Visceral adiposity is strongly linked to metabolic and reproductive dysfunction in obese women. The Visceral Adiposity Index (VAI) is a composite measure reflecting visceral fat distribution and metabolic status. This study aimed to investigate the association between VAI and embryo quality in obese women undergoing their first in vitro fertilization (IVF) cycle.

In this cross-sectional study, 882 women aged 20–34 years with BMI ≥30 kg/m² undergoing their first IVF cycle were evaluated. VAI was calculated using anthropometric and lipid parameters measured during the pre-IVF assessment. Embryo quality was categorized at the cleavage stage as high-, moderate-, or low-quality according to Istanbul Consensus criteria. Associations between VAI and embryo quality were assessed using group comparisons, correlation analyses, and exploratory receiver operating characteristic (ROC) analyses.

Mean VAI increased progressively across embryo-quality categories (1.41±0.95 in high-quality, 1.71±1.08 in moderate-quality, and 1.97±1.34 in low-quality groups; p = 0.001). In ROC, VAI demonstrated strong discrimination between low-quality and non-low-quality embryos (AUC=0.915; 95%CI: 0.882–0.949). The internally derived cut-off of 1.83 yielded 92% sensitivity and 81.2% specificity; however, this threshold requires external validation. Higher VAI was also associated with longer infertility duration and smoking status in exploratory regression models.

Higher VAI was associated with poorer embryo quality at the cleavage stage, suggesting that visceral adiposity and its metabolic correlates may adversely influence early embryo competence. Although VAI demonstrated strong discriminatory performance for low-quality embryos within this dataset, these findings should be interpreted as associative rather than predictive, and external longitudinal validation is required before any clinical application.