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Liu C, Dou Y, Zhang M, Han S, Hu S, Li Y, Yu Z, Liu Y, Liang X, Chen ZJ, Zhao H, Zhang Y. High-fat and high-sucrose diet impairs female reproduction by altering ovarian transcriptomic and metabolic signatures. J Transl Med 2024; 22:145. [PMID: 38347623 PMCID: PMC10860219 DOI: 10.1186/s12967-024-04952-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 02/03/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Excessive energy intake in modern society has led to an epidemic surge in metabolic diseases, such as obesity and type 2 diabetes, posing profound threats to women's reproductive health. However, the precise impact and underlying pathogenesis of energy excess on female reproduction remain unclear. METHODS We established an obese and hyperglycemic female mouse model induced by a high-fat and high-sucrose (HFHS) diet, then reproductive phenotypes of these mice were evaluated by examing sexual hormones, estrous cycles, and ovarian morphologies. Transcriptomic and precise metabolomic analyses of the ovaries were performed to compare the molecular and metabolic changes in HFHS mice. Finally, orthogonal partial least squares discriminant analysis was performed to compare the similarities of traits between HFHS mice and women with polycystic ovary syndrome (PCOS). RESULTS The HFHS mice displayed marked reproductive dysfunctions, including elevated serum testosterone and luteinizing hormone levels, irregular estrous cycles, and impaired folliculogenesis, mimicking the clinical manifestations of women with PCOS. Precise metabolomic overview suggested that HFHS diet disrupted amino acid metabolism in the ovaries of female mice. Additionally, transcriptional profiling revealed pronounced disturbances in ovarian steroid hormone biosynthesis and glucolipid metabolism in HFHS mice. Further multi-omics analyses unveiled prominent aberration in ovarian arginine biosynthesis pathway. Notably, comparisons between HFHS mice and a cohort of PCOS patients identified analogous reproductive and metabolic signatures. CONCLUSIONS Our results provide direct in vivo evidence for the detrimental effects of overnutrition on female reproduction and offer insights into the metabolic underpinnings of PCOS.
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Affiliation(s)
- Congcong Liu
- Institute of Women, Children and Reproductive Health, Shandong University, Jinan, 250012, Shandong, China
- State Key Laboratory of Reproductive Medicine and Offspring Health, Shandong University, Jinan, 250012, Shandong, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, 250012, Shandong, China
| | - Yunde Dou
- Institute of Women, Children and Reproductive Health, Shandong University, Jinan, 250012, Shandong, China
- State Key Laboratory of Reproductive Medicine and Offspring Health, Shandong University, Jinan, 250012, Shandong, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, 250012, Shandong, China
| | - Mengge Zhang
- Institute of Women, Children and Reproductive Health, Shandong University, Jinan, 250012, Shandong, China
- State Key Laboratory of Reproductive Medicine and Offspring Health, Shandong University, Jinan, 250012, Shandong, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, 250012, Shandong, China
| | - Shan Han
- Institute of Women, Children and Reproductive Health, Shandong University, Jinan, 250012, Shandong, China
- State Key Laboratory of Reproductive Medicine and Offspring Health, Shandong University, Jinan, 250012, Shandong, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, 250012, Shandong, China
| | - Shourui Hu
- Institute of Women, Children and Reproductive Health, Shandong University, Jinan, 250012, Shandong, China
- State Key Laboratory of Reproductive Medicine and Offspring Health, Shandong University, Jinan, 250012, Shandong, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, 250012, Shandong, China
| | - Yuxuan Li
- Institute of Women, Children and Reproductive Health, Shandong University, Jinan, 250012, Shandong, China
- State Key Laboratory of Reproductive Medicine and Offspring Health, Shandong University, Jinan, 250012, Shandong, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, 250012, Shandong, China
| | - Zhiheng Yu
- Institute of Women, Children and Reproductive Health, Shandong University, Jinan, 250012, Shandong, China
- State Key Laboratory of Reproductive Medicine and Offspring Health, Shandong University, Jinan, 250012, Shandong, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, 250012, Shandong, China
| | - Yue Liu
- Institute of Women, Children and Reproductive Health, Shandong University, Jinan, 250012, Shandong, China
- State Key Laboratory of Reproductive Medicine and Offspring Health, Shandong University, Jinan, 250012, Shandong, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, 250012, Shandong, China
| | - Xiaofan Liang
- Institute of Women, Children and Reproductive Health, Shandong University, Jinan, 250012, Shandong, China
- State Key Laboratory of Reproductive Medicine and Offspring Health, Shandong University, Jinan, 250012, Shandong, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, 250012, Shandong, China
| | - Zi-Jiang Chen
- Institute of Women, Children and Reproductive Health, Shandong University, Jinan, 250012, Shandong, China
- State Key Laboratory of Reproductive Medicine and Offspring Health, Shandong University, Jinan, 250012, Shandong, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, 250012, Shandong, China
- Key Laboratory of Reproductive Endocrinology (Shandong University), Ministry of Education, Jinan, 250012, Shandong, China
- Shandong Technology Innovation Center for Reproductive Health, Jinan, 250012, Shandong, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012, Shandong, China
- Shandong Key Laboratory of Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250012, Shandong, China
- Research Unit of Gametogenesis and Health of ART-Offspring, Chinese Academy of Medical Sciences (No. 2021RU001), Jinan, 250012, Shandong, China
- Department of Reproductive Medicine, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200135, China
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, 200135, China
| | - Han Zhao
- Institute of Women, Children and Reproductive Health, Shandong University, Jinan, 250012, Shandong, China.
- State Key Laboratory of Reproductive Medicine and Offspring Health, Shandong University, Jinan, 250012, Shandong, China.
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, 250012, Shandong, China.
- Key Laboratory of Reproductive Endocrinology (Shandong University), Ministry of Education, Jinan, 250012, Shandong, China.
- Shandong Technology Innovation Center for Reproductive Health, Jinan, 250012, Shandong, China.
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012, Shandong, China.
- Shandong Key Laboratory of Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250012, Shandong, China.
- Research Unit of Gametogenesis and Health of ART-Offspring, Chinese Academy of Medical Sciences (No. 2021RU001), Jinan, 250012, Shandong, China.
| | - Yuqing Zhang
- Institute of Women, Children and Reproductive Health, Shandong University, Jinan, 250012, Shandong, China.
- State Key Laboratory of Reproductive Medicine and Offspring Health, Shandong University, Jinan, 250012, Shandong, China.
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, 250012, Shandong, China.
- Key Laboratory of Reproductive Endocrinology (Shandong University), Ministry of Education, Jinan, 250012, Shandong, China.
- Shandong Technology Innovation Center for Reproductive Health, Jinan, 250012, Shandong, China.
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012, Shandong, China.
- Shandong Key Laboratory of Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250012, Shandong, China.
- Research Unit of Gametogenesis and Health of ART-Offspring, Chinese Academy of Medical Sciences (No. 2021RU001), Jinan, 250012, Shandong, China.
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Zhang C, Wang WS, Yao G, Zhu Y, Lin Y, Lu J, Sun K, Sun Y. Attenuation of palmitic acid-induced lysyl oxidase overexpression in the ovary contributes to the improvement of ovulation in obesity by metformin. Hum Reprod Open 2024; 2024:hoae002. [PMID: 38333108 PMCID: PMC10850847 DOI: 10.1093/hropen/hoae002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 12/20/2023] [Indexed: 02/10/2024] Open
Abstract
STUDY QUESTION Does palmitic acid (PA), the most common saturated free fatty acid (FFA) in individuals with obesity, contribute to anovulation through upregulation of the collagen-crosslinking enzyme lysyl oxidase (LOX) in the ovary? SUMMARY ANSWER Increased PA in individuals with obesity can cause LOX upregulation via the activation of hypoxia-inducible factor-1α (HIF-1α), resulting in abnormal collagen deposition in the ovary and anovulation, which can be ameliorated by metformin therapy. WHAT IS KNOWN ALREADY The underlying cause of anovulation in individuals with obesity is poorly defined, and accumulating evidence indicates that hormonal disturbance, insulin resistance, and inflammation may all play a role in the development of ovulation disorders in individuals with obesity. However, it remains to be determined whether PA plays a role in the regulation of LOX expression, thus disrupting ovarian extracellular matrix (ECM) remodelling in the ovary and resulting in impaired ovulation in individuals with obesity. STUDY DESIGN SIZE DURATION PA concentration and LOX protein abundance and activity in follicular fluid and ovarian tissue were compared between control (n = 21) subjects, patients with obesity with ovulation (n = 22), and patients with obesity with anovulation (n = 16). The effect of PA on LOX protein expression, and the underlying mechanism, was examined in primary human granulosa cells in vitro. The improvements in obesity conditions induced by LOX inhibition combined with metformin were investigated in a high-fat diet-induced obese rat model. PARTICIPANTS/MATERIALS SETTING METHODS The abundance of PA concentration and LOX activity was measured via a LOX activity assay and ELISA, respectively. The effect of PA on LOX protein expression was examined in the presence or absence of inhibitors of signalling molecules and siRNA-mediated knockdown of the putative transcription factor. Chromatin immunoprecipitation assays were subsequently conducted to further identify the responsible transcription factor. The role of metformin in the treatment of anovulation by LOX inhibition was investigated in a high-fat diet (HFD)-induced obese rat model. The numbers of retrieved total oocytes and metaphase II oocytes were recorded upon ovarian stimulation. Masson's trichrome staining was used to measure the total collagen content, and immunohistochemical staining and western blotting were used to measure LOX, HIF-1α, and collagen I and IV in the ovary. MAIN RESULTS AND THE ROLE OF CHANCE Significantly increased FFA, LOX, and collagen abundance were observed in the ovaries of obese women with anovulation, compared to healthy controls or obese women with ovulation. In a HFD-induced obese rat model, metformin corrected the distortion of ovarian morphology by decreasing LOX and collagen protein abundance in the ovary and improving oestrous cyclicity and ovulation. PA increased LOX expression via the activation of HIF-1α in human granulosa cells, which was attenuated by metformin. LARGE SCALE DATA N/A. LIMITATIONS REASONS FOR CAUTION Several other saturated and polyunsaturated FFAs, such as stearic acid and arachidonic acid, are also increased in the blood of individuals with obesity, and increased levels of other FFAs may also contribute to the development of anovulation in individuals with obesity, which needs to be further verified in the future. WIDER IMPLICATIONS OF THE FINDINGS Elevated PA in individuals with obesity can cause LOX dysregulation via activation of HIF-1α, resulting in abnormal collagen deposition in the ovary and anovulation. This dysregulation can be ameliorated by metformin therapy through its local effect on ECM remodelling in the ovary, which is independent of its systemic effect on insulin sensitivity and chronic inflammation. STUDY FUNDING/COMPETING INTERESTS This work was supported by the National Natural Science Foundation of China (grant numbers 82101730, 82130046, and 31900598) and Innovative Research Team of High-level local Universities in Shanghai (SHSMU-ZLCX20210201). All the authors declare no conflicts of interest in relation to this work.
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Affiliation(s)
- Chuyue Zhang
- Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, China
| | - Wang-Sheng Wang
- Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, China
| | - Guangxin Yao
- Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, China
| | - Yanan Zhu
- Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Hubei, China
| | - Yikai Lin
- Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, China
| | - Jiangwen Lu
- Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, China
| | - Kang Sun
- Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, China
| | - Yun Sun
- Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, China
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Shaikh S, Srivastava G, Homburg R. Should women with high body mass index be denied fertility treatments? HUM FERTIL 2023; 26:1179-1184. [PMID: 37527665 DOI: 10.1080/14647273.2022.2152741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 02/26/2022] [Indexed: 08/03/2023]
Abstract
Obesity is an emerging global epidemic with a negative impact on fertility. Almost all guidelines and policies have a stringent limit of body mass index (BMI) to access fertility services which has promoted a debate amongst fertility practitioners globally. Proponents of placing such a limit point to the negative impact of elevated BMI on the outcome of fertility treatment, its cost effectiveness and the risk it poses to the intending mother and unborn child. Opponents of placing a restriction base their arguments on the lack of conclusive, robust evidence regarding the variables along with the ethical dilemmas of promoting discrimination and stigmatization by denying a couple their basic right of parenthood. In this review, we analyse these medical and ethical dilemmas in the light of current evidence. The focus is on female infertility.
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Affiliation(s)
- Sadaf Shaikh
- Homerton Fertility Centre, Homerton University Hospital, London, UK
| | | | - Roy Homburg
- Homerton Fertility Centre, Homerton University Hospital, London, UK
- Department of Reproductive Medicine, Queen Mary University of London, London, UK
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Kim H, Subramanian V, Baird F, Beebeejaun Y, Sarris I, Kamath MS, Sunkara SK. Effect of female body mass index on intrauterine insemination outcomes: a systematic review and meta-analysis. HUM FERTIL 2023; 26:1511-1518. [PMID: 38264836 DOI: 10.1080/14647273.2023.2287617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 10/26/2023] [Indexed: 01/25/2024]
Abstract
The prevalence of women with a raised body mass index (BMI) seeking assisted conception treatment is increasing. Findings of existing studies evaluating the effect of female BMI on intrauterine insemination (IUI) treatment outcomes remain inconsistent. This systematic review and meta-analysis evaluate the effect of female BMI on IUI treatment outcomes. Two authors independently conducted data extraction and assessed study quality. Risk ratios (RR) and 95% confidence intervals were calculated using the Mantel-Haenszel approach for dichotomous outcomes. 11 studies involving 23,145 IUI treatment events, comprising 21,211 cycles from 8 studies, and 1,934 participants in three studies, met the inclusion criteria for the meta-analysis. Two cohorts of women undergoing IUI treatment were compared - women with normal BMI < 25 kg/m2 were compared with a second cohort of women with a BMI category ≥ 25 kg/m2. There was no statistically significant difference in live birth rate (LBR) (RR 1.06, 95% CI 0.86-1.307); clinical pregnancy rate (CPR) (RR 0.94, 95% CI 0.78-1.13); miscarriage (RR 0.92, 95% CI 0.31-2.74) or ectopic pregnancy rate (RR 2.20, 95% CI 0.78-6.23). Our meta-analysis showed that a raised female BMI did not affect IUI treatment outcomes. Nevertheless, weight loss counselling should be offered to women with a raised BMI undergoing IUI, to reduce the associated obstetric morbidity.
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Affiliation(s)
- Haeun Kim
- School of Medicine, King's Fertility, King's College London, London, UK
| | | | - Freya Baird
- School of Medicine, King's Fertility, King's College London, London, UK
| | - Yusuf Beebeejaun
- School of Medicine, King's Fertility, King's College London, London, UK
| | | | - Mohan S Kamath
- Department of Reproductive Medicine and Surgery, Christian Medical College, Vellore, India
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Kuang J, Sun S, Ke F. The effects of exercise intervention on complications and pregnancy outcomes in pregnant women with overweight or obesity: A systematic review and meta-analysis. Medicine (Baltimore) 2023; 102:e34804. [PMID: 37800765 PMCID: PMC10553027 DOI: 10.1097/md.0000000000034804] [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] [Received: 12/03/2022] [Accepted: 07/27/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Being overweight or obese is closely related to adverse pregnancy outcomes and harms both pregnant women and neonates, increasing complications during pregnancy and leading to adverse pregnancy outcomes. Consequently, a meta-analysis was done to investigate exercise therapy impact on the complications and outcomes of pregnant women who are obese or overweight. MATERIALS AND METHODS The computer system searched PubMed, Cochrane Library, Wanfang, EMBASE, and CNKI databases. The search duration extended from the database establishment until October 2022. A thorough search was carried out for pertinent studies investigating exercise therapy impact on pregnancy complications and outcomes in obese or overweight pregnant women. The heterogeneity test was carried out using Cochrane Q and Chi-square tests. The combined findings from the meta-analysis were examined for reliability and robustness using sensitivity and publication bias analyses. All statistics used RevMan 5.3 software. RESULTS This meta-analysis included data from 8026 patients from 22 randomized controlled trials. The results demonstrated that exercise therapy might successfully decrease the incidence of gestational diabetes mellitus (GDM) (odds ratio [OR] = 0.85, 95% confidence interval [CI]: 0.74-0.96, P = .01) and macrosomia (OR = 0.78, 95% CI: 0.68-0.89, P < .001), and control weight gain during pregnancy (SMD = -0.2, 95% CI: -0.31 to -0.08, P < .001). CONCLUSIONS Exercise therapy can control weight gain during pregnancy, lower the incidence of GDM and the macrosomia rate, and improve adverse pregnancy outcomes.
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Affiliation(s)
- Jun Kuang
- Department of Obstetrics and Gynecology, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, Hubei, China
| | - Suwen Sun
- Department of Obstetrics and Gynecology, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, Hubei, China
| | - Fengmei Ke
- Department of Obstetrics and Gynecology, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, Hubei, China
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A Multi-Ingredient Supplement Protects against Obesity and Infertility in Western Diet-Fed Mice. Nutrients 2023; 15:nu15030611. [PMID: 36771318 PMCID: PMC9921271 DOI: 10.3390/nu15030611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 01/17/2023] [Accepted: 01/20/2023] [Indexed: 01/26/2023] Open
Abstract
The Western diet (WD) predisposes to bodyweight gain and obesity and is linked to mitochondrial dysfunction, oxidative damage, inflammation, and multisystem disease, even affecting the reproductive organs, fertility, and pregnancy outcomes. In this study, we investigated the effects of multi-ingredient supplementation (MIS) with antioxidants, phytonutrients, and vitamins ('Fertility Enhancer'; FE) on white adipose tissue (WAT) expansion, nonalcoholic fatty liver disease (NAFLD), and infertility in WD-fed C57BL/6J mice. Five-month-old male (M) and female (F) mice were fed a low-fat diet (LF) or a high fat/sucrose WD (HF) for six weeks, followed by six weeks of LF (3.64 kcal/g), HF (4.56 kcal/g), or HF combined with FE (4.50 kcal/g). A sub-set of animals were sacrificed at 12 weeks, while the remainder were harem-mated in a 1:2 male-to-female ratio, and singly housed during the gestational period. Two-way, factorial ANOVA analysis revealed a main effect of diet on bodyweight (BW), total body fat, % body fat, white adipose tissue mass, and liver lipid content (all p < 0.001), driven by the anti-obesogenic effects of the 'Fertility Enhancer'. Similarly, a main effect of diet was found on PGC1-α mRNA levels (p < 0.05) and mitochondrial protein content (p < 0.001) in perigonadal WAT, with PGC1-α induction and higher complex II and complex III expression in FE vs. HF animals. Copulatory plug counts were higher in FE vs. HE couples (30% vs. 6%), resulting in more litters (4 vs. 0) and higher copulatory success (67% vs. 0%). Although the trends of all histology outcomes were suggestive of a benefit from the FE diet, only the number of atretic follicles and testicular mass were significant. Ovarian IL-1β mRNA induction was significantly attenuated in the FE group (p < 0.05 vs. HF) with CASP1 attenuation trending lower (p = 0.09 vs. HF), which is indicative of anti-inflammatory benefits of the 'Fertility Enhancer.' We conclude that supplementation with specific phytonutrients, antioxidants, and vitamins may have utility as an adjunctive therapy for weight management, fatty liver disease, and infertility in overweight and obese couples.
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Leroy JLMR, Meulders B, Moorkens K, Xhonneux I, Slootmans J, De Keersmaeker L, Smits A, Bogado Pascottini O, Marei WFA. Maternal metabolic health and fertility: we should not only care about but also for the oocyte! Reprod Fertil Dev 2022; 35:1-18. [PMID: 36592978 DOI: 10.1071/rd22204] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Metabolic disorders due to obesity and unhealthy lifestyle directly alter the oocyte's microenvironment and impact oocyte quality. Oxidative stress and mitochondrial dysfunction play key roles in the pathogenesis. Acute effects on the fully grown oocytes are evident, but early follicular stages are also sensitive to metabolic stress leading to a long-term impact on follicular cells and oocytes. Improving the preconception health is therefore of capital importance but research in animal models has demonstrated that oocyte quality is not fully recovered. In the in vitro fertilisation clinic, maternal metabolic disorders are linked with disappointing assisted reproductive technology results. Embryos derived from metabolically compromised oocytes exhibit persistently high intracellular stress levels due to weak cellular homeostatic mechanisms. The assisted reproductive technology procedures themselves form an extra burden for these defective embryos. Minimising cellular stress during culture using mitochondrial-targeted therapy could rescue compromised embryos in a bovine model. However, translating such applications to human in vitro fertilisation clinics is not simple. It is crucial to consider the sensitive epigenetic programming during early development. Research in humans and relevant animal models should result in preconception care interventions and in vitro strategies not only aiming at improving fertility but also safeguarding offspring health.
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Affiliation(s)
- J L M R Leroy
- Gamete Research Centre, Department of Veterinary Sciences, University of Antwerp, Wilrijk, Belgium
| | - B Meulders
- Gamete Research Centre, Department of Veterinary Sciences, University of Antwerp, Wilrijk, Belgium
| | - K Moorkens
- Gamete Research Centre, Department of Veterinary Sciences, University of Antwerp, Wilrijk, Belgium
| | - I Xhonneux
- Gamete Research Centre, Department of Veterinary Sciences, University of Antwerp, Wilrijk, Belgium
| | - J Slootmans
- Gamete Research Centre, Department of Veterinary Sciences, University of Antwerp, Wilrijk, Belgium
| | - L De Keersmaeker
- Gamete Research Centre, Department of Veterinary Sciences, University of Antwerp, Wilrijk, Belgium
| | - A Smits
- Gamete Research Centre, Department of Veterinary Sciences, University of Antwerp, Wilrijk, Belgium
| | - O Bogado Pascottini
- Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - W F A Marei
- Gamete Research Centre, Department of Veterinary Sciences, University of Antwerp, Wilrijk, Belgium
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Dornelles VC, Hentschke MR, Badalotti M, Telöken IB, Trindade VD, Cunegatto B, de Vasconcelos NF, da Costa BEP, Petracco A, Padoin AV. The impact of body mass index on laboratory, clinical outcomes and treatment costs in assisted reproduction: a retrospective cohort study. BMC Womens Health 2022; 22:479. [PMID: 36443765 PMCID: PMC9703707 DOI: 10.1186/s12905-022-02036-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/29/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate the influence of the body mass index (BMI) on laboratory, clinical outcomes and treatment costs of assisted reproduction, as there are still controversial and inconclusive studies on this subject. METHODS This research was retrospective cohort study, including women undergoing assisted reproduction in a Reproductive Medicine Center between 2013 and 2020. The participants were divided into groups according to BMI (kg/m2): Group 1 < 25; Group 2, 25-29.9 and Group 3, ≥ 30. A total of 1753 in vitro fertilization (IVF) fresh embryo transfer (ET) cycles were included for assisted reproduction outcomes analysis and 1869 IVF-ET plus frozen embryo transfer (FET) for cumulative pregnancy analysis. RESULTS As higher the BMI, higher was the proportion of canceled IVF cycles (G1 (6.9%) vs. G2 (7.8%) vs. G3 (10.4%), p = 0.002) and gonadotropin's total dose (IU) and treatment costs (G1 (1685 ± 595, U$ 683,02) vs. G2 (1779 ± 610, U$ 721,13) vs. G3 (1805 ± 563, U$ 764,09), p = 0.001). A greater number of mature oocytes was observed in G1 and G2 (6 [6.4-7.0] vs. 6 [5.6-6.6] vs. 4 [4.6-6.7], p = 0.011), which was not found in oocyte maturity rate (p = 0.877). A significant linear tendency (p = 0.042) was found in cumulative pregnancy rates, pointing to worse clinical outcomes in overweight and obese patients. CONCLUSION These findings highlight the importance of considering the higher treatment costs for these patients, beyond all the well-known risks regarding weight excess, fertility, and pregnancy, before starting IVF treatments.
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Affiliation(s)
- Victoria Campos Dornelles
- Fertilitat - Reproductive Medicine Center, Rua Gomes Jardim, 201 Torre Norte 15º andar - Santana, Porto Alegre, Rio Grande do Sul 91530-001 Brazil ,grid.412519.a0000 0001 2166 9094Graduate Program in Medicine and Health Sciences - School of Medicine, Pontifical Catholic University of Rio Grande do Sul, PUCRS, Av. Ipiranga, 6681, Prédio 12A Partenon, Porto Alegre, Rio Grande do Sul 90619-900 Brazil
| | - Marta Ribeiro Hentschke
- Fertilitat - Reproductive Medicine Center, Rua Gomes Jardim, 201 Torre Norte 15º andar - Santana, Porto Alegre, Rio Grande do Sul 91530-001 Brazil
| | - Mariangela Badalotti
- Fertilitat - Reproductive Medicine Center, Rua Gomes Jardim, 201 Torre Norte 15º andar - Santana, Porto Alegre, Rio Grande do Sul 91530-001 Brazil
| | - Isadora Badalotti Telöken
- Fertilitat - Reproductive Medicine Center, Rua Gomes Jardim, 201 Torre Norte 15º andar - Santana, Porto Alegre, Rio Grande do Sul 91530-001 Brazil
| | - Vanessa Devens Trindade
- Fertilitat - Reproductive Medicine Center, Rua Gomes Jardim, 201 Torre Norte 15º andar - Santana, Porto Alegre, Rio Grande do Sul 91530-001 Brazil
| | - Bibiana Cunegatto
- Fertilitat - Reproductive Medicine Center, Rua Gomes Jardim, 201 Torre Norte 15º andar - Santana, Porto Alegre, Rio Grande do Sul 91530-001 Brazil
| | - Natália Fontoura de Vasconcelos
- Fertilitat - Reproductive Medicine Center, Rua Gomes Jardim, 201 Torre Norte 15º andar - Santana, Porto Alegre, Rio Grande do Sul 91530-001 Brazil
| | - Bartira Ercília Pinheiro da Costa
- grid.412519.a0000 0001 2166 9094Graduate Program in Medicine and Health Sciences - School of Medicine, Pontifical Catholic University of Rio Grande do Sul, PUCRS, Av. Ipiranga, 6681, Prédio 12A Partenon, Porto Alegre, Rio Grande do Sul 90619-900 Brazil
| | - Alvaro Petracco
- Fertilitat - Reproductive Medicine Center, Rua Gomes Jardim, 201 Torre Norte 15º andar - Santana, Porto Alegre, Rio Grande do Sul 91530-001 Brazil
| | - Alexandre Vontobel Padoin
- grid.412519.a0000 0001 2166 9094Graduate Program in Medicine and Health Sciences - School of Medicine, Pontifical Catholic University of Rio Grande do Sul, PUCRS, Av. Ipiranga, 6681, Prédio 12A Partenon, Porto Alegre, Rio Grande do Sul 90619-900 Brazil
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9
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Lean SC, Candia AA, Gulacsi E, Lee GCL, Sferruzzi-Perri AN. Obesogenic diet in mice compromises maternal metabolic physiology and lactation ability leading to reductions in neonatal viability. Acta Physiol (Oxf) 2022; 236:e13861. [PMID: 35880402 PMCID: PMC9787084 DOI: 10.1111/apha.13861] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/12/2022] [Accepted: 07/20/2022] [Indexed: 01/29/2023]
Abstract
AIMS Diets containing high-fat and high sugar (HFHS) lead to overweight/obesity. Overweight/obesity increases the risk of infertility, and of the pregnant mother and her child for developing metabolic conditions. Overweight/obesity has been recreated in mice, but most studies focus on the effects of chronic, long-term HFHS diet exposure. Here, we exposed mice to HFHS from 3 weeks prior to pregnancy with the aim of determining impacts on fertility, and gestational and neonatal outcomes. METHODS Time-domain NMR scanning was used to assess adiposity, glucose, and insulin tolerance tests were employed to examine metabolic physiology, and morphological and proteomic analyses conducted to assess structure and nutrient levels of maternal organs and placenta. RESULTS Fertility measures of HFHS dams were largely the same as controls. HFHS dams had increased adiposity pre-pregnancy, however, exhibited exacerbated lipolysis/hyper-mobilization of adipose stores in late pregnancy. While there were no differences in glucose or insulin tolerance, HFHS dams were hyperglycemic and hyperinsulinemic in pregnancy. HFHS dams had fatty livers and altered pancreatic islet morphology. Although fetuses were hyperglycemic and hyperinsulinemic, there was no change in fetal growth in HFHS dams. There were also reductions in placenta formation. Moreover, there was increased offspring loss during lactation, which was related to aberrant mammary gland development and milk protein composition in HFHS dams. CONCLUSIONS These findings are relevant given current dietary habits and the development of maternal and offspring alterations in the absence of an increase in maternal weight and adiposity during pregnancy, which are the current clinical markers to determine risk across gestation.
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Affiliation(s)
- Samantha C Lean
- Centre for Trophoblast Research, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
| | - Alejandro A Candia
- Centre for Trophoblast Research, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK.,Department for the Woman and Newborn Health Promotion, Universidad de Chile, Santiago, Chile
| | - Edina Gulacsi
- Centre for Trophoblast Research, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
| | - Giselle C L Lee
- Centre for Trophoblast Research, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
| | - Amanda N Sferruzzi-Perri
- Centre for Trophoblast Research, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
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Gorczyca AM, Steger FL, Ptomey LT, Montgomery RN, Mickelsen R, Smith P, Donnelly JE, Marsh CA. The impact of a group based, remotely delivered weight loss intervention in women with polycystic ovary syndrome on ovulation, quality of life and body composition. FRONTIERS IN REPRODUCTIVE HEALTH 2022; 4:940945. [PMID: 36303658 PMCID: PMC9580823 DOI: 10.3389/frph.2022.940945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 07/04/2022] [Indexed: 11/22/2022] Open
Abstract
Background Obesity and visceral adiposity are associated with anovulation. The most common cause of anovulatory infertility in women of reproductive age is polycystic ovary syndrome (PCOS). We conducted this formative study to examine the effects of a remotely delivered, group-based lifestyle program for women with overweight/obesity and PCOS on ovulation, PCOS related quality of life (PCOSQ) and body composition. Methods Women with anovulatory infertility caused by PCOS (N = 12) were enrolled in a 6-month high-intensity weight management intervention. Participants were asked to attend 45 min., group behavioral lifestyle sessions, delivered remotely by a registered dietitian weekly across the 6-mo. study and comply with a reduced energy diet, increased physical activity (225 min/wk.), and self-monitoring of weight, physical activity and diet. Diets consisted of five portion-controlled meals (three shakes + two entrees), at least five servings of fruits/vegetables, and ad libitum non-caloric beverages daily. Wilcoxon signed-rank tests were used to assess changes in outcomes across the intervention. Results Twelve women received the weight loss intervention (mean age = 32.7 ± 4.2 yrs., BMI = 36.8 ± 4.5 kg/m2, 92% college educated), and 8 completed the intervention. Eight (67%) women reported ovulating during the intervention with an average time to ovulation of 57 ± 45 days. Women lost an average of 3.85 ± 5.94 kg (p = 0.02), decreased their BMI (−1.61 ± 1.09 kg/m2; p = 0.04), and waist circumference (−4.54 ± 3.03 cm; p = 0.04) over the 6-mo. intervention. Additionally, self-reported menstrual problems measured by PCOSQ significantly improved over the study (p = 0.03). Conclusion A multicomponent group-based, remotely delivered, lifestyle intervention delivered remotely is a feasible and potentially scalable option to achieve clinically relevant (>3%) weight loss in women with PCOS. Clinical trial registration www.clinicaltrials.gov, identifier: NCT03677362.
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Affiliation(s)
- Anna M. Gorczyca
- Division of Physical Activity and Weight Management, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, MO, United States
- *Correspondence: Anna M. Gorczyca
| | - Felicia L. Steger
- Division of Endocrinology, Diabetes and Clinical Pharmacology, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, MO, United States
| | - Lauren T. Ptomey
- Division of Physical Activity and Weight Management, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, MO, United States
| | - Robert N. Montgomery
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, MO, United States
| | - Riley Mickelsen
- Department of Obstetrics and Gynecology, Center for Advanced Reproductive Medicine, University of Kansas Medical Center, Kansas City, MO, United States
| | - Patricia Smith
- Division of Physical Activity and Weight Management, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, MO, United States
| | - Joseph E. Donnelly
- Division of Physical Activity and Weight Management, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, MO, United States
| | - Courtney A. Marsh
- Department of Obstetrics and Gynecology, Center for Advanced Reproductive Medicine, University of Kansas Medical Center, Kansas City, MO, United States
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11
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The Success of Ovulation Induction with Letrozole and Gonadotropins in Obese and Nonobese Women: A Study from a Tertiary Center. Int J Reprod Med 2022; 2022:1931716. [PMID: 35756974 PMCID: PMC9232370 DOI: 10.1155/2022/1931716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 05/02/2022] [Accepted: 06/08/2022] [Indexed: 12/03/2022] Open
Abstract
Background Letrozole, an aromatase inhibitor, is suggested as a first-line drug for ovulation induction in women with polycystic ovary syndrome (PCOS) especially in obese women. Letrozole has also been used in women with unexplained infertility with similar rates of success to clomiphene. However, literature on letrozole and gonadotropins in obese and nonobese women is sparse. Hence, this study was done to assess the success of ovulation induction (OI) with letrozole plus follicle stimulating hormone (FSH) in obese (BMI ≥ 30 kg/m2) and nonobese women (BMI < 30 kg/m2). Methods A retrospective descriptive cohort study was conducted involving 135 women who underwent OI with letrozole plus follicle stimulating hormone therapy and either timed intercourse or intrauterine insemination. The data was collected from the hospital information system, including the age, body mass index, the type of infertility, number of induction cycles with letrozole, number of gonadotropin injections, and the pregnancy occurrence following treatment. SPSS was used to analyze the data. Results There were 135 women who used FSH injections along with letrozole. Of this, 28.5% obese women got pregnant compared to 29.2% nonobese women, but this did not attain statistical significance (P = 0.75). About 70% of obese women and 57% on nonobese women had polycystic ovarian syndrome. The median number of FSH injections was six, and the interquartile range was 3 to 11. Conclusion Of the 135 women undergoing letrozole and FSH, there was almost an equal probability of pregnancy in the obese group (BMI ≥ 30 kg/m2) and nonobese women.
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12
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Chen MX, Meng XQ, Zhong ZH, Tang XJ, Li T, Feng Q, Adu-Gyamfi EA, Jia Y, Lv XY, Geng LH, Zhu L, He W, Wan Q, Ding YB. An Individualized Recommendation for Controlled Ovary Stimulation Protocol in Women Who Received the GnRH Agonist Long-Acting Protocol or the GnRH Antagonist Protocol: A Retrospective Cohort Study. Front Endocrinol (Lausanne) 2022; 13:899000. [PMID: 35937797 PMCID: PMC9355571 DOI: 10.3389/fendo.2022.899000] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 06/17/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The GnRH agonist long-acting protocol and GnRH antagonist protocol are widely used in ovarian stimulation. Which protocol eliciting higher live birth rate for IVF/ICSI patients with different ages, different ovarian reserves and different body mass index (BMI) has not been studied. However, among these protocols, the one that elicits higher live birth in IVF/ICSI patients with different ages, ovarian reserves and body mass indexes (BMI) has not been identified. METHODS This was a retrospective cohort study about 8579 women who underwent the first IVF-ET from January, 2018 to August, 2021. Propensity Score Matching (PSM) was used to improve the comparability between two protocols. RESULTS After PSM, significant higher live birth rates were found in the GnRH agonist long-acting protocol compared to GnRH antagonist protocol (44.04% vs. 38.32%) (p<0.001). Stratified analysis showed that for those with AMH levels between 3 ng/ml and 6 ng/ml, with BMI ≥ 24 kg/m2 and were aged ≥ 30 years old, and for those women with BMI < 24kg/m2 and were aged ≥30 years whose AMH levels were ≤ 3ng/ml, the GnRH agonist long-acting protocol was more likely to elicit live births [OR (95%CI), 2.13(1.19,3.80)], [OR (95%CI), 1.41(1.05,1.91)]. However, among women with BMI ≥ 24kg/m2 and were aged ≥30 years whose AMH levels were ≤ 3ng/ml, the GnRH agonist long-acting protocol had a lower possibility of eliciting live births [OR (95%CI), 0.54(0.32,0.90)]. Also, among women with AMH levels between 3 ng/ml and 6 ng/ml, with BMI ≥ 24 kg/m2 and with age < 30 years and for those with AMH levels between 3 ng/ml and 6 ng/ml, regardless of age, and with BMI<24kg/m2,, the possibility of live births was similar between the two protocols [OR (95%CI), 1.06(0.60,1.89)], [OR (95%CI), 1.38(0.97,1.97)], [OR (95%CI), 0.99(0.72,1.37)]. Among the women with AMH levels ≤ 3 ng/ml and with were aged < 30years, regardless of BMI, the possibility of live birth was similar between the two protocols [OR (95%CI), 1.02(0.68,1.54)], [OR (95%CI), 1.43(0.68,2.98)]. Moreover, among women with AMH levels ≥ 6ng/ml, the possibility of live birth was similar between the two protocols [OR (95%CI),1.42(0.75,2.69)], [OR (95%CI),1.02(0.19,5.35)], [OR (95%CI), 1.68(0.81,3.51)], [OR (95%CI), 0.51(0.10,2.55)]. CONCLUSIONS The suitability of the GnRH agonist long-acting protocol or GnRH antagonist protocol to infertility patients is dependent on specific biological characteristics of the patients.
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Affiliation(s)
- Ming-Xing Chen
- Department of Obstetrics and Gynecology, Women and Children’s Hospital of Chongqing Medical University, Chongqing, China
- Joint International Research Laboratory of Reproduction and Development of the Ministry of Education of China, School of Public Health, Chongqing, China
| | - Xiang-Qian Meng
- Reproductive Medical Center, Chengdu Xinan Gynecological Hospital, Chengdu, China
| | - Zhao-Hui Zhong
- Department of Obstetrics and Gynecology, Women and Children’s Hospital of Chongqing Medical University, Chongqing, China
- Department of Epidemiology, School of Public Health and Management, Research Center for Medicine and Social Development, Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, China
| | - Xiao-Jun Tang
- Department of Epidemiology, School of Public Health and Management, Research Center for Medicine and Social Development, Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, China
| | - Tian Li
- The Department of Reproductive Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qian Feng
- Department of Gynecology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Enoch Appiah Adu-Gyamfi
- Joint International Research Laboratory of Reproduction and Development of the Ministry of Education of China, School of Public Health, Chongqing, China
| | - Yan Jia
- Infertility and Infertility Center, Chengdu Jinjiang Hospital for Women‘s and Children’s Health, Chengdu, China
| | - Xing-Yu Lv
- Reproductive Medical Center, Chengdu Xinan Gynecological Hospital, Chengdu, China
| | - Li-Hong Geng
- Infertility and Infertility Center, Chengdu Jinjiang Hospital for Women‘s and Children’s Health, Chengdu, China
| | - Lin Zhu
- Reproductive Medical Center, Southwest Hospital, Army Medical University, Third Military Medical University, Chongqing, China
| | - Wei He
- Reproductive Medical Center, Southwest Hospital, Army Medical University, Third Military Medical University, Chongqing, China
- *Correspondence: Wei He, ; Qi Wan, ; Yu-Bin Ding,
| | - Qi Wan
- Reproductive Medical Center, Chengdu Xinan Gynecological Hospital, Chengdu, China
- *Correspondence: Wei He, ; Qi Wan, ; Yu-Bin Ding,
| | - Yu-Bin Ding
- Department of Obstetrics and Gynecology, Women and Children’s Hospital of Chongqing Medical University, Chongqing, China
- Joint International Research Laboratory of Reproduction and Development of the Ministry of Education of China, School of Public Health, Chongqing, China
- *Correspondence: Wei He, ; Qi Wan, ; Yu-Bin Ding,
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van der Windt M, Schoenmakers S, Willemsen S, van Rossem L, Steegers-Theunissen R. Optimizing the Periconception Lifestyle of Women With Overweight Using a Blended Personalized Care Intervention Combining eHealth and Face-to-face Counseling (eFUSE): Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2021; 10:e28600. [PMID: 34477561 PMCID: PMC8449297 DOI: 10.2196/28600] [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: 03/08/2021] [Revised: 06/11/2021] [Accepted: 06/14/2021] [Indexed: 01/23/2023] Open
Abstract
Background Maternal overweight has a substantial impact on reproductive, maternal, pregnancy, and neonatal outcomes with long-term and transgenerational health consequences. Interventions that aim to optimize periconception maternal lifestyle can improve maternal and fetal health during pregnancy and throughout the life course. However, it remains difficult to change and adopt adequate lifestyle behaviors. We hypothesize that additional psychological therapy targeting cognitive and affective factors substantially contribute to the effectiveness of these interventions. Objective The proposed study aims to examine the feasibility and effectiveness of a blended personalized periconception lifestyle care intervention with additional psychological therapy aimed at women with a BMI≥25 and who are contemplating pregnancy or are already pregnant (≤12 weeks) in reducing inadequate lifestyle behaviors and improving early and late pregnancy outcome. Methods The eHealth and Face-to-face Counseling (eFUSE) study follows a single-center two-arm randomized controlled trial design at the Erasmus MC, University Medical Center, with a multicenter regional referral. The female patients with overweight (BMI≥25), together with their male partner, will be stratified by pregnancy status (preconception vs pregnant) and randomized to receive either the blended personalized periconception lifestyle care intervention with additional psychological therapy (n=313) or usual care (n=313). The primary outcome is a change in the lifestyle risk score (between baseline and 24 weeks) between the randomization arms (difference in differences). Secondary outcomes include measurements defined as most relevant by the International Consortium for Health Outcomes Measurement, including behavioral determinants, patient satisfaction, provider feasibility, and maternal pregnancy and neonatal complications. Results The study will be open for recruitment from Fall 2021 onward. Data collection is expected to be completed by the beginning of 2023, and the results are expected to be published by Fall 2023. Conclusions This study will evaluate the feasibility and effectiveness of a blended periconception lifestyle intervention with additional psychological therapy, aimed at women with a BMI≥25. Positive results of this innovative care approach will be used for implementation in routine medical care of all women with overweight, with the ultimate aim to improve clinical outcomes of these high-risk pregnancies. Trial Registration Netherlands Trial Register NL9264; https://www.trialregister.nl/trial/9264 International Registered Report Identifier (IRRID) PRR1-10.2196/28600
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Affiliation(s)
- Melissa van der Windt
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Sam Schoenmakers
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Sten Willemsen
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Lenie van Rossem
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, Netherlands
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Mandelbaum RS, Bainvoll L, Violette CJ, Smith MB, Matsuzaki S, Klar M, Ho JR, Bendikson KA, Paulson RJ, Matsuo K. The influence of obesity on incidence of complications in patients hospitalized with ovarian hyperstimulation syndrome. Arch Gynecol Obstet 2021; 305:483-493. [PMID: 34241687 DOI: 10.1007/s00404-021-06124-5] [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: 12/03/2020] [Accepted: 06/12/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To study the impact of body habitus on risk of complications resulting from ovarian hyperstimulation syndrome (OHSS) in hospitalized patients. METHODS This is a retrospective observational study examining the National Inpatient Sample between January 2012 and September 2015. Patients were women < 50 years of age diagnosed with OHSS, classified as non-obese, class I-II obesity, or class III obesity. Intervention included multinomial logistic regression to identify factors associated with obesity and binary logistic regression for independent risk factors for complications. Main outcome measures were incidence of (i) any or (ii) multiple complication(s). RESULTS Of 2745 women hospitalized with OHSS, 2440 (88.9%) were non-obese, 155 (5.6%) had class I-II obesity, and 150 (5.5%) had class III obesity. Obese women (either class I-II or III) had a higher degree of comorbidity, had lower incomes, and were less likely to have private insurance than non-obese women (all P < 0.001). Obese women had lower rates of OHSS-related complications than non-obese women (any complication: non-obese 65.2%, class I-II 54.8%, and class III 46.7%, P < 0.001; and multiple complications: non-obese 38.5%, class I-II 32.3%, and class III 20.0%, P < 0.001). In the multivariable model, obesity remained independently associated with a decreased risk of complications (class I-II odds ratio 0.57, 95% confidence interval 0.39-0.83, P = 0.003; class III odds ratio 0.30, 95% confidence interval 0.20-0.44, P < 0.001). Obese women were also less likely to require paracentesis (non-obese 32.8%, class I-II 9.7%, and class III 13.3%, P < 0.001). CONCLUSION Our study suggests that obesity is associated with decreased OHSS-related complication rates in hospitalized patients.
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Affiliation(s)
- Rachel S Mandelbaum
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, 2020 Zonal Avenue, IRD 520, Los Angeles, CA, 90033, USA.,Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Liat Bainvoll
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Caroline J Violette
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, 2020 Zonal Avenue, IRD 520, Los Angeles, CA, 90033, USA.,Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Meghan B Smith
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Shinya Matsuzaki
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, 2020 Zonal Avenue, IRD 520, Los Angeles, CA, 90033, USA
| | - Maximilian Klar
- Department of Obstetrics and Gynecology, University of Freiburg, Freiburg, Germany
| | - Jacqueline R Ho
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Kristin A Bendikson
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Richard J Paulson
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, 2020 Zonal Avenue, IRD 520, Los Angeles, CA, 90033, USA. .,Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA.
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15
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Grzegorczyk-Martin V, Fréour T, De Bantel Finet A, Bonnet E, Merzouk M, Roset J, Roger V, Cédrin-Durnerin I, Wainer R, Avril C, Landais P. IVF outcomes in patients with a history of bariatric surgery: a multicenter retrospective cohort study. Hum Reprod 2021; 35:2755-2762. [PMID: 33083823 PMCID: PMC7744158 DOI: 10.1093/humrep/deaa208] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/13/2020] [Indexed: 02/06/2023] Open
Abstract
STUDY QUESTION How does a history of dramatic weight loss linked to bariatric surgery impact IVF outcomes? SUMMARY ANSWER Women with a history of bariatric surgery who had undergone IVF had a comparable cumulative live birth rate (CLBR) to non-operated patients of the same BMI after the first IVF cycle. WHAT IS KNOWN ALREADY In the current context of increasing prevalence of obesity in women of reproductive age, weight loss induced by bariatric surgery has been shown to improve spontaneous fertility in obese women. However, little is known on the clinical benefit of bariatric surgery in obese infertile women undergoing IVF. STUDY DESIGN, SIZE, DURATION This exploratory retrospective multicenter cohort study was conducted in 10 287 IVF/ICSI cycles performed between 2012 and 2016. We compared the outcome of the first IVF cycle in women with a history of bariatric surgery to two age-matched groups composed of non-operated women matched on the post-operative BMI of cases, and non-operated severely obese women. PARTICIPANTS/MATERIALS, SETTING, METHODS The three exposure groups of age-matched women undergoing their first IVF cycle were compared: Group 1: 83 women with a history of bariatric surgery (exposure, mean BMI 28.9 kg/m2); Group 2: 166 non-operated women (non-exposed to bariatric surgery, mean BMI = 28.8 kg/m2) with a similar BMI to Group 1 at the time of IVF treatment; and Group 3: 83 non-operated severely obese women (non-exposed to bariatric surgery, mean BMI = 37.7 kg/m2). The main outcome measure was the CLBR. Secondary outcomes were the number of mature oocytes retrieved and embryos obtained, implantation and miscarriage rates, live birth rate per transfer as well as birthweight. MAIN RESULTS AND THE ROLE OF CHANCE No significant difference in CLBR between the operated Group 1 patients and the two non-operated Groups 2 and 3 was observed (22.9%, 25.9%, and 12.0%, in Groups 1, 2 and 3, respectively). No significant difference in average number of mature oocytes and embryos obtained was observed among the three groups. The implantation rates were not different between Groups 1 and 2 (13.8% versus 13.7%), and although lower (6.9%) in obese women of Group 3, this difference was not statistically significant. Miscarriage rates in Groups 1, 2 and 3 were 38.7%, 35.8% and 56.5%, respectively (P = 0.256). Live birth rate per transfer in obese patients was significantly lower compared to the other two groups (20%, 18%, 9.3%, respectively, in Groups 1, 2 and 3, P = 0.0167). Multivariate analysis revealed that a 1-unit lower BMI increased the chances of live birth by 9%. In operated women, a significantly smaller weight for gestational age was observed in newborns of Group 1 compared to Group 3 (P = 0.04). LIMITATIONS, REASONS FOR CAUTION This study was conducted in France and nearly all patients were Caucasian, questioning the generalizability of the results in other countries and ethnicities. Moreover, 950 women per group would be needed to achieve a properly powered study in order to detect a significant improvement in live birth rate after bariatric surgery as compared to infertile obese women. WIDER IMPLICATIONS OF THE FINDINGS These data fuel the debate on the importance of pluridisciplinary care of infertile obese women, and advocate for further discussion on whether bariatric surgery should be proposed in severely obese infertile women before IVF. However, in light of the present results, infertile women with a history of bariatric surgery can be reassured that surgery-induced dramatic weight loss has no significant impact on IVF prognosis. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by unrestricted grants from FINOX-Gédéon Richter and FERRING Pharmaceuticals awarded to the ART center of the Clinique Mathilde to fund the data collection and the statistical analysis. There are no conflicts of interest to declare. TRIAL REGISTRATION NUMBER NCT02884258.
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Affiliation(s)
- V Grzegorczyk-Martin
- Department of Assisted Reproductive Technology and Fertility Preservation, Clinique Mathilde, ROUEN
| | - T Fréour
- CHU Nantes, Nantes Université, Service de Biologie et Médecine de la reproduction, Nantes, France
| | - A De Bantel Finet
- Department of Assisted Reproductive Technology and Fertility Preservation, Clinique Mathilde, ROUEN
| | - E Bonnet
- Montpellier University, UPRES EA2415, Decision Support for a Personalized Medicine, Clinical Research University Institute, Montpellier, France
| | - M Merzouk
- Department of Reproductive Medicine, CHI POISSY-ST GERMAIN
| | - J Roset
- Department of Assisted Reproductive Technology and Fertility Preservation, Clinique Mathilde, ROUEN
| | - V Roger
- Department of Digestive Surgery, Clinique Mathilde, ROUEN
| | - I Cédrin-Durnerin
- Department of Assisted Reproductive Technology, Hôpital Jean Verdier, BONDY
| | - R Wainer
- Department of Reproductive Medicine, CHI POISSY-ST GERMAIN
| | - C Avril
- Department of Assisted Reproductive Technology and Fertility Preservation, Clinique Mathilde, ROUEN
| | - P Landais
- Montpellier University, UPRES EA2415, Decision Support for a Personalized Medicine, Clinical Research University Institute, Montpellier, France
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Tang K, Guo Y, Wu L, Luo Y, Gong B, Feng L. A non-linear dose-response relation of female body mass index and in vitro fertilization outcomes. J Assist Reprod Genet 2021; 38:931-939. [PMID: 33496916 PMCID: PMC8079560 DOI: 10.1007/s10815-021-02082-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 01/19/2021] [Indexed: 10/22/2022] Open
Abstract
PURPOSE Obesity, measured by body mass index (BMI), is implicated in adverse pregnancy outcomes for women seeking in vitro fertilization (IVF) care. However, the shape of the dose-response relationship between BMI and IVF outcomes remains unclear. METHODS We therefore conducted a dose-response meta-analysis using a random effects model to estimate summary relative risk (RR) for clinical pregnancy (CPR), live birth (LBR), and miscarriage risk (MR) after IVF. RESULTS A total of 18 cohort-based studies involving 975,889 cycles were included. For each 5-unit increase in BMI, the summary RR was 0.95 (95% CI: 0.94-0.97) for CPR, 0.93 (95% CI: 0.92-0.95) for LBR, and 1.09 (95% CI: 1.05-1.12) for MR. There was evidence of a non-linear association between BMI and CPR (Pnon-linearity < 10-5) with CPR decreasing sharply among obese women (BMI > 30). Non-linear dose-response meta-analysis showed a relatively flat curve over a broad range of BMI from 16 to 30 for LBR (Pnon-linearity = 0.0009). In addition, we observed a J-shaped association between BMI and MR (Pnon-linearity = 0.006) with the lowest miscarriage risk observed with a BMI of 22-25. CONCLUSIONS In conclusion, obesity contributed to increased risk of adverse IVF outcomes in a non-linear dose-response manner. More prospective trials in evaluating the effect of body weight control are necessary.
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Affiliation(s)
- Kefu Tang
- Prenatal Diagnosis Center, Department of Clinical Laboratory, Changning Maternity and Infant Health Hospital, East China Normal University, #786 Yuyuan Road, Shanghai, 200051, China.
- Center for Reproductive Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200135, China.
| | - Yuanqing Guo
- Prenatal Diagnosis Center, Department of Clinical Laboratory, Changning Maternity and Infant Health Hospital, East China Normal University, #786 Yuyuan Road, Shanghai, 200051, China
| | - Lei Wu
- Prenatal Diagnosis Center, Department of Clinical Laboratory, Changning Maternity and Infant Health Hospital, East China Normal University, #786 Yuyuan Road, Shanghai, 200051, China
| | - Ying Luo
- Prenatal Diagnosis Center, Department of Clinical Laboratory, Changning Maternity and Infant Health Hospital, East China Normal University, #786 Yuyuan Road, Shanghai, 200051, China
| | - Bo Gong
- Prenatal Diagnosis Center, Department of Clinical Laboratory, Changning Maternity and Infant Health Hospital, East China Normal University, #786 Yuyuan Road, Shanghai, 200051, China
| | - Liyun Feng
- Prenatal Diagnosis Center, Department of Clinical Laboratory, Changning Maternity and Infant Health Hospital, East China Normal University, #786 Yuyuan Road, Shanghai, 200051, China
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17
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Chang JJ, Lathi RB, Kim SH. A Retrospective Study Examining Phentermine on Preconception Weight Loss and Pregnancy Outcomes. Endocr Pract 2020; 26:990-996. [PMID: 33471704 DOI: 10.4158/ep-2019-0609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 04/26/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Obesity is a well-known risk factor for infertility. However, the use of weight loss medications prior to conception is underutilized. The objectives of our study are to describe weight loss, pregnancy rates, and live birth rates after short-term phentermine use in women with obesity and infertility. METHODS This was a retrospective analysis of 55 women (18 to 45 years old) who were overweight or obese, diagnosed with infertility, and prescribed phentermine for weight loss in an ambulatory endocrinology clinic at a single, tertiary level academic medical center. Main outcome measures were mean percent weight change at 3 months after starting phentermine, and pregnancy, and live birth rates from start of phentermine to June 30, 2017. RESULTS Median duration of phentermine use was 70 days (Q1, Q3 [33, 129]). Mean ± SD percent weight change at 3 months after starting phentermine was -5.3 ± 4.1% (P<.001). The pregnancy rate was 60% and the live birth rate was 49%. There was no significant difference in pregnancy rates (52% versus 68%; P = .23) or live birth rates (44% versus 54%; P = .50) in women who lost ≥5% versus <5% of their baseline weight. The number of metabolic comorbidities was negatively associated with the pregnancy rate. Phentermine was generally well-tolerated with no serious adverse events. CONCLUSION Phentermine can produce clinically significant weight loss in women with obesity during the preconception period. Higher pregnancy or live birth rates were not observed with a greater degree of weight loss with phentermine.
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Affiliation(s)
- Julia J Chang
- From the Division of Endocrinology, Gerontology, and Metabolism, Department of Medicine, Stanford, California.
| | - Ruth B Lathi
- the Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Stanford Health Care, Sunnyvale, California
| | - Sun H Kim
- From the Division of Endocrinology, Gerontology, and Metabolism, Department of Medicine, Stanford, California; the Stanford Diabetes Research Center, Division of Endocrinology, Gerontology, and Metabolism, Department of Medicine, Stanford, California
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18
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Kim J, Juneau C, Patounakis G, Morin S, Neal S, Seli E, Scott R. The appraisal of body content (ABC) trial: obesity does not significantly impact gamete production in infertile men and women. J Assist Reprod Genet 2020; 37:2733-2742. [PMID: 32827101 DOI: 10.1007/s10815-020-01930-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 08/17/2020] [Indexed: 02/08/2023] Open
Abstract
PURPOSE As obesity becomes increasingly prevalent, its impact on fertility has been a subject of great debate. Nearly all prior research is retrospective and evaluates obesity utilizing body mass index (BMI), which may overestimate adiposity in individuals with a greater amount of lean muscle and underestimate adiposity in those with less muscle mass. METHODS We prospectively evaluated 2013 couples undergoing infertility treatment with in vitro fertilization (IVF). Percent body fat (%BF) was measured by use of a bioelectric impedance analysis (BIA) scale at baseline. BMI was also determined. Ovarian reserve parameters, ovarian response to controlled ovarian hyperstimulation, and semen analyses were measured in correlation with their %BF and BMI. RESULTS Females classified as obese based on %BF or BMI had lower serum FSH. However, when the analysis was limited to women without PCOS (n = 1706), obesity based on %BF or BMI was associated with lower serum AMH. Female obesity-regardless of a PCOS diagnosis-did not affect number of mature oocytes retrieved. Males who were in obese %BF category were found to have lower TMSC compared with normal weight counterparts (p < 0.05); however, the observed decrease was not significant enough to limit the success of assisted reproductive technologies. CONCLUSIONS These findings suggest that while obesity may affect ovarian reserve in women variably depending on presence of PCOS, it does not affect number of mature oocytes available after COH. Similarly, while a high %BF in males is associated with lower TMSC, the observed difference is unlikely to affect IVF outcomes.
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Affiliation(s)
- Julia Kim
- IVI RMA New Jersey, Basking Ridge, NJ, USA. .,Sidney Kimmel Medical School of Jefferson University, Philadelphia, PA, USA.
| | | | | | - Scott Morin
- IVI RMA New Jersey, Basking Ridge, NJ, USA.,Sidney Kimmel Medical School of Jefferson University, Philadelphia, PA, USA.,IVI RMA of Northern California, San Francisco, CA, USA
| | - Shelby Neal
- IVI RMA New Jersey, Basking Ridge, NJ, USA.,Sidney Kimmel Medical School of Jefferson University, Philadelphia, PA, USA.,Wake Forest School of Medicine, Wake Forest, NC, USA
| | - Emre Seli
- IVI RMA New Jersey, Basking Ridge, NJ, USA.,Yale School of Medicine, New Haven, CT, USA
| | - Richard Scott
- IVI RMA New Jersey, Basking Ridge, NJ, USA.,Sidney Kimmel Medical School of Jefferson University, Philadelphia, PA, USA
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19
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Asemota O, Thornton K, Merhi Z, Berger DS, Williams L, Seki Y, Du XQ, Jindal S, Charron MJ, Buyuk E. Monocyte chemotactic protein-1 plays a role in ovarian dysfunction related to high-fat diet-induced obesity. Syst Biol Reprod Med 2020; 66:236-243. [PMID: 32603611 DOI: 10.1080/19396368.2020.1780649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Obesity, known to cause a systemic elevation in monocyte chemotactic protein-1 (MCP-1), adversely affects normal ovarian function. The aim of this study was to determine whether MCP-1 plays a role in ovarian dysfunction that is related to obesity induced by high-fat (HF) diet intake. Wild type (WT) C57BL/6J mice were fed either normal chow (NC) (Group 1, control group) or HF diet (Group 2). To assess whether MCP-1 is involved in HF-diet-induced ovarian dysfunction, MCP-1 knock-out mice were fed HF diet (Group 3). Body weight, body fat composition, number of oocytes collected following ovarian superovulation with gonadotropins, ovarian macrophage markers and expression of genes important in folliculogenesis and steroidogenesis were quantified in the 3 groups of animals. Animals in Group 2 gained significant body weight and body mass, produced the fewest number of oocytes following superovulation, and had significant alterations in ovarian genes involved in folliculogenesis and steroidogenesis as well as genes involved in inflammation. Although animals in Group 3 had the highest body weight and body fat composition, they produced similar number of oocytes compared to animals in Group 1 but had different ovarian gene expression compared to Group 2. These findings suggest that MCP-1 gene knockout could reverse some of the adverse effects of obesity induced by HF diet intake. Future studies assessing ovarian histology in MCP-1 knock out mouse model will confirm our findings. MCP-1 inhibition could represent a future therapeutic target to protect ovarian health from the adverse effects of HF diet ingestion.
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Affiliation(s)
- Obehi Asemota
- Montefiore's Institute for Reproductive Medicine and Health, Albert Einstein College of Medicine , Hartsdale, NY, USA.,Albert Einstein College of Medicine , Bronx, NY, USA.,Currently at Aspire Fertility , Atlanta, GA, USA
| | - Kimberley Thornton
- Montefiore's Institute for Reproductive Medicine and Health, Albert Einstein College of Medicine , Hartsdale, NY, USA.,Albert Einstein College of Medicine , Bronx, NY, USA.,Icahn School of Medicine at Mount Sinai , New York, NY, USA
| | - Zaher Merhi
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, SUNY Downstate University , Brooklyn, NY, USA.,Department of Biochemistry, Albert Einstein College of Medicine , Bronx, NY, USA
| | - Dara S Berger
- Montefiore's Institute for Reproductive Medicine and Health, Albert Einstein College of Medicine , Hartsdale, NY, USA.,Albert Einstein College of Medicine , Bronx, NY, USA.,Currently at Department of Obstetrics and Gynecology, University of Pennsylvania , Philadelphia, PA, USA
| | - Lyda Williams
- Department of Biochemistry, Albert Einstein College of Medicine , Bronx, NY, USA.,Biology Department, Currently at the Lehman College , Bronx, NY, USA
| | - Yoshinori Seki
- Department of Biochemistry, Albert Einstein College of Medicine , Bronx, NY, USA
| | - Xiu Quan Du
- Department of Biochemistry, Albert Einstein College of Medicine , Bronx, NY, USA
| | - Sangita Jindal
- Montefiore's Institute for Reproductive Medicine and Health, Albert Einstein College of Medicine , Hartsdale, NY, USA.,Albert Einstein College of Medicine , Bronx, NY, USA
| | - Maureen J Charron
- Albert Einstein College of Medicine , Bronx, NY, USA.,Department of Biochemistry, Albert Einstein College of Medicine , Bronx, NY, USA.,Department of Medicine, Division of Endocrinology, Albert Einstein College of Medicine , Bronx, NY, USA
| | - Erkan Buyuk
- Montefiore's Institute for Reproductive Medicine and Health, Albert Einstein College of Medicine , Hartsdale, NY, USA.,Albert Einstein College of Medicine , Bronx, NY, USA.,Icahn School of Medicine at Mount Sinai , New York, NY, USA
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20
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Dayan N, Fell DB, Guo Y, Wang H, Velez MP, Spitzer K, Laskin CA. Severe maternal morbidity in women with high BMI in IVF and unassisted singleton pregnancies. Hum Reprod 2020; 33:1548-1556. [PMID: 29982477 DOI: 10.1093/humrep/dey224] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 04/16/2018] [Accepted: 06/22/2018] [Indexed: 12/14/2022] Open
Abstract
STUDY QUESTION Is there a synergistic risk of severe maternal morbidity (SMM) in overweight/obese women who conceived by IVF compared to normal-weight women without IVF? SUMMARY ANSWER SMM was more common in IVF pregnancies, and among overweight/obese women, but we did not detect a synergistic effect of both factors. WHAT IS KNOWN ALREADY While much is known about the impact of overweight and obesity on success rates after IVF, there is less data on maternal health outcomes. STUDY DESIGN, SIZE, DURATION This is a population-based cohort study of 114 409 singleton pregnancies with conceptions dating from 11 January 2013 until 10 January 2014 in Ontario, Canada. The data source was the Canadian Assisted Reproductive Technologies Register (CARTR Plus) linked with the Ontario birth registry (BORN Information System). PARTICIPANTS/MATERIALS, SETTING, METHODS We included women who delivered at ≥20 weeks gestation, and excluded those younger than 18 years or with twin pregnancies. Women were classified according to the mode of conception (IVF or unassisted) and according to pre-pregnancy BMI (high BMI (≥25 kg/m2) or low-normal BMI (<25 kg/m2)). The main outcome was SMM, a composite of serious complications using International Classification of Diseases, 10th revision (ICD-10) codes. Secondary outcomes were gestational hypertension, pre-eclampsia, gestational diabetes and cesarean delivery. Adjusted risk ratios (aRR) with 95% CI were estimated using log binomial regression, adjusted for maternal age, parity, education, income and baseline maternal comorbidity. MAIN RESULTS AND THE ROLE OF CHANCE Of 114 409 pregnancies, 1596 (1.4%) were IVF conceptions. Overall, 41.2% of the sample had high BMI, which was similar in IVF and non-IVF groups. We observed 674 SMM events (rate: 5.9 per 1000 deliveries). IVF was associated with an increased risk of SMM (rate 11.3/1000; aRR 1.89, 95% CI: 1.06-3.39). High BMI was modestly associated with SMM (rate 7.0/1000; aRR 1.23, 95% CI: 1.04-1.45) There was no interaction between the two factors (P = 0.22). We noted supra-additive effects of high BMI and IVF on the risk of pre-eclampsia and gestational diabetes, but not gestational hypertension or cesarean delivery. LIMITATIONS, REASONS FOR CAUTION We were unable to assess outcomes according to reason for treatment. Type II error (beta ~25%) may affect our results. WIDER IMPLICATIONS OF THE FINDINGS Our results support previous data indicating a greater risk of SMM in IVF pregnancies, and among women with high BMI. However, these factors do not interact. Overweight and obese women who seek treatment with IVF should be counseled about pregnancy risks. The decision to proceed with IVF should be based on clinical judgment after considering an individual's chance of success and risk of complications. STUDY FUNDING/COMPETING INTEREST(S) This study was supported by the Research Institute of the McGill University Health Centre (grant 6291) and also supported by the Trio Fertility (formerly Lifequest) Research Fund. The authors report no competing interests. TRIAL REGISTRATION NUMBER Not applicable.
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Affiliation(s)
- N Dayan
- Centre for Outcomes Research and Evaluation (CORE), Research Institute, McGill University Health Centre, 5252 de Maisonneuve West, 2B.40, Montréal, Quebec, Canada
| | - D B Fell
- School of Epidemiology and Public Health, University of Ottawa, Alta Vista Campus, Room 101, 600 Peter Morand Crescent, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, Canada
| | - Y Guo
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, Canada.,Better Outcomes Registry & Network (BORN) Ontario, 401 Smyth Road, Ottawa, Canada
| | - H Wang
- Better Outcomes Registry & Network (BORN) Ontario, 401 Smyth Road, Ottawa, Canada
| | - M P Velez
- Department of Obstetrics and Gynecology, Kingston General Hospital, Queen's University, Victory 4, Stuart Street, Kingston, ON Canada
| | - K Spitzer
- Departments of Medicine and Obstetrics & Gynecology, University of Toronto, TRIO Fertility, 1101-655 Bay St, Toronto, ON, Canada
| | - C A Laskin
- Departments of Medicine and Obstetrics & Gynecology, University of Toronto, TRIO Fertility, 1101-655 Bay St, Toronto, ON, Canada
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21
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Hilal G, Fatma T, Ferruh Y, Sabire G, Yüksel A. Effect of high-fat diet on the various morphological parameters of the ovary. Anat Cell Biol 2020; 53:58-67. [PMID: 32274250 PMCID: PMC7118267 DOI: 10.5115/acb.19.082] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 06/26/2019] [Accepted: 06/26/2019] [Indexed: 01/03/2023] Open
Abstract
Increased food consumption rich in fat and carbohydrate and sedentary lifestyle have seriously increased the rates of obesity and obesity-associated diseases in developed countries. Female mice with diet-induced obesity exhibit infertility and thus can serve as a model for human polycystic ovary syndrome. The aim of the present study was to examine how ovary is affected by diet-induced obesity. The effects of high-fat diet (HFD) on ovary morphology in mice fed with HFD were investigated using unbiased stereological methods. The ovary of mice fed with HFD (n=8, C1090-60, Altromine) for 9 weeks, were compared with that of mice fed with standard chow diet (n=8, C1090-10, Altromine). Stereological parameters were obtained in diestrus cycle. The samples were processed through routine and standard paraffin embedding and were serially sectioned in 5-µm thickness then, every 10th section was saved, stained with Crossman's triple stain for counting and measuring. In all sampled sections mean follicle numbers, diameters, total ovarian volume cortex to medulla ratio (Vv), ovum to cell ratio in secondary follicle were examined in all sampled sections. The present results showed that weight of ovarian and amount of intraperitoneal adipose tissue and the body weight markedly increased in obese mice when compared with control groups. Moreover, follicle numbers (except primordial follicles) and diameters were significantly increased in obese mice. Cortex to medulla ratio (Vv) and ovum to cell ratio in secondary follicle were also considerably different between experimental and the control groups. The present findings indicate that obesity adversely affects overall ovarian morphology.
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Affiliation(s)
- Gören Hilal
- Department of Anatomy, Faculty of Medicine, Duzce University, Duzce, Turkey
| | - Topal Fatma
- Department of Medical Services and Techniques, Bilecik Seyh Edebali University, Bilecik, Turkey
| | - Yücel Ferruh
- Department of Anatomy, Medical School of Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Güler Sabire
- Department of Histology Embriology, Faculty of Veterinary Medicine, Uludag University, Bursa, Turkey
| | - Aydar Yüksel
- Department of Anatomy, Medical School of Eskişehir Osmangazi University, Eskişehir, Turkey
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22
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Obirikorang C, Owiredu WKBA, Adu-Afram S, Acheampong E, Asamoah EA, Antwi-Boasiakoh EK, Owiredu EW. Assessing the variability and predictability of adipokines (adiponectin, leptin, resistin and their ratios) in non-obese and obese women with anovulatory polycystic ovary syndrome. BMC Res Notes 2019; 12:513. [PMID: 31416473 PMCID: PMC6696689 DOI: 10.1186/s13104-019-4546-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 08/07/2019] [Indexed: 12/16/2022] Open
Abstract
Objectives To assess the variability and predictability of adiponectin, leptin, resistin and their ratios in non-obese and obese women with anovulatory polycystic ovary syndrome (aPCOS). Results A total of 52 ovulatory controls (mean age = 31.63 ± 4.88 years, BMI = 25.33 ± 2.68 kg/m2); 54 non-obese (mean age = 32.11 ± 4.25 years, BMI = 25.72 ± 2.95 kg/m2) and 50 obese women with aPCOS (mean age = 33.64 ± 4.14 years, BMI = 39.19 ± 2.99 kg/m2) were recruited. The aPCOS group had lower adiponectin [13.0 (10.49–16.59) vs 18.42 (15.72–19.92) µg/ml, p < 0.0001], adiponectin: leptin ratio (A:L) [0.60 (0.35–0.88) vs 1.19 (0.92–1.37), p < 0.0001], and adiponectin: resistin ratio (A:R) [0.30 (0.21–0.43) vs 0.42 (0.32–0.62), p < 0.0001] but a higher leptin [20.02 (14.54–26.80) vs 16.17 (14.51–18.36) ng/ml, p < 0.0001] and leptin: resistin ratio (L:R) [0.53 (0.37–0.82) vs 0.40 (0.27–0.48), p < 0.0001] compared to the controls. The obese aPCOS group had lower adiponectin [11.04 (5.66–13.25) vs 14.18 (11.04–18.02), p < 0.0001 and 18.42 (15.72–19.92) µg/ml, p < 0.0001], A:L [0.36 (0.27–0.44) vs 0.78 (0.61–1.16), p < 0.0001 and 1.19 (0.92–1.37), p < 0.0001], and A:R [0.24 (0.17–0.38) vs 0.40 (0.23–0.58), p < 0.0001 and 0.42 (0.32–0.62), p < 0.0001] but a higher leptin [26.80 (14.28–32.09) vs 17.95 (14.86–21.26), p < 0.05 and 16.17 (14.51–18.36) ng/ml, p < 0.0001] and L:R [0.63 (0.46–1.03) vs 0.41 (0.30–0.61), p < 0.0001 and 0.40 (0.27–0.48), p < 0.0001] compared to the non-obese aPCOS and control group, respectively. A:L showed the best discriminatory power in predicting aPCOS (AUC = 0.83), followed by adiponectin alone (AUC = 0.79), L:R and leptin alone (both AUC = 0.69). Resistin alone had the poorest discriminatory power (AUC = 0.48). Electronic supplementary material The online version of this article (10.1186/s13104-019-4546-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Christian Obirikorang
- Department of Molecular Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - William K B A Owiredu
- Department of Molecular Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Sandra Adu-Afram
- Department of Molecular Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Emmanuel Acheampong
- School of Medical and Health Science, Edith Cowan University, Joondalup, Australia
| | - Evans Adu Asamoah
- Department of Molecular Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Eddie-Williams Owiredu
- Department of Molecular Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
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23
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Sasaki RSA, Approbato MS, Maia MCS, Ferreira EABFE, Zanluchi N. Ovulatory status of overweight women without Polycystic Ovary Syndrome. JBRA Assist Reprod 2019; 23:2-6. [PMID: 30614235 PMCID: PMC6364286 DOI: 10.5935/1518-0557.20180071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Objective: Obesity is one of the extra hypothalamic-pituitary-ovarian axis factors that
can influence ovulation. The isolated impact of obesity on ovulation without
other comorbidities needs to be further studied. Our goal is to evaluate the
association between the anovulation in the ultrasonographic monitoring of
the ovulation cycle and the body mass increase of infertile patients without
polycystic ovaries of a university service. Methods: Case-control study performed at the Human Reproduction Laboratory of the
University Hospital. We evaluated 1,356 ultrasound monitoring reports of
ovulation between January 2011 and December 2015. We named case those
patients who ovulated on the monitored cycle. After applying the exclusion
criteria, we consolidated a total of 110 cases and 118 controls. The
exposure variables were normal BMI or patients classified with a BMI above
normal. Data analysis was performed using SPSS 22.0. Differences in
proportions were assessed by X2 test Pearson, Fisher and Wilcoxon
test. The value of p<0.05 was considered statistically
significant. Results: The groups were comparable in age, age at menarche, number of pregnancies,
deliveries, cesarean sections and abortions, number of antral follicles,
FSH, prolactin and TSH values. Among the anovulatory patients, 57 (51.82%)
were overweight, while among ovulatory patients, 44 (37.29%) were in this
same BMI category. The odds ratio was 1.8655, with a significant p value
(p<0.05). Conclusion: There was an association between anovulation and increase in the Body Mass
Index, with an increased risk of anovulation in patients with BMI above
normal.
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Affiliation(s)
- Reinaldo S A Sasaki
- Assisted Reproduction Laboratory - Hospital das Clínicas - Federal University of Goiás
| | - Mário S Approbato
- Assisted Reproduction Laboratory - Hospital das Clínicas - Federal University of Goiás
| | - Mônica C S Maia
- Assisted Reproduction Laboratory - Hospital das Clínicas - Federal University of Goiás
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24
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Ding W, Zhang FL, Liu XC, Hu LL, Dai SJ, Li G, Kong HJ, Guo YH. Impact of Female Obesity on Cumulative Live Birth Rates in the First Complete Ovarian Stimulation Cycle. Front Endocrinol (Lausanne) 2019; 10:516. [PMID: 31428050 PMCID: PMC6687867 DOI: 10.3389/fendo.2019.00516] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 07/15/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Female overweight/obesity has been reported to be associated with compromised pregnancy outcomes in fresh embryo transfer cycles. It is unclear whether the cumulative live birth rate (CLBR) is adversely affected after all viable embryos are transferred from the first ovarian stimulation cycle. Objectives: To investigate whether the CLBR was compromised in obese women. Method: A total of 9,772 young women underwent their first IVF/ICSI cycles from January 2012 to October 2017. Pregnancy outcomes were compared according to female BMI. Results: Among 1,671 women with polycystic ovary syndrome (PCOS), those with a BMI ≥ 28 kg/m2 had a lower cumulative clinical pregnancy rate (CCPR) and CLBR during the first complete ovarian stimulation cycle. Additionally, the pregnancy loss rate was increased in this group, although the difference was not significant. Among the 8,101 women without PCOS, the CCPR and CLBR of obese patients was also significantly decreased, and this group also showed increased pregnancy loss rates. Moreover, overweight women also had a decreased CLBR. Conclusions: Female obesity adversely affected the CLBR after utilizing the viable embryos from first oocytes retrieval.
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Affiliation(s)
- Wen Ding
- Reproductive Medicine Center, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Fu-li Zhang
- Reproductive Medicine Center, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiao-cong Liu
- Reproductive Medicine Center, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lin-li Hu
- Reproductive Medicine Center, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shan-jun Dai
- Reproductive Medicine Center, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Gang Li
- Reproductive Medicine Center, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hui-juan Kong
- Reproductive Medicine Center, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yi-hong Guo
- Reproductive Medicine Center, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- *Correspondence: Yi-hong Guo
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van Oers AM, Mutsaerts MAQ, Burggraaff JM, Kuchenbecker WKH, Perquin DAM, Koks CAM, van Golde R, Kaaijk EM, Schierbeek JM, Klijn NF, van Kasteren YM, Land JA, Mol BWJ, Hoek A, Groen H. Cost-effectiveness analysis of lifestyle intervention in obese infertile women. Hum Reprod 2018; 32:1418-1426. [PMID: 28486704 DOI: 10.1093/humrep/dex092] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 04/27/2017] [Indexed: 11/12/2022] Open
Abstract
STUDY QUESTION What is the cost-effectiveness of lifestyle intervention preceding infertility treatment in obese infertile women? SUMMARY ANSWER Lifestyle intervention preceding infertility treatment as compared to prompt infertility treatment in obese infertile women is not a cost-effective strategy in terms of healthy live birth rate within 24 months after randomization, but is more likely to be cost-effective using a longer follow-up period and live birth rate as endpoint. WHAT IS KNOWN ALREADY In infertile couples, obesity decreases conception chances. We previously showed that lifestyle intervention prior to infertility treatment in obese infertile women did not increase the healthy singleton vaginal live birth rate at term, but increased natural conceptions, especially in anovulatory women. Cost-effectiveness analyses could provide relevant additional information to guide decisions regarding offering a lifestyle intervention to obese infertile women. STUDY DESIGN, SIZE, DURATION The cost-effectiveness of lifestyle intervention preceding infertility treatment compared to prompt infertility treatment was evaluated based on data of a previous RCT, the LIFEstyle study. The primary outcome for effectiveness was the vaginal birth of a healthy singleton at term within 24 months after randomization (the healthy live birth rate). The economic evaluation was performed from a hospital perspective and included direct medical costs of the lifestyle intervention, infertility treatments, medication and pregnancy in the intervention and control group. In addition, we performed exploratory cost-effectiveness analyses of scenarios with additional effectiveness outcomes (overall live birth within 24 months and overall live birth conceived within 24 months) and of subgroups, i.e. of ovulatory and anovulatory women, women <36 years and ≥36 years of age and of completers of the lifestyle intervention. Bootstrap analyses were performed to assess the uncertainty surrounding cost-effectiveness. PARTICIPANTS/MATERIALS, SETTINGS, METHODS Infertile women with a BMI of ≥29 kg/m2 (no upper limit) were allocated to a 6-month lifestyle intervention programme preceding infertility treatment (intervention group, n = 290) or to prompt infertility treatment (control group, n = 287). After excluding women who withdrew informed consent or who were lost to follow-up we included 280 women in the intervention group and 284 women in the control group in the analysis. MAIN RESULTS AND THE ROLE OF CHANCE Total mean costs per woman in the intervention group within 24 months after randomization were €4324 (SD €4276) versus €5603 (SD €4632) in the control group (cost difference of -€1278, P < 0.05). Healthy live birth rates were 27 and 35% in the intervention group and the control group, respectively (effect difference of -8.1%, P < 0.05), resulting in an incremental cost-effectiveness ratio of €15 845 per additional percentage increase of the healthy live birth rate. Mean costs per healthy live birth event were €15 932 in the intervention group and €15 912 in the control group. Exploratory scenario analyses showed that after changing the effectiveness outcome to all live births conceived within 24 months, irrespective of delivery within or after 24 months, cost-effectiveness of the lifestyle intervention improved. Using this effectiveness outcome, the probability that lifestyle intervention preceding infertility treatment was cost-effective in anovulatory women was 40%, in completers of the lifestyle intervention 39%, and in women ≥36 years 29%. LIMITATIONS, REASONS FOR CAUTION In contrast to the study protocol, we were not able to perform the analysis from a societal perspective. Besides the primary outcome of the LIFEstyle study, we performed exploratory analyses using outcomes observed at longer follow-up times and we evaluated subgroups of women; the trial was not powered on these additional outcomes or subgroup analyses. WIDER IMPLICATIONS OF THE FINDINGS Cost-effectiveness of a lifestyle intervention is more likely for longer follow-up times, and with live births conceived within 24 months as the effectiveness outcome. This effect was most profound in anovulatory women, in completers of the lifestyle intervention and in women ≥36 years old. This result indicates that the follow-up period of lifestyle interventions in obese infertile women is important. The scenario analyses performed in this study suggest that offering and reimbursing lifestyle intervention programmes in certain patient categories may be cost-effective and it provides directions for future research in this field. STUDY FUNDING/COMPETING INTEREST(S) The study was supported by a grant from ZonMw, the Dutch Organization for Health Research and Development (50-50110-96-518). The department of obstetrics and gynaecology of the UMCG received an unrestricted educational grant from Ferring pharmaceuticals BV, The Netherlands. B.W.J.M. is a consultant for ObsEva, Geneva. TRIAL REGISTRATION NUMBER The LIFEstyle RCT was registered at the Dutch trial registry (NTR 1530). http://www.trialregister.nl/trialreg/admin/rctview.asp?TC = 1530.
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Affiliation(s)
- A M van Oers
- Department of Obstetrics and Gynaecology, University of Groningen, University Medical Center Groningen, 9700RB Groningen, The Netherlands
| | - M A Q Mutsaerts
- Department of Obstetrics and Gynaecology, University of Groningen, University Medical Center Groningen, 9700RB Groningen, The Netherlands.,Department of General Practice, University of Utrecht, University Medical Center Utrecht, 3508GA Utrecht, The Netherlands
| | - J M Burggraaff
- Department of Obstetrics and Gynaecology, Scheper Hospital, 7800RA Emmen, The Netherlands
| | - W K H Kuchenbecker
- Department of Obstetrics and Gynaecology, Isala Clinics, 8000 GK Zwolle, The Netherlands
| | - D A M Perquin
- Department of Obstetrics and Gynaecology, Medical Center Leeuwarden, 8901BR Leeuwarden, The Netherlands
| | - C A M Koks
- Department of Obstetrics and Gynaecology, Maxima Medical Center, 5500MB Veldhoven, The Netherlands
| | - R van Golde
- Department of Obstetrics and Gynaecology, University of Maastricht, Maastricht University Medical Center, 6202AZ Maastricht, The Netherlands
| | - E M Kaaijk
- Department of Obstetrics and Gynaecology, OLVG, 1090HM Amsterdam, The Netherlands
| | - J M Schierbeek
- Department of Obstetrics and Gynaecology, Deventer Hospital, 7400GC Deventer, The Netherlands
| | - N F Klijn
- Department of Gynaecology and Reproductive Medicine, Leiden University Medical Centre, 2300RC Leiden, The Netherlands
| | - Y M van Kasteren
- Department of Obstetrics and Gynaecology, Noordwest Ziekenhuisgroep, 1815 JD Alkmaar, The Netherlands
| | - J A Land
- Department of Obstetrics and Gynaecology, University of Groningen, University Medical Center Groningen, 9700RB Groningen, The Netherlands
| | - B W J Mol
- The Robinson Research Institute, School of Pediatrics and Reproductive Health, University of Adelaide, 5000SA Adelaide, Australia
| | - A Hoek
- Department of Obstetrics and Gynaecology, University of Groningen, University Medical Center Groningen, 9700RB Groningen, The Netherlands
| | - H Groen
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, 9700RB Groningen, The Netherlands
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Deputy NP, Dub B, Sharma AJ. Prevalence and Trends in Prepregnancy Normal Weight - 48 States, New York City, and District of Columbia, 2011-2015. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2018; 66:1402-1407. [PMID: 29300720 PMCID: PMC5758298 DOI: 10.15585/mmwr.mm665152a3] [Citation(s) in RCA: 117] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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27
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Martínez F, Kava-Braverman A, Clúa E, Rodríguez I, Gaggiotti Marre S, Coroleu B, Barri PN. Reproductive outcomes in recipients are not associated with oocyte donor body mass index up to 28 kg/m 2 : a cohort study of 2722 cycles. Reprod Biomed Online 2017; 35:739-746. [DOI: 10.1016/j.rbmo.2017.07.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 07/11/2017] [Accepted: 07/28/2017] [Indexed: 11/16/2022]
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Ciavattini A, Montik N, Clemente N, Santoni F, Moriconi L, Serri M, Barbadoro P, Sabbatinelli J, Vignini A. Obesity and ultrasound-estimated visceral fat deposits in women undergoing Assisted Reproductive Technology (ART) procedures. Gynecol Endocrinol 2017; 33:972-976. [PMID: 28475432 DOI: 10.1080/09513590.2017.1323858] [Citation(s) in RCA: 3] [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] [Indexed: 01/14/2023] Open
Abstract
The aim of this study was to evaluate the influence of body mass index (BMI) and ultrasound-estimated visceral adipose tissue deposits on oocyte quality and pregnancy rate in women undergoing Assisted Reproductive Technology (ART) procedures. The study included 58 women who underwent ART procedures. According to their BMI, the women were divided into normal weight and overweight/obese; an ultrasound evaluation of preperitoneal fat thickness (PFT) was also performed for each patient. The oocyte quality was then assessed, and samples of follicular fluid were collected from each woman, in order to evaluate the intrafollicular concentration of reactive oxygen species (ROS) as markers of oxidative stress and pro-inflammatory cytokines (IL-1β and IL-6) as markers of chronic inflammation. A negative correlation was found between BMI (as well as PFT) and the number of retrieved oocytes (r = -0.3; p <0.05 and r = -0.5; p < 0.001, respectively), good quality oocytes (r = -0.4; p = <0.05) and obtained embryos (r = -0.3; p < 0.05). In women undergoing ART procedures, BMI and PFT negatively influence the number of oocytes retrieved and their quality. However, on multivariable analysis, only age, PFT and number of retrieved oocytes affect the success rate of ART procedures.
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Affiliation(s)
| | - Nina Montik
- a Woman's Health Sciences Department, Gynecologic Section
| | | | | | | | - Matteo Serri
- a Woman's Health Sciences Department, Gynecologic Section
| | | | - Jacopo Sabbatinelli
- c Department of Clinical Sciences , Section of Biochemistry, Biology and Physics, Polytechnic University of Marche , Ancona , Italy
| | - Arianna Vignini
- c Department of Clinical Sciences , Section of Biochemistry, Biology and Physics, Polytechnic University of Marche , Ancona , Italy
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Koning A, Mol BW, Dondorp W. It is not justified to reject fertility treatment based on obesity. Hum Reprod Open 2017; 2017:hox009. [PMID: 30895227 PMCID: PMC6276680 DOI: 10.1093/hropen/hox009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 06/06/2017] [Accepted: 06/17/2017] [Indexed: 11/14/2022] Open
Abstract
Obesity can lead to anovulation and subfertility. Around the world fertility treatment is withheld from women above a certain BMI, with a threshold ranging from 25 to 40 kg/m2. The proponents of this policy use three different arguments to justify their restrictions: risks for the woman, health and wellbeing of the future child, and importance for society. In this article we critically appraise these arguments. We conclude that obese women should be informed about the consequences of their weight on fertility and pregnancy complications and encouraged to lose weight. If, however, a woman is unable to lose weight despite effort, we feel there is no argument to withhold treatment from her. This would be unjustified with respect to the treatment of other women with a high risk of complications.
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Affiliation(s)
- Aafke Koning
- Ziekenhuis Amstelland, Department of Obstetrics and gynecology, Laan van de Helende Meesters 8, Amstelveen, The Netherlands
| | - Ben Willem Mol
- University of Adelaide, The Robinson Institute, School of Pediatrics and Reproductive Health, Adelaide, Australia
| | - Wybo Dondorp
- Maastricht University, Health, Ethics and Society-Research schools CAPHRI and GROW, Universiteitssingel 40, Maastricht, The Netherlands
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Deletion of Suppressor of Cytokine Signaling 3 from Forebrain Neurons Delays Infertility and Onset of Hypothalamic Leptin Resistance in Response to a High Caloric Diet. J Neurosci 2017; 36:7142-53. [PMID: 27383590 DOI: 10.1523/jneurosci.2714-14.2016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 05/27/2016] [Indexed: 12/19/2022] Open
Abstract
UNLABELLED The cellular processes that cause high caloric diet (HCD)-induced infertility are poorly understood but may involve upregulation of suppressor of cytokine signaling (SOCS-3) proteins that are associated with hypothalamic leptin resistance. Deletion of SOCS-3 from brain cells is known to protect mice from diet-induced obesity, but the effects on HCD-induced infertility are unknown. We used neuron-specific SOCS3 knock-out mice to elucidate this and the effects on regional hypothalamic leptin resistance. As expected, male and female neuron-specific SOCS3 knock-out mice were protected from HCD-induced obesity. While female wild-type mice became infertile after 4 months of HCD feeding, infertility onset in knock-out females was delayed by 4 weeks. Similarly, knock-out mice had delayed leptin resistance development in the medial preoptic area and anteroventral periventricular nucleus, regions important for generation of the surge of GnRH and LH that induces ovulation. We therefore tested whether the suppressive effects of HCD on the estradiol-induced GnRH/LH surge were overcome by neuron-specific SOCS3 knock-out. Although only 20% of control HCD-mice experienced a preovulatory-like LH surge, LH surges could be induced in almost all neuron-specific SOCS3 knock-out mice on this diet. In contrast to females, HCD-fed male mice did not exhibit any fertility decline compared with low caloric diet-fed males despite their resistance to the satiety effects of leptin. These data show that deletion of SOCS3 delays the onset of leptin resistance and infertility in HCD-fed female mice, but given continued HCD feeding this state does eventually occur, presumably in response to other mechanisms inhibiting leptin signal transduction. SIGNIFICANCE STATEMENT Obesity is commonly associated with infertility in humans and other animals. Treatments for human infertility show a decreased success rate with increasing body mass index. A hallmark of obesity is an increase in circulating leptin levels; despite this, the brain responds as if there were low levels of leptin, leading to increased appetite and suppressed fertility. Here we show that leptin resistant infertility is caused in part by the leptin signaling molecule SOCS3. Deletion of SOCS3 from brain neurons delays the onset of diet-induced infertility.
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MacKenna A, Schwarze JE, Crosby JA, Zegers-Hochschild F. Outcome of assisted reproductive technology in overweight and obese women. JBRA Assist Reprod 2017; 21:79-83. [PMID: 28609272 PMCID: PMC5473698 DOI: 10.5935/1518-0557.20170020] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective The main objective of this study was to assess the prevalence of overweight
and obesity among patients undergoing assisted reproductive technology (ART)
in Latin America and its consequences on treatment outcomes. Methods We used the Latin American Registry of ART to obtain women's age and body
mass index (BMI), cancellation rate, number of oocytes retrieved and embryos
transferred, clinical pregnancy, live birth and miscarriage rates from
107.313 patients undergoing autologous IVF and ICSI during four years; a
multivariable analysis was performed to determine the effect of BMI on
cancellation, oocytes retrieved, pregnancy, live birth and miscarriage,
adjusting for age, number of embryos transferred and embryo developmental
stage upon embryo transfer, when appropriate. Results The prevalence of overweight and obesity was 16.1% and 42.4%, respectively;
correcting for age of female partner, overweight and obesity were associated
to an increase in the odds of cancellation and to a lower mean number of
oocytes retrieved; after adjusting for age, number of embryos transferred
and stage of embryo development at transfer, we found that the BMI category
was not associated to a change in the likelihoods of pregnancy, live birth
and miscarriage. Conclusions The prevalence of obesity among women seeking ART in Latin America is
surprisingly high; however, BMI does not influence the outcome of ART
performed in these women.
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Affiliation(s)
- Antonio MacKenna
- Latin American Network of Assisted Reproduction.,Unit of Reproductive Medicine, Clinica Las Condes, Santiago, Chile
| | - Juan Enrique Schwarze
- Latin American Network of Assisted Reproduction.,Unit of Reproductive Medicine, Clinica Monteblanco, Santiago, Chile
| | - Javier A Crosby
- Latin American Network of Assisted Reproduction.,Unit of Reproductive Medicine, Clinica Las Condes, Santiago, Chile
| | - Fernando Zegers-Hochschild
- Latin American Network of Assisted Reproduction.,Unit of Reproductive Medicine, Clinica Las Condes, Santiago, Chile.,Program of Ethics and Public Policies in Human Reproduction, University Diego Portales, Santiago, Chile
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32
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Adipositas und kontrollierte ovarielle Stimulation (COH). GYNAKOLOGISCHE ENDOKRINOLOGIE 2017. [DOI: 10.1007/s10304-017-0121-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Jiskoot G, Benneheij SH, Beerthuizen A, de Niet JE, de Klerk C, Timman R, Busschbach JJ, Laven JSE. A three-component cognitive behavioural lifestyle program for preconceptional weight-loss in women with polycystic ovary syndrome (PCOS): a protocol for a randomized controlled trial. Reprod Health 2017; 14:34. [PMID: 28264692 PMCID: PMC5339998 DOI: 10.1186/s12978-017-0295-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 02/22/2017] [Indexed: 12/24/2022] Open
Abstract
Background Obesity in women with polycystic ovary syndrome (PCOS) negatively affects all clinical features, and a 5 to 10% weight loss has shown promising results on reproductive, metabolic and psychological level. Incorporating a healthy diet, increasing physical activity and changing dysfunctional thought patterns in women with PCOS are key points in losing weight. The biggest challenge in weight management programs is to achieve a reasonable and sustainable weight loss. The aim of this study is to explore whether Cognitive Behavioural Therapy (CBT) by a mental health professional, working in a multidisciplinary team with a dietician and a physical therapist (a three-component intervention), is more effective for weight loss in the long term, within 12 months. We will also explore whether mobile phone applications are effective in supporting behavioural change and sustainable weight loss. Methods The present study is a longitudinal randomized controlled trial (RCT) to study the effectiveness of a three-component 1-year cognitive-behavioural lifestyle intervention in overweight/obese women with PCOS. A total of 210 participants are randomly assigned to three groups: 1) CBT provided by the multidisciplinary team or; 2) CBT provided by the multidisciplinary team and Short Message Service (SMS) or; 3) usual care: encourage weight loss through publicly available services (control group). The primary aim of the 12-month intervention is to explore whether a three-component 1-year cognitive-behavioural lifestyle intervention is effective to decrease weight, when compared to usual care. Secondary outcomes include: the effect of the intervention on the PCOS phenotype, waist circumference, waist to hip ratio, ovulation rates, total testosterone, SHBG, free androgen index (FAI), AMH, hirsutism, acne, fasting glucose, blood pressure and all psychological parameters. Additionally, we assessed time to pregnancy, ongoing pregnancies, clinical pregnancies, miscarriages and birth weight. All outcome variables are measured at the start of the study, and again at 3 months, 6 months, nine months and 12 months. Discussion We expect that CBT provided by a multidisciplinary team, especially combined with SMS, is effective in developing a healthy lifestyle and achieving a long-term weight loss in women with PCOS. Losing 5– 10% body weight improves various PCOS characteristics. Consequently, we expect to show that CBT provided by a multidisciplinary team improves reproductive and metabolic outcomes, as well as quality of life, while at the same time being cost-effective. Trial registration Registered at the Netherlands National Trial Register with number NTR2450 on August 2nd, 2010.
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Affiliation(s)
- G Jiskoot
- Division Reproductive Medicine, Department of Obstetrics and Gynaecology, Erasmus MC, PO Box 2040, 3000, CA, Rotterdam, The Netherlands. .,Department of Psychiatry, Section of Medical Psychology and Psychotherapy, Erasmus MC, PO Box 2040, 3000, CA, Rotterdam, The Netherlands.
| | - S H Benneheij
- Division Reproductive Medicine, Department of Obstetrics and Gynaecology, Erasmus MC, PO Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - A Beerthuizen
- Department of Psychiatry, Section of Medical Psychology and Psychotherapy, Erasmus MC, PO Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - J E de Niet
- Division Reproductive Medicine, Department of Obstetrics and Gynaecology, Erasmus MC, PO Box 2040, 3000, CA, Rotterdam, The Netherlands.,Department of Psychiatry, Section of Medical Psychology and Psychotherapy, Erasmus MC, PO Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - C de Klerk
- Department of Psychiatry, Section of Medical Psychology and Psychotherapy, Erasmus MC, PO Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - R Timman
- Department of Psychiatry, Section of Medical Psychology and Psychotherapy, Erasmus MC, PO Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - J J Busschbach
- Department of Psychiatry, Section of Medical Psychology and Psychotherapy, Erasmus MC, PO Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - J S E Laven
- Division Reproductive Medicine, Department of Obstetrics and Gynaecology, Erasmus MC, PO Box 2040, 3000, CA, Rotterdam, The Netherlands
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Giviziez CR, Sanchez EGM, Approbato MS, Maia MCS, Fleury EAB, Sasaki RSA. Obesity and anovulatory infertility: A review. JBRA Assist Reprod 2016; 20:240-245. [PMID: 28050960 PMCID: PMC5265624 DOI: 10.5935/1518-0557.20160046] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
This global overweight and obesity epidemics has become one of the largest public
health problem worldwide and is increasingly more common among women in
reproductive age. Along with the prevalence of overweight women, there is an
increase in women with anovulatory infertility. Thus, we carried out a
bibliographic research in the PubMed, Lilacs and SciELO databases, using the
combinations in Portuguese, Spanish and English of the following descriptors:
"Body Mass Index", "obesity", "overweight", "female infertility" and
"anovulation". The aim of this study was to assess the effects of obesity on the
ovulatory profile of infertile women in the available literature.
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Affiliation(s)
- Christiane R Giviziez
- Universidade Federal de Goiás. Faculdade de Medicina. Hospital das Clínicas. Departamento de Ginecologia e Obstetrícia. Laboratório de Reprodução Humana - Goiânia/GO - Brazil.,Unidade Acadêmica de Ciências da Saúde/Biomedicina da Universidade Federal de Goiás, Jataí/GO - Brazil
| | - Eliane G M Sanchez
- Faculdade de Ciências Biológicas da Universidade de Rio Verde/GO - Brazil
| | - Mário S Approbato
- Universidade Federal de Goiás. Faculdade de Medicina. Hospital das Clínicas. Departamento de Ginecologia e Obstetrícia. Laboratório de Reprodução Humana - Goiânia/GO - Brazil
| | - Monica C S Maia
- Universidade Federal de Goiás. Faculdade de Medicina. Hospital das Clínicas. Departamento de Ginecologia e Obstetrícia. Laboratório de Reprodução Humana - Goiânia/GO - Brazil
| | - Eliamar Aparecida B Fleury
- Universidade Federal de Goiás. Faculdade de Medicina. Hospital das Clínicas. Departamento de Ginecologia e Obstetrícia. Laboratório de Reprodução Humana - Goiânia/GO - Brazil
| | - Reinaldo S A Sasaki
- Universidade Federal de Goiás. Faculdade de Medicina. Hospital das Clínicas. Departamento de Ginecologia e Obstetrícia. Laboratório de Reprodução Humana - Goiânia/GO - Brazil.,Seção de Ensino e Pesquisa do Centro de Referência de Medicina Interativa e Complementar/GO - Brazil
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Kalateh Sadati A, Rahnavard F, Namavar Jahromi B. Qualitative Study of Iranian Infertile Females. WOMEN’S HEALTH BULLETIN 2016. [DOI: 10.17795/whb-33490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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van Oers AM, Groen H, Mutsaerts MAQ, Burggraaff JM, Kuchenbecker WKH, Perquin DAM, Koks CAM, van Golde R, Kaaijk EM, Schierbeek JM, Oosterhuis GJE, Broekmans FJ, Vogel NEA, Land JA, Mol BWJ, Hoek A. Effectiveness of lifestyle intervention in subgroups of obese infertile women: a subgroup analysis of a RCT. Hum Reprod 2016; 31:2704-2713. [PMID: 27798042 DOI: 10.1093/humrep/dew252] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 07/21/2016] [Accepted: 07/26/2016] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION Do age, ovulatory status, severity of obesity and body fat distribution affect the effectiveness of lifestyle intervention in obese infertile women? SUMMARY ANSWER We did not identify a subgroup in which lifestyle intervention increased the healthy live birth rate however it did increase the natural conception rate in anovulatory obese infertile women. WHAT IS KNOWN ALREADY Obese women are at increased risk of infertility and are less likely to conceive after infertility treatment. We previously demonstrated that a 6-month lifestyle intervention preceding infertility treatment did not increase the rate of healthy live births (vaginal live birth of a healthy singleton at term) within 24 months of follow-up as compared to prompt infertility treatment in obese infertile women. Natural conceptions occurred more frequently in women who received a 6-month lifestyle intervention preceding infertility treatment. STUDY DESIGN, SIZE, DURATION This is a secondary analysis of a multicentre RCT (randomized controlled trial), the LIFEstyle study. Between 2009 and 2012, 577 obese infertile women were randomly assigned to a 6-month lifestyle intervention followed by infertility treatment (intervention group) or to prompt infertility treatment (control group). Subgroups were predefined in the study protocol, based on frequently used cut-off values in the literature: age (≥36 or <36 years), ovulatory status (anovulatory or ovulatory), BMI (≥35 or <35 kg/m2) and waist-hip (WH) ratio (≥0.8 or <0.8). PARTICIPANTS/MATERIALS, SETTING, METHODS Data of 564 (98%) randomized women who completed follow-up were analyzed. We studied the effect of the intervention program in various subgroups on healthy live birth rate within 24 months, as well as the rate of overall live births (live births independent of gestational age, mode of delivery and health) and natural conceptions within 24 months. Live birth rates included pregnancies resulting from both treatment dependent and natural conceptions. Logistic regression models with randomization group, subgroup and the interaction between randomization group and subgroup were used. Significant interaction was defined as a P-value <0.1. MAIN RESULTS AND THE ROLE OF CHANCE Neither maternal age, ovulatory status nor BMI had an impact on the healthy live birth rate within 24 months, nor did they influence the overall live birth rate within 24 months after randomization. WH ratio showed a significant interaction with the effect of lifestyle intervention on healthy live birth rate (P = 0.05), resulting in a lower healthy live birth rate in women with a WH ratio <0.8. WH ratio had no interaction regarding overall live birth rate (P = 0.27) or natural conception rate (P = 0.38). In anovulatory women, the effect of lifestyle intervention resulted in more natural conceptions compared to ovulatory women (P-value for interaction = 0.02). There was no interaction between other subgroups and the effect of the intervention on the rate of natural conception. LIMITATIONS, REASONS FOR CAUTION Since this was a subgroup analysis of a RCT and sample size determination of the trial was based on the primary outcome of the study, the study was not powered for analyses of all subgroups. WIDER IMPLICATIONS OF THE FINDINGS Our finding that lifestyle intervention leads to increased natural conception in anovulatory obese women could be used in the counselling of these women, but requires further research using an appropriately powered study in order to confirm this result. STUDY FUNDING/COMPETING INTERESTS The study was supported by a grant from ZonMw, the Dutch Organisation for Health Research and Development (50-50110-96-518). The Department of Obstetrics and Gynaecology of the UMCG received an unrestricted educational grant from Ferring pharmaceuticals BV, The Netherlands. Ben Mol is a consultant for ObsEva, Geneva. Annemieke Hoek received a speaker's fee for a postgraduate education from MSD pharmaceutical company, outside the submitted work. TRIAL REGISTRATION NUMBER The LIFEstyle study was registered at the Dutch trial registry (NTR 1530).
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Affiliation(s)
- A M van Oers
- Department of Obstetrics and Gynaecology, University of Groningen, University Medical Center Groningen, 9700RB Groningen, The Netherlands
| | - H Groen
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, 9700RB Groningen, The Netherlands
| | - M A Q Mutsaerts
- Department of Obstetrics and Gynaecology, University of Groningen, University Medical Center Groningen, 9700RB Groningen, The Netherlands.,Department of General Practice, University of Utrecht, University Medical Center Utrecht, 3508GA Utrecht, The Netherlands
| | - J M Burggraaff
- Department of Obstetrics and Gynaecology, Scheper Hospital, 7800RA Emmen, The Netherlands
| | - W K H Kuchenbecker
- Department of Obstetrics and Gynaecology, Isala Clinics, 8000GK Zwolle, The Netherlands
| | - D A M Perquin
- Department of Obstetrics and Gynaecology, Medical Center Leeuwarden, 8901BR Leeuwarden, The Netherlands
| | - C A M Koks
- Department of Obstetrics and Gynaecology, Maxima Medical Center, 5500MB Veldhoven, The Netherlands
| | - R van Golde
- Department of Obstetrics and Gynaecology, University of Maastricht, Maastricht University Medical Center, 6202AZ Maastricht, The Netherlands
| | - E M Kaaijk
- Department of Obstetrics and Gynaecology, OLVG, 1090HM Amsterdam, The Netherlands
| | - J M Schierbeek
- Department of Obstetrics and Gynaecology, Deventer Hospital, 7400GC Deventer, The Netherlands
| | - G J E Oosterhuis
- Department of Obstetrics and Gynaecology, St. Antonius Hospital, 3430EM Nieuwegein, The Netherlands
| | - F J Broekmans
- Department for Reproductive Medicine, Division Female and Baby, University of Utrecht, University Medical Center Utrecht, 3508GA Utrecht, The Netherlands
| | - N E A Vogel
- Department of Obstetrics and Gynaecology, Martini Hospital, 9700RM Groningen, The Netherlands
| | - J A Land
- Department of Obstetrics and Gynaecology, University of Groningen, University Medical Center Groningen, 9700RB Groningen, The Netherlands
| | - B W J Mol
- The Robinson Research Institute, School of Pediatrics and Reproductive Health, University of Adelaide, 5000SA Adelaide, Australia
| | - A Hoek
- Department of Obstetrics and Gynaecology, University of Groningen, University Medical Center Groningen, 9700RB Groningen, The Netherlands
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Duval K, Langlois MF, Carranza-Mamane B, Pesant MH, Hivert MF, Poder TG, Lavoie HB, Ainmelk Y, St-Cyr Tribble D, Laredo S, Greenblatt E, Sagle M, Waddell G, Belisle S, Riverin D, Jean-Denis F, Belan M, Baillargeon JP. The Obesity-Fertility Protocol: a randomized controlled trial assessing clinical outcomes and costs of a transferable interdisciplinary lifestyle intervention, before and during pregnancy, in obese infertile women. BMC OBESITY 2015; 2:47. [PMID: 26635965 PMCID: PMC4666156 DOI: 10.1186/s40608-015-0077-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Accepted: 11/20/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND Obesity in infertile women increases the costs of fertility treatments, reduces their effectiveness and increases significantly the risks of many complications of pregnancy and for the newborn. Studies suggest that even a modest loss of 5-10 % of body weight can restore ovulation. However, there are gaps in knowledge regarding the benefits and cost-effectiveness of a lifestyle modification program targeting obese infertile women and integrated into the fertility clinics. This study will evaluate clinical outcomes and costs of a transferable interdisciplinary lifestyle intervention, before and during pregnancy, in obese infertile women. We hypothesize that the intervention will: 1) improve fertility, efficacy of fertility treatments, and health of mothers and their children; and 2) reduce the cost per live birth, including costs of fertility treatments and pregnancy outcomes. METHODS/DESIGN Obese infertile women (age: 18-40 years; BMI ≥30 kg/m(2) or ≥27 kg/m(2) with polycystic ovary syndrome) will be randomised to either a lifestyle intervention followed by standard fertility treatments after 6 months if no conception has been achieved (intervention group) or standard fertility treatments only (control group). The intervention and/or follow-up will last for a maximum of 18 months or up to the end of pregnancy. Evaluation visits will be planned every 6 months where different outcome measures will be assessed. The primary outcome will be live-birth rates at 18 months. The secondary outcomes will be sub-divided into four categories: lifestyle and anthropometric, fertility, pregnancy complications, and neonatal outcomes. Outcomes and costs will be also compared to similar women seen in three fertility clinics across Canada. Qualitative data will also be collected from both professionals and obese infertile women. DISCUSSION This study will generate new knowledge about the implementation, impacts and costs of a lifestyle management program in obese infertile women. This information will be relevant for decision-makers and health care professionals, and should be generalizable to North American fertility clinics. TRIAL REGISTRATION ClinicalTrials.gov NCT01483612. Registered 25 November 2011.
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Affiliation(s)
- Karine Duval
- Research Center of the Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec Canada ; Division of Endocrinology, Department of medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001-12e Avenue Nord, Sherbrooke, Québec J1H 5N4 Canada
| | - Marie-France Langlois
- Research Center of the Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec Canada ; Division of Endocrinology, Department of medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001-12e Avenue Nord, Sherbrooke, Québec J1H 5N4 Canada
| | - Belina Carranza-Mamane
- Research Center of the Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec Canada ; Department of Obstetrics and Gynecology, Université de Sherbrooke, Sherbrooke, Québec Canada ; Procrea Cliniques, Montréal, Québec Canada
| | - Marie-Hélène Pesant
- Research Center of the Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec Canada ; Division of Endocrinology, Department of medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001-12e Avenue Nord, Sherbrooke, Québec J1H 5N4 Canada
| | - Marie-France Hivert
- Research Center of the Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec Canada ; Division of Endocrinology, Department of medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001-12e Avenue Nord, Sherbrooke, Québec J1H 5N4 Canada
| | - Thomas G Poder
- Research Center of the Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec Canada ; Department of Economics, Faculty of Administration, Université de Sherbrooke, Sherbrooke, Québec Canada ; UETMIS, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec Canada
| | - Hélène B Lavoie
- Procrea Cliniques, Montréal, Québec Canada ; Department of Medicine, Division of Endocrinology, Université de Montréal, Montréal, Québec Canada
| | - Youssef Ainmelk
- Department of Obstetrics and Gynecology, Université de Sherbrooke, Sherbrooke, Québec Canada
| | | | - Sheila Laredo
- Department of Medicine, Division of Endocrinology, Women's College Hospital, University of Toronto, Toronto, Ontario Canada
| | - Ellen Greenblatt
- Centre for Fertility and Reproductive Health, Mount Sinai Hospital, University of Toronto, Toronto, Ontario Canada
| | - Margaret Sagle
- Department of Obstetrics and Gynaecology, University of Alberta, Edmonton, Ontario Canada
| | - Guy Waddell
- Department of Obstetrics and Gynecology, Université de Sherbrooke, Sherbrooke, Québec Canada
| | - Serge Belisle
- Department of Obstetrics & Gynecology, Université de Montréal, Montréal, Québec Canada
| | | | - Farrah Jean-Denis
- Research Center of the Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec Canada
| | - Matea Belan
- Research Center of the Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec Canada ; Division of Endocrinology, Department of medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001-12e Avenue Nord, Sherbrooke, Québec J1H 5N4 Canada
| | - Jean-Patrice Baillargeon
- Research Center of the Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec Canada ; Division of Endocrinology, Department of medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001-12e Avenue Nord, Sherbrooke, Québec J1H 5N4 Canada
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Le W, Su SH, Shi LH, Zhang JF, Wu DL. Effect of male body mass index on clinical outcomes following assisted reproductive technology: a meta-analysis. Andrologia 2015; 48:406-24. [PMID: 26276351 DOI: 10.1111/and.12461] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2015] [Indexed: 12/01/2022] Open
Affiliation(s)
- W. Le
- Department of Urology; Tongji Hospital; Tongji University School of Medicine; Shanghai China
- Department of Reproductive Center; Tongji Hospital; Tongji University School of Medicine; Shanghai China
| | - S.-H. Su
- Department of Surgery; Tongji Hospital; Tongji University School of Medicine; Shanghai China
| | - L.-H. Shi
- Department of Reproductive Center; Tongji Hospital; Tongji University School of Medicine; Shanghai China
| | - J.-F. Zhang
- Department of Reproductive Center; Tongji Hospital; Tongji University School of Medicine; Shanghai China
- Department of Urology; Tongren Hospital; Shanghai Jiaotong University School of Medicine; Shanghai China
| | - D.-L. Wu
- Department of Urology; Tongji Hospital; Tongji University School of Medicine; Shanghai China
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Caillon H, Fréour T, Bach-Ngohou K, Colombel A, Denis MG, Barrière P, Masson D. Effects of female increased body mass index on in vitro fertilization cycles outcome. Obes Res Clin Pract 2015; 9:382-8. [PMID: 25769458 DOI: 10.1016/j.orcp.2015.02.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 01/14/2015] [Accepted: 02/11/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND As being overweight can impair female spontaneous fertility or after assisted reproductive technology (ART) cycles, the aim of this study was to compare in vitro fertilization (IVF) outcome according to women's body mass index (BMI). METHODS Retrospective study conducted from 2006 to 2009 in the IVF unit of Nantes University Hospital, France. 582 patients undergoing standard infertility workup and controlled ovarian stimulation were categorized according to BMI into two groups: group 1: normal weight (20-24.9 kg/m(2); n=409) and group 2: overweight and obese (≥25 kg/m(2); n=149). Basal hormonal status, smoking habitus, infertility duration, IVF cycle parameters and outcome were recorded. RESULTS Basal LH, FSH and estradiol levels were higher in group 1 than group 2, but ovarian reserve markers were comparable across the two BMI groups. Higher doses of gonadotropins were required in group 2 to obtain equivalent ovarian response than in group 1. No difference was observed on ovarian response and embryonic parameters. Cycle outcome were not significantly different between both groups, but we found a strong trend towards increasing transfer cancellation and miscarriage rates in group 2. CONCLUSION Although overweight and obesity do not compromise ovarian stimulation results whenever adaptation of recombinant FSH doses is made, our data suggest an increased risk of cancellation transfer and miscarriage rate, leading to poorer IVF outcome.
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Affiliation(s)
- Hélène Caillon
- Hormonology and Biochemistry Laboratory, CHU Nantes, France.
| | - Thomas Fréour
- Department of Human Reproduction, CHU Nantes, France
| | | | | | - Marc G Denis
- Hormonology and Biochemistry Laboratory, CHU Nantes, France
| | - Paul Barrière
- Department of Human Reproduction, CHU Nantes, France
| | - Damien Masson
- Hormonology and Biochemistry Laboratory, CHU Nantes, France
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Dayan N, Pilote L, Opatrny L, Basso O, Messerlian C, El-Messidi A, Daskalopoulou SS. Combined impact of high body mass index and in vitro fertilization on preeclampsia risk: a hospital-based cohort study. Obesity (Silver Spring) 2015; 23:200-6. [PMID: 25293810 DOI: 10.1002/oby.20896] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 08/18/2014] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Overweight and obese women may be heavy users of in vitro fertilization (IVF) owing to obesity-related oligo-anovulation. The higher doses of gonadotropins required to achieve pregnancy in obese women may contribute to impaired placentation and the development of preeclampsia. This study was designed to assess the combined effect of high maternal body mass index (BMI) and IVF on risk of preeclampsia and to evaluate for an interaction between the two factors. METHODS This is a hospital-based cohort study of 10,013 singleton pregnancies that delivered from 2001 to 2008 at a tertiary hospital in Montreal, Canada. The combined effect of high BMI and IVF on preeclampsia versus no risk factors was estimated in multivariate logistic regression models fitted with an interaction term between high BMI (> 25 or > 30 kg/m(2) ) and IVF. RESULTS IVF pregnancies in obese women had a considerably higher risk of preeclampsia than spontaneous nonobese pregnancies (OR 6.7, 95% CI 3.3-13.8; p interaction 0.03). IVF was not independently associated with preeclampsia (OR 0.6, 95% CI 0.3-1.4). Analyses were similar in subgroup analyses and in analyses correcting for bias. CONCLUSIONS High BMI is strongly associated with preeclampsia, and this risk is compounded in IVF pregnancies.
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Affiliation(s)
- Natalie Dayan
- Division of General Internal Medicine, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
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Akhter N, CarlLee T, Syed MM, Odle AK, Cozart MA, Haney AC, Allensworth-James ML, Beneš H, Childs GV. Selective deletion of leptin receptors in gonadotropes reveals activin and GnRH-binding sites as leptin targets in support of fertility. Endocrinology 2014; 155:4027-42. [PMID: 25057790 PMCID: PMC4164926 DOI: 10.1210/en.2014-1132] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The adipokine, leptin (LEP), is a hormonal gateway, signaling energy stores to appetite-regulatory neurons, permitting reproduction when stores are sufficient. Dual-labeling for LEP receptors (LEPRs) and gonadotropins or GH revealed a 2-fold increase in LEPR during proestrus, some of which was seen in LH gonadotropes. We therefore investigated LEPR functions in gonadotropes with Cre-LoxP technology, deleting the signaling domain of the LEPR (Lepr-exon 17) with Cre-recombinase driven by the rat LH-β promoter (Lhβ-cre). Selectivity of the deletion was validated by organ genotyping and lack of LEPR and responses to LEP by mutant gonadotropes. The mutation had no impact on growth, body weight, the timing of puberty, or pregnancy. Mutant females took 36% longer to produce their first litter and had 50% fewer pups/litter. When the broad impact of the loss of gonadotrope LEPR on all pituitary hormones was studied, mutant diestrous females had reduced serum levels of LH (40%), FSH (70%), and GH (54%) and mRNA levels of Fshβ (59%) and inhibin/activin β A and β B (25%). Mutant males had reduced serum levels of GH (74%), TSH (31%), and prolactin (69%) and mRNA levels of Gh (31%), Ghrhr (30%), Fshβ (22%), and glycoprotein α-subunit (Cga) (22%). Serum levels of LEP and ACTH and mRNA levels of Gnrhr were unchanged. However, binding to GnRH receptors was reduced in LEPR-null LH or FSH gonadotropes by 82% or 89%, respectively, in females (P < .0001) and 27% or 53%, respectively, in males (P < .03). This correlated with reductions in GnRH receptor protein immunolabeling, suggesting that LEP's actions may be posttranscriptional. Collectively, these studies highlight the importance of LEP to gonadotropes with GnRH-binding sites and activin as potential targets. LEP may modulate population growth, adjusting the number of offspring to the availability of food supplies.
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Affiliation(s)
- Noor Akhter
- Department of Neurobiology and Developmental Sciences, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205
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Pandey S, McLernon DJ, Scotland G, Mollison J, Wordsworth S, Bhattacharya S. Cost of fertility treatment and live birth outcome in women of different ages and BMI. Hum Reprod 2014; 29:2199-211. [PMID: 25061026 DOI: 10.1093/humrep/deu184] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION What is the impact of different age and BMI groups on total investigation and treatment costs in women attending a secondary/tertiary care fertility clinic? SUMMARY ANSWER Women in their early to mid-30s and women with normal BMI had higher cumulative investigation and treatment costs, but also higher probability of live birth. WHAT IS KNOWN ALREADY Female age and BMI have been used as criteria for rationing publically funded fertility treatments. Population-based data on the costs of investigating and treating infertility are lacking. STUDY DESIGN, SIZE AND DURATION A retrospective cohort study of 2463 women was conducted in a single secondary/tertiary care fertility clinic in Aberdeen, Scotland from 1998 to 2008. PARTICIPANTS/MATERIALS, SETTING, METHODS Participants included all women living in a defined geographical area referred from primary care to a specialized fertility clinic over an 11-year period. Women were followed up for 5 years or until live birth if this occurred sooner. Mean discounted cumulative National Health Service costs (expressed in 2010/2011 GBP) of fertility investigations, treatments (including all types of assisted reproduction), and pregnancy (including delivery episode) and neonatal admissions were calculated and summarized by age (≤ 30, 31-35, 36-40, >40 years) and BMI groupings (<18.50, 18.50-24.99 (normal BMI), 25.00-29.99, 30.00-34.99, ≥ 35.00 kg/m(2)). Further multivariate modelling was carried out to estimate the impact of age and BMI on investigation and treatment costs and live birth outcome, adjusting for covariates predictive of the treatment pathway and live birth. MAIN RESULTS AND THE ROLE OF CHANCE Of the 2463 women referred, 1258 (51.1%) had a live birth within 5 years, with 694 (55.1%) of these being natural conceptions. The live birth rate was highest among women in the youngest age group (64.3%), and lowest in those aged >40 years (13.4%). Overall live birth rates were generally lower in women with BMI >30 kg/m(2). The total costs of investigations were generally highest among women younger than 30 years (£491 in those with normal BMI), whilst treatment costs tended to be higher in 31-35 year olds (£1,840 in those with normal BMI). Multivariate modelling predicted a cost increase associated with treatment which was highest among women in the lowest BMI group (across all ages), and also highest among women aged 31-35 years. The increase in the predicted probability of live birth with exposure to treatment was consistent across age and BMI categories (∼ 10%), except in the oldest age group where a slightly smaller increase in the probability of live birth was observed. The ratio of increased costs to the increased probability of live birth in women who were treated increased markedly in women over the age of 40 years, but tended to fall as BMI increased within all age groups. LIMITATIONS AND REASON FOR CAUTION Our results, based on retrospective observational data from a single centre, have limited generalizability and are not free from clinician and clinic selection bias which can influence the choice of treatments as well as their costs. WIDER IMPLICATIONS OF THE FINDINGS Spontaneous live birth rates were particularly high in younger women with unexplained infertility, suggesting that expectant management is a reasonable option in this group. The policy of not over-investigating older women and offering early treatment where appropriate still incurred the highest costs per additional live birth associated with treatment, owing to the lower probability of treatment success. The increased additional cost for each live birth associated with treatment for women with decreasing BMI across all age groups, suggests that it may be possible to identify a more targeted approach to treatment. STUDY FUNDING/COMPETING INTERESTS This study was partly funded by an NHS endowment grant (Grant Number 12/48) and D.J.M. by a Chief Scientist Office Postdoctoral Fellowship (Ref PDF/12/06). There are no conflicts of interest to declare.
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Affiliation(s)
- Shilpi Pandey
- Reproductive Medicine, CARE Fertility, 6 Lawrence Drive, Nottingham NG8 6PZ, UK
| | - David J McLernon
- Division of Applied Health Sciences, University of Aberdeen, Polwarth Building, Aberdeen AB25 2ZD, UK
| | - Graham Scotland
- Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen AB25 2ZD, UK
| | - Jill Mollison
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen AB25 2ZD, UK
| | - Sarah Wordsworth
- Health Economic Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - Siladitya Bhattacharya
- Division of Applied Health Sciences, University of Aberdeen, Polwarth Building, Aberdeen AB25 2ZD, UK
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Management of poor responders in IVF: is there anything new? BIOMED RESEARCH INTERNATIONAL 2014; 2014:352098. [PMID: 25136579 PMCID: PMC4127291 DOI: 10.1155/2014/352098] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 06/26/2014] [Indexed: 12/22/2022]
Abstract
Despite the fact that in the last two decades an enormous number of papers on the topic of poor ovarian response have been published in the literature, so far it has been impossible to identify any efficient treatment to improve the ovarian response and the clinical outcome of this group of patients. The incidence of poor ovarian responders among infertile women has been estimated at 9–24% but according to recent reviews, it seems to have slightly increased. The limitation in quantifying the incidence of these patients among the infertile population is due to the difficulty of a clear definition in literature. A recent paper by the Bologna ESHRE working group on poor ovarian response has been the first real attempt to find a common definition. Current literature proposes new risk factors which could be the cause of a reduction in ovarian reserve, which also includes genetic factors. This represents the first necessary step towards finding applicable solutions for these patients. To date, there is a substantial lack of literature that identifies an ideal protocol for these patients. The use of the “Bologna criteria” and the introduction of long acting gonadotropin in clinical practice have given rise to new promising stimulation protocols for this group of patients.
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Dayan N, Pilote L, Opatrny L, Daskalopoulou SS. Assisted Reproductive Therapy in Women With Higher Body Mass Index. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2014; 36:513-514. [DOI: 10.1016/s1701-2163(15)30567-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Valckx SDM, Arias-Alvarez M, De Pauw I, Fievez V, Vlaeminck B, Fransen E, Bols PEJ, Leroy JLMR. Fatty acid composition of the follicular fluid of normal weight, overweight and obese women undergoing assisted reproductive treatment: a descriptive cross-sectional study. Reprod Biol Endocrinol 2014; 12:13. [PMID: 24498875 PMCID: PMC3916060 DOI: 10.1186/1477-7827-12-13] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 02/01/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It has been well documented that the maturing oocyte is very vulnerable to changes in its micro-environment, the follicular fluid (FF). Recent research has focused on different components within this FF, like hormones, growth factors and metabolites, and how their concentrations are altered by diet and the metabolic health of the mother. It has been proposed that fatty acids (FAs) are potential factors that influence oocyte maturation and subsequent embryo development. However, a thorough study of the specific FF FA composition per lipid fraction and how this may be affected by BMI is currently lacking. Therefore, we investigated the BMI-related concentration of FAs in the phospholipid (PL), cholesteryl-ester (CHE), triglyceride (TG) and non-esterified (NE) lipid fraction in the FF of women undergoing assisted reproductive treatment (ART). METHODS In this descriptive cross-sectional study, the FF of normal weight (18.5 ≤ BMI < 25.0 kg/m(2), n = 10), overweight (25.0 ≤ BMI < 30.0 kg/m(2), n = 10) and obese (BMI ≥ 30.0 kg/m(2), n = 10) women, undergoing ART, was sampled and analyzed for 23 specific FAs in the PL, CHE, TG and NEFA fraction, using a gas chromatographic analysis method. Differences between BMI-groups were studied by means of univariate general linear models and post hoc Sheffé tests. RESULTS Total FA concentrations in the PL and CHE fraction did not differ between BMI groups. Total TG concentrations tended to differ and total NEFA concentrations differed significantly between BMI groups. Interestingly, 42% and 34% of the total FAs was esterified in the PL and CHE fraction, respectively, while only 10% were present in both the TG and NEFA fraction. Only few individual FA concentrations differed in the PL, CHE and TG fraction between BMI groups, whereas abundant BMI-related differences were found in the NEFA fraction. CONCLUSIONS Our data show that differences in BMI are associated with alterations in the FA composition of the FF, an effect most pronounced in the NEFA fraction. These BMI-related variations could possibly affect granulosa cell viability, oocyte developmental competence and subsequent embryo quality possibly explaining differences in oocyte quality in obese patients described by others.
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Affiliation(s)
- Sara DM Valckx
- Veterinary Physiology and Biochemistry, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Maria Arias-Alvarez
- Dpto. Producción Animal, Facultad de Veterinaria, Universidad Complutense de Madrid, Ciudad Universitaria s/n., 28040 Madrid, Spain
| | - Ingrid De Pauw
- Centre for Reproductive Medicine, ZNA Middelheim, Lindendreef 1, 2020 Antwerpen, Belgium
| | - Veerle Fievez
- Laboratory for Animal Nutrition and Animal Product Quality, Ghent University, Proefhoevestraat 10, 9090 Melle, Belgium
| | - Bruno Vlaeminck
- Laboratory for Animal Nutrition and Animal Product Quality, Ghent University, Proefhoevestraat 10, 9090 Melle, Belgium
| | - Erik Fransen
- StatUA Center for Statistics, University of Antwerp, Prinsstraat 13, 2000 Antwerp, Belgium
| | - Peter EJ Bols
- Veterinary Physiology and Biochemistry, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Jo LMR Leroy
- Veterinary Physiology and Biochemistry, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
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Gupta S, Fedor J, Biedenharn K, Agarwal A. Lifestyle factors and oxidative stress in female infertility: is there an evidence base to support the linkage? ACTA ACUST UNITED AC 2014. [DOI: 10.1586/17474108.2013.849418] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Wang N, Luo LL, Xu JJ, Xu MY, Zhang XM, Zhou XL, Liu WJ, Fu YC. Obesity accelerates ovarian follicle development and follicle loss in rats. Metabolism 2014; 63:94-103. [PMID: 24135502 DOI: 10.1016/j.metabol.2013.09.001] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 09/04/2013] [Accepted: 09/04/2013] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Studies have shown that excess body fat negatively affects reproductive functions in females. However, whether obesity affects the ovarian follicle development and ovarian lifespan and the underlying mechanism has not been well elucidated. The aim of the present study was to investigate the association between obesity and ovarian follicle development. METHODS Adult female Sprague-Dawley rats (n = 36) were randomly divided into three groups: the normal control (NC) group, the caloric restriction (CR) group (fed 70% food of the NC group) and the high-fat diet (HF) group. They were maintained on these regimens for 18 weeks. RESULTS The body weight, ovary weight and visceral fat in the HF group were significantly higher than those in the NC group and the CR group at the end of treatment. Histological analysis showed that the HF rats had significantly less number and percentage of primordial follicles, but greater number and percentage of developing and atretic follicles than the NC rats and CR rats. Western blot analysis demonstrated that the level of mTORC1 and p-S6K1 proteins significantly increased in the ovaries of HF rats, whereas that of SIRT1, SIRT6, FOXO3a and NRF-1 decreased compared to the NC rats. In contrast, the expression of mTORC1 and p-S6K1 dramatically declined, while that of SIRT1, SIRT6, FOXO3a and NRF1 increased in the ovaries of CR rats. CONCLUSIONS Our study suggests that the HF diet induced obesity may accelerate the ovarian follicle development and rate of follicle loss through activating mTOR and suppressing SIRT1 signaling, thus leading to POF, and that CR may inhibit the activation of primordial follicles, follicular development and loss, thus extending the ovarian lifespan through suppressing mTOR and activating SIRT1 signaling.
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Affiliation(s)
- Na Wang
- Laboratory of Cell Senescence, Shantou University Medical College, Xinling Road 22, Shantou 515041, P.R. China
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Sharma R. Prospective Study of Effect of Body Weight on in vitro Fertilization Outcome in Reproductive Age Group. ACTA ACUST UNITED AC 2014. [DOI: 10.5005/jp-journals-10016-1082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
ABSTRACT
Background
Various prognostic factors in assisted reproduction procedures have been described and analyzed which includes woman's age, cause of infertility, ovarian response and uterine receptivity, the semen quality, and the body mass index (BMI). Optimal BMI is required for an optimal response. There is controversy among various reports, which is partly caused by the varying focus of investigators and differences in study designs, which led us to examine the relationship between BMI, in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) outcome in our unit.
Objective
To study impact of BMI on IVF outcome prospectively
Materials and methods
It is a prospective study over a period of 1 year in the age group 25 to 35 years attending the IVF clinic was conducted at a tertiary infertility center in Bangalore, India between November 2010 and October 2011.
Results
There is a close association of increased BMl in particular when BMl is > 30 kg/m2 and the reduced outcomes of IVF/ ICSI treatment in the form of decreased clinical pregnancy and higher early pregnancy loss. Furthermore, increased BMl is related to higher dosage and duration of gonadotropins requirement increased risk of cancellation and fewer collected oocytes.
Conclusion
Obesity is associated with an increased risk of early pregnancy loss. Also need of high dose of gonadotropin, less number of collected oocytes is observed. Implantation rate, pregnancy rate and miscarriage rate was comparable but live births are high in normal weight and overweight as compared to extremes of BMI. So will be appropriate to recommend life style modifications including weight loss to achieve an appropriate BMI prior to IVF.
How to cite this article
Sharma R. Prospective Study of Effect of Body Weight on in vitro Fertilization Outcome in Reproductive Age Group. Int J Infertil Fetal Med 2014;5(2):58-63.
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Pinborg A, Petersen GL, Schmidt L. Recent insights into the influence of female bodyweight on assisted reproductive technology outcomes. ACTA ACUST UNITED AC 2013; 9:1-4. [PMID: 23241149 DOI: 10.2217/whe.12.67] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Valckx SDM, De Pauw I, De Neubourg D, Inion I, Berth M, Fransen E, Bols PEJ, Leroy JLMR. BMI-related metabolic composition of the follicular fluid of women undergoing assisted reproductive treatment and the consequences for oocyte and embryo quality. Hum Reprod 2012; 27:3531-9. [PMID: 23019302 DOI: 10.1093/humrep/des350] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
STUDY QUESTION Is the metabolic composition of the follicular fluid of women undergoing assisted reproductive treatment (ART) related to serum composition and BMI and is it associated with oocyte and embryo quality? SUMMARY ANSWER We showed that metabolic alterations in the serum are reflected in the follicular fluid and that some of these alterations may affect oocyte quality, irrespective of BMI. WHAT IS KNOWN ALREADY Many studies have focused on the effect of metabolic disorders, such as obesity and type 2 diabetes, on assisted reproduction outcomes. There are, however, only few studies focusing on the importance of the correlation between serum and follicular fluid compositions and the composition of the follicular fluid as the oocyte's micro-environment, affecting its development and subsequent embryo quality. DESIGN, PARTICIPANTS AND SETTING In this prospective cohort study, patient information, fertility treatment outcome data, follicular fluid and serum were obtained from women undergoing ART. Patients were categorized according to their BMI (kg/m(2)) as normal (n = 60), overweight (n = 26) or obese (n = 20). Serum and follicular fluid samples were analyzed for urea, total protein, albumin, cholesterol, high-density lipoprotein cholesterol, triglycerides, non-esterified fatty acids, apolipoprotein A1, apolipoprotein B, glucose, lactate, C-reactive protein, insulin-like growth factor -1 (IGF-1), IGF-binding protein 3 (only in follicular fluid), free carnitine and total carnitine. Metabolite concentrations in serum and follicular fluid samples were correlated and were associated with BMI and fertility treatment outcome. MAIN RESULTS Most serum metabolite differences between patients were reflected in the follicular fluid (P < 0.05). Follicular fluid apolipoprotein A1 and follicular fluid total protein concentrations negatively affected oocyte quality parameters (P < 0.05). However, overall BMI-related associations were poor. BIAS, CONFOUNDING AND OTHER REASONS FOR CAUTION In this study, we included every patient willing to participate. Within this cohort, women with a BMI transcending 35 kg/m(2) were scarce (n = 2), because extremely overweight women are mostly advised to lose weight before starting ART. Furthermore, the number of patients in each BMI group was different, possibly masking associations between the metabolic composition of serum and follicular fluid and oocyte quality parameters. GENERALIZABILITY TO OTHER POPULATIONS There were significant associations indicating that metabolic changes in the serum are reflected in the follicular fluid, potentially affecting oocyte quality, irrespective of the patient's BMI. For ethical reasons, this study only focused on women already in need of artificial reproductive treatment. From a metabolic point of view, we consider this cohort as a representative sample of all women of reproductive age. STUDY FUNDING This study was funded by the special research fund, university of Antwerp (BOF UA). None of the authors has any conflict of interest to declare.
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Affiliation(s)
- S D M Valckx
- Veterinary Physiology and Biochemistry, Department of Veterinary Sciences, University of Antwerp, 2610 Wilrijk, Belgium.
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