Obstetrical outcomes of ART pregnancies in patients with male factor infertility

Where do obesity and male infertility collide?

The parallel rise in obesity and male infertility in modern societies necessitates the identification of susceptibility genes underlying these interconnected health issues. In our study, we conducted a comprehensive search in the OMIM database to identify genes commonly associated with male infertility and obesity. Subsequently, we performed an insilico analysis using the REVEL algorithm to detect pathogenic single nucleotide polymorphisms (SNPs) in the coding region of these candidate genes. To validate our findings in vivo, we conducted a comprehensive analysis of SNPs and gene expression of candidate genes in 200 obese infertile subjects and 240 obese fertile individuals using ARMS-PCR. Additionally, we analyzed 20 fertile and 22 infertile obese individuals using Realtime-qPCR. By removing duplicated queries, we obtained 197 obesity-related genes and 102 male infertility-related genes from the OMIM database. Interestingly, the APOB gene was found in common between the two datasets. REVEL identified the rs13306194 variant as potentially pathogenic with a calculated score of 0.524. The study identified a significant association between the AA (P value = 0.001) genotype and A allele (P value = 0.003) of the APOB rs13306194 variant and infertility in obese men. APOB expression levels were significantly lower in obese infertile men compared to obese fertile controls (p < 0.01). Moreover, the AA genotype of rs13306194 APOB was associated with a significant decrease in APOB gene expression in obese infertile men (p = 0.05). There is a significant association between the Waist-to-Hip Ratio (WHR) and LH with infertility in the obese infertile group. These results are likely to contribute to a better understanding of the causes of male infertility and its association with obesity.

Pregnancy Outcomes in Females with Stage 1 Hypertension and Elevated Blood Pressure Undergoing In Vitro Fertilization and Embryo Transfer

Objective: To determine whether stage 1 hypertension and elevated blood pressure (BP), as defined by the 2017 American College of Cardiology/American Heart Association (ACC/AHA) guidelines, prior to pregnancy contributes to adverse pregnancy outcomes in females who conceived by in vitro fertilization and embryo transfer (IVF-ET). Methods: This retrospective cohort study involved 2239 females who conceived by IVF-ET and delivered live neonates. BPs recorded before IVF-ET were collected. Elevated BP was defined as at least two systolic BPs of 120 to 129 mmHg. Stage 1 hypertension was defined as at least two systolic BPs of 130 to 139 mmHg or diastolic BPs of 80 to 89 mmHg. Results: Among the females included in this study, 18.5% (415/2239) had elevated BP and 10.0% (223/2239) had stage 1 hypertension. Multiple logistic regression analysis showed that females with stage 1 hypertension had higher risks of hypertensive disorders in pregnancy (HDP) [adjusted odds ratio (aOR) 1.65; 95% confidence interval (CI) 1.16-2.35] and preeclampsia (aOR 1.52; 95% CI 1.02-2.26) than normotensive females. However, the risks of HDP (aOR 0.88; 95% CI 0.64-1.21) and preeclampsia (aOR 0.83; 95% CI, 0.57-1.20) in females with elevated BP were not significantly different from those in normotensive females. The females were then categorized into five groups by systolic and diastolic BP; females with systolic BP of 130 to 139 mmHg or diastolic BP of 85 to 89 mmHg had significantly increased risks of HDP and preeclampsia. Conclusion: Stage 1 hypertension before IVF-ET was an independent risk factor for HDP and preeclampsia.

Placental histology and pregnancy complications following intracytoplasmic sperm injection for non-male factor infertility

PURPOSE

To assess obstetric outcomes and placental histology following intracytoplasmic sperm injection (ICSI), for non-male infertility.

METHODS

This was a retrospective cohort of live born singleton deliveries after in vitro fertilization (IVF) at a single university affiliated medical center between 2009 and 2017. Excluded were IVF cycles with male infertility and oocyte recipients. We compared obstetric outcomes and placental histology in cases ICSI was performed (ICSI group) and cases with no ICSI (IVF group).

RESULTS

A total of 400 deliveries following ICSI were compared to 218 in the IVF group. Maternal age was similar between the groups, while diminished ovarian reserve was more common among ICSI patients and tubal disease less common (p < 0.001). The rate of blastocyte transfer was also significantly lower in the ICSI group-67.5% vs. 77%, p = 0.01. Pregnancies following ICSI were characterized by similar rates of preeclampsia, preterm birth, and small for gestational age neonates. Although cesarean delivery rate was significantly higher in the group, this did no attain significance after adjustment for confounders. Placentas in the ICSI group were notable for a lower rate of villitis of unknown etiology (1% vs. 4.5%, p = 0.007) and a higher rate of maternal surface calcifications (33% vs. 23.8%, p = 0.01) after adjustment for confounders.

CONCLUSION

The employment of ICSI with no male indication is associated with similar obstetric outcomes. Despite isolated placental differences among many investigated, placental histology seems overall comparable as well. These results are reassuring to clinicians and patients.