José Bellver

Obesity and the risk of spontaneous abortion after oocyte donation.

OBJECTIVE To determine whether obesity increases the risk of spontaneous abortion. DESIGN Retrospective study. SETTING Oocyte donation program at the Instituto Valenciano de Infertilidad in Spain. PATIENT(S) Seven hundred twelve cycles of recipients of ovum donation with known body mass index (BMI), good-quality embryo transfer, and absence of uterine pathology or clinical history of antiphospholipid antibodies or recurrent abortion. INTERVENTION(S) Recipients were divided in four BMI (kg/m(2)) groups: lean, with BMI <20 (n = 92; 12.9%); normal, with BMI = 20-24.9 (n = 398; 55.9%); overweight, with BMI = 25-29.9 (n = 172; 24.2%); and obese, with BMI >/=30 (n = 50; 7%). Clinical parameters were compared among the groups. MAIN OUTCOME MEASURE(S) Spontaneous abortion rates according to BMI. RESULT(S) No difference was found among the four BMI groups in any of the parameters of the cycle analyzed. The overall abortion rate was 15.8% (57 of 360). There were significant differences in abortion rates between the obese (38.1%), and the normal (13.3%) and overweight (15.5%) groups. When several cutoff BMI values were established (20, 25, and 30), only the obese women demonstrated a greater risk of abortion. Compared with the normal population, the obese group showed a significant fourfold increase in the risk of spontaneous abortion. CONCLUSION(S) Our findings confirm that obesity (BMI >/=30) is an independent risk factor for spontaneous abortion. Therefore, it would be advisable for obese patients to reduce weight before becoming pregnant.

Female obesity impairs in vitro fertilization outcome without affecting embryo quality

OBJECTIVE To compare embryo quality and reproductive outcome in our IVF program according to the womens body mass index (BMI). DESIGN Retrospective study. SETTING University-affiliated infertility clinic, between January 2001 and April 2007. PATIENT(S) Women undergoing a total of 6,500 IVF-intracytoplasmic sperm injection (ICSI) cycles. INTERVENTION(S) Six thousand five hundred IVF-ICSI cycles were included and divided into four groups: lean (<20 kg/m(2); n = 1,070; 16.5%); normal (20-24.9 kg/m(2); n = 3,930; 60.5%); overweight (25-29.9 kg/m(2); n = 1,081; 16.6%); and obese (> or =30 kg/m(2); n = 419; 6.4%). MAIN OUTCOME MEASURE(S) Comparison of embryo quality and reproductive outcome (implantation, pregnancy, miscarriage, and live birth rates) among BMI groups. RESULT(S) No difference in insemination procedure, fertilization rate, day of ET, mean number of transferred and cryopreserved embryos, percentage of blastocyst transfers, or embryo quality on day 2 and 3 was found among groups. However, implantation, pregnancy, and live birth rates were poorer in obese women. In fact, pregnancy and live birth rates were reduced progressively with each unit of BMI (kilograms per square meter) with a significant odds ratio of 0.984 (95% confidence interval 0.972-0.997) and 0.981 (95% confidence interval 0.967-0.995), respectively. In addition, the cumulative pregnancy rate after four IVF cycles was reduced as BMI increased. CONCLUSION(S) Female obesity impairs IVF outcome, but embryo quality is not affected, pointing to an alteration in the uterine environment.

Obesity reduces uterine receptivity: clinical experience from 9,587 first cycles of ovum donation with normal weight donors

OBJECTIVE To analyze the reproductive outcome of recipients of donated ova according to their body mass index (BMI). DESIGN Twelve-year retrospective cohort analysis. SETTING Fertility clinics. PATIENT(S) 9,587 first cycles of ovum donation with ova from normoweight donors. INTERVENTION(S) Recipients divided according to their BMI to analyze IVF laboratory and outcome parameters: lean with BMI <20 kg/m(2) (n = 1,458; 15.2%); normoweight with BMI 20-24.9 kg/m(2) (n = 5,706; 59.5%), overweight with BMI 25-29.9 kg/m(2) (n = 1,770; 18.5%), and obese with BMI ≥30 kg/m(2) (n = 653; 6.8%). MAIN OUTCOME MEASURE(S) Implantation, biochemical and clinical pregnancy, miscarriage, and live-birth rates. RESULT(S) In vitro fertilization laboratory parameters did not differ according to BMI. However, implantation, pregnancy, clinical pregnancy, twin pregnancy, and live-birth rates were significantly reduced as BMI increased. In the lean, normoweight, overweight, and obese groups, the implantation rate was 40.4%, 39.9%, 38.5%, and 30.9%, clinical pregnancy rate was 56.9%, 55.9%, 54.3%, and 45.3%, and live-birth rate was 38.6%, 37.9%, 34.9%, and 27.7%, respectively. However, clinical miscarriage rates were similar in all the groups. CONCLUSION(S) Female obesity impairs the reproductive outcome of ovum donation probably as a result of reduced uterine receptivity.

Obesity and assisted reproductive technology outcomes

Obesity is a rising health problem in Western societies. It has been related to increased morbidity and mortality rates due to several pathologies. In the field of gynaecology and reproduction, obesity is associated with menstrual disorders, hirsutism, infertility, miscarriage and obstetric complications. It is known to impair human reproduction through different mechanisms such as insulin resistance, hyperandrogenism and elevated leptin levels. Weight management and dietary intervention can reverse this situation and improve reproductive function. Obesity can also impair the outcome of assisted reproductive technologies. The lower probability of a healthy live birth described in obese women seems to be the result of a combination of lower implantation and pregnancy rates, higher preclinical and clinical miscarriage rates and increased complications during pregnancy for both mother and fetus. Studies performed in infertile women undergoing assisted reproduction technologies indicate that the ovary plays a leading, but not exclusive, role in the fertility prognosis of these patients. The endocrine and metabolic environment may affect oocyte quality and, therefore, embryo development, implantation and pregnancy outcome. The endometrium seems to play a subtle role in the more negative reproductive outcome of obese women, according to recent studies based on the ovum donation model.

New options in assisted reproduction technology: the Cryotop method of oocyte vitrification

The Cryotop vitrification method has been shown to be a very useful tool for oocyte cryopreservation, giving excellent results regarding survival and clinical outcome. There are several clinical situations in which oocyte cryopreservation provides solutions that have not been available to date. This report describes three of these situations: (i) a low-responder patient who needed a single gene diagnosis due to the presence of a genetic disease; (ii) a patient undergoing endometrial bleeding on the day of oocyte retrieval who was also affected by a genetic disorder; and (iii) a patient who failed to become pregnant after the donation of vitrified oocytes and subsequently had the re-vitrified surplus embryos transferred. The resolution of these cases provides evidence of the enormous potential of the Cryotop method as a tool within assisted reproduction technology.

Ovarian stimulation for ovulation induction and in vitro fertilization in patients with systemic lupus erythematosus and antiphospholipid syndrome

OBJECTIVE To review the current evidence regarding the relationship between systemic lupus erythematosus (SLE) and antiphospholipid syndrome and female infertility, as well as the risks associated with ovarian stimulation for ovulation induction and IVF. To establish, based on this information, guidelines for safe and successful assisted reproductive technology (ART). DESIGN A MEDLINE computer search was performed to identify relevant articles. RESULT(S) Systemic lupus erythematosus and antiphospholipid syndrome are not related to infertility, except for cases of amenorrhea accompanying severe flares, renal insufficiency-related hypofertility, and ovarian failure secondary to cyclophosphamide (CTX) therapy. The most threatening conditions in affected women undergoing ovarian stimulation are lupus flares and thrombosis, with the latter being especially associated with the occurrence of an overt ovarian hyperstimulation syndrome (OHSS). Friendly ovarian stimulation, single embryo transfer, avoidance of OHSS, administration of coadjuvant therapy, and use of natural E(2) or P through a nonoral route may constitute the safest approach. Systemic lupus manifested in acute flares, badly controlled arterial hypertension, pulmonary hypertension, advanced renal disease, severe valvulopathy or heart disease, and major previous thrombotic events are situations on which to discourage ART, especially due to the high risk of complications for both mother and fetus during pregnancy and puerperium. CONCLUSION(S) Ovarian stimulation for ovulation induction and IVF seems to be safe and successful in well-selected women with SLE and antiphospholipid syndrome.

Endometrial gene expression in the window of implantation is altered in obese women especially in association with polycystic ovary syndrome.

OBJECTIVE To determine whether luteal phase endometrial transcriptome is altered in obese women during the window of implantation (WOI), considering the presence of infertility, fat distribution and association with polycystic ovary syndrome (PCOS). DESIGN Prospective study. SETTING University-affiliated infertility clinic, between May 2007 and March 2009. PATIENT(S) One control group of women with normal weight (n=4), and four study groups of obese women (n=6 each one) according to the association with infertility, PCOS, and ovarian stimulation. INTERVENTION(S) The endometrium was biopsied 7 days after LH surge or hCG administration in 28 women. MAIN OUTCOME MEASURE(S) Endometrial gene expression during the WOI. RESULT(S) One hundred and fifty-one genes were dysregulated in obese groups compared with controls. This dysregulation was more pronounced when infertility was associated. The biologic processes of these genes belonged mainly to development and regulation of different biological functions such as transcription and biosynthesis. The molecular functions overrepresented were transcription and peptide receptor activity. The endometrium of obese women with PCOS showed dysregulated genes related to biologic processes such as development, morphogenesis, and the immune system, as well as different molecular functions such as protein binding, binding, growth factor activity, and carboxylic acid transmembrane transporter activity. Some of these genes have been previously related to implantation and unexplained infertility. CONCLUSION(S) Obese women present a different endometrial gene expression than controls during the WOI, which is more pronounced when infertility or polycystic ovary syndrome are associated.

Examination of the fetal brain by transabdominal three-dimensional ultrasound: potential for routine neurosonographic studies.

To evaluate the role of transabdominal three‐dimensional (3D) ultrasound in the assessment of the fetal brain and its potential for routine neurosonographic studies.

Influence of paternal age on assisted reproduction outcome

There has been an increasing tendency to delay parenthood in developed countries in recent years, and there is not enough information available regarding the effect of this on fertility. The aim of this work was to determine the role of paternal age on the outcome of assisted reproduction. A retrospective study was designed comprising a total of 2204 intrauterine insemination (IUI) cycles, 1286 IVF cycles and 1412 IVF cycles with donated oocytes during the period 2000 to 2006. Male mean age was 34.3 years (range 25-56) for IUI, 34.8 years (range 19-62) for IVF and 41.10 years (range 25-71) for ovum donation cycles. Statistics revealed no differences regarding pregnancy and miscarriage rates when the results were compared among age groups. In standard IVF and ovum donation cycles there was no clear association between embryo quality and paternal age. There was no significant relationship between male age and implantation rate. So far this is the largest study concerning the relevance of male age in assisted reproduction. As confirmed by the present data, the effect of the age of the male in the range studied is irrelevant. This finding contributes to the information that can be provided to infertile couples.

Increased doses of vaginal progesterone for the prevention of preterm birth in twin pregnancies: a randomised controlled double‐blind multicentre trial

Objective  Previous trials have shown little benefit for preventing preterm birth in twin pregnancies using 90–200 mg of daily vaginal natural progesterone. Higher doses have not been tested. Our aim was to determine the efficacy and safety of two different daily doses of vaginal natural progesterone (200 and 400 mg), compared with placebo, for preventing preterm birth in unselected twin pregnancies.