Urinary phthalate metabolite concentrations in relation to history of infertility and use of assisted reproductive technology

OBJECTIVE

To examine urinary phthalate metabolite concentrations in pregnant women with planned pregnancies in relation to history of infertility and use of assisted reproductive technology (ART).

DESIGN

Phthalate metabolite concentrations were measured in first-trimester urine samples collected from women participating in a prospective pregnancy cohort study.

SETTING

Prenatal clinics.

PATIENT(S)

A total of 750 women, of whom 86 had a history of infertility. Forty-one women used ART to conceive.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

Primary outcomes were concentrations of four metabolites of diethylhexyl phthalate (DEHP) and their molar sum (∑DEHP). Multivariable analyses compared phthalate metabolite levels in [1] women reporting a history of infertility vs. those who did not (comparison group); and [2] those who used ART to conceive the index pregnancy vs. women with a history of infertility who did not use ART.

RESULT(S)

Among women with a history of infertility, ∑DEHP was significantly lower in women who conceived after ART compared with those who did not (geometric mean ratio: 0.83; 95% confidence interval 0.71-0.98). Similar significant associations were observed for all of the individual DEHP metabolites. There were no differences in DEHP metabolite concentrations between women with a history of infertility and the comparison group.

CONCLUSION(S)

Women who used ART to conceive had lower first-trimester phthalate metabolite concentrations than women with a history of infertility who did not use ART. Further research is needed to explore whether those pursuing fertility treatments take precautions to avoid exposure to environmental toxins, to improve treatment outcomes.

Obesity and weight loss in polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) and obesity are common and complicated disorders that are influenced by genetic and environmental factors. Obesity is a prominent feature of PCOS; at least 50% of patients with PCOS are obese. Obesity appears to exert an additive, synergistic effect on the manifestations of PCOS, independently impacting insulin sensitivity, risk for diabetes, and adverse cardiovascular profile. There is evidence for the benefit of weight reduction in the management of PCOS in the obese patient. Weight loss remains a primary intervention in treatment of this disorder.

Complications of laparoscopy--operative and diagnostic

OBJECTIVE

To assess the characteristics and rates of complications for operative laparoscopy and diagnostic laparoscopy.

DESIGN

Retrospective review.

SETTING

Tertiary-care university hospital.

PATIENTS

Two thousand three hundred twenty-four patients undergoing operative laparoscopy or diagnostic laparoscopy.

INTERVENTIONS

Operative laparoscopy including lysis of adhesions, tubal surgery, ovarian surgery, uterine surgery, or destruction of endometriosis.

MAIN OUTCOME MEASURES

Complication rates for operative and diagnostic laparoscopies were tabulated and compared.

RESULTS

The overall major complication rate for this series of 2,324 laparoscopies was 0.22%. There were five major and 15 minor complications. In the operative laparoscopy group, there were more complications from Veress needle and trocar insertion (n = 15) than from the actual operative procedures (n = 3). There were more total complications in the operative laparoscopy group (n = 18) than in the diagnostic laparoscopy group (n = 3).

CONCLUSION

Operative laparoscopy is efficacious for a variety of gynecologic surgical procedures.