The present study aimed to evaluate the impact of body mass index (BMI) on pregnancy outcome after intracytoplasmic sperm injection (ICSI). The study analyzed pregnancy outcome of 349 women who underwent ICSI by their BMI: <25, 25–<30, and ≥30？kg/m2. The associations were generated by applying logistic regression models. A significant reduction in positive pregnancy outcome was observed among overweight and obese women (odds ratio (OR) = 0.50; 95% confidence interval (CI) = 0.25–0.99 for overweight women and OR = 0.45; 95% CI = 0.20–0.89 for obese women). These estimates show that the pregnancy rates are reduced with increasing BMI. The effect of obesity on pregnancy outcome was absent when three and more embryos were transferred. Our study contributes to the reports linking overweight and obesity with decreased positive pregnancy outcome after ICSI and suggests women’s age, infertility type, and number of embryos transferred to modify this reducing effect. 1. Introduction Body mass index (BMI) has an adverse effect on reproduction [1]. Overweight women have a higher incidence of menstrual dysfunction and anovulation, possibly because of altered secretion of gonadotropin releasing hormone, sex hormone binding globulin, ovarian and adrenal androgen, and luteinising hormone and also because of altered insulin resistance [2]. A body mass index that was either high or low was associated with reduced probability of achieving pregnancy in women receiving assisted reproduction treatment. Mechanisms through which body mass affects reproduction that have been cited include menstrual disturbance and anovulation [3] but these problems can be overcome through assisted reproduction treatment. There is no evidence that body mass affects the quality of the embryo and therefore the pregnancy rate. Other mechanisms may be proposed such as altered receptivity of the uterus after transfer of embryos, possibly because of disturbed endometrial function [2]. The prevalence of obesity in infertile women is high, and there is growing evidence that BMI is associated with pregnancy outcome after ART. Several recent and previous studies have linked overweight and obesity to low pregnancy rate [4–8] and spontaneous abortion [9] in ART programs. Obesity is also potentially modifiable, possibly amenable to low cost, noninvasive self-management by patients. These studies, however, did not examine the interaction (effect modification) between BMI and other related factors on the probability of pregnancy outcome in these women. According to published studies [10, 11], patient’s age,
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