A. Zapantis

Semen Parameters are Unrelated to BMI But Vary With SSRI Use and Prior Urological Surgery

Background: Male infertility affects approximately 6% of reproductive-aged men. It has been suggested that overweight men or men with obese body mass index (BMI) experience prolonged time to pregnancy, though the influence of male BMI on fertility remains understudied. Aims: We hypothesized that BMI is inversely correlated with fertility, manifested by reduced sperm concentration, motility, and morphology. Methods: Males of age 18 to 50 with semen analyses and self-reported BMI were included (n = 530). Patient parameters analyzed included age, BMI, smoking, urological, and fertility history. Leutinizing hormone (LH), Follicle-stimulating hormone, testosterone, steroid hormone-binding globulin (SHBG) and free androgen index (FAI) levels (n = 55), and selective serotonin reuptake inhibitor (SSRI) use (n = 12) were also measured. Results: The men in this study had a mean BMI of 28.2 ± 4.9 kg/m2 (range = 15-60), which is considered overweight, and a mean semen concentration of 55.4 ± 46.8 million/mL, which is in normal range, according to WHO standard. No consistent relationship was observed between increasing BMI and sperm concentration, motility, or morphology, although the testosterone levels trended downward with increasing BMI; there was a suggestion for decreased sperm concentration in current smokers. Men treated with combination SSRI and other psychotropic agent therapy (n = 12) had significantly reduced sperm motility (P = .009). Not unexpectedly, prior urological surgery (n = 77) was associated with lower sperm concentration (P = .0001) and morphology (P = .0008). When in vitro fertilization−embryo transfer (IVF-ET) was used as a treatment modality (n = 121), male BMI was not a significant predictor of clinical pregnancy (P = .06). Conclusions: In our study, we did not observe a significant association between male BMI and sperm concentration, motility or morphology, or clinical pregnancy following IVF-ET. Significantly, SSRI use may affect sperm parameters negatively.

How many eggs are needed to produce an assisted reproductive technology baby: is more always better?

OBJECTIVE To evaluate the association between the number of mature (metaphase II [MII]) oocytes per assisted reproductive technology (ART) cycle and the likelihood of live birth. DESIGN Retrospective study. SETTING Academic infertility practice. PATIENT(S) Seven hundred thirty-seven infertile women undergoing their initial fresh embryo, nondonor IVF or intracytoplasmic sperm injection cycle at Montefiores Institute for Reproductive Medicine and Health between January 2002 and December 2008. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Live birth. RESULT(S) Two hundred twenty-four cycles resulted in a live birth (30.4%). Live birth cycles had significantly more MII oocytes obtained per cycle as compared with their unsuccessful counterparts (11.0 ± 5.9 vs. 9.7 ± 6.2, respectively). Multivariate logistic regression was done to determine the minimum number of MII oocytes per cycle as a predictor of live birth after adjustment for age and historical maximum FSH values. Cycles that included the average number of MII in this cohort were used as a reference group. For cycles with five or fewer MII oocytes obtained, there was a statistically significant decrease in the likelihood of a live birth as compared with the reference group (odds ratio 0.61, 95% confidence interval 0.38-0.99). However, cycles with six or fewer obtained MII oocytes were not less likely to result in a live birth when compared with the reference group (odds ratio 0.69, 95% confidence interval 0.45-1.08). CONCLUSION(S) In our cohort, there was an advantage to obtaining six or more MII oocytes during the fresh oocyte retrieval compared with five or fewer oocytes. There was not an advantage, however, to obtaining 10 or more or 15 or more oocytes as compared with obtaining 6-9 oocytes. The strategy of aiming for a greater number of oocytes in an ART cycle should be revisited.

Male adiposity impairs clinical pregnancy rate by in vitro fertilization without affecting day 3 embryo quality.

Male adiposity is detrimental for achieving clinical pregnancy rate (CPR) following assisted reproductive technologies (ART). The hypothesis that the association of male adiposity with decreased success following ART is mediated by worse embryo quality was tested.

Declining ovarian reserve adversely influences granulosa cell viability

OBJECTIVE To identify if declining ovarian reserve adversely influences granulosa cell (GC) parameters in patients undergoing IVF. DESIGN Prospective study. SETTING Academic IVF Center. PATIENT(S) Twenty-four women undergoing IVF. INTERVENTION(S) Mural and cumulus GCs were harvested (at time of egg retrieval). MAIN OUTCOME MEASURE(S) Influence of ovarian reserve, reflected by maximal basal FSH levels, on GC (cumulative, mural, and cumulus) counts and viability were investigated. RESULT(S) The FSH levels demonstrated an inverse correlation with cumulative and mural, but not cumulus, GC viability. Adverse influence of increasing FSH on cumulative GC viability was independent of patients age. The GC counts were uninfluenced by ovarian reserve status. Neither GC count nor viability demonstrated any relationship with clinical pregnancy after IVF. CONCLUSION(S) We observed an adverse association between declining ovarian reserve and GC parameters. We believe these findings may partly explain the suboptimal reproductive performance in these women.

Reproductive implications of psychological distress for couples undergoing IVF

ObjectiveTo study implications of psychological distress on in vitro fertilization (IVF) outcome of an infertile couple.MethodsProspective study in an academic infertility practice setting. Couples undergoing embryo transfer (ET) following IVF were offered participation. Female patient (n = 89) and partner (n = 77) completed questionnaires reflecting dysphoria (POMS) and pessimism (LOT) after undergoing ET. Relationship between dysphoria and pessimism and implications of individual and couple’s psychological distress on IVF cycle parameters and outcomes were assessed using multivariable analyses.ResultsStatistically significant correlations between dysphoria and pessimism were observed within the individual and between partners, (p < 0.01). Higher couple pessimism correlated with longer duration of controlled ovarian hyperstimulation (COH, p = 0.02); higher partner psychological distress related to lower fertilization rate (FR, p = 0.03). On adjusted analyses, partner’s depression score was an independent predictor of reduced likelihood of clinical pregnancy (p = 0.03).ConclusionsOur data validate the concept of a “stressed couple”. Adverse implications of a couple’s psychological distress for gamete biology (longer duration of COH and lower FR with increasing distress) are suggested. Partner’s depressive scores negatively correlated with IVF success. These findings suggest the importance of including partner’s evaluation in studies that focus on effects of psychological stress on IVF outcome; future studies should examine whether interventions aimed at reducing psychological stress for the infertile couple may improve IVF cycle success.

Full-sibling embryos created by anonymous gamete donation in unrelated recipients

OBJECTIVE To report the rare occurrence of full-sibling embryos in unrelated women using independently chosen donor sperm and donor oocytes in two different cycles unintentionally created at our IVF program, and to discuss the concept of disclosure to the patients. DESIGN Case report. SETTING Academic IVF program. PATIENT(S) Two women independently undergoing donor recipient cycles with anonymous donor oocytes and donor sperm. INTERVENTION(S) Both women received oocytes from the same donor several months apart and then by coincidence selected the same anonymous sperm donor to create anonymous full-sibling embryos. MAIN OUTCOME MEASURE(S) Clinical pregnancy after donor-recipient IVF cycle. RESULT(S) Both women conceived using the same donor sperm and donor oocytes in independent cycles, resulting in simultaneous pregnancy of full siblings. CONCLUSION(S) As providers with the knowledge that anonymous full sibling embryos have been created, we may have an obligation to disclose this information to the patients.

Serum and follicular fluid monocyte chemotactic protein-1 levels are elevated in obese women and are associated with poorer clinical pregnancy rate after in vitro fertilization: a pilot study

OBJECTIVE To determine whether monocyte chemotactic protein-1 (MCP-1), a proinflammatory chemokine important in ovulation, is abnormally elevated in obese women undergoing IVF and whether serum and follicular fluid (FF) levels of MCP-1 are associated with IVF outcome. DESIGN Prospective pilot study. SETTING Academic center. PATIENT(S) Women undergoing IVF. INTERVENTION(S) Serum and FF were collected from women undergoing IVF. MAIN OUTCOME MEASURE(S) Correlation between MCP-1 and other inflammatory markers with adiposity and pregnancy outcome after IVF. RESULT(S) Obese women had significantly higher serum and FF MCP-1 levels compared with overweight and normal weight women. Serum MCP-1, granulocyte colony stimulating factor, catalase, and C-reactive protein (CRP) were positively correlated with body mass index (BMI). After adjusting for age and baseline FSH, these correlations remained significant for serum MCP-1, granulocyte colony stimulating factor, and CRP. In the FF, only MCP-1 was positively correlated with BMI. Women who became pregnant had significantly lower serum MCP-1 and CRP levels compared with those who did not become pregnant; this difference was more pronounced among women with diminished ovarian reserve. Receiver operating characteristic curve demonstrated that serum MCP-1 levels >373.0 pg/mL in all women and >362.6pg/mL in women with diminished ovarian reserve predicted failure to achieve a clinical pregnancy. CONCLUSION(S) Elevations in serum and FF MCP-1 levels are positively correlated with adiposity and negatively correlated with pregnancy rates (PRs) in women undergoing IVF.