Brooke V. Rossi

Prevalence of Metabolic Syndrome and Related Characteristics in Obese Adolescents with and without Polycystic Ovary Syndrome

CONTEXT Adults with polycystic ovary syndrome (PCOS) may be at increased risk for metabolic syndrome (MBS) and related cardiovascular disease. It is not clear whether PCOS diagnosed in adolescence increases the risk of MBS in this age group. OBJECTIVE The aim was to compare the prevalence and related characteristics of MBS in obese adolescents with and without PCOS. DESIGN We conducted a cross-sectional study of overweight and obese PCOS adolescents and BMI matched controls. PATIENTS AND PARTICIPANTS A total of 74 subjects, 43 with PCOS and 31 controls, participated in the study. INTERVENTIONS Each subject underwent a physical examination and laboratory evaluation for a diagnosis of MBS. Regional fat distribution was determined by computerized tomography scan in the PCOS adolescents. MAIN OUTCOME MEASURES We measured the prevalence of MBS and its components in adolescent subjects and controls. RESULTS The PCOS group had larger ovarian volume and higher measures of total testosterone and free androgen index than controls, but there were no differences in waist circumference, fasting glucose, blood pressure, or lipids. PCOS adolescents demonstrated more glucose abnormalities and higher plasminogen activator inhibitor-1. By pediatric criteria, 53% of the PCOS and 55% of the control adolescents had MBS. By adult criteria, 26% of PCOS and 29% of controls met diagnostic criteria for MBS. CONCLUSIONS Obese adolescent women have a high prevalence of MBS, and PCOS does not add additional risk for MBS. There appears to be an association between MBS and visceral adiposity. PCOS is associated with increased incidence of glucose intolerance and increased plasminogen activator inhibitor-1. Our results reinforce the importance of obesity counseling in adolescents to recognize the possible risk of future cardiovascular disease in these young women.

Effect of alcohol consumption on in vitro fertilization.

OBJECTIVE: To estimate whether alcohol use at the initiation of an in vitro fertilization (IVF) cycle is associated with IVF outcomes. METHODS: In this prospective cohort study, men and women completed a self-administered questionnaire before their first IVF cycle. Participants reported alcohol type, amount, and frequency consumed. Discrete survival analysis was applied to calculate the odds ratio (OR) and 95% confidence interval (CI) for live birth—the primary outcome. Secondary outcomes were cycle characteristics and points of failure in the IVF process (cycle cancellation, failed fertilization, implantation failure, and spontaneous abortion). We conducted multicycle analyses with final models adjusted for potential confounders that included cycle number, cigarette use, body mass index, and age. RESULTS: A total of 2,545 couples contributed 4,729 cycles. Forty-one percent of women and 58% of men drank one to six drinks per week. Women drinking at least four drinks per week had 16% less odds of a live birth rate compared with those who drank fewer than four drinks per week (OR 0.84, CI 0.71–0.99). For couples in which both partners drank at least four drinks per week, the odds of live birth were 21% lower compared with couples in which both drank fewer than four drinks per week (OR 0.79; CI 0.66–0.96). CONCLUSION: Consumption of as few as four alcoholic drinks per week is associated with a decrease in IVF live birth rate. LEVEL OF EVIDENCE: II

The Clinical Presentation and Surgical Management of Adnexal Torsion in the Pediatric and Adolescent Population

STUDY OBJECTIVE To determine the history, clinical presentation, physical exam, and laboratory findings of ovarian and/or tubal torsion in the pediatric and adolescent population and to examine the surgical management of adnexal torsion. DESIGN Descriptive, retrospective chart review. SETTING Academic childrens hospital. PARTICIPANTS Children and adolescents, aged 3-21 years, with the surgical diagnosis of ovarian and/or tubal torsion. MAIN OUTCOME MEASURES Pain, physical exam, and laboratory characteristics and surgical outcomes. RESULTS Of the 82 cases, there was a higher rate of right-sided adnexal torsion (64%). The most commonly reported duration of pain was 24 hours. Most (91%) stated the pain has sudden onset and 69% qualified the pain as severe. Eighty-three percent complained of nausea and 67% had vomiting. There was a higher rate of tachycardia in younger patients (P = 0.003). On exam, 91% of subjects presented with tenderness, usually in the right lower quadrant (61%). A longer duration of pain was associated with a higher rate of oophorectomy and/or salpingectomy. There was no difference in the rates of the removal of adnexal structures between gynecologists and pediatric surgeons. CONCLUSIONS Most pediatric or adolescent patients with adnexal torsion present with acute onset of severe, intermittent pain lasting for 24 hours. Nausea and vomiting, as well as abdominal tenderness were common. Our findings will facilitate the accurate diagnosis of adnexal torsion and may contribute to more expedient surgical management.

Embryo banking between induction and consolidation chemotherapy in women with leukemia

OBJECTIVE To report the results of controlled ovarian hyperstimulation (COH) after long-acting GnRH agonist (GnRH-a) and chemotherapy for the purposes of embryo cryopreservation. DESIGN Case report. SETTING University medical center. PATIENT(S) Two premenopausal women with acute myelogenous leukemia with recent treatment with GnRH-a and induction chemotherapy for hematopoietic cell transplantation (HCT). INTERVENTION(S) COH with embryo cryopreservation. MAIN OUTCOME MEASURE(S) Numbers of oocytes and embryos cryopreserved. RESULT(S) Both patients responded to gonadotropin stimulation and cryopreserved embryos. CONCLUSION(S) Women who have received recent long-acting GnRH-a and chemotherapy may respond to gonadotropin stimulation. The option of embryo banking can be offered to leukemia patients who are preparing for HCT.

Ovarian Reserve in Women Treated for Acute Lymphocytic Leukemia or Acute Myeloid Leukemia with Chemotherapy, but Not Stem Cell Transplantation

Purpose. It is well known that chemotherapy regimens may have a negative effect on ovarian reserve, leading to amenorrhea or premature ovarian failure. There are little data regarding the effects of leukemia chemotherapy on ovarian reserve, specifically in women who received the chemotherapy as adults and are having regular menstrual periods. Our primary objective was to determine if premenopausal women with a history of chemotherapy for leukemia, without subsequent stem cell transplantation, have decreased ovarian reserve. Materials and Methods. We measured ovarian reserve in five women who had been treated for acute lymphocytic leukemia (ALL) or acute myeloid leukemia (AML) and compared them to age-matched control women without a history of chemotherapy. Results. There appeared to be a trend towards lower antimullerian hormone and antral follicle counts and higher follicle-stimulating hormone levels in the leukemia group. Conclusion. Our results indicate that chemotherapy for AML or ALL without stem cell transplantation may compromise ovarian reserve. Although our results should be confirmed by a larger study, oncologists, infertility specialists, and patients should be aware of the potential risks to ovarian function and should be counseled on options for fertility preservation.

Modifiable Risk Factors and Infertility: What are the Connections?

Infertility is a relatively common condition, greatly affecting couples medically and psychologically. Although infertility treatment is safe, it can be time-intensive, expensive, and increase the risk of multiple gestations. Thus, to reduce costs and risks, couples may initially consider lifestyle change to increase their fertility and chances of pregnancy. For many of the diet factors studied (eg, caffeine, soy, protein, iron), there are conflicting data. However, there are some items men and women consume that are detrimental to fertility, such as alcohol and tobacco. The data on exercise are varied but may have an effect on ovulation and fertility—positive or negative. Body mass index appears to affect fertility also, with obesity in both men and women negatively affecting pregnancy rates. In addition, there remains concern and a growing body of research on environmental toxin exposures and reproductive health. Finally, supporting patients through infertility diagnosis and treatment is critical, as psychological stress may affect conception. It is imperative that the relationship between lifestyle factors and fertility continue to be explored so as to lessen the morbidity associated with infertility.

The impact of lifestyle modifications, diet, and vitamin supplementation on natural fertility

BackgroundInfertility is a relatively common condition. When patients are confronted with this diagnosis, there are medical, psychological, and financial sequelae. Patients often wonder if there is anything they can do to optimize their natural fertility or increase the effectiveness of infertility treatments.FindingsIf there is a clear impact on fertility, such as with smoking and alcohol, cessation should be advised. Similarly, weight loss should be recommended if the BMI is in the overweight and obese category, and weight gain should be recommended for an underweight BMI. The evidence surrounding other lifestyle modifications is less clear. There are conflicting data regarding an optimal fertility diet and consumption of vitamins and supplements. Antioxidants seem to improve semen parameters in men, but the effect on female fertility is less clear. If conflicting evidence exists, such as with caffeine consumption or exercise, moderation should be emphasized. Finally, the diagnosis of infertility and subsequent fertility treatments are stressful for both partners. The psychological aspects should not be ignored and methods such as yoga and cognitive behavioral therapy may be beneficial.ConclusionContinued research will determine the optimal lifestyle modifications to achieve pregnancy.

In vitro fertilization outcomes and alcohol consumption in at-risk drinkers: The effects of a randomized intervention

BACKGROUND AND OBJECTIVES Womens use of alcohol in pregnancy is associated with an increased risk of fetal loss and birth defects. Also, alcohol use in women decreases the success of infertility treatment, such as in vitro fertilization (IVF). Our goal was to determine if there were differences in IVF outcomes and alcohol use parameters among at-risk drinkers randomized to a brief intervention (BI) versus assessment only (AO). METHODS We conducted a randomized controlled trial to determine the effect of BI or AO among at-risk drinkers on IVF. We studied 37 women (AO = 21; BI = 16). RESULTS While the BI group had a significantly greater decrease in the number of drinks/drinking day compared to the AO group (p = .04), there were no differences in the likelihood of implantation failure, chemical pregnancy, spontaneous abortion, preterm birth, or live birth. CONCLUSIONS BI and AO contributed to a decrease in alcohol use and did not demonstrate differences in IVF outcomes. A larger study may confirm these preliminary findings. SCIENTIFIC SIGNIFICANCE Our results will assist care providers in treating alcohol use in pregnancy in an effective way, such that IVF cycles and the chance of pregnancy are optimized.

Alcohol and fertility: how much is too much?

Alcohol use is prevalent in the United States. Given that a substantial portion of the drinking population is of reproductive age, it is not uncommon for couples who are attempting conception, or for women who are already pregnant, to be regularly consuming alcohol. Alcohol use is associated with multiple reproductive risks, including having a child with a Fetal Alcohol Spectrum Disorder, increased risk of fetal loss, and decreased chance of live birth. This review serves to examine the risks of alcohol in the context of reproductive health.

Embryo Donation: Medical Aspects

It is estimated that over 400,000 embryos remain in storage in the United States. These surplus embryos are the by-products of modern-day assisted reproductive techniques. Couples who have completed childbearing often struggle with decisions regarding the disposition of these embryos. Options include embryo disposal, donation to research, or donation to other infertile couples. Use of these surplus embryos would potentially benefit infertile couples at lower costs compared to fresh in vitro fertilization (IVF) cycles, with costs approaching those of frozen embryo transfer (FET) cycles. Limited data show pregnancy success rates to be comparable to fresh IVF and autologous FET cycles. Eligible donors and recipients should ideally comply with and meet all criteria established by the American Society of Reproductive Medicine prior to embryo donation. While embryo donation has numerous inherent medical and legal challenges, it may be an ideal option for couples who do not find embryo disposal acceptable and wish to help other infertile couples in their efforts to conceive.