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Abstract
The purpose of this American Society for Reproductive Medicine Practice Committee report is to provide clinicians with principles and strategies for the evaluation and treatment of couples with infertility associated with obesity. This revised document replaces the Practice Committee document titled "Obesity and reproduction: an educational bulletin" last published in 2015 (Fertil Steril 2015;104:1116-26).
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Affiliation(s)
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- American Society for Reproductive Medicine, Birmingham, Alabama
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52
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Muirhead R, Kizirian N, Lal R, Black K, Prys-Davies A, Nassar N, Baur L, Sainsbury A, Sweeting A, Markovic T, Skilton M, Hyett J, de Vries B, Tarnow-Mordi W, Brand-Miller J, Gordon A. A Pilot Randomized Controlled Trial of a Partial Meal Replacement Preconception Weight Loss Program for Women with Overweight and Obesity. Nutrients 2021; 13:nu13093200. [PMID: 34579077 PMCID: PMC8469733 DOI: 10.3390/nu13093200] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/05/2021] [Accepted: 09/08/2021] [Indexed: 11/16/2022] Open
Abstract
About half of Australian women have a body mass index in the overweight or obese range at the start of pregnancy, with serious consequences including preterm birth, gestational hypertension and diabetes, caesarean section, stillbirth, and childhood obesity. Trials to limit weight gain during pregnancy have had limited success and reducing weight before pregnancy has greater potential to improve outcomes. The PreBabe Pilot study was a randomised controlled pilot trial to assess the feasibility, acceptability and potential weight loss achieved using a commercial online partial meal replacement program, (MR) vs. telephone-based conventional dietary advice, (DA) for pre-conception weight-loss over a 10-week period. Women 18–40 years of age with a BMI ≥ 25 kg/m2 planning pregnancy within the next 6 to 12 months were included in the study. All participants had three clinic visits with a dietitian and one obstetric consultation. In total, 50 women were enrolled in the study between June 2018 and October 2019–26 in MR and 24 in DA. Study retention at the end of 10 week intervention 81% in the MR arm and 75% in the DA arm. In the-intention-to-treat analysis, women using meal replacements lost on average 5.4 ± 3.1% body weight compared to 2.3 ± 4.2% for women receiving conventional advice (p = 0.029). Over 80% of women in the MR arm rated the support received as excellent, compared to 39% in the DA arm (p < 0.001). Women assigned to the MR intervention were more likely to achieve pregnancy within 12 months of the 10 week intervention (57% (12 of 21) women assigned to MR intervention vs. 22% (4 of 18) assigned to the DA group (p = 0.049) became pregnant). The findings suggest that a weight loss intervention using meal replacements in the preconception period was acceptable and may result in greater weight loss than conventional dietary advice alone.
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Affiliation(s)
- Roslyn Muirhead
- Charles Perkins Centre, School of Life and Environmental Biosciences, University of Sydney, Sydney, NSW 2006, Australia; (R.M.); (J.B.-M.)
| | - Nathalie Kizirian
- Charles Perkins Centre, University of Sydney, Sydney, NSW 2006, Australia; (N.K.); (R.L.)
| | - Ravin Lal
- Charles Perkins Centre, University of Sydney, Sydney, NSW 2006, Australia; (N.K.); (R.L.)
| | - Kirsten Black
- Speciality of Obstetrics, Gynaecology and Neonatology, Central Clinical School, Faculty of Medicine and Health, Charles Perkins Centre, University of Sydney, Sydney, NSW 2006, Australia;
- Department of Women and Babies, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, NSW 2050, Australia;
| | - Ann Prys-Davies
- Department of Women and Babies, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, NSW 2050, Australia;
| | - Natasha Nassar
- Charles Perkins Centre, Childrens Hospital Westmead Clinical School, University of Sydney, Sydney, NSW 2006, Australia; (N.N.); (L.B.)
| | - Louise Baur
- Charles Perkins Centre, Childrens Hospital Westmead Clinical School, University of Sydney, Sydney, NSW 2006, Australia; (N.N.); (L.B.)
| | - Amanda Sainsbury
- School of Human Sciences, Faculty of Science, University of Western Australia, Crawley, WA 6009, Australia;
| | - Arianne Sweeting
- Sydney Medical School, The University of Sydney, NSW 2006, Australia; (A.S.); (T.M.); (M.S.)
| | - Tania Markovic
- Sydney Medical School, The University of Sydney, NSW 2006, Australia; (A.S.); (T.M.); (M.S.)
| | - Michael Skilton
- Sydney Medical School, The University of Sydney, NSW 2006, Australia; (A.S.); (T.M.); (M.S.)
| | - Jon Hyett
- Charles Perkins Centre, Boden Initiative, The University of Sydney, NSW 2006, Australia
| | - Bradley de Vries
- Charles Perkins Centre, Boden Initiative, The University of Sydney, NSW 2006, Australia
| | | | - Jennie Brand-Miller
- Charles Perkins Centre, School of Life and Environmental Biosciences, University of Sydney, Sydney, NSW 2006, Australia; (R.M.); (J.B.-M.)
| | - Adrienne Gordon
- Speciality of Obstetrics, Gynaecology and Neonatology, Central Clinical School, Faculty of Medicine and Health, Charles Perkins Centre, University of Sydney, Sydney, NSW 2006, Australia;
- Speciality of Obstetrics, Gynaecology and Neonatology, Central Clinical School, Faculty of Medicine and Health, Royal Prince Alfred Hospital Newborn Care, Sydney Local Health District, Sydney, NSW 2050, Australia; (J.H.); (B.d.V.)
- Correspondence:
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Lv B, Xing C, He B. Effects of bariatric surgery on the menstruation- and reproductive-related hormones of women with obesity without polycystic ovary syndrome: a systematic review and meta-analysis. Surg Obes Relat Dis 2021; 18:148-160. [PMID: 34756568 DOI: 10.1016/j.soard.2021.09.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/11/2021] [Accepted: 09/06/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND Bariatric surgery is an effective treatment for severe obesity. Several studies have been conducted on the effects of bariatric surgery on the reproductive function of women with obesity who do not have polycystic ovary syndrome (PCOS). OBJECTIVES To evaluate the effects of bariatric surgery on the menstruation and reproductive related hormones of women of childbearing age with who do not have PCOS. SETTING A systematic review and meta-analysis at a university hospital. METHODS Online databases were searched for all studies reporting the efficacy of bariatric surgery for women with obesity until March 2021. The language of publication was limited to English and Chinese. Incidence of abnormal menstruation and reproductive-related hormone levels were the primary outcomes. RESULTS Fifteen studies comprising 725 patients were enrolled in this meta-analysis. Results showed a significantly lower incidence of abnormal menstruation (relative risk: .40, 95% confidence interval [CI]: .20-.79, P = .008) after bariatric surgery. Moreover, bariatric surgery led to a decrease in serum insulin levels (mean difference [MD] = -13.12 mIU/L, 95% CI: -15.03 to -11.22, P < .00001), glucose (MD = -.91 mmol/L, 95% CI: -1.26 to -.56, P < .00001), triglyceride (MD = -.61 g/L, 95% CI: -.76 to -.46, P < .00001), total testosterone (MD = -.22 ng/mL, 95% CI: -.24 to -.20, P < .00001), dehydroepiandrosterone (DHEA) (MD = -25.34 μg/dL, 95% CI: -31.19 to -19.49, P < .00001), estradiol (MD = -25.13 pg/mL, 95% CI: -34.13 to -16.13, P < .00001), and anti-Mullerian hormone (AMH) (MD = -.40 ng/mL, 95% CI: -.67 to -.13, P = .003). Serum sex hormone binding globulin (SHBG) levels increased after bariatric surgery (MD = 43.99 nmol/L, 95% CI: 34.99-52.99, P < .00001). CONCLUSION Bariatric surgery can lower fasting insulin, glucose, and triglyceride levels, reduce the incidence of abnormal menstruation, decrease total serum testosterone, DHEA, estradiol, and AMH levels, and increase SHBG level for women with obesity of childbearing age who do not have PCOS. This meta-analysis indicated that bariatric surgery could be effective in improving reproductive function for women with severe obesity.
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Affiliation(s)
- Bo Lv
- Department of Endocrinology, The Third People's Hospital of Dalian, Dalian, China
| | - Chuan Xing
- Department of Endocrinology, Shengjing Hospital, China Medical University, Shenyang, China
| | - Bing He
- Department of Endocrinology, Shengjing Hospital, China Medical University, Shenyang, China.
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Wang Z, Zhao J, Ma X, Sun Y, Hao G, Yang A, Ren W, Jin L, Lu Q, Wu G, Ling X, Hao C, Zhang B, Liu X, Yang D, Zhu Y, Li J, Bao H, Wang A, Liu J, Chen ZJ, Tan J, Shi Y. Effect of Orlistat on Live Birth Rate in Overweight or Obese Women Undergoing IVF-ET: A Randomized Clinical Trial. J Clin Endocrinol Metab 2021; 106:e3533-e3545. [PMID: 33991186 DOI: 10.1210/clinem/dgab340] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Obesity management prior to infertility treatment remains a challenge. To date, results from randomized clinical trials involving weight loss by lifestyle interventions have shown no evidence of improved live birth rate. OBJECTIVE This work aimed to determine whether pharmacologic weight-loss intervention before in vitro fertilization and embryo transfer (IVF-ET) can improve live birth rate among overweight or obese women. METHODS We conducted a randomized, double-blinded, placebo-controlled trial across 19 reproductive medical centers in China, from July 2017 to January 2019. A total of 877 infertile women scheduled for IVF who had a body mass index of 25 or greater were randomly assigned to receive orlistat (n = 439) or placebo (n = 438) treatment for 4 to 12 weeks. The main outcome measurement was the live birth rate after fresh ET. RESULTS The live birth rate was not significantly different between the 2 groups (112 of 439 [25.5%] with orlistat and 112 of 438 [25.6%] with placebo; P = .984). No significant differences existed between the groups as to the rates of conception, clinical pregnancy, or pregnancy loss. A statistically significant increase in singleton birth weight was observed after orlistat treatment (3487.50 g vs 3285.17 g in the placebo group; P = .039). The mean change in body weight during the intervention was -2.49 kg in the orlistat group, as compared to -1.22 kg in the placebo group, with a significant difference (P = .005). CONCLUSION Orlistat treatment, prior to IVF-ET, did not improve the live birth rate among overweight or obese women, although it was beneficial for weight reduction.
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Affiliation(s)
- Ze Wang
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University; The Key Laboratory of Reproductive Endocrinology of Ministry of Education; National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan, Shandong Province, 250001,China
| | - Junli Zhao
- Department of Reproductive Medicine, General Hospital of Ningxia Medical University, Ningxia, China
| | - Xiang Ma
- Department of Reproductive Medicine, First Affiliated Hospital of Nanjing Medical University/Jiangsu Province Hospital; State Key Laboratory of Reproductive Medicine, Nanjing, Jiangsu Province, 210029, China
| | - Yun Sun
- Center for Reproductive Medicine, Ren Ji Hospital; School of Medicine, Shanghai Jiao Tong University; Shanghai Key Laboratory of Assisted Reproduction and Reproductive Genetics, Shanghai, 200135, China
| | - Guimin Hao
- Department of Reproductive Medicine, the Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, 050000, China
| | - Aijun Yang
- Department of Reproductive Medicine, Affiliated Hospital of Jining Medical University, Jining, Shandong Province, 272001, China
| | - Wenchao Ren
- Reproductive Hospital of Weifang Medical University, Weifang, Shandong Province, 261031, China
| | - Lei Jin
- Department of Reproductive Medicine, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, 430030, China
| | - Qun Lu
- Center of Reproductive Medicine, Peking University People's Hospital, Beijing, 100044, China
| | - Gengxiang Wu
- Center for Reproductive Medicine, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, 430060, China
| | - Xiufeng Ling
- Department of Reproductive Medicine, Maternity and Child Health Care Hospital, Women's Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, 210004, China
| | - Cuifang Hao
- Center for Reproductive Medicine, Yantai Yuhuangding Hospital, Yantai, Shandong Province, 264000, China
| | - Bo Zhang
- Center for Reproductive Medicine, Maternal and Child Health Hospital/Obstetrics and Gynecology Hospital of Guangxi Zhuang Autonomous Region, Guangxi, 530000, China
| | - Xinyu Liu
- Department of Reproductive Medicine, Shenyang 204 Hospital, Shenyang, Liaoning Province, 110122, China
| | - Dongzi Yang
- Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, 510120, China
| | - Yimin Zhu
- Department of Reproductive Endocrinology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, 310006, China
| | - Jing Li
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University; The Key Laboratory of Reproductive Endocrinology of Ministry of Education; National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan, Shandong Province, 250001,China
| | - Hongchu Bao
- Center for Reproductive Medicine, Yantai Yuhuangding Hospital, Yantai, Shandong Province, 264000, China
| | - Ancong Wang
- Department of Reproductive Medicine, Linyi People' Hospital, Linyi, Shandong Province, 276000, China
| | - Jianqiao Liu
- Department of Obstetrics and Gynecology, Center for Reproductive Medicine/Department of Fetal Medicine and Prenatal Diagnosis/BioResource Research Center, Key Laboratory for Major Obstetric Diseases of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, 510150, China
| | - Zi-Jiang Chen
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University; The Key Laboratory of Reproductive Endocrinology of Ministry of Education; National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan, Shandong Province, 250001,China
| | - Jichun Tan
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, 110022, China
| | - Yuhua Shi
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University; The Key Laboratory of Reproductive Endocrinology of Ministry of Education; National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan, Shandong Province, 250001,China
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Boedt T, Matthys C, Lie Fong S, De Neubourg D, Vereeck S, Seghers J, Van der Gucht K, Weyn B, Geerts D, Spiessens C, Dancet EAF. Systematic development of a mobile preconception lifestyle programme for couples undergoing IVF: the PreLiFe-programme. Hum Reprod 2021; 36:2493-2505. [PMID: 34379119 DOI: 10.1093/humrep/deab166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 06/04/2021] [Indexed: 12/14/2022] Open
Abstract
STUDY QUESTION Can we develop a preconception lifestyle programme for couples undergoing IVF that is in line with their needs. SUMMARY ANSWER A mobile preconception lifestyle programme was systematically developed based on expert opinion, literature and needs of IVF-patients. WHAT IS KNOWN ALREADY A healthy lifestyle prior to conception is not only beneficial for the general health of couples, but evidence on its importance for their reproductive health and the health of their children is also emerging. So far, the vast majority of fertility clinics do not offer a lifestyle programme for couples undergoing IVF. Therefore, the present study aimed to develop a lifestyle programme for IVF-couples. STUDY DESIGN, SIZE, DURATION The development of the PreLiFe-programme was guided by the steps of the Medical Research Council (MRC) framework for developing complex interventions, a systematic approach for developing theory- and evidence-based health promotion interventions. PARTICIPANTS/MATERIALS, SETTINGS, METHODS First, the evidence base on lifestyle programmes for IVF-couples was reviewed. Second, several iterations between an expert panel, the literature, and quantitative and qualitative data from IVF-patients identified the content, the format, behaviour change techniques and theory of the programme. Third, the PreLiFe-programme was produced and the expected process and outcomes of a randomized controlled trial assessing it were modelled. Finally, user tests among experts and patients and pilot tests among patients were conducted. MAIN RESULTS AND ROLE OF CHANCE The finally developed PreLiFe-programme is a mobile application to be used autonomously by both partners of IVF-couples during the first year of IVF, in combination with motivational interviewing over the telephone every three months (i.e. blended care). The PreLiFe-programme provides advice and skills training on physical activity, diet and mindfulness based stress reduction and is in part tailored based on monitoring and tracking the lifestyle of patients. Based on the literature the expert panel considers it plausible that all three components contribute to IVF-success rates. The PreLiFe-programme is likely to be acceptable to patients as it meets the need of patients for lifestyle advice and treatment information. LIMITATIONS, REASON FOR CAUTION The pilot in IVF-couples had a 3-month duration. The feasibility of the PreLiFe-programme in other infertile populations and/or upon longer use is yet to be examined. Whether the PreLiFe-programme effectively improves lifestyle and IVF-success rates is currently being examined in a trial randomizing heterosexual couples starting IVF to the PreLiFe-programme or an attention-control group for 12 months. WIDER IMPLICATIONS OF THE FINDINGS If the PreLiFe-programme improves lifestyle and the chance of IVF-success, it will be a powerful tool and provide guidance for implementing lifestyle programmes in fertility clinics. STUDY FUNDING/COMPETING INTEREST(S) Funded by the Research Foundation Flanders (FWO-TBM (Applied Biomedical Research with a Primary Social finality); reference: T005417N). The authors have no conflict of interest to report. TRIAL REGISTRATION NUMBER NCT03790449.
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Affiliation(s)
- T Boedt
- Department of Chronic Diseases and Metabolism, Clinical and Experimental Endocrinology, KU Leuven, Leuven, Belgium.,Leuven University Fertility Centre, University Hospitals Leuven, Leuven, Belgium
| | - C Matthys
- Department of Chronic Diseases and Metabolism, Clinical and Experimental Endocrinology, KU Leuven, Leuven, Belgium.,Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium
| | - S Lie Fong
- Leuven University Fertility Centre, University Hospitals Leuven, Leuven, Belgium.,Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - D De Neubourg
- Centre for Reproductive Medicine, Antwerp University Hospital, Edegem, Belgium
| | - S Vereeck
- Centre for Reproductive Medicine, Antwerp University Hospital, Edegem, Belgium
| | - J Seghers
- Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | - K Van der Gucht
- Leuven Mindfulness Centre, KU Leuven, Leuven, Belgium.,Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - B Weyn
- Department of Electric Engineering, Leuven, Belgium
| | - D Geerts
- Meaningful Interactions Lab, KU Leuven, Leuven, Belgium
| | - C Spiessens
- Leuven University Fertility Centre, University Hospitals Leuven, Leuven, Belgium.,Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - E A F Dancet
- Leuven University Fertility Centre, University Hospitals Leuven, Leuven, Belgium.,Department of Development and Regeneration, KU Leuven, Leuven, Belgium
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Dupont C, Didon S, Ciangura C, Selleret L, Bachelot A, Lévy R, Sermondade N. Impact of Bariatric Surgery-Induced Weight Loss on Ovarian Reserve in Women with Obesity: A Systematic Review. Bariatr Surg Pract Patient Care 2021. [DOI: 10.1089/bari.2021.0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Charlotte Dupont
- Service de Biologie de la Reproduction CECOS, Hôpital Tenon (AP-HP), Sorbonne-Université, Paris, France
- Sorbonne Université, Centre de Recherche Saint-Antoine, Paris, France
| | - Samia Didon
- Service de Biologie de la Reproduction CECOS, Hôpital Tenon (AP-HP), Sorbonne-Université, Paris, France
| | - Cécile Ciangura
- Service de Nutrition, Institute of Cardiometabolism and Nutrition, ICAN, Hôpital Pitié-Salpêtrière (AP-HP), Sorbonne Université, Paris, France
| | - Lise Selleret
- Service de Gynécologie, Obstétrique et Médecine de la Reproduction, Hôpital Tenon (AP-HP), Sorbonne-Université, Paris, France
| | - Anne Bachelot
- Service d'Endocrinologie et Médecine de la Reproduction, IE3M, Centre de Référence des Maladies Endocriniennes Rares de la Croissance et du Développement, Centre de Maladies Gynécologiques Rares, Institute of Cardiometabolism and Nutrition, ICAN, Hôpital Pitié-Salpêtrière (AP-HP), Sorbonne Université, Paris, France
| | - Rachel Lévy
- Service de Biologie de la Reproduction CECOS, Hôpital Tenon (AP-HP), Sorbonne-Université, Paris, France
- Sorbonne Université, Centre de Recherche Saint-Antoine, Paris, France
| | - Nathalie Sermondade
- Service de Biologie de la Reproduction CECOS, Hôpital Tenon (AP-HP), Sorbonne-Université, Paris, France
- Sorbonne Université, Centre de Recherche Saint-Antoine, Paris, France
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Zhang Y, Li D, Yan Q, Song X, Tian W, Wang Y, Teng F, Wei L, Wang J, Zhang H, Xue F. Weight Loss Improves Pregnancy and Livebirth Outcomes in Young Women with Early-Stage Endometrial Cancer and Atypical Hyperplasia. Cancer Manag Res 2021; 13:5711-5722. [PMID: 34285588 PMCID: PMC8286730 DOI: 10.2147/cmar.s316040] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 06/12/2021] [Indexed: 12/21/2022] Open
Abstract
Purpose To evaluate the effects of body weight loss on reproductive outcomes in young women with early-stage endometrial cancer (EC) and atypical hyperplasia (AH) who underwent fertility-sparing therapy. Patients and Methods Patients with well-differentiated EC (n=8, FIGO stage Ia) and AH (n=36) who achieved complete regression after fertility-sparing therapy were retrospectively reviewed. Patients were divided into a weight loss group (n=25) and a non-weight loss group (n=19). Subgroup analysis according to body mass index and relative weight loss were performed to investigate the effect of weight loss on pregnancy and live birth outcomes. Univariate and multivariate logistic regression analyses were undertaken to determine pregnancy-associated factors. Results Mean body weight and body mass index at pre-progestin treatment and at fertility treatment initiation were 70.63±12.03 and 67.08±8.18 kg, respectively, 27.06±4.44 and 25.73±3.15 kg/m2, respectively. Twenty-five patients (56.82%) lost weight, the median absolute weight loss was 5.00 kg (1.00–34.50), and the median relative weight loss was 6.70% (1.00–36.00%) over a median of 12 months (5.00–97.00). A favorable pregnancy rate (65.91%) and live birth rate (50.00%) were achieved. The pregnancy and live birth rates were meaningfully higher in the weight loss group than in the non-weight loss group (88.00% vs 36.84%, P=0.000; 64.00% vs 31.58%, P=0.033); weight loss ≥5% significantly increased pregnancy and live birth rate in patients with BMI ≥25 kg/m2. The risk ratio of weight loss ≥5% in multivariate logistic analysis for pregnancy was 10.448 (1.102, 99.056, P=0.041). Conclusion Weight loss could positively affect pregnancy rate and improve live birth rate in overweight and obese women with early-stage EC and AH during/after fertility-sparing therapy. Weight loss ≥5% increased pregnancy and livebirth rates significantly in overweight and obese women.
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Affiliation(s)
- Yanfang Zhang
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China; Tianjin Key laboratory of Female Reproductive Health and Eugenics, Tianjin, People's Republic of China
| | - Dan Li
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China; Tianjin Key laboratory of Female Reproductive Health and Eugenics, Tianjin, People's Republic of China
| | - Qi Yan
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China; Tianjin Key laboratory of Female Reproductive Health and Eugenics, Tianjin, People's Republic of China
| | - Xueru Song
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China; Tianjin Key laboratory of Female Reproductive Health and Eugenics, Tianjin, People's Republic of China
| | - Wenyan Tian
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China; Tianjin Key laboratory of Female Reproductive Health and Eugenics, Tianjin, People's Republic of China
| | - Yingmei Wang
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China; Tianjin Key laboratory of Female Reproductive Health and Eugenics, Tianjin, People's Republic of China
| | - Fei Teng
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China; Tianjin Key laboratory of Female Reproductive Health and Eugenics, Tianjin, People's Republic of China
| | - Likun Wei
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China; Tianjin Key laboratory of Female Reproductive Health and Eugenics, Tianjin, People's Republic of China
| | - Jinghua Wang
- Laboratory of Epidemiology, Tianjin Neurological Institute, Department of Neurology, Tianjin Medical University General Hospital, Tianjin, People's Republic of China
| | - Huiying Zhang
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China; Tianjin Key laboratory of Female Reproductive Health and Eugenics, Tianjin, People's Republic of China
| | - Fengxia Xue
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China; Tianjin Key laboratory of Female Reproductive Health and Eugenics, Tianjin, People's Republic of China
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Pithois A, Mauppin C, Decaigny P, Tio G, Berdin A, Roux C, Pretalli JB. [Overweight or obesity: impact on the results of the first IVF/ICSI attempt]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2021; 49:593-600. [PMID: 33484901 DOI: 10.1016/j.gofs.2021.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To evaluate the influence of overweight and obesity on the results of the first in vitro fertilization attempt, without or with intracytoplasmic microinjection (IVF/ICSI), in terms of live births. METHODS Retrospective observational study concerning the first IVF/ICSI attempts from 01/01/2006 to 31/12/2017 carried out at the Assisted Reproductive Technology of the CHU of Besançon, studying the delivery rate (excluding frozen embryos transfers), and the data of Assisted Reproductive Technology attempts, in overweight (BMI 25 to 29.9kg/m2) and obese women (BMI≥30kg/m2), compared to women with a standard BMI (18 to 24.9kg/m2). RESULTS A total of 3192 patients were included. At the end of their first IVF/ICSI attempt, the delivery rate of women with standard BMI was 34.7%. The delivery rate was significantly lower in overweight women (29.5%, p=0.011) and comparable in obese women (32.4%, p=0.476). The birth rate of women with a BMI≥25 kg/m2 was also significantly lower than that of women with a standard BMI (30.4% versus 34.7%, p=0.019). After multivariate analysis, the delivery rate in overweight patients remained significantly lower compared to the population with standard BMI (OR=0.707; 95% CI 0.561-0.890), and comparable in obese patients (OR=0.796; 95% CI 0.585-1.084). CONCLUSION The delivery rate was lower in overweight women, whereas it was not significantly different in obese women.
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Affiliation(s)
- A Pithois
- Centre d'AMP, CHU Besançon, 25000 Besançon, France.
| | - C Mauppin
- Centre d'AMP, CHU Besançon, 25000 Besançon, France
| | - P Decaigny
- Centre d'AMP, CHU Besançon, 25000 Besançon, France
| | - G Tio
- Inserm CIC 1431, CHU Besançon, 25000 Besançon, France
| | - A Berdin
- Centre d'AMP, CHU Besançon, 25000 Besançon, France
| | - C Roux
- Centre d'AMP, CHU Besançon, 25000 Besançon, France; Inserm CIC 1431, CHU Besançon, 25000 Besançon, France
| | - J-B Pretalli
- Centre d'AMP, CHU Besançon, 25000 Besançon, France; Inserm CIC 1431, CHU Besançon, 25000 Besançon, France
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Zhang S, Zhang M, Sun S, Wei X, Chen Y, Zhou P, Zheng R, Chen G, Liu C. Moderate calorie restriction ameliorates reproduction via attenuating oxidative stress-induced apoptosis through SIRT1 signaling in obese mice. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:933. [PMID: 34350248 PMCID: PMC8263864 DOI: 10.21037/atm-21-2458] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/02/2021] [Indexed: 11/06/2022]
Abstract
Background Obesity is a growing global public health problem. It has been associated with diabetes, cardiovascular disease, cancer, and an increased risk of all-cause mortality, as well as infertility. Calorie restriction (CR) is an effective life intervention to defend against obesity. This study aimed to investigate the effects of long-term moderate CR on the reproductive function and underlying mechanisms in a mouse model of obesity. Methods Male C57BL/6 mice were randomized to two groups receiving either a standard diet (STD) or a high-fat diet (HFD) for 8 weeks to induce obesity. The HFD-induced obesity mice were further randomized into two groups: HFD group and CR group (reduced the mean amount of HFD by 25%). After 12 weeks, the body weight, testicular coefficients, fasting blood glucose (FBG), serum triglyceride (TG), and total cholesterol (TC) were detected and measured. The sperm quality was detected by an automatic sperm quality analyzer (SQA-V). The structure of testicular tissues was examined by hematoxylin and eosin (HE) staining. Testicular cell apoptosis was assessed by terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) staining. The levels of NAD-dependent deacetylase sirtuin-1 (SIRT1) and antioxidative enzymes were detected in the testes. Results CR treatment reduced weight gain and increased testicle coefficients in HFD-induced obese mice. CR reduced the serum level of FBG, TG, and TC, and increased the serum levels of testosterone. Moreover, CR increased sperm count and motility, and sperm normality in obese mice. Furthermore, CR ameliorated the testicular morphological damage and cell apoptosis in obese mice. CR also attenuated the oxidative stress level and increased the protein expressions of SIRT1 in testicular tissues of obese mice. Conclusions Long-term moderate CR improves obese male fertility, probably by alleviating oxidative stress via activation of SIRT1 signaling.
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Affiliation(s)
- Shaohong Zhang
- Endocrinology Department, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China.,Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Mengxiao Zhang
- Endocrinology Department, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China.,Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Shuoshuo Sun
- Endocrinology Department, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China.,Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Xiao Wei
- Endocrinology Department, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China.,Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Yu Chen
- Endocrinology Department, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China.,Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Peng Zhou
- Endocrinology Department, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China.,Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Rendong Zheng
- Endocrinology Department, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China.,Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Guofang Chen
- Endocrinology Department, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China.,Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Chao Liu
- Endocrinology Department, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China.,Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
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Si C, Wang N, Wang M, Liu Y, Niu Z, Ding Z. TMT-based proteomic and bioinformatic analyses of human granulosa cells from obese and normal-weight female subjects. Reprod Biol Endocrinol 2021; 19:75. [PMID: 34016141 PMCID: PMC8135161 DOI: 10.1186/s12958-021-00760-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/10/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Increasing evidence supports a relationship between obesity and either infertility or subfertility in women. Most previous omics studies were focused on determining if the serum and follicular fluid expression profiles of subjects afflicted with both obesity-related infertility and polycystic ovary syndrome (PCOS) are different than those in normal healthy controls. As granulosa cells (GCs) are essential for oocyte development and fertility, we determined here if the protein expression profiles in the GCs from obese subjects are different than those in their normal-weight counterpart. METHODS GC samples were collected from obese female subjects (n = 14) and normal-weight female subjects (n = 12) who were infertile and underwent in vitro fertilization (IVF) treatment due to tubal pathology. A quantitative approach including tandem mass tag labeling and liquid chromatography tandem mass spectrometry (TMT) was employed to identify differentially expressed proteins. Gene Ontology (GO) and the Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses were then conducted to interrogate the functions and pathways of identified proteins. Clinical, hormonal, and biochemical parameters were also analyzed in both groups. RESULTS A total of 228 differentially expressed proteins were noted, including 138 that were upregulated whereas 90 others were downregulated. Significant pathways and GO terms associated with protein expression changes were also identified, especially within the mitochondrial electron transport chain. The levels of free fatty acids in both the serum and follicular fluid of obese subjects were significantly higher than those in matched normal-weight subjects. CONCLUSIONS In GCs obtained from obese subjects, their mitochondria were damaged and the endoplasmic reticulum stress response was accompanied by dysregulated hormonal synthesis whereas none of these changes occurred in normal-weight subjects. These alterations may be related to the high FFA and TG levels detected in human follicular fluid.
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Affiliation(s)
- Chenchen Si
- Department of Histology, Embryology, Genetics and Developmental Biology, Shanghai Key Laboratory for Reproductive Medicine, School of Medicine, Shanghai Jiao Tong University, 200025, Shanghai, China
- Department of Gynecology and Obstetrics, Reproductive Medical Center, School of Medicine, Ruijin Hospital, Shanghai Jiao Tong University, 197 Ruijin 2nd Road, 200025, Shanghai, China
| | - Nan Wang
- Department of Histology, Embryology, Genetics and Developmental Biology, Shanghai Key Laboratory for Reproductive Medicine, School of Medicine, Shanghai Jiao Tong University, 200025, Shanghai, China
| | - Mingjie Wang
- Department of Gynecology and Obstetrics, Reproductive Medical Center, School of Medicine, Ruijin Hospital, Shanghai Jiao Tong University, 197 Ruijin 2nd Road, 200025, Shanghai, China
| | - Yue Liu
- Department of Histology, Embryology, Genetics and Developmental Biology, Shanghai Key Laboratory for Reproductive Medicine, School of Medicine, Shanghai Jiao Tong University, 200025, Shanghai, China
| | - Zhihong Niu
- Department of Gynecology and Obstetrics, Reproductive Medical Center, School of Medicine, Ruijin Hospital, Shanghai Jiao Tong University, 197 Ruijin 2nd Road, 200025, Shanghai, China.
| | - Zhide Ding
- Department of Histology, Embryology, Genetics and Developmental Biology, Shanghai Key Laboratory for Reproductive Medicine, School of Medicine, Shanghai Jiao Tong University, 200025, Shanghai, China.
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McPherson NO. Can we blame fathers who are obese peri-conception, for increasing chronic disease risk in children? Obes Res Clin Pract 2021; 14:195-196. [PMID: 32593417 DOI: 10.1016/j.orcp.2020.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 05/18/2020] [Accepted: 05/22/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Nicole Olivia McPherson
- Freemasons Foundation Centre for Men's Health, University of Adelaide, Adelaide, South Australia, 5005, Australia; Robinson Research Institute, School of Medicine, University of Adelaide, Adelaide, South Australia, 5005, Australia; Repromed, Dulwich, South Australia, 5065, Australia.
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Boedt T, Vanhove AC, Vercoe MA, Matthys C, Dancet E, Lie Fong S. Preconception lifestyle advice for people with infertility. Cochrane Database Syst Rev 2021; 4:CD008189. [PMID: 33914901 PMCID: PMC8092458 DOI: 10.1002/14651858.cd008189.pub3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Infertility is a prevalent problem that has significant consequences for individuals, families, and the community. Modifiable lifestyle factors may affect the chance of people with infertility having a baby. However, no guideline is available about what preconception advice should be offered. It is important to determine what preconception advice should be given to people with infertility and to evaluate whether this advice helps them make positive behavioural changes to improve their lifestyle and their chances of conceiving. OBJECTIVES To assess the safety and effectiveness of preconception lifestyle advice on fertility outcomes and lifestyle behavioural changes for people with infertility. SEARCH METHODS We searched the Cochrane Gynaecology and Fertility Group Specialised Register of controlled trials, CENTRAL, MEDLINE, Embase, PsycINFO, AMED, CINAHL, trial registers, Google Scholar, and Epistemonikos in January 2021; we checked references and contacted field experts to identify additional studies. SELECTION CRITERIA We included randomised controlled trials (RCTs), randomised cross-over studies, and cluster-randomised studies that compared at least one form of preconception lifestyle advice with routine care or attention control for people with infertility. DATA COLLECTION AND ANALYSIS We used standard methodological procedures recommended by Cochrane. Primary effectiveness outcomes were live birth and ongoing pregnancy. Primary safety outcomes were adverse events and miscarriage. Secondary outcomes included reported behavioural changes in lifestyle, birth weight, gestational age, clinical pregnancy, time to pregnancy, quality of life, and male factor infertility outcomes. We assessed the overall quality of evidence using GRADE criteria. MAIN RESULTS We included in the review seven RCTs involving 2130 participants. Only one RCT included male partners. Three studies compared preconception lifestyle advice on a combination of topics with routine care or attention control. Four studies compared preconception lifestyle advice on one topic (weight, alcohol intake, or smoking) with routine care for women with infertility and specific lifestyle characteristics. The evidence was of low to very low-quality. The main limitations of the included studies were serious risk of bias due to lack of blinding, serious imprecision, and poor reporting of outcome measures. Preconception lifestyle advice on a combination of topics versus routine care or attention control Preconception lifestyle advice on a combination of topics may result in little to no difference in the number of live births (risk ratio (RR) 0.93, 95% confidence interval (CI) 0.79 to 1.10; 1 RCT, 626 participants), but the quality of evidence was low. No studies reported on adverse events or miscarriage. Due to very low-quality evidence, we are uncertain whether preconception lifestyle advice on a combination of topics affects lifestyle behavioural changes: body mass index (BMI) (mean difference (MD) -1.06 kg/m², 95% CI -2.33 to 0.21; 1 RCT, 180 participants), vegetable intake (MD 12.50 grams/d, 95% CI -8.43 to 33.43; 1 RCT, 264 participants), alcohol abstinence in men (RR 1.08, 95% CI 0.74 to 1.58; 1 RCT, 210 participants), or smoking cessation in men (RR 1.01, 95% CI 0.91 to 1.12; 1 RCT, 212 participants). Preconception lifestyle advice on a combination of topics may result in little to no difference in the number of women with adequate folic acid supplement use (RR 0.98, 95% CI 0.95 to 1.01; 2 RCTs, 850 participants; I² = 4%), alcohol abstinence (RR 1.07, 95% CI 0.99 to 1.17; 1 RCT, 607 participants), and smoking cessation (RR 1.01, 95% CI 0.98 to 1.04; 1 RCT, 606 participants), on low quality evidence. No studies reported on other behavioural changes. Preconception lifestyle advice on weight versus routine care Studies on preconception lifestyle advice on weight were identified only in women with infertility and obesity. Compared to routine care, we are uncertain whether preconception lifestyle advice on weight affects the number of live births (RR 0.94, 95% CI 0.62 to 1.43; 2 RCTs, 707 participants; I² = 68%; very low-quality evidence), adverse events including gestational diabetes (RR 0.78, 95% CI 0.48 to 1.26; 1 RCT, 317 participants; very low-quality evidence), hypertension (RR 1.07, 95% CI 0.66 to 1.75; 1 RCT, 317 participants; very low-quality evidence), or miscarriage (RR 1.50, 95% CI 0.95 to 2.37; 1 RCT, 577 participants; very low-quality evidence). Regarding lifestyle behavioural changes for women with infertility and obesity, preconception lifestyle advice on weight may slightly reduce BMI (MD -1.30 kg/m², 95% CI -1.58 to -1.02; 1 RCT, 574 participants; low-quality evidence). Due to very low-quality evidence, we are uncertain whether preconception lifestyle advice affects the percentage of weight loss, vegetable and fruit intake, alcohol abstinence, or physical activity. No studies reported on other behavioural changes. Preconception lifestyle advice on alcohol intake versus routine care Studies on preconception lifestyle advice on alcohol intake were identified only in at-risk drinking women with infertility. We are uncertain whether preconception lifestyle advice on alcohol intake affects the number of live births (RR 1.15, 95% CI 0.53 to 2.50; 1 RCT, 37 participants; very low-quality evidence) or miscarriages (RR 1.31, 95% CI 0.21 to 8.34; 1 RCT, 37 participants; very low-quality evidence). One study reported on behavioural changes for alcohol consumption but not as defined in the review methods. No studies reported on adverse events or other behavioural changes. Preconception lifestyle advice on smoking versus routine care Studies on preconception lifestyle advice on smoking were identified only in smoking women with infertility. No studies reported on live birth, ongoing pregnancy, adverse events, or miscarriage. One study reported on behavioural changes for smoking but not as defined in the review methods. AUTHORS' CONCLUSIONS Low-quality evidence suggests that preconception lifestyle advice on a combination of topics may result in little to no difference in the number of live births. Evidence was insufficient to allow conclusions on the effects of preconception lifestyle advice on adverse events and miscarriage and on safety, as no studies were found that looked at these outcomes, or the studies were of very low quality. This review does not provide clear guidance for clinical practice in this area. However, it does highlight the need for high-quality RCTs to investigate preconception lifestyle advice on a combination of topics and to assess relevant effectiveness and safety outcomes in men and women with infertility.
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Affiliation(s)
- Tessy Boedt
- Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Anne-Catherine Vanhove
- Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium
- Belgian Centre for Evidence-Based Medicine - Cochrane Belgium, Leuven, Belgium
| | - Melissa A Vercoe
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Christophe Matthys
- Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Eline Dancet
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Sharon Lie Fong
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynaecology, Leuven University Fertility Center, University Hospitals Leuven, Leuven, Belgium
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Taghavi SA, van Wely M, Jahanfar S, Bazarganipour F. Pharmacological and non-pharmacological strategies for obese women with subfertility. Cochrane Database Syst Rev 2021; 3:CD012650. [PMID: 33765343 PMCID: PMC8094444 DOI: 10.1002/14651858.cd012650.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Clinicians primarily recommend weight loss for obese women seeking pregnancy. The effectiveness of interventions aimed at weight loss in obese women with subfertility is unclear. OBJECTIVES To assess the effectiveness and safety of pharmacological and non-pharmacological strategies compared with each other, placebo, or no treatment for achieving weight loss in obese women with subfertility. SEARCH METHODS We searched the CGF Specialised Register, CENTRAL, MEDLINE, Embase, PsycINFO, and AMED from inception to 18 August 2020. We also checked reference lists and contacted experts in the field for additional relevant papers. SELECTION CRITERIA We included published and unpublished randomised controlled trials in which weight loss was the main goal of the intervention. Our primary effectiveness outcomes were live birth or ongoing pregnancy and primary safety outcomes were miscarriage and adverse events. Secondary outcomes included clinical pregnancy, weight change, quality of life, and mental health outcome. DATA COLLECTION AND ANALYSIS Review authors followed standard Cochrane methodology. MAIN RESULTS This review includes 10 trials. Evidence was of very low to low quality: the main limitations were due to lack of studies and poor reporting of study methods. The main reasons for downgrading evidence were lack of details by which to judge risk of bias (randomisation and allocation concealment), lack of blinding, and imprecision. Non-pharmacological intervention versus no intervention or placebo Evidence is insufficient to determine whether a diet or lifestyle intervention compared to no intervention affects live birth (odds ratio (OR) 0.85, 95% confidence interval (CI) 0.65 to 1.11; 918 women, 3 studies; I² = 78%; low-quality evidence). This suggests that if the chance of live birth following no intervention is assumed to be 43%, the chance following diet or lifestyle changes would be 33% to 46%. We are uncertain if lifestyle change compared with no intervention affects miscarriage rate (OR 1.54, 95% CI 0.99 to 2.39; 917 women, 3 studies; I² = 0%; very low-quality evidence). Evidence is insufficient to determine whether lifestyle change compared with no intervention affects clinical pregnancy (OR 1.06, 95% CI 0.81 to 1.40; 917 women, 3 studies; I² = 73%; low-quality evidence). Lifestyle intervention resulted in a decrease in body mass index (BMI), but data were not pooled due to heterogeneity in effect (mean difference (MD) -3.70, 95% CI -4.10 to -3.30; 305 women, 1 study; low-quality evidence; and MD -1.80, 95% CI -2.67 to -0.93; 43 women, 1 study; very low-quality evidence). Non-pharmacological versus non-pharmacological intervention We are uncertain whether intensive weight loss interventions compared to standard care nutrition counselling affects live birth (OR 11.00, 95% CI 0.43 to 284; 11 women, 1 study; very low-quality evidence), clinical pregnancy (OR 11.00, 95% CI 0.43 to 284; 11 women, 1 study; very low-quality evidence), BMI (MD -3.00, 95% CI -5.37 to -0.63; 11 women, 1 study; very low-quality evidence), weight change (MD -9.00, 95% CI -15.50 to -2.50; 11 women, 1 study; very low-quality evidence), quality of life (MD 0.06, 95% CI -0.03 to 0.15; 11 women, 1 study; very low-quality evidence), or mental health (MD -7.00, 95% CI -13.92 to -0.08; 11 women, 1 study; very low-quality evidence). No study reported on adverse events . Pharmacological versus pharmacological intervention For metformin plus liraglutide compared to metformin we are uncertain of an effect on the adverse events nausea (OR 7.22, 95% CI 0.72 to 72.7; 28 women, 1 study; very low-quality evidence), diarrhoea (OR 0.31, 95% CI 0.01 to 8.3; 28 women, 1 study; very low-quality evidence), and headache (OR 5.80, 95% CI 0.25 to 133; 28 women, 1 study; very low-quality evidence). We are uncertain if a combination of metformin plus liraglutide vs metformin affects BMI (MD 2.1, 95% CI -0.42 to 2.62; 28 women, 1 study; very low-quality evidence) and total body fat (MD -0.50, 95% CI -4.65 to 3.65; 28 women, 1 study; very low-quality evidence). For metformin, clomiphene, and L-carnitine versus metformin, clomiphene, and placebo, we are uncertain of an effect on miscarriage (OR 3.58, 95% CI 0.73 to 17.55; 274 women, 1 study; very low-quality evidence), clinical pregnancy (OR 5.56, 95% CI 2.57 to 12.02; 274 women, 1 study; very low-quality evidence) or BMI (MD -0.3, 95% CI 1.17 to 0.57, 274 women, 1 study, very low-quality evidence). We are uncertain if dexfenfluramine versus placebo affects weight loss in kilograms (MD -0.10, 95% CI -2.77 to 2.57; 21 women, 1 study; very low-quality evidence). No study reported on live birth, quality of life, or mental health outcomes. Pharmacological intervention versus no intervention or placebo We are uncertain if metformin compared with placebo affects live birth (OR 1.57, 95% CI 0.44 to 5.57; 65 women, 1 study; very low-quality evidence). This suggests that if the chance of live birth following placebo is assumed to be 15%, the chance following metformin would be 7% to 50%. We are uncertain if metformin compared with placebo affects gastrointestinal adverse events (OR 0.91, 95% CI 0.32 to 2.57; 65 women, 1 study; very low-quality evidence) or miscarriage (OR 0.50, 95% CI 0.04 to 5.80; 65 women, 1 study; very low-quality evidence) or clinical pregnancy (OR 2.67, 95% CI 0.90 to 7.93; 96 women, 2 studies; I² = 48%; very low-quality evidence). We are also uncertain if diet combined with metformin versus diet and placebo affects BMI (MD -0.30, 95% CI -2.16 to 1.56; 143 women, 1 study; very low-quality evidence) or waist-to-hip ratio (WHR) (MD 2.00, 95% CI -2.21 to 6.21; 143 women, 1 study; very low-quality evidence). Pharmacological versus non-pharmacological intervention No study undertook this comparison. AUTHORS' CONCLUSIONS Evidence is insufficient to support the use of pharmacological and non-pharmacological strategies for obese women with subfertility. No data are available for the comparison of pharmacological versus non-pharmacological strategies. We are uncertain whether pharmacological or non-pharmacological strategies effect live birth, ongoing pregnancy, adverse events, clinical pregnancy, quality of life, or mental heath outcomes. However, for obese women with subfertility, a lifestyle intervention may reduce BMI. Future studies should compare a combination of pharmacological and lifestyle interventions for obese women with subfertility.
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Affiliation(s)
- Seyed Abdolvahab Taghavi
- Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Madelon van Wely
- Center for Reproductive Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Shayesteh Jahanfar
- MPH Program, Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Fatemeh Bazarganipour
- Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
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Chronopoulou E, Seifalian A, Stephenson J, Serhal P, Saab W, Seshadri S. Preconceptual care for couples seeking fertility treatment, an evidence-based approach. ACTA ACUST UNITED AC 2021. [DOI: 10.1016/j.xfnr.2020.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Palomba S, Piltonen TT, Giudice LC. Endometrial function in women with polycystic ovary syndrome: a comprehensive review. Hum Reprod Update 2020; 27:584-618. [PMID: 33302299 DOI: 10.1093/humupd/dmaa051] [Citation(s) in RCA: 142] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/29/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is the most common cause of anovulatory infertility. An endometrial component has been suggested to contribute to subfertility and poor reproductive outcomes in affected women. OBJECTIVE AND RATIONALE The aim of this review was to determine whether there is sufficient evidence to support that endometrial function is altered in women with PCOS, whether clinical features of PCOS affect the endometrium, and whether there are evidence-based interventions to improve endometrial dysfunction in PCOS women. SEARCH METHODS An extensive literature search was performed from 1970 up to July 2020 using PubMed and Web of Science without language restriction. The search included all titles and abstracts assessing a relationship between PCOS and endometrial function, the role played by clinical and biochemical/hormonal factors related to PCOS and endometrial function, and the potential interventions aimed to improve endometrial function in women with PCOS. All published papers were included if considered relevant. Studies having a specific topic/hypothesis regarding endometrial cancer/hyperplasia in women with PCOS were excluded from the analysis. OUTCOMES Experimental and clinical data suggest that the endometrium differs in women with PCOS when compared to healthy controls. Clinical characteristics related to the syndrome, alone and/or in combination, may contribute to dysregulation of endometrial expression of sex hormone receptors and co-receptors, increase endometrial insulin-resistance with impaired glucose transport and utilization, and result in chronic low-grade inflammation, immune dysfunction, altered uterine vascularity, abnormal endometrial gene expression and cellular abnormalities in women with PCOS. Among several interventions to improve endometrial function in women with PCOS, to date, only lifestyle modification, metformin and bariatric surgery have the highest scientific evidence for clinical benefit. WIDER IMPLICATIONS Endometrial dysfunction and abnormal trophoblast invasion and placentation in PCOS women can predispose to miscarriage and pregnancy complications. Thus, patients and their health care providers should advise about these risks. Although currently no intervention can be universally recommended to reverse endometrial dysfunction in PCOS women, lifestyle modifications and metformin may improve underlying endometrial dysfunction and pregnancy outcomes in obese and/or insulin resistant patients. Bariatric surgery has shown its efficacy in severely obese PCOS patients, but a careful evaluation of the benefit/risk ratio is warranted. Large scale randomized controlled clinical trials should address these possibilities.
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Affiliation(s)
- Stefano Palomba
- Unit of Obstetrics and Gynecology, Grande Ospedale Metropolitano of Reggio Calabria, Reggio Calabria, Italy
| | - Terhi T Piltonen
- Department of Obstetrics and Gynecology, PEDEGO Research Unit, Medical Research Center, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Linda C Giudice
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA
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The Increasing Possibility of Pregnancy Postbariatric Surgery: a Comprehensive National Cohort Study in Asian Population. Obes Surg 2020; 31:1022-1029. [PMID: 33188494 DOI: 10.1007/s11695-020-05099-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/27/2020] [Accepted: 10/29/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE The present study aimed to investigate bariatric surgery's effects on pregnancy in obese women. MATERIALS AND METHODS The source of the data was the Taiwan National Health Insurance Research Database. We extracted female patients aged 18 to 45 years who had been diagnosed with obesity from 2005 to 2010. Two groups were formed based on bariatric surgery, according to the medical procedure codes of ICD-9-2001. The propensity score match of 1:1 was coordinated, based on the age, previous delivery, and the existence of comorbidities in patients. The primary endpoint was regarded as a pregnancy, including abortion, ectopic pregnancy, and delivery. The follow-up was performed until the end of 2013, or death. RESULTS There were 689 patients placed in each group, with a median of 64.8 follow-up months. Following multivariate analysis of the data, bariatric surgery resulted in significantly higher chances for pregnancy (aHR 2.886, p < 0.001) and resulted in a higher chance of successful delivery (aHR 2.775, p < 0.001) and vaginal delivery (aHR = 6.426, p < 0.001) compared with NS group. Moreover, we identified BS has a significantly higher proportion of vaginal delivery (BS 44.74% vs. NS 20%, p = 0.025) with significantly lower overall complications during labor (BS 9.21% vs. NS 33.3%, p = 0.006). CONCLUSION Patients suffering from obesity who undergo bariatric surgery have higher chances of pregnancy, successful delivery, vaginal delivery, and lower maternal complications during labor. Bariatric surgery did increase the possibility of pregnancy in obese patients.
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Efficacy of an Internet-Based Intervention to Promote a Healthy Lifestyle on the Reproductive Parameters of Overweight and Obese Women: Study Protocol for a Randomised Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228312. [PMID: 33561055 PMCID: PMC7696477 DOI: 10.3390/ijerph17228312] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/03/2020] [Accepted: 11/07/2020] [Indexed: 12/15/2022]
Abstract
Background: Infertility is estimated to affect 15% of couples of reproductive age. Weight management problems (being obese or overweight) are among the problems that produce infertility, both in women seeking spontaneous pregnancy and in those undergoing assisted reproduction techniques. Over the last few decades, the prevalence of obesity has increased alarmingly in our society and is now considered one of the most important public health problems. The combination of diet and exercise to achieve weight loss are currently considered an effective intervention for the improvement of reproductive parameters in overweight or obese infertile women. In other population groups, it has been shown that Internet-based interventions are just as effective as traditional ones, and these cover a larger population with a good cost–benefit ratio. However, to the best of our knowledge, no studies so far have analysed any specific online interventions for this group of infertile women. Thus, the objective of this project will be to evaluate the effectiveness of an online program to promote a healthy lifestyle among women who are overweight or obese who also have a diagnosis of infertility and are on the waiting list for in vitro fertilisation treatment. Methods: This will be a randomised controlled clinical trial conducted in 94 women which will compare a self-administered Internet-based intervention promoting a healthy lifestyle in terms of diet and exercise (n = 47) to a control group that will receive standard medical care. The online program will comprise nine modules, will last for 3 months, and will be monitored every 3 months after the intervention until the final follow-up at 12 months. The main outcome will be the spontaneous pregnancy rate. Secondary outcomes will include changes in body composition, dietary and physical exercise habits, glycaemic profiles, lipid profiles, hormonal profiles, and patient quality of life related to their fertility problems. The data analysis will be done on an intention-to-treat basis. Discussion: The aim of this study is to increase our knowledge of the effectiveness of online interventions specifically adapted to infertile women who are overweight or obese in the promotion of healthy lifestyles.
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Kim SY, Park ES, Kim HW. Effectiveness of Non-Pharmacological Interventions for Overweight or Obese Infertile Women: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207438. [PMID: 33066039 PMCID: PMC7650570 DOI: 10.3390/ijerph17207438] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/27/2020] [Accepted: 10/05/2020] [Indexed: 12/23/2022]
Abstract
Obesity is a well-known risk factor for infertility, and nonpharmacological treatments are recommended as effective and safe, but evidence is still lacking on whether nonpharmacological interventions improve fertility in overweight or obese women. The aim of this study was to systematically assess the current evidence in the literature and to evaluate the impact of nonpharmacological interventions on improving pregnancy-related outcomes in overweight or obese infertile women. Seven databases were searched for randomized controlled trials (RCTs) of nonpharmacological interventions for infertile women with overweight or obesity through August 16, 2019 with no language restriction. A meta-analysis was conducted of the primary outcomes. A total of 21 RCTs were selected and systematically reviewed. Compared to the control group, nonpharmacological interventions significantly increased the pregnancy rate (relative risk (RR), 1.37; 95% CI, 1.04–1.81; p = 0.03; I2 = 58%; nine RCTs) and the natural conception rate (RR, 2.17, 95% CI, 1.41–3.34; p = 0.0004; I2 = 19%, five RCTs). However, they had no significant effect on the live birth rate (RR, 1.36, 95% CI, 0.94–1.95; p=0.10, I2 = 65%, eight RCTs) and increased the risk of miscarriage (RR: 1.57, 95% CI, 1.05–2.36; p = 0.03; I2 = 0%). Therefore, nonpharmacological interventions could have a positive effect on the pregnancy and natural conception rates, whereas it is unclear whether they improve the live birth rate. Further research is needed to demonstrate the integrated effects of nonpharmacological interventions involving psychological outcomes, as well as pregnancy-related outcomes.
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Affiliation(s)
- Seo Yun Kim
- College of Nursing, Seoul National University, Seoul 03080, Korea;
| | - Eun-Sun Park
- Medical Library, Seoul National University, Seoul 03080, Korea;
| | - Hae Won Kim
- Research Institute of Nursing Science, College of Nursing, Seoul National University, Seoul 03080, Korea
- Correspondence: ; Tel.: +82-2-740-8820
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69
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Kaneda C, Kanejima Y, Kitamura M, Izawa KP. Physical Activity and Body Mass Index in Relation to Infertility in Women. Rev Recent Clin Trials 2020; 15:199-204. [PMID: 32370724 DOI: 10.2174/1574887115666200506091936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/09/2020] [Accepted: 04/22/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Infertility is a global social issue, and reproductive health is a priority in global health. This review aimed to study the relation between physical activity (PA) and infertility in non-obese or non-overweight women. METHODS We used search strategies in the National Library of Medicine database including the PubMed database to October 2019 to find articles related to women and fertility, infertility, exercise, PA, pregnancy rate, live births, fecundability, and conception. Only cohort studies or randomized controlled trials in English were chosen for review that included outcomes directly related to becoming pregnant. We selected studies in which the participants were categorized by low or high body mass index (BMI). RESULTS We found 6 papers meeting our criteria. In the association between PA and outcome, vigorous PA in women with low BMI resulted in both positive and negative effects that were weaker than those in women with high BMI. Among women with low BMI, moderate PA was weakly but positively associated with outcome whereas walking was not. CONCLUSION We observed some trends and a slight difference between the outcomes of women with low versus high BMI. There are only a few studies on infertile women with low BMI, and further investigation is warranted.
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Affiliation(s)
- Chieko Kaneda
- Cardiovascular Stroke Renal Project (CRP), Kobe 654-0142, Japan
| | - Yuji Kanejima
- Cardiovascular Stroke Renal Project (CRP), Kobe 654-0142, Japan
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Abstract
PURPOSE OF REVIEW The association between obesity and infertility has gained increasing provider and public awareness. The purpose of this review is to outline the recent research into the pathophysiology regarding obesity and its impact of reproductive function in both women and men. RECENT FINDINGS A BMI more than 25 has a detrimental impact on the hypothalamus-pituitary-gonadal (HPG) axis in both men and women, leading to alterations of HPG hormones, gametogenesis, as well as an increase in inflammation and lipotoxicity from excessive adipose tissue. Additionally, BMI likely impacts assisted reproductive technology (ART) outcomes, with a greater influence on women than men. Studies regarding weight loss interventions are heterogenous in methods and outcomes, and it is difficult to extrapolate from current data if weight loss truly leads to improved outcomes. SUMMARY Elevated BMI induces changes in the HPG axis, hormone levels, gametogenesis, and adverse ART outcomes. Inconsistencies regarding weight loss interventions make it difficult to assess the impact on outcomes after weight loss interventions.
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McAuliffe FM, Killeen SL, Jacob CM, Hanson MA, Hadar E, McIntyre HD, Kapur A, Kihara AB, Ma RC, Divakar H, Hod M. Management of prepregnancy, pregnancy, and postpartum obesity from the FIGO Pregnancy and Non-Communicable Diseases Committee: A FIGO (International Federation of Gynecology and Obstetrics) guideline. Int J Gynaecol Obstet 2020; 151 Suppl 1:16-36. [PMID: 32894590 PMCID: PMC7590083 DOI: 10.1002/ijgo.13334] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Fionnuala M McAuliffe
- UCD Perinatal Research Centre, School of Medicine, National Maternity Hospital, University College Dublin, Dublin, Ireland
| | - Sarah Louise Killeen
- UCD Perinatal Research Centre, School of Medicine, National Maternity Hospital, University College Dublin, Dublin, Ireland
| | - Chandni Maria Jacob
- Institute of Developmental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK
| | - Mark A Hanson
- Institute of Developmental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK
| | - Eran Hadar
- Maternal-Fetal Medicine Unit, Rabin Medical Center, Petach-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - H David McIntyre
- Mater Research, The University of Queensland, South Brisbane, Qld, Australia
| | - Anil Kapur
- World Diabetes Foundation, Bagsvaerd, Denmark
| | - Anne B Kihara
- African Federation of Obstetricians and Gynaecologists, Khartoum, Sudan.,Department of Obstetrics and Gynecology, School of Medicine, University of Nairobi, Nairobi, Kenya
| | - Ronald C Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China.,Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong SAR, China
| | | | - Moshe Hod
- Mor Comprehensive Women's Health Care Center, Tel Aviv, Israel.,FIGO Pregnancy and Non-Communicable Diseases Committee, International Federation of Gynecology and Obstetrics, London, UK
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Yokota R, Okuhara T, Ueno H, Okada H, Furukawa E, Kiuchi T. Online Japanese-Language Information on Lifestyle Factors Associated With Reduced Fertility: Content Analysis. J Med Internet Res 2020; 22:e19777. [PMID: 32840486 PMCID: PMC7479583 DOI: 10.2196/19777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 06/23/2020] [Accepted: 07/07/2020] [Indexed: 01/16/2023] Open
Abstract
Background Approximately one-third of Japanese couples currently worry or previously worried about infertility. To develop strategies for the primary prevention of infertility as a population approach, it is important for the general population to be knowledgeable about fertility and infertility. The internet may contribute to the dissemination of information regarding infertility and fertility. However, few studies have examined online information about fertility. Objective This study aimed to quantitatively examine online Japanese-language information about lifestyle factors associated with reduced fertility. Methods We conducted online searches, using the 10 search terms with the highest numbers of searches that people hoping to conceive are likely to input in two major search engines in Japan (Google Japan and Yahoo! Japan). From the 2200 retrieved websites, 1181 duplicates and 500 websites unrelated to our objective were excluded, resulting in a final dataset of 519 websites. Coding guidelines were developed for the following lifestyle factors associated with reduced fertility: sexually transmitted diseases, psychological stress, cigarette smoking, alcohol use, nutrition and diet, physical activity and exercise, underweight, overweight and obesity, and environmental pollutants. Results In terms of the website author’s professional expertise, 69.6 % of the coding instances for the selected lifestyle factors were mentioned by hospitals, clinics, or the media, whereas only 1.7% were mentioned by laypersons. Psychological stress (20.1%) and sexually transmitted diseases (18.8%) were the most frequently mentioned lifestyle factors associated with reduced fertility. In contrast, cigarette smoking, alcohol use, nutrition and diet, physical activity and exercise, underweight, overweight and obesity, and environmental pollutants were mentioned relatively infrequently. The association between reduced fertility and sexually transmitted diseases was mentioned significantly more frequently by hospitals and clinics than by the media (P<.001). The association between reduced fertility and nutrition and diet was mentioned significantly more frequently by the media than by hospitals and clinics (P=.008). With regard to the sex of the target audience for the information, female-specific references to psychological stress, sexually transmitted diseases, nutrition and diet, underweight, physical activity and exercise, and overweight and obesity were significantly more frequent than were male-specific references to these lifestyle factors (psychological stress: P=.002, sexually transmitted diseases: P<.001, nutrition and diet: P<.001, underweight: P<.001, physical activity and exercise: P<.001, overweight and obesity: P<.001). Conclusions Of the lifestyle factors known to be related to reduced fertility, cigarette smoking, alcohol use, and male-specific lifestyle factors are mentioned relatively infrequently in online information sources in Japan, and these factors should be discussed more in information published on websites.
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Affiliation(s)
- Rie Yokota
- Department of Health Communication, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Tsuyoshi Okuhara
- Department of Health Communication, School of Public Health, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Haruka Ueno
- Department of Health and Dietetics, Faculty of Health and Medical Science, Teikyo Heisei Unievrsity, Toshima-ku, Tokyo, Japan
| | - Hiroko Okada
- Department of Health Communication, School of Public Health, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Emi Furukawa
- Department of Health Communication, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Takahiro Kiuchi
- Department of Health Communication, School of Public Health, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
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Horne JR, Gilliland JA, O'Connor CP, Seabrook JA, Madill J. Change in Weight, BMI, and Body Composition in a Population-Based Intervention Versus Genetic-Based Intervention: The NOW Trial. Obesity (Silver Spring) 2020; 28:1419-1427. [PMID: 32935529 DOI: 10.1002/oby.22880] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 04/29/2020] [Accepted: 04/30/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The aim of this study was to compare changes in body fat percentage (BFP), weight, and BMI between a standard intervention and a nutrigenomics intervention. METHODS The Nutrigenomics, Overweight/Obesity and Weight Management (NOW) trial is a parallel-group, pragmatic, randomized controlled clinical trial incorporated into the Group Lifestyle BalanceTM (GLB) Program. Statistical analyses included two-way ANOVA and split-plot ANOVA. Inclusion criteria consisted of: BMI ≥ 25.0 kg/m2 , ≥18 years of age, English speaking, willing to undergo genetic testing, having internet access, and not seeing another health care provider for weight-loss advice outside of the study. Pregnancy and lactation were exclusion criteria. GLB groups were randomly assigned 1 to 1 (N = 140) so that participants received either the standard 12-month GLB program or a modified 12-month program (GLB plus nutrigenomics), which included the provision of nutrigenomics information and advice for weight management. The primary outcome was percent change in BFP. Secondary outcomes were change in weight and BMI. RESULTS The GLB plus nutrigenomics group experienced significantly (P < 0.05) greater reductions in percent and absolute BFP at the 3-month follow-up and percent BFP at the 6-month follow-up compared with the standard GLB group. CONCLUSIONS The nutrigenomics intervention used in the NOW trial can optimize change in body composition up to 6 months.
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Affiliation(s)
- Justine R Horne
- Graduate Program in Health and Rehabilitation Sciences, The University of Western Ontario, London, Ontario, Canada
- The East Elgin Family Health Team, Aylmer, Ontario, Canada
- Human Environments Analysis Laboratory, The University of Western Ontario, London, Ontario, Canada
| | - Jason A Gilliland
- Human Environments Analysis Laboratory, The University of Western Ontario, London, Ontario, Canada
- School of Health Studies, The University of Western Ontario, London, Ontario, Canada
- Department of Paediatrics, The University of Western Ontario, London, Ontario, Canada
- Department of Geography, The University of Western Ontario, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
- Children's Health Research Institute, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, The University of Western Ontario, London, Ontario, Canada
| | - Colleen P O'Connor
- Human Environments Analysis Laboratory, The University of Western Ontario, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
- School of Food and Nutritional Sciences, Brescia University College, The University of Western Ontario, London, Ontario, Canada
| | - Jamie A Seabrook
- Human Environments Analysis Laboratory, The University of Western Ontario, London, Ontario, Canada
- Department of Paediatrics, The University of Western Ontario, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
- Children's Health Research Institute, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, The University of Western Ontario, London, Ontario, Canada
- School of Food and Nutritional Sciences, Brescia University College, The University of Western Ontario, London, Ontario, Canada
| | - Janet Madill
- Human Environments Analysis Laboratory, The University of Western Ontario, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
- School of Food and Nutritional Sciences, Brescia University College, The University of Western Ontario, London, Ontario, Canada
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Amiri M, Ramezani Tehrani F. Potential Adverse Effects of Female and Male Obesity on Fertility: A Narrative Review. Int J Endocrinol Metab 2020; 18:e101776. [PMID: 33257906 PMCID: PMC7695350 DOI: 10.5812/ijem.101776] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 09/15/2020] [Accepted: 09/19/2020] [Indexed: 12/16/2022] Open
Abstract
CONTEXT Despite several studies documenting that obesity affects female and male fertility and leads to multiple adverse reproductive outcomes, the mechanisms involved are not elucidated. We aimed to summarize the potential adverse effects of female and male obesity, as well as the impact of weight loss on their fertility status. EVIDENCE ACQUISITION This review summarizes papers investigating the potential adverse effects of female and male obesity and the impact of weight-loss interventions on fertility among reproductive age populations. PubMed, Scopus, Web of Science, and Google Scholar databases were searched for retrieving studies published up to November 2019 on obesity/overweight among reproductive age populations. RESULTS The review of 68 studies revealed that female and male obesity/overweight increases the risk of sub-fecundity and infertility. The destructive effects of female obesity on reproduction are attributed to a variety of ovarian and extra-ovarian factors. In women with overweight or obesity, the time taken to conceive is longer, and they have a decreased fertility rate, increased requirement for gonadotropins, and higher miscarriage rate when compared to those with normal weight. Male obesity may lead to subfertility, mainly because of the disruption of the hypothalamus-pituitary-gonadal (HPG) axis, increased testicular temperature, impairment of the physical and molecular structure of sperm, decreased sperm quality, and erectile dysfunction due to peripheral vascular disease. Most studies recommend lifestyle interventions as first-line therapy in the general population of women and men with obesity and infertility. CONCLUSIONS This study shows the negative effects of female and male overweight and obesity on fertility. Therefore, educational interventions on the adverse effects of obesity and the benefits of weight reduction, such as increasing pregnancy rate, should be considered for couples seeking fertility.
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Affiliation(s)
- Mina Amiri
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Corresponding Author: Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Mintziori G, Nigdelis MP, Mathew H, Mousiolis A, Goulis DG, Mantzoros CS. The effect of excess body fat on female and male reproduction. Metabolism 2020; 107:154193. [PMID: 32119876 DOI: 10.1016/j.metabol.2020.154193] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 02/11/2020] [Accepted: 02/27/2020] [Indexed: 02/07/2023]
Abstract
The dramatic increase in the prevalence of obesity coincides with a decline in reproductive health indices in both sexes. Energy excess mediates changes to the regulatory mechanisms of the reproductive system. Obese individuals exhibit increased estrogen concentrations, due to the overexpression of aromatase in the adipose tissue; via a negative feedback loop, men present with symptoms of hypogonadotropic hypogonadism. These hormonal changes, along with increased oxidative stress, lipotoxicity and disturbances in the concentrations of adipokines, directly affect the gonads, peripheral reproductive organs and the embryo. Clinical evidence is somewhat contradicting, with only some studies advocating worse semen parameters, increased incidence of erectile dysfunction, increased doses of ovulation induction medications, and worse live birth rates in assisted reproductive technology (ART) cycles in obese individuals compared with those of normal weight. Similar conclusions are drawn about patients with insulin resistance syndromes, namely polycystic ovary syndrome (PCOS). As far as treatment options are concerned, lifestyle changes, medical therapy and bariatric surgery may improve the reproductive outcome, although the evidence remains inconclusive. In this review, we summarize the evidence on the association of obesity and reproductive health on both the molecular and the clinical level, and the effect of weight-loss interventions on reproductive potential.
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Affiliation(s)
- Gesthimani Mintziori
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Greece.
| | - Meletios P Nigdelis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Greece
| | - Hannah Mathew
- Department of Medicine Boston VA Healthcare System and Department of Medicine Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Athanasios Mousiolis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Greece
| | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Greece
| | - Christos S Mantzoros
- Department of Medicine Boston VA Healthcare System and Department of Medicine Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
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Brouillet S, Boursier G, Anav M, Du Boulet De La Boissière B, Gala A, Ferrieres-Hoa A, Touitou I, Hamamah S. C-reactive protein and ART outcomes: a systematic review. Hum Reprod Update 2020; 26:753-773. [DOI: 10.1093/humupd/dmaa012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 01/17/2020] [Indexed: 12/23/2022] Open
Abstract
Abstract
BACKGROUND
A dynamic balance between pro- and anti-inflammatory factors contributes to regulating human female reproduction. Chronic low-grade inflammation has been detected in several female reproductive conditions, from anovulation to embryo implantation failure. C-reactive protein (CRP) is a reliable marker of inflammation that is extensively used in clinical practice. Recent studies quantified CRP in the serum of infertile women undergoing ART and suggested its potential for the prediction of ART reproductive outcomes.
OBJECTIVE AND RATIONALE
The first objective of this systematic review of the available literature was to evaluate the association between pre-implantation circulating CRP concentration and pregnancy rates in women undergoing ART. The second objective was to describe serum CRP concentration changes after early embryo implantation. The changes in circulating CRP throughout the ART cycle, clinical implications of CRP quantification for the management of women undergoing ART, and future therapeutic options will also be discussed.
SEARCH METHODS
The MEDLINE database was systematically searched from inception to March 2019 using the following key words: (C-reactive protein) AND (assisted reproductive techniques OR ovulation induction OR insemination OR in vitro fertilization). Only articles in English were considered. Studies were selected based on title and abstract. The full text of potentially relevant articles was retrieved and assessed for inclusion by two reviewers (S.B. and S.H.). The protocol was registered in the International prospective register of systematic reviews (PROSPERO; registration number: CRD148687).
OUTCOMES
In total, 10 studies were included in this systematic review. Most of these studies reported lower circulating CRP values before the window of implantation and higher circulating CRP values during the peri-implantation period in women with successful ART outcome (biochemical or clinical pregnancy) compared to women without a successful outcome. Several lifestyle factors and/or drugs that reduce the concentration of circulating CRP significantly improve ART outcomes. Subgroup analyses according to female BMI and baseline circulating CRP concentration are highly recommended in future analyses.
WIDER IMPLICATIONS
These findings highlight a possible detrimental impact of preconception high circulating CRP concentration on ART outcomes. However, the biochemical or clinical pregnancy rate endpoints used in the studies examined here are insufficient (there were no data on live birth outcome), and the impact of major variables that can influence CRP and/or ART, for example maternal age, BMI, number of transferred embryos, and use of anti-inflammatory drugs, were not considered in the analyses. CRP quantification may be a potential marker of ART outcome, but its predictive value still needs to be investigated in large prospective studies. In future, the quantification of circulating CRP before starting ART could help to identify patients with a poor ART prognosis, leading to ART cycle cancellation or to preconception treatment to minimize the medical risks and costs.
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Affiliation(s)
- Sophie Brouillet
- Université Grenoble-Alpes, Inserm 1036, Commissariat à l'Énergie Atomique et aux Énergies Alternatives (CEA), Institut de Biosciences et Biotechnologies de Grenoble (BIG), Laboratoire Biologie du Cancer et de l’Infection (BCI), 38000 Grenoble, France
- Centre Hospitalier Universitaire de Grenoble, Hôpital Couple-Enfant, Centre Clinique et Biologique d’Assistance Médicale à la Procréation-Centre d'Étude et de Conservation des Oeufs et du Sperme Humains (CECOS), La Tronche, France
- Univ Montpellier, Développement Embryonnaire Précoce Humain et Pluripotence, INSERM 1203, Montpellier, France
- CHU Montpellier, Univ Montpellier, Département de Biologie de la Reproduction, Biologie de la Reproduction et Diagnostic Pre-Implantatoire, Montpellier, France
| | - Guilaine Boursier
- CHU Montpellier, Univ Montpellier, Département de Génétique Médicale, Maladies Rares et Médecine Personnalisée, Génétique des Maladies Rares et Autoinflammatoires, Montpellier, France
| | - Margaux Anav
- CHU Montpellier, Univ Montpellier, Département de Biologie de la Reproduction, Biologie de la Reproduction et Diagnostic Pre-Implantatoire, Montpellier, France
| | - Bertille Du Boulet De La Boissière
- CHU Montpellier, Univ Montpellier, Département de Biologie de la Reproduction, Biologie de la Reproduction et Diagnostic Pre-Implantatoire, Montpellier, France
| | - Anna Gala
- CHU Montpellier, Univ Montpellier, Département de Biologie de la Reproduction, Biologie de la Reproduction et Diagnostic Pre-Implantatoire, Montpellier, France
| | - Alice Ferrieres-Hoa
- CHU Montpellier, Univ Montpellier, Département de Biologie de la Reproduction, Biologie de la Reproduction et Diagnostic Pre-Implantatoire, Montpellier, France
| | - Isabelle Touitou
- CHU Montpellier, Univ Montpellier, Département de Génétique Médicale, Maladies Rares et Médecine Personnalisée, Génétique des Maladies Rares et Autoinflammatoires, Montpellier, France
- Cellules Souches, Plasticité Cellulaire, Médecine Régénératrice et Immunothérapies, INSERM, Univ de Montpellier, Montpellier, France
| | - Samir Hamamah
- Univ Montpellier, Développement Embryonnaire Précoce Humain et Pluripotence, INSERM 1203, Montpellier, France
- CHU Montpellier, Univ Montpellier, Département de Biologie de la Reproduction, Biologie de la Reproduction et Diagnostic Pre-Implantatoire, Montpellier, France
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Dupont C, Aegerter P, Foucaut AM, Reyre A, Lhuissier FJ, Bourgain M, Chabbert-Buffet N, Cédrin-Durnerin I, Selleret L, Cosson E, Lévy R. Effectiveness of a therapeutic multiple-lifestyle intervention taking into account the periconceptional environment in the management of infertile couples: study design of a randomized controlled trial - the PEPCI study. BMC Pregnancy Childbirth 2020; 20:322. [PMID: 32456614 PMCID: PMC7251692 DOI: 10.1186/s12884-020-2855-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 03/03/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Infertility is defined as the inability to conceive after 12 months of unprotected intercourse. It affects approximately one in six couples seeking pregnancy in France or western countries. Many lifestyle factors of the couples' pre and peri-conceptional environment (weight, diet, alcohol, tobacco, coffee, drugs, physical activity, stress, sleep…) have been identified as risk factors for infertility in both males and females. The high prevalence rates of unhealthy diets and lifestyles in the reproductive population of industrialized countries are worrisome. Nevertheless, adoption of a healthy lifestyle may improve fertility but lifestyle changes are difficult to achieve and to maintain due notably to behavioral factors. METHODS Consequently, we decided to propose an interventional study aimed at improving the quality of life of infertile couples before the start of assisted reproductive technology treatment. It is a randomized controlled multicentre trial. Both members of the couples are involved in an integrated global care program (PEPCI for "Parcours Environnement PériConceptionnel en Infertilité") vs. usual care. This global intervention not only considers diet and/or physical activity but follows a holistic approach, including a multidisciplinary assessment to address complete physical, psychological and social well-being. According to patient needs, this includes interventions on weight, exercise, diet, alcohol and drugs, mental and social health. DISCUSSION The main objective of trial is to demonstrate that periconceptional multidisciplinary care has a positive impact on reproductive functions. We will also focus on feasibility, acceptance, compliance and conditions of success of a multifaceted lifestyle intervention. TRIAL REGISTRATION The trial was registered at ClinicalTrials.gov, Identifier: NCT02961907 on November 11, 2016.
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Affiliation(s)
- Charlotte Dupont
- Saint Antoine Research Center, INSERM équipe Lipodystrophies génétiques et acquises, Service de biologie de la reproduction-CECOS, AP-HP, Hôpital Tenon, Sorbonne Université, 4 rue de la Chine, F-75020, Paris, France.
| | - Philippe Aegerter
- Unité de Recherche Clinique et Département de Santé Publique, Assistance Publique - Hôpitaux de Paris, Hôpital Ambroise Paré, Boulogne, France.,UVSQ, UMR-S 1168 Université de Versailles Saint Quentin Paris Saclay, INSERM VIMA Aging and Chronic diseases, Epidemiological and Public Health approaches, Paris, France
| | - Aude-Marie Foucaut
- Université Sorbonne Paris Nord, Laboratoire Educations et Pratiques de Santé, LEPS, UR 3412, F-93017, Bobigny, France.,Département STAPS, Université Sorbonne Paris Nord, Bobigny, France
| | - Aymeric Reyre
- Department of Addiction Medicine and Psychiatry, APHP Avicenne University Hospital, Bobigny, France.,CESP-INSERM U1178, Villejuif, France
| | - François J Lhuissier
- Université Sorbonne Paris Nord, UMR INSERM 1272 Hypoxie et poumon, Bobigny, France.,Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Jean Verdier, Médecine de l'exercice et du sport, Bondy, France
| | - Marie Bourgain
- Department of Addiction Medicine and Psychiatry, APHP Avicenne University Hospital, Bobigny, France
| | - Nathalie Chabbert-Buffet
- Service de Gynécologie-Obstétrique et Médecine de La Reproduction, APHP Hôpital Tenon, 4 Rue de La Chine, 75020, Paris, France
| | - Isabelle Cédrin-Durnerin
- APHP Hôpital Jean verdier Service de médecine de la reproduction et préservation de la fertilité, avenue du 14-Juillet, 93143, Bondy, France
| | - Lise Selleret
- Service de Gynécologie-Obstétrique et Médecine de La Reproduction, APHP Hôpital Tenon, 4 Rue de La Chine, 75020, Paris, France
| | - Emmanuel Cosson
- Paris 13 University, Sorbonne Paris Cité, Assistance Publique - Hôpitaux de Paris, Avicenne Hospital, Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, Bobigny, France.,Paris 13 University, Sorbonne Paris Cité, UMR U557 INSERM/U11125 INRA/CNAM/Université Paris13, Unité de Recherche Epidémiologique Nutritionnelle, Bobigny, France
| | - Rachel Lévy
- Saint Antoine Research Center, INSERM équipe Lipodystrophies génétiques et acquises, Service de biologie de la reproduction-CECOS, AP-HP, Hôpital Tenon, Sorbonne Université, 4 rue de la Chine, F-75020, Paris, France
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Mena GP, Mielke GI, Brown WJ. The effect of physical activity on reproductive health outcomes in young women: a systematic review and meta-analysis. Hum Reprod Update 2020; 25:541-563. [PMID: 31304974 DOI: 10.1093/humupd/dmz013] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 02/25/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND In the context of increasing rates of overweight and obesity in young adult women, and the increasing numbers of women seeking help for fertility problems, it is important to understand whether physical activity (PA) could help with management of reproductive health problems, with or without weight loss. OBJECTIVE AND RATIONALE The primary aim of this systematic review and meta-analysis was to assess the effects of PA on selected reproductive health outcomes in young adult women, in order to inform best practice advice for women in terms of promoting fertility and reproductive health in young adulthood. SEARCH METHODS An electronic search of PubMed, EMBASE, MEDLINE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Web of Science, SportDiscus, and Cochrane was performed for studies published between January 2000 and May 2018. Keywords and Medical Subject Headings terms related to PA, reproductive health, and weight gain were used. Studies were selected if they were intervention studies, if PA was delivered as part of an intervention to pre-menopausal women, and if any reproductive health outcome was reported. Quality analysis was performed using the Tool for the assEssment of Study qualiTy and reporting in EXercise. OUTCOMES Eighteen studies, with a mix of four types of study design (4 randomized controlled trials (RCTs), 11 randomized comparison trials, 2 non-randomized comparison trials, and 1 single-arm clinical trial), were identified. Comparisons included fertility treatment (four studies) and common treatments for women with polycystic ovary syndrome (PCOS) symptoms (nine studies). Pooled analysis of data from three of the four studies with a control group showed higher pregnancy [risk ratio (RR) 2.10, 95% CI (1.32, 3.35); three studies] and live birth [RR 2.11, 95% CI (1.02, 4.39); two studies] rates in the intervention groups compared with non-therapy controls. Aggregated data from the fertility treatment comparative studies (i.e. those that compared PA with standard fertility treatment such as clomiphene, gonadotrophins, and/or IVF) showed no significant intervention differences: RR 1.46, 95% CI (0.87, 2.45) for clinical pregnancy (four studies) and RR 1.09, 95% CI (0.56, 2.12) for live births (two studies). Pooled analysis from the comparison trials that used pharmaceutical or dietary treatment for PCOS as comparison showed higher pregnancy rates [RR 1.59, 95% CI (1.06, 2.38); five studies] and live birth rates [RR 2.45, 95% CI (1.24, 4.83); two observations] in the PA intervention groups than in the comparison groups. Analysis of other outcomes, such as ovulation rates, menstrual regularity, and conception rates, showed no differences between the PA intervention and comparison groups. WIDER IMPLICATIONS There is emerging evidence from RCT that PA may improve pregnancy rates in women with reproductive health problems. Comparative studies indicate that PA intervention may be as effective as other commonly used clinical intervention strategies for improving reproductive health outcomes. While the type, intensity, frequency, and duration of optimal PA intervention, and the role of PA independent of weight loss, remain unclear, these preliminary findings suggest that PA may be an affordable and feasible alternative or complementary therapy to fertility treatments.
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Affiliation(s)
- Gabriela P Mena
- Centre for Research on Exercise, Physical Activity and Health, School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane St Lucia, QLD, Australia
| | - Gregore I Mielke
- Centre for Research on Exercise, Physical Activity and Health, School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane St Lucia, QLD, Australia
| | - Wendy J Brown
- Centre for Research on Exercise, Physical Activity and Health, School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane St Lucia, QLD, Australia
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Effect of a Short Message Service Intervention on Excessive Gestational Weight Gain in a Low-Income Population: A Randomized Controlled Trial. Nutrients 2020; 12:nu12051428. [PMID: 32429069 PMCID: PMC7285124 DOI: 10.3390/nu12051428] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 04/30/2020] [Accepted: 05/11/2020] [Indexed: 12/16/2022] Open
Abstract
Objectives: The objective of this trial was to investigate the effect of educational short message service (SMS), or text messages, on excessive gestational weight gain (GWG) in a low-income, predominantly overweight/obese population. Methods: Participants (n = 83) were mostly overweight/obese women recruited at Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) clinics on the island of O’ahu, Hawai’i at 15–20 weeks gestational age. The intervention group received SMS on nutrition and physical activity during pregnancy designed to help them meet Institute of Medicine (IOM) guidelines for GWG and American College of Obstetricians and Gynecologists guidelines for exercise, respectively. The control group received SMS about general health topics during pregnancy, excluding nutrition and physical activity. Both groups received one text message per week for eighteen weeks. GWG was defined as the difference between the last self-reported weight taken before delivery and participants’ self-reported weight before pregnancy. Differences between study groups were examined using t-tests and Chi-square tests. Linear regression models were used to examine association of GWG with study group and other factors. Results: GWG was similar (p = 0.58) in the control group (14.1 ± 11.4 kg) and the intervention group (15.5 ± 11.6 kg). The percentage of participants exceeding IOM guidelines for GWG was similar (p = 0.51) in the control group (50.0%, n = 17) and the intervention group (60.5%, n = 23). Conclusions: GWG was not significantly different between intervention and control groups. Trials that begin earlier in pregnancy or before pregnancy with longer intervention durations and varying message frequency as well as personalized or interactive messages may be needed to produce significant improvements.
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Espinós JJ, Solà I, Valli C, Polo A, Ziolkowska L, Martínez-Zapata MJ. The Effect of Lifestyle Intervention on Pregnancy and Birth Outcomes on Obese Infertile Women: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2020; 14:1-9. [PMID: 32112628 PMCID: PMC7139226 DOI: 10.22074/ijfs.2020.5921] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 10/05/2019] [Indexed: 12/28/2022]
Abstract
Obesity has been associated with negative effects on natural fertility and poor prognosis when assisted reproductive technologies (ART) are performed. Patients attending for fertility treatments are often advised to optimize their weights to improve the outcomes. There is lack of enough information on how weight-loss would be effective for improving fertility in women who are overweight or obese. We conducted a systematic review to evaluate whether weight-loss achieved by lifestyle program improves natural or assisted reproduction in obese infertile women. We searched CENTRAL, MEDLINE, and EMBASE up to March 2018. Two reviews were selected as randomised trials assessing a lifestyle intervention in women with obesity before receiving treatments for infertility and appraised their risk of bias. We extracted data on pregnancy, birth, and miscarriage rates as the primary outcomes and pooled effect estimates using a random effects model. The primary outcome was the live birth rate. We reported summary measures as the relative risk (RR), 95% confidence interval (CI), and percentage of heterogeneity (I2). We included eight randomised trials with 1175 women. Lifestyle programmes, improved pregnancy rates (RR: 1.43, CI: 95% 1.02 to 2.01; I2=60%; 8 RCTs; N=1098) but had no impact on live births (RR: 1.39, CI: 95% 0.90 to 2.14; I2=64%; 7RCTs; N=1034). Our findings suggest that women participating in lifestyle interventions had an increased risk of miscarriage (RR: 1.50, CI: 95% 1.04 to 2.16; I2=0; 6RCTs; N=543). We rated the quality of evidence for these outcomes as the moderate-to-low. Lifestyle interventions slightly increased the pregnancy rate, while it would be uncertain whether it can improve the live birth. Lifestyle interventions can increase the risk of miscarriage. More research is needed to further explore lifestyle interventions on reproductive outcomes in obese infertile women.
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Affiliation(s)
- Juan J Espinós
- Department of Obstetrics and Gynaecology, Hospital de la Santa Creu i Sant Pau, Barcelona, Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain. Electronic Address:
| | - Ivan Solà
- IbCC Iberoamerican Cochrane Center, Barcelona, Spain
- CIBERESP CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
- IIB Sant Pau Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Claudia Valli
- IbCC Iberoamerican Cochrane Center, Barcelona, Spain
| | - Ana Polo
- Department of Reproduction Puigvert Foundation, Barcelona, Spain
| | - Lucja Ziolkowska
- IbCC Iberoamerican Cochrane Center, Barcelona, Spain
- Medical University of Silesia, Katowice, Poland
| | - M José Martínez-Zapata
- IbCC Iberoamerican Cochrane Center, Barcelona, Spain
- CIBERESP CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
- IIB Sant Pau Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
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Malik S, Teh JL, Lomanto D, Kim G, So JBY, Shabbir A. Maternal and fetal outcomes of Asian pregnancies after bariatric surgery. Surg Obes Relat Dis 2020; 16:529-535. [PMID: 32085937 DOI: 10.1016/j.soard.2020.01.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 12/02/2019] [Accepted: 01/13/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Obesity is a risk factor for pregnancy-induced hypertension, preeclampsia, gestational diabetes, and large gestational age pregnancy. Bariatric surgery is widely accepted to treat obesity but associated with small for gestational age fetuses. OBJECTIVE To report maternal and fetal outcomes after bariatric surgery in morbidly obese Asian females. SETTING University Hospital, Singapore. METHODS We maintain a prospective cohort of patients who underwent bariatric surgery in our institution. Maternal and fetal outcomes are compared with a control group of 31 pregnancies matched for age, parity, presurgery weight, and year of delivery. RESULTS Twenty-four pregnancies occurred in 16 patients in our postoperative cohort. Morbidly obese women in the control group were more likely to develop gestational diabetes (19.3% versus 5.0%, P = .150) and pregnancy-induced hypertension/preeclampsia (32.2% versus 0%, P = .003) compared with the postoperative group. Of fetuses, 37.5% in the bariatric group had low birth weight compared with only 9.4% fetuses in the control group (P = .016). Preoperative body mass index, short interval between conception and surgery, and poor weight gain during pregnancy did not predict for small for gestational age fetuses. Subsequent weights were available for 37.5% of the children in the surgical cohort and none of these children exhibited growth retardation. CONCLUSION Bariatric surgery lowers the risk of maternal co-morbidities and large gestational age fetus during pregnancy. Asians are at high risk of small for gestational age pregnancies after bariatric surgery and should undergo close monitoring for fetal growth throughout their pregnancy.
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Affiliation(s)
- Sajid Malik
- Department of Surgery, National University Hospital, National University Health System, Singapore
| | - Jun Liang Teh
- Department of Surgery, National University Hospital, National University Health System, Singapore; Department of Surgery, Jurong Health Campus, National University Health System, Singapore
| | - Davide Lomanto
- Department of Surgery, National University Hospital, National University Health System, Singapore; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore
| | - Guowei Kim
- Department of Surgery, National University Hospital, National University Health System, Singapore
| | - Jimmy Bok-Yan So
- Department of Surgery, National University Hospital, National University Health System, Singapore; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore
| | - Asim Shabbir
- Department of Surgery, National University Hospital, National University Health System, Singapore.
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Candeloro M, Di Nisio M, Ponzano A, Tiboni GM, Potere N, Tana M, Rutjes AWS, Porreca E. Effects of Obesity and Thrombophilia on the Risk of Abortion in Women Undergoing In Vitro Fertilization. Front Endocrinol (Lausanne) 2020; 11:594867. [PMID: 33424770 PMCID: PMC7786836 DOI: 10.3389/fendo.2020.594867] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 11/19/2020] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Obesity is associated with a higher risk of abortion in women undergoing in vitro fertilization (IVF). Whether thrombophilia amplifies this risk is currently unclear. The aim of this study was to evaluate the effects of thrombophilia on the risk of abortion in obese women treated with IVF. METHODS Patient characteristics, presence of inherited or acquired thrombophilia, and comorbidities were prospectively collected before the procedure in consecutive women undergoing IVF. The primary outcome was the incidence of abortion among women who achieved a clinical pregnancy. RESULTS A total of 633 non-obese and 49 obese Caucasian women undergoing IVF were included. 204 (32%) women achieved clinical pregnancy, of whom six had an ectopic pregnancy and 63 experienced an abortion. The incidence of abortion was higher in obese women compared to non-obese women after adjusting for age (64.3% vs. 29.3%, odds ratio [OR] 4.41; 95% CI 1.41 to 13.81). Women with one or more thrombophilia were at increased risk of abortion relative to those without thrombophilia (OR 2.70; 95% CI 1.34 to 5.45), and the risk seemed to be higher with hereditary (OR 5.12; 95% CI 1.77 to 14.8) than acquired thrombophilia (OR 1.92; 95% CI 0.52 to 5.12; p for interaction 0.194). Among obese women, the presence of one or more thrombophilia seemed associated with a substantially increased risk of abortion (unadjusted OR 14.00; 95% CI 0.94 to 207.6). CONCLUSIONS Obese women undergoing IVF have a high risk of abortion which seems further amplified by the concomitant presence of thrombophilia.
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Affiliation(s)
- Matteo Candeloro
- Department of Medical, Oral and Biotechnological Sciences, University G. D’Annunzio, Chieti-Pescara, Italy
| | - Marcello Di Nisio
- Department of Medicine and Ageing Sciences, University G. D’Annunzio, Chieti-Pescara, Italy
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, Netherlands
| | - Adalisa Ponzano
- Unit of Gynecology and Obstetrics, “Floraspe Renzetti” Hospital, Lanciano, Italy
| | - Gian Mario Tiboni
- Department of Medical, Oral and Biotechnological Sciences, University G. D’Annunzio, Chieti-Pescara, Italy
| | - Nicola Potere
- Unit of Internal Medicine, “SS Annunziata” Hospital, Chieti, Italy
| | - Marco Tana
- Unit of Internal Medicine, “SS Annunziata” Hospital, Chieti, Italy
| | - Anne W. S. Rutjes
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Ettore Porreca
- Department of Medical, Oral and Biotechnological Sciences, University G. D’Annunzio, Chieti-Pescara, Italy
- *Correspondence: Ettore Porreca,
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Coutinho EA, Prescott M, Hessler S, Marshall CJ, Herbison AE, Campbell RE. Activation of a Classic Hunger Circuit Slows Luteinizing Hormone Pulsatility. Neuroendocrinology 2020; 110:671-687. [PMID: 31630145 DOI: 10.1159/000504225] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 10/11/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The central regulation of fertility is carefully coordinated with energy homeostasis, and infertility is frequently the outcome of energy imbalance. Neurons in the hypothalamus expressing neuropeptide Y and agouti-related peptide (NPY/AgRP neurons) are strongly implicated in linking metabolic cues with fertility regulation. OBJECTIVE We aimed here to determine the impact of selectively activating NPY/AgRP neurons, critical regulators of metabolism, on the activity of luteinizing hormone (LH) pulse generation. METHODS We employed a suite of in vivo optogenetic and chemogenetic approaches with serial measurements of LH to determine the impact of selectively activating NPY/AgRP neurons on dynamic LH secretion. In addition, electrophysiological studies in ex vivo brain slices were employed to ascertain the functional impact of activating NPY/AgRP neurons on gonadotropin-releasing hormone (GnRH) neurons. RESULTS Selective activation of NPY/AgRP neurons significantly decreased post-castration LH secretion. This was observed in males and females, as well as in prenatally androgenized females that recapitulate the persistently elevated LH pulse frequency characteristic of polycystic ovary syndrome (PCOS). Reduced LH pulse frequency was also observed when optogenetic stimulation was restricted to NPY/AgRP fiber projections surrounding GnRH neuron cell bodies in the rostral preoptic area. However, electrophysiological studies in ex vivo brain slices indicated these effects were likely to be indirect. CONCLUSIONS These data demonstrate the ability of NPY/AgRP neuronal signaling to modulate and, specifically, reduce GnRH/LH pulse generation. The findings suggest a mechanism by which increased activity of this hunger circuit, in response to negative energy balance, mediates impaired fertility in otherwise reproductively fit states, and highlight a potential mechanism to slow LH pulsatility in female infertility disorders, such as PCOS, that are associated with hyperactive LH secretion.
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Affiliation(s)
- Eulalia A Coutinho
- Department of Physiology and Centre for Neuroendocrinology, Otago School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - Melanie Prescott
- Department of Physiology and Centre for Neuroendocrinology, Otago School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - Sabine Hessler
- Department of Physiology and Centre for Neuroendocrinology, Otago School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - Christopher J Marshall
- Department of Physiology and Centre for Neuroendocrinology, Otago School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - Allan E Herbison
- Department of Physiology and Centre for Neuroendocrinology, Otago School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - Rebecca E Campbell
- Department of Physiology and Centre for Neuroendocrinology, Otago School of Biomedical Sciences, University of Otago, Dunedin, New Zealand,
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Quantification of testicular fat deposition in the evaluation of middle-aged overweight male infertility. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2019; 33:377-384. [PMID: 31845302 DOI: 10.1007/s10334-019-00803-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 11/14/2019] [Accepted: 11/15/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To measure the testicular volume and testicular fat deposition of middle-aged overweight men and to assess the utility of testicular fat deposition and testicular volume in determining and monitoring testicular infertility. MATERIALS AND METHODS Pelvic MRI with thin slice T2WI, T1WI and mDIXON Quant was performed on 30 middle-aged overweight patients in the treatment group and 30 middle-aged overweight men in the control group. Testicular volume and testicular fat deposition were measured separately based on thin slice T2WI and the fat fraction (FF) map of mDIXON Quant, and the testicular fat deposition observed with T1WI was used as a reference for qualitative diagnosis. Testicular volume and testicular fat deposition in middle-aged overweight individuals were compared using a t test with Bonferroni correction and receiver operating characteristic (ROC) curve. RESULTS The testicular volumes (10.6-17.9 cm3) of individuals in the treatment group were smaller than those (12.6-19.0 cm3) of individuals in the control group (p < 0.05), and the average FF value (2.2-4.6%) of the testes in the treatment group was higher than that (1.5-3.1%) in the control group (p < 0.05). The ROC analysis showed that the area under the curve (AUC) of testicular fat deposition (0.899) was higher than that of testicular volume (0.777), and biopsy and sperm count were used as references to diagnose infertility. The diagnostic sensitivity (90.00%) of testicular fat deposition of the mDIXON Quant sequence was higher than that (50.00%) of the T1W sequence (p < 0.05). Testicular fat deposition was decreased after 6 months of active treatment with exercise weight loss and drug treatment, and no significant change in testicular volume was observed 6 months later. CONCLUSION The findings suggest that the proton density fat fraction (mDIXON Quant sequence in this study) approach is a novel tool for the quantitative and objective evaluation of testicular fat deposition. Testicular fat deposition measurement is more specific than testicular volume measurement in the diagnosis of male infertility, and the mDIXON Quant is more sensitive than T1WI in the diagnosis of testicular fat deposition. Furthermore, our findings may facilitate a more accurate diagnosis and monitoring of testicular infertility, therapeutic effect, and prognosis by measuring testicular fat deposition.
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Abstract
Chronic diseases are the leading cause of death worldwide with increasing prevalence in all age groups, genders, and ethnicities. Most chronic disease deaths occur in middle-to low-income countries but are also a significant health problem in developed nations. Multiple chronic diseases now affect children and adolescents as well as adults. Being physically inactive is associated with increased chronic disease risk. Global societies are being negatively impacted by the increasing prevalence of chronic disease which is directly related to rising healthcare expenditures, workforce complications regarding attendance and productivity, military personnel recruitment, and academic success. However, increased physical activity (PA) and exercise are associated with reduced chronic disease risk. Most physiologic systems in the body benefit positively from PA and exercise by primary disease prevention and secondary disease prevention/treatment. The purpose of this brief review is to describe the significant global problem of chronic diseases for adults and children, and how PA and exercise can provide a non-invasive means for added prevention and treatment.
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86
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Molina-Luque R, Romero-Saldaña M, Álvarez-Fernández C, Bennasar-Veny M, Álvarez-López Á, Molina-Recio G. Equation Córdoba: A Simplified Method for Estimation of Body Fat (ECORE-BF). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16224529. [PMID: 31731813 PMCID: PMC6888348 DOI: 10.3390/ijerph16224529] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 11/13/2019] [Accepted: 11/15/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Many methods for measuring body fat have been developed, but applications in clinical settings are limited. For this reason, researchers have tried to identify different formulas for its estimation but most of are hard to incorporate into daily work due to the variability in population and difficulty of use. The aim of this study was to develop and validate a new equation for the simplified estimation of body fat using the Clínica Universidad de Navarra - Body Adiposity Estimator (CUN-BAE) as a reference. METHODS This research was conducted in two phases. In the first, the new body fat estimation equation was developed. The developed equation was validated in the second phase. Pearson's linear correlation, raw and adjusted linear regressions, the intraclass correlation coefficient, and Bland-Altman graphs were used. RESULTS The variables that best adjusted the body fat percentage were age, sex, and the Napierian logarithm of Body Mass Index (LnBMI), forming the Equation Córdoba for Estimation of Body Fat (ECORE-BF) model. In its validation, the model presented correlation values of 0.994, an intraclass correlation coefficient of 0.960, with the Bland-Altman graph indicating means differences of 1.82 with respect to the estimation with the CUN-BAE. Nevertheless, although the aim was to simplify the CUN-BAE, the main limitation of this study is that a gold standard, such as air displacement plethysmography (ADP) or dual-energy X-ray absorptiometry (DXA), was not used. CONCLUSIONS The proposed equation (ECORE-BF) simplified the CUN-BAE and provided a precise method, respecting the principle of parsimony, for the calculation of body fat.
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Affiliation(s)
- Rafael Molina-Luque
- Department of Nursing, Faculty of Medicine and Nursing, University of Córdoba, Avd Menéndez Pidal No/No, 14004 Córdoba, Spain; (R.M.-L.); (G.M.-R.)
| | - Manuel Romero-Saldaña
- Department of Occupational Safety and Health, Córdoba City Hall, Huerto de San Pedro el Real, 1, 14003 Córdoba, Spain;
- Correspondence: ; Tel.: +34-686460989
| | - Carlos Álvarez-Fernández
- Department of Occupational Safety and Health, Córdoba City Hall, Huerto de San Pedro el Real, 1, 14003 Córdoba, Spain;
| | - Miquel Bennasar-Veny
- Nursing and Physiotherapy Department, Research Group on Evidence, Lifestyles & Health, Research Institute on Health Sciences (IUNICS), Universitat Illes Balears, Carretera de Valldemossa, 5, 07122 Palma, Illes Balears, Spain;
| | - Álvaro Álvarez-López
- Hospital Infanta Cristina, Extremadura Health Service, Av. de Elvas, No/No, 06080 Badajoz, Spain;
| | - Guillermo Molina-Recio
- Department of Nursing, Faculty of Medicine and Nursing, University of Córdoba, Avd Menéndez Pidal No/No, 14004 Córdoba, Spain; (R.M.-L.); (G.M.-R.)
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De Carolis S, Botta A, Del Sordo G, Guerrisi R, Salvi S, De Carolis MP, Iaconelli A, Giustacchini P, Raffaelli M, Lanzone A. Influence of Biliopancreatic Diversion on Pregnancy Outcomes in Comparison to Other Bariatric Surgery Procedures. Obes Surg 2019; 28:3284-3292. [PMID: 29909515 DOI: 10.1007/s11695-018-3350-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Pregnancy after bariatric surgery (BS) has an increased risk for small-for-gestational-age infants (SGA), shorter length of gestation, and probably perinatal mortality. The aim of this study was to investigate if biliopancreatic diversion could impair pregnancy outcomes in comparison to other bariatric surgery procedures. METHODS We conducted a cohort retrospective single-center study in 65 women before and after BS. Thirty-one pregnancies occurred before BS, while 109 after BS, amongst which n = 51 after biliopancreatic diversion (BPD) and n = 58 after non-malabsorptive procedures. RESULTS The pregnancy outcomes after BS in comparison with those before BS resulted less affected by diabetes, hypertensive disorders, macrosomia, and large-for-gestational-age (LGA), but more complicated by preterm births (14.5 versus 4.0%) and low birth weight (LBW) infants (28.9 versus 0%). Moreover, mean birth weight resulted lower after BS than before BS (p < 0.001). In pregnancies after BPD in comparison to those before BS, the LBW rate (42.5%) resulted a drastic increase (p < 0.001), and mean birth weight (p < 0.001) and mean birth weight centile (p < 0.001) were lower after BPD. When pregnancy outcomes after BPD were compared with those after non-malabsorptive procedures, the rate of congenital anomalies, preterm births, LBW, and SGA resulted an increase (p = 0.002, 0.008, 0.032, and < 0.001, respectively). CONCLUSIONS BPD drastically reduced diabetes, hypertensive disorders, macrosomia, and LGA; however, it was associated with the poorest pregnancy outcomes in comparison to those observed after other BS procedures. On the basis of the present study, we recommend a cautious multidisciplinary selection of severely obese patients for BPD during the fertile age.
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Affiliation(s)
- S De Carolis
- Department of Woman and Child Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - A Botta
- Department of Woman and Child Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gelsomina Del Sordo
- Department of Woman and Child Health, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - R Guerrisi
- Department of Woman and Child Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - S Salvi
- Department of Woman and Child Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - M P De Carolis
- Department of Woman and Child Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - A Iaconelli
- Department of Internal Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - P Giustacchini
- Division of Endocrine and Metabolic Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - M Raffaelli
- Division of Endocrine and Metabolic Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - A Lanzone
- Department of Woman and Child Health, Università Cattolica del Sacro Cuore, Rome, Italy
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88
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Esteves SC. Interventions to Prevent Sperm DNA Damage Effects on Reproduction. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1166:119-148. [PMID: 31301050 DOI: 10.1007/978-3-030-21664-1_8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Excessive oxidation and antioxidant imbalance resulting from several conditions may cause sperm DNA damage, which, in turn, affect male fertility, both natural and assisted. Sperm DNA damage transferred to the embryo might also affect the health of offspring. Several conditions associated with excessive oxidative stress are modifiable by the use of specific treatments, lifestyle changes, and averting exposure to environmental/occupational toxicants. Here, we discuss the strategies to reduce sperm DNA damage with a focus on clinical and surgical interventions.
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Affiliation(s)
- Sandro C Esteves
- ANDROFERT, Andrology and Human Reproduction Clinic, Referral Center for Male Reproduction, Campinas, SP, Brazil. .,Department of Surgery (Division of Urology), University of Campinas (UNICAMP), Campinas, SP, Brazil. .,Faculty of Health, Aarhus University, Aarhus, Denmark.
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89
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Fuller EA, Younesi S, Xavier S, Sominsky L. Neuroimmune regulation of female reproduction in health and disease. Curr Opin Behav Sci 2019. [DOI: 10.1016/j.cobeha.2019.01.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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90
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Pattinson AL, Nassar N, da Luz FQ, Hay P, Touyz S, Sainsbury A. The Real Happy Study: Protocol for a Prospective Assessment of the Real-World Effectiveness of the HAPIFED Program-a Healthy APproach to we Ight management and Food in Eating Disorders. Behav Sci (Basel) 2019; 9:bs9070072. [PMID: 31266238 PMCID: PMC6680425 DOI: 10.3390/bs9070072] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 06/12/2019] [Accepted: 06/25/2019] [Indexed: 01/16/2023] Open
Abstract
The prevalence of obesity with comorbid binge eating behaviour is growing at a faster rate than that seen for either obesity or eating disorders as separate conditions. Approximately 6% of the population are affected and they potentially face a lifetime of poor physical and mental health outcomes and an inability to sustain long-term weight loss. Current treatment options are inadequate in that they typically address either obesity or eating disorders exclusively, not the combination of both conditions. By treating one condition without treating the other, relapse is common, and patients are often left disappointed with their lack of weight loss. An integrated approach to treating these individuals is needed to prevent a worsening of the comorbidities associated with excess body weight and eating disorders. A new therapy has recently been developed, named HAPIFED, which addresses both overweight/obesity and comorbid binge eating behaviour with the combination of behavioural weight loss therapy and cognitive behaviour therapy-enhanced (CBT-E). The aim of this paper is to document the protocol for the Real Happy Study, which will evaluate the effectiveness of the HAPIFED program in treating overweight or obesity with comorbid binge-eating behaviour in a real-world setting.
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Affiliation(s)
- Andrea L Pattinson
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, NSW 2006, Australia
| | - Natasha Nassar
- Child Population and Translational Health Research, Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, NSW 2006, Australia
| | - Felipe Q da Luz
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, NSW 2006, Australia
| | - Phillipa Hay
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Penrith, NSW 2751, Australia
| | - Stephen Touyz
- School of Psychology, Faculty of Science, The University of Sydney, NSW 2006, Australia
| | - Amanda Sainsbury
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, NSW 2006, Australia.
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Mikalsen SM, Bjørke-Monsen AL, Flaten TP, Whist JE, Aaseth J. Cadmium, lead and mercury in Norwegian obese patients before and 12 months after bariatric surgery. J Trace Elem Med Biol 2019; 54:150-155. [PMID: 31109605 DOI: 10.1016/j.jtemb.2019.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 04/11/2019] [Accepted: 04/17/2019] [Indexed: 12/31/2022]
Abstract
PURPOSE Previous studies have suggested a role for the toxic elements lead (Pb), mercury (Hg) and cadmium (Cd) in the development of insulin resistance and hypertension. Increased blood Pb levels have been reported after bariatric surgery and weight loss. As about 80% of patients undergoing bariatric surgery are women, most of them of childbearing age, there are concerns regarding fetal exposure to toxic trace elements. We measured whole blood Hg, Pb and Cd concentrations in morbidly obese patients before and 12 months after Roux-en-Y gastric bypass (RYGB). PATIENTS AND METHODS Forty-six patients eligible for bariatric surgery were recruited at Innlandet Hospital Trust, Norway (2012-2014). The majority were women and 54% were of reproductive age. Whole blood samples were collected prior to and 12 months after surgery. Trace element concentrations were measured using mass spectrometry (HR-ICP-MS). RESULTS Median whole blood Pb concentrations increased by 73% during the 12 months study period while Hg and Cd decreased by 31% and 27%, respectively. We found a negative correlation between Pb levels before surgery and BMI (p = 0.02). Before surgery patients with hypertension had significantly higher median whole blood Hg levels compared to patients with normal blood pressure (p < 0.001). CONCLUSION One year after bariatric surgery, the median whole blood Pb concentration was increased, while Hg and Cd concentrations were decreased. The majority of bariatric surgery patients are women of reproductive age and weight loss is associated with improved fertility. As even low dose Pb exposure during fetal life is associated with negative effects on the central nervous system, the observed increase in whole blood Pb after weight loss causes concern. Further studies are needed to elucidate these observations.
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Affiliation(s)
- Solveig Meyer Mikalsen
- Laboratory of Medical Biochemistry, Innlandet Hospital Trust, 2609, Lillehammer, Norway.
| | - Anne-Lise Bjørke-Monsen
- Laboratory of Clinical Biochemistry, Haukeland University Hospital, 5021, Bergen, Norway; Department of Clinical Science, University of Bergen, Norway
| | - Trond Peder Flaten
- Department of Chemistry, Norwegian University of Science and Technology (NTNU), 7491, Trondheim, Norway
| | - Jon Elling Whist
- Laboratory of Medical Biochemistry, Innlandet Hospital Trust, 2609, Lillehammer, Norway; Department of Research, Innlandet Hospital Trust, 2380, Brumunddal, Norway
| | - Jan Aaseth
- Department of Research, Innlandet Hospital Trust, 2380, Brumunddal, Norway; Inland Norway University of Applied Sciences, 2411, Elverum, Norway
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Vitamin D and Obesity: Two Interacting Players in the Field of Infertility. Nutrients 2019; 11:nu11071455. [PMID: 31252555 PMCID: PMC6683323 DOI: 10.3390/nu11071455] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 06/24/2019] [Accepted: 06/26/2019] [Indexed: 12/31/2022] Open
Abstract
Obesity plays an important role in human fertility in both genders. The same is true for vitamin D, for which accumulating evidence from observational human studies suggests a key role for both male and female fertility. In the latter case, however, robust data from relevant interventional studies are currently lacking. It is also not clear whether obesity and vitamin D deficiency, besides their independent effect on human infertility, act in synergy. Several pathogenetic mechanisms may be proposed as a linkage between vitamin D deficiency and obesity, with respect to infertility. In any case, the independent contribution of vitamin D deficiency in obese infertile states needs to be proven in interventional studies focusing on either vitamin D supplementation in obese or weight loss strategies in vitamin D-deficient infertile patients.
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93
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Use of Cumulative Live Birth Rate per Total Number of Embryos to Calculate the Success of IVF in Consecutive IVF Cycles in Women Aged ≥35 Years. BIOMED RESEARCH INTERNATIONAL 2019; 2019:6159793. [PMID: 31346521 PMCID: PMC6617928 DOI: 10.1155/2019/6159793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 04/28/2019] [Accepted: 05/20/2019] [Indexed: 12/12/2022]
Abstract
Objective The use of cumulative live birth rate (CLBR) per ovarian stimulation cycle is proving to be an accurate method to calculate the success of IVF; however, the cycle outcome is closely associated with the number of embryos transferred (ET). Our aim was to report CLBR after IVF according to the number of embryos required to achieve a live birth in women aged ≥35 years, considering age, body mass index (BMI), and ethnicity. Methods We conducted a retrospective cohort study including 1344 patients who underwent IVF between January 2013 and June 2016 at the First Affiliated Hospital of Xinjiang Medical University. The cumulative probability of live birth for each couple was estimated using the Kaplan–Meier method, and survival curves were compared according to age, BMI, and ethnicity using the log-rank test. Results CLBR increased rapidly from 1 to 5 ETs, moderately from 6 to 10 ETs, and slowly thereafter. CLBR was significantly different across 4 categories based on BMI as well as across those based on age; low CLBR was significantly associated with the age of ≥42 years and obesity. Conclusion The association between CLBR and number of ET provides realistic and precise information regarding the success of IVF and can be applied to guide clinicians and patients.
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Bhattacharya S, Evers JLH, Gameiro S, Negri E, Somigliana E, Vercellini P, Wellings K, Baird DT, Crosignani P, Glasier A, La Vecchia C. Towards a more pragmatic and wiser approach to infertility care. Hum Reprod 2019; 34:1165-1172. [DOI: 10.1093/humrep/dez101] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 05/13/2019] [Accepted: 05/17/2019] [Indexed: 12/25/2022] Open
Abstract
Abstract
Infertility represents a very peculiar area of medicine. Contrary to other areas, where signs and symptoms lead to a diagnosis, which in turn leads to a specific treatment, in reproduction the lack of signs and symptoms for more than 12 months suggests the diagnosis of ‘unexplained subfertility’, and if this condition has lasted for some years, couples qualify for IVF. Diagnosis and treatments can extend over long periods of time (even years) and the accuracy of the diagnostic armamentarium is not optimal. Uncertainty about diagnosis and the need for significant perseverance is demanding on both couples and physicians, and actually constitute a very favourable situation for overdiagnosis (‘unexplained subfertility’) and overtreatment (IVF) on one hand, and, on the other, it may also affect compliance with treatments. To improve our capacity to properly handle this challenging situation, increased attention should be given to the duration of pregnancy seeking. Initiating treatments earlier in older women is unwise because this population has a lower fecundity and, therefore, duration of pregnancy seeking is even more important to achieve a reliable diagnosis of infertility. Moreover, if the infertility work-up is unremarkable, duration of pregnancy seeking should be extended up to more than 2 years prior to making a diagnosis of unexplained infertility regardless of age. An adequate period of pregnancy seeking is also required for couples who are diagnosed with conditions that can interfere with fertility to avoid overdiagnosis and overtreatment. Indeed, most causes of infertility will reduce but not impair natural conception. Within this sometimes long-term management, physicians should also pay attention to detrimental life habits in order to optimize the chances of both natural and assisted reproduction technology -mediated pregnancy. Even if interventional studies are not conclusive, it is advisable to address the problems of obesity and smoking. Focussing on frequency of sexual intercourse may be also beneficial for natural conception. Finally, there is the need for improving our capacity to handle compliance. Providing information on the importance of persevering at the start of treatment, promoting shared decision-making and tackling patient, clinic and treatment causes of drop-out can all improve the overall chances of parenthood. Thus, we plead for a wiser and more pragmatic approach to infertility, paying more attention to these neglected, but in our opinion essential, aspects of infertility care.
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95
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Kamocka A, Miras AD. Comment on: Changes in total sperm count after gastric bypass and sleeve gastrectomy: the BARIASPERM prospective study. Surg Obes Relat Dis 2019; 15:1279-1280. [PMID: 31221546 DOI: 10.1016/j.soard.2019.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 05/06/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Anna Kamocka
- Department of Diabetes, Endocrinology and Metabolism, Imperial College London, London, United Kingdom
| | - Alexander Dimitri Miras
- Department of Diabetes, Endocrinology and Metabolism, Imperial College London, London, United Kingdom
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Carette C, Levy R, Eustache F, Baron G, Coupaye M, Msika S, Barrat C, Cohen R, Catheline JM, Brugnon F, Slim K, Barsamian C, Chevallier JM, Bretault M, Bouillot JL, Antignac JP, Rives-Lange C, Ravaud P, Czernichow S. Changes in total sperm count after gastric bypass and sleeve gastrectomy: the BARIASPERM prospective study. Surg Obes Relat Dis 2019; 15:1271-1279. [PMID: 31147284 DOI: 10.1016/j.soard.2019.04.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 04/15/2019] [Accepted: 04/15/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND The massive weight loss induced by bariatric surgery is associated with major benefits, but the effect on semen variables is still uncertain. OBJECTIVES To explore semen modifications with gastric bypass and sleeve gastrectomy. SETTING Five French University Hospitals. METHODS Male candidates for bariatric surgery with no history of infertility were recruited in this controlled prospective study. Sperm characteristics were collected before surgery and then 6 months and up to 12 months after surgery. RESULTS Forty-six adult men who underwent gastric bypass (n = 20) or sleeve gastrectomy (n = 26) were included. Total sperm count tended to be lower at 6 months and showed a significant decrease at 12 months in both surgery groups, at -69.5 million (-96.8 to -42.2 million; P = 0.0021). Total sperm count at 12 months relative to baseline was -41.4 million (P = .0391) after gastric bypass and -91.1 million (P = .0080) after sleeve gastrectomy. This was counterbalanced by an associated resolution of hypogonadism and decrease of DNA fragmentation in most patients with time after surgery. CONCLUSION Improvement in some semen variables after bariatric surgery observed in 3 previous studies is in contrast to the lower mean total sperm count found in this study at 1 year. The possible reversibility of this effect in the long term and the impact of surgery on fertility both remain unknown.
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Affiliation(s)
- Claire Carette
- Hôpital Européen Georges Pompidou, Service de Nutrition, Centre Spécialisé Obésité (CSO) Ile-de-France Sud, APHP, Université Paris Descartes, Paris, France.
| | - Rachel Levy
- Hôpital Tenon, Service de Biologie de la Reproduction, APHP, Université Pierre et Marie Curie, Paris, France; INSERM UMRS 938, Centre de Recherche Saint-Antoine, Sorbonne Universités, Université Pierre et Marie Curie, IHU ICAN, Paris, France
| | - Florence Eustache
- Hôpital Jean-Verdier, Hôpitaux Universitaires Paris Seine-Saint-Denis, Biologie de la Reproduction, CECOS, APHP, Bondy, France
| | - Gabriel Baron
- Centre d'Épidémiologie Clinique, Hôpital Hôtel-Dieu, Paris, France; Team METHODS, Centre of Research in Epidemiology and Statistics Sorbonne, Paris Cité-CRESS Inserm UMR1153, Paris, France; Université Paris Descartes, Paris, France
| | - Muriel Coupaye
- Service des Explorations Fonctionnelles, Centre Integre Nord Francilien de prise en charge de l'Obesite (CINFO), Hopital Louis Mourier, APHP, Colombes, France
| | - Simon Msika
- Service de Chirurgie Digestive, Centre Intégré Nord Francilien de prise en charge de l'Obésité (CINFO), Hôpital Louis Mourier, APHP, Colombes, France
| | - Christophe Barrat
- Hôpital Avicenne, Hôpitaux Universitaires Paris Seine-Saint-Denis, Service de Chirurgie Générale et Digestive, Centre Intégré Nord Francilien de prise en charge de l'Obésité (CINFO), APHP, Bobigny, France
| | - Régis Cohen
- Hôpital Delafontaine, Centre Hospitalier de Saint-Denis, Chirurgie de l'Obésité, Saint-Denis, France
| | - Jean-Marc Catheline
- Hôpital Delafontaine, Centre Hospitalier de Saint-Denis, Chirurgie de l'Obésité, Saint-Denis, France
| | - Florence Brugnon
- CHU Clermont Ferrand, Pole Femme Enfants, CECOS, AMP, 1 place Aubrac Clermont Ferrand & IMoST, INSERM 1240, Faculté de médecine, Place Henri Dunand, Clermont Ferrand, France
| | - Karem Slim
- Centre Hospitalier Universitaire de Clermont-Ferrand, Service de Chirurgie Générale et Digestive, Université Clermont-Auvergne, Clermont-Ferrand, France
| | - Charles Barsamian
- Hôpital Européen Georges Pompidou, Service de Nutrition, Centre Spécialisé Obésité (CSO) Ile-de-France Sud, APHP, Université Paris Descartes, Paris, France
| | - Jean-Marc Chevallier
- Hôpital Européen Georges Pompidou, Service de Chirurgie Digestive, APHP, Université Paris Descartes, Paris, France
| | - Marion Bretault
- Hôpital Ambroise Paré, Service de Nutrition, APHP, Université Versailles Saint Quentin, Boulogne-Billancourt, France
| | - Jean-Luc Bouillot
- Hôpital Ambroise Paré, Service de Chirurgie Digestive, APHP, Université Versailles Saint Quentin, Boulogne-Billancourt, France
| | - Jean-Philippe Antignac
- Laboratoire d'Etude des Résidus et Contaminants dans les Aliments (LABERCA), UMR 1329 Oniris-INRA, Nantes, France
| | - Claire Rives-Lange
- Hôpital Européen Georges Pompidou, Service de Nutrition, Centre Spécialisé Obésité (CSO) Ile-de-France Sud, APHP, Université Paris Descartes, Paris, France
| | - Philippe Ravaud
- Centre d'Épidémiologie Clinique, Hôpital Hôtel-Dieu, Paris, France; Team METHODS, Centre of Research in Epidemiology and Statistics Sorbonne, Paris Cité-CRESS Inserm UMR1153, Paris, France; Université Paris Descartes, Paris, France
| | - Sébastien Czernichow
- Hôpital Européen Georges Pompidou, Service de Nutrition, Centre Spécialisé Obésité (CSO) Ile-de-France Sud, APHP, Université Paris Descartes, Paris, France; Centre d'Épidémiologie Clinique, Hôpital Hôtel-Dieu, Paris, France; Team METHODS, Centre of Research in Epidemiology and Statistics Sorbonne, Paris Cité-CRESS Inserm UMR1153, Paris, France; Université Paris Descartes, Paris, France
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Farquhar CM, Bhattacharya S, Repping S, Mastenbroek S, Kamath MS, Marjoribanks J, Boivin J. Female subfertility. Nat Rev Dis Primers 2019; 5:7. [PMID: 30679436 DOI: 10.1038/s41572-018-0058-8] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Subfertility is common and affects one in six couples, half of whom lack an explanation for their delay in conceiving. Developments in the diagnosis and treatment of subfertility over the past 50 years have been truly remarkable. Indeed, current generations of couples with subfertility are more fortunate than previous generations, as they have many more opportunities to become parents. The timely access to effective treatment for subfertility is important as many couples have a narrow window of opportunity before the age-related effects of subfertility limit the likelihood of success. Assisted reproduction can overcome the barriers to fertility caused by tubal disease and low sperm count, but little progress has been made in reducing the effect of increasing age on ovarian function. The next 5-10 years will likely see further increases in birth rates in women with subfertility, a greater awareness of lifestyle factors and a possible refinement of current assisted reproduction techniques and the development of new ones. Such progress will bring challenging questions regarding the potential benefits and harms of treatments involving germ cell manipulation, artificial gametes, genetic screening of embryos and gene editing of embryos. We hope to see a major increase in fertility awareness, access to safe and cost-effective fertility care in low-income countries and a reduction in the current disparity of access to fertility care.
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Affiliation(s)
- Cynthia M Farquhar
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand.
| | - Siladitya Bhattacharya
- College of Biomedical and Life Sciences, Cardiff University School of Medicine, Cardiff, UK
| | - Sjoerd Repping
- Amsterdam UMC, University of Amsterdam, Center for Reproductive Medicine, Amsterdam Reproduction & Development research institute, Amsterdam, Netherlands
| | - Sebastiaan Mastenbroek
- Amsterdam UMC, University of Amsterdam, Center for Reproductive Medicine, Amsterdam Reproduction & Development research institute, Amsterdam, Netherlands
| | - Mohan S Kamath
- Department of Reproductive Medicine, Christian Medical College, Vellore, India
| | - Jane Marjoribanks
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Jacky Boivin
- School of Psychology, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
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Falcone V, Stopp T, Feichtinger M, Kiss H, Eppel W, Husslein PW, Prager G, Göbl CS. Pregnancy after bariatric surgery: a narrative literature review and discussion of impact on pregnancy management and outcome. BMC Pregnancy Childbirth 2018; 18:507. [PMID: 30587161 PMCID: PMC6307154 DOI: 10.1186/s12884-018-2124-3] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 11/27/2018] [Indexed: 02/07/2023] Open
Abstract
Bariatric surgery (BS) is regarded to be the most effective treatment of obesity with long lasting beneficial effects including weight loss and improvement of metabolic disorders. A considerable number of women undergoing BS are at childbearing age.Although the surgery mediated weight loss has a positive effect on pregnancy outcome, the procedures might be associated with adverse outcomes as well, for example micronutrient deficiencies, iron or B12 deficiency anemia, dumping syndrome, surgical complications such as internal hernias, and small for gestational age (SGA) offspring, possibly due to maternal undernutrition. Also, there is no international consensus concerning the ideal time to conception after BS. Hence, the present narrative review intents to summarize the available literature concerning the most common challenges which arise before and during pregnancy after BS, such as fertility related considerations, vitamin and nutritional deficiencies and their adequate compensation through supplementation, altered glucose metabolism and its implications for gestational diabetes screening, the symptoms and treatment of dumping syndrome, surgical complications and the impact of BS on pregnancy outcome. The impact of different bariatric procedures on pregnancy and fetal outcome will also be discussed, as well as general considerations concerning the monitoring and management of pregnancies after BS.Whereas BS leads to the mitigation of many obesity-related pregnancy complications, such as gestational diabetes mellitus (GDM), pregnancy induced hypertension and fetal macrosomia; those procedures pose new risks which might lead to adverse outcomes for mothers and offspring, for example nutritional deficiencies, anemia, altered maternal glucose metabolism and small for gestational age children.
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Affiliation(s)
- Veronica Falcone
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Tina Stopp
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Michael Feichtinger
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Wunschbaby Institut Feichtinger, Lainzerstrasse 6, Vienna, Austria
| | - Herbert Kiss
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Wolfgang Eppel
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Peter Wolf Husslein
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Gerhard Prager
- Department of General Surgery, Division of Bariatric Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Christian S Göbl
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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Stopp T, Falcone V, Feichtinger M, Göbl C. Fertility, Pregnancy and Lactation After Bariatric Surgery - a Consensus Statement from the OEGGG. Geburtshilfe Frauenheilkd 2018; 78:1207-1211. [PMID: 30655646 PMCID: PMC6294640 DOI: 10.1055/a-0706-7578] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 08/20/2018] [Accepted: 08/20/2018] [Indexed: 12/11/2022] Open
Abstract
Bariatric surgery is recommended when other weight loss interventions, such as lifestyle modification or medications, have failed. A considerable number of women undergoing bariatric surgery are of childbearing age; hence, it is necessary to be aware of the effects of bariatric surgery on pregnancy for managing these patients. Although bariatric surgery is associated with positive effects on cardiovascular and metabolic parameters, side effects such as anaemia, the risk of developing internal hernia, altered glucose metabolism and the risk of small for gestational age offspring have to be considered. Pregnant women with a history of gastric bypass should not undergo the oral glucose tolerance test (OGTT) due to the high risk of hypoglycaemia. There are no contraindications for vaginal delivery and breastfeeding. This paper has been published as a consensus statement by the Austrian Society of Gynaecology and Obstetrics (OEGGG).
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Affiliation(s)
- Tina Stopp
- Universitätsklinik für Frauenheilkunde, Klinische Abteilung für Geburtshilfe und feto-maternale Medizin, Medizinische Universität, Wien, Austria
| | - Veronica Falcone
- Universitätsklinik für Frauenheilkunde, Klinische Abteilung für Geburtshilfe und feto-maternale Medizin, Medizinische Universität, Wien, Austria
| | | | - Christian Göbl
- Universitätsklinik für Frauenheilkunde, Klinische Abteilung für Geburtshilfe und feto-maternale Medizin, Medizinische Universität, Wien, Austria
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100
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Berkseth KE, Rubinow KB, Melhorn SJ, Webb MF, Rosalynn B De Leon M, Marck BT, Matsumoto AM, Amory JK, Page ST, Schur EA. Hypothalamic Gliosis by MRI and Visceral Fat Mass Negatively Correlate with Plasma Testosterone Concentrations in Healthy Men. Obesity (Silver Spring) 2018; 26:1898-1904. [PMID: 30460775 PMCID: PMC6251490 DOI: 10.1002/oby.22324] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 08/16/2018] [Accepted: 08/30/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE This study aimed to determine whether a relationship was evident between gliosis in the mediobasal hypothalamus (MBH) and plasma testosterone concentrations in men. METHODS A total of 41 adult men (aged 18-50 years) from 23 twin pairs underwent fasting morning blood draw and brain magnetic resonance imaging. T2 relaxation time was used to quantify gliosis in the MBH and control areas in the putamen and amygdala. Plasma concentrations of testosterone and 17β-estradiol were measured by liquid chromatography-tandem mass spectrometry. Body composition including visceral adiposity was measured by dual x-ray absorptiometry. RESULTS A negative association was found between MBH T2 relaxation time and plasma concentrations of both free and total testosterone (r = -0.29, P < 0.05 and r = -0.37, P < 0.01, respectively). Visceral adiposity exhibited a negative correlation with plasma total testosterone concentration (r = -0.45, P = 0.001) but a positive correlation with MBH T2 relaxation time (r = 0.24, P = 0.03). The negative correlation between plasma total testosterone and MBH T2 relaxation time remained significant after adjustment for visceral adiposity, age, BMI, and insulin resistance. CONCLUSIONS In healthy men across a range of BMIs, MBH gliosis was associated with higher visceral adiposity but lower endogenous testosterone. These findings suggest that MBH gliosis could provide novel mechanistic insights into gonadal dysfunction in men with obesity.
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Affiliation(s)
- Kathryn E Berkseth
- Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Katya B Rubinow
- Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Susan J Melhorn
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Mary F Webb
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Mary Rosalynn B De Leon
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Brett T Marck
- Geriatric Research, Education and Clinical Center, VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Alvin M Matsumoto
- Geriatric Research, Education and Clinical Center, VA Puget Sound Health Care System, Seattle, Washington, USA
- Division of Gerontology & Geriatric Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - John K Amory
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Stephanie T Page
- Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Ellen A Schur
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA
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