care, Belan said.

"We think that the Fit-for-Fertility program could be deemed cost-effective and could represent an interesting alternative to the usual standard of care for women with obesity seeking fertility treatments," she commented.

The Canadian Institutes of Health Research is funding a larger randomized controlled trial of the program at six Canadian centers to validate these results.

Belan, Baillargeon, and Zera have reported no relevant financial relationships.

Miriam E. Tucker is a freelance journalist based in the Washington DC area. She is a regular contributor to Medscape, with other work appearing in the Washington Post, NPR's Shots blog, and Diabetes Forecast magazine. She can be found on Twitter @MiriamETucker.

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