A preliminary evaluation of influence of body mass index on in vitro fertilization outcome in non-obese endometriosis patients.

BACKGROUND/AIMS: Obese and overweight women experience a lower probability for pregnancy after IVF. However, despite the increasing prevalence of obesity, the large majority of infertile women are non-obese. One of the most common indications for IVF is endometriosis. Thought-provoking inverse correlation has been established between BMI and endometriosis. Lower BMI is a risk factor for development of endometriosis and a predictive factor for severe endometriosis. Since severe endometriosis carries lower reproductive chances, even after IVF, we preliminary tested a hypothesis that higher BMI among non-obese endometriosis patients improves IVF outcomes. METHODS: Preliminary retrospective observational cross-sectional study was performed in women with endometriosis as a sole infertility cause who underwent IVF. During analyzed period we performed 2782 IVF procedures. In order to achieve highly homogenous study sample and to eliminate almost all confound factors that could lead to bias, we implemented strict study criteria. The number of eligible subjects was 156 and they were divided into underweight, normal weight and overweight groups. Primary outcomes were number of retrieved oocytes, good quality oocytes, embryos, and the rates of biochemical, clinical and ongoing pregnancies. For group comparisons, we used parametric test, analysis of variance, and non-parametric tests (Kruskal-Wallis test, Chi-square test). Logistic regression and General linear model was used to assess correlation between BMI and dependent variables (outcome and stimulation duration) when adjusted for age. RESULTS: Endometriosis as a single infertility factor among IVF couples had prevalence of 5.61%. Underweight women accounted for 10.26%, normal weight 71.15% and overweight 18.59% of study population. Significant differences were not found in number of retrieved oocytes (p = 0.880), good quality oocytes (p = 0.476), obtained embryos (p = 0.706), and biochemical (p = 0.298), clinical (p = 0.770) and ongoing (p = 0.822) pregnancy rates between study groups. CONCLUSION: Although preliminary results do not support our hypothesis, increase in BMI did not adversely affect the outcome of IVF in non-obese endometriosis patients, which is in contrast to literature data as regards general population of infertile women undergoing IVF. Prospective studies with large number of patients with endometriosis or prospective case-control studies should address these issues and provide more comprehensive counseling of infertile endometriosis patients regarding achievement of optimal BMI prior to IVF with the intention of achievement higher pregnancy rates.

Association between online social networking and depression in high school students: behavioral physiology viewpoint.

BACKGROUND: Frequent use of Facebook and other social networks is thought to be associated with certain behavioral changes, and some authors have expressed concerns about its possible detrimental effect on mental health. In this work, we investigated the relationship between social networking and depression indicators in adolescent population. SUBJECTS AND METHODS: Total of 160 high school students were interviewed using an anonymous, structured questionnaire and Back Depression Inventory - second edition (BDI-II-II). Apart from BDI-II-II, students were asked to provide the data for height and weight, gender, average daily time spent on social networking sites, average time spent watching TV, and sleep duration in a 24-hour period. RESULTS: Average BDI-II-II score was 8.19 (SD=5.86). Average daily time spent on social networking was 1.86 h (SD=2.08 h), and average time spent watching TV was 2.44 h (SD=1.74 h). Average body mass index of participants was 21.84 (SD=3.55) and average sleep duration was 7.37 (SD=1.82). BDI-II-II score indicated minimal depression in 104 students, mild depression in 46 students, and moderate depression in 10 students. Statistically significant positive correlation (p<0.05, R=0.15) was found between BDI-II-II score and the time spent on social networking. CONCLUSIONS: Our results indicate that online social networking is related to depression. Additional research is required to determine the possible causal nature of this relationship.

Hamilton anxiety scale (HAMA) in infertile women with endometriosis and its correlation with magnesium levels in peritoneal fluid.

BACKGROUND: Endometriosis is a complex disease that can result in substantial morbidity, including chronic pain, dysmenorrhea and dyspareunia. There are contradictory reports regarding the connection between acute and chronic stress and magnesium levels in body fluids. SUBJECTS AND METHODS: A prospective study included 87 patients undergoing laparoscopy. The study group included 40 women with endometriosis and the control group consisted of 47 women with other causes of infertility. The levels of fright were determined using HAMA scale. The measurements of Mg levels were performed using biochemical analyzer "Monarch Plus". RESULTS: One day before the operation, HAMA score was 9.54+/-7.34 in the women with endometriosis, and 6.69+/-5.51 in the women without endometriosis. The morning before the operation, HAMA score was 8.64 +/- 8.10 in the women with endometriosis, and 4.29+/-2.29 in the women without endometriosis. The second postoperative day, HAMA score was 8.96+/-7.60 in the women with endometriosis and 6.92+/-5.16 in the women without endometriosis. Higher HAMA score in the women with endometriosis, in comparison with the control group, in all three time periods has been found, but the differences were not statistically significant (p>0.05). A negative correlation between the concentration of Mg in peritoneal fluid and HAMA score was found in the control group (p<0.01). CONCLUSIONS: In infertile women without endometriosis a correlation between Mg concentration in peritoneal fluid and HAMA score was found. No such correlation was found in the women with endometriosis, possibly due to a systemic disorder in endometriosis that might affect Mg transport through the cell membrane.

Follicular fluid thyroid autoantibodies, thyrotropin, free thyroxine levels and assisted reproductive technology outcome.

OBJECTIVE: Although there are substantial data linking thyroid autoimmunity (TAI) and infertility, data regarding assisted reproductive technology (ART) outcomes and TAI markers in follicular fluid (FF) of women undergoing ART are scarce. Objective of the study was to assess the association of the levels of thyroid autoantibodies in FF and ART outcome expressed as the achieved pregnancies. METHODS: This study enrolled 52 women undergoing ART (26 TAI positive subjects and 26 age and body mass index matched TAI negative controls). Blood samples were drawn before the initiation of protocol for controlled ovarian stimulation, and thyrotropin (TSH), free triiodothyronine (fT3), free thyroxine (fT4), thyroid peroxidase antibodies (TPOAbs) and thyroglobulin antibodies (TgAbs) levels were measured. TSH, fT4, TPOAbs, TgAbs and progesterone levels were also measured in FF. RESULTS: There were no significant differences between the groups regarding mean levels of FF TSH and FF fT4. Statistically significant correlation was discovered regarding the levels of serum and FF TPOAbs (0,961, p<0.001 in TAI positive, 0,438, p = 0.025 in TAI negative group) and TgAbs (0,945, p<0.001 in TAI positive, 0,554, p = 0.003 in TAI negative group). Pregnancies rates per initiated cycle and per embryotransfer cycle were significantly different between TAI positive and TAI negative group, (30.8% vs 61.5%), p = 0.026 and (34.8% vs 66.7%), p = 0.029, respectively. Multivariate analysis showed that TAI positive women had less chance to achieve pregnancy (p = 0.004, OR = 0.036, 95% CI 0.004-0.347). CONCLUSIONS: Higher levels of thyroid autoantibodies in FF of TAI positive women are strongly correlated with serum levels and may have effect on the post-implantation embryo development.

[Woman with surgical reconstruction of anal atresia who realized pregnancy with in vitro fertilisation].

INTRODUCTION: Anal atresia is a congenital anomaly, very life-threatening and urgent. Surgical treatment of this anomaly consists of colostomy first, and then of anal reconstruction. CASE REPORT: We presented a 31-year old female with the surgery treatment of anal atresia in the early childhood. In the reproductive period, due to tubal infertily, the patient was included in the program of in vitro fertilization (IVF), in the Clinic for Gynecology and Obstetrics "Narodni front", Belgrade. Within this program a long protocol of ovarian stimulation was performed. Ultrasonographic and color Doppler monitoring of the patient was applied by the use of an ultrasonographic apparatus type Siemens Acuson X 150, while any hormonal examinations were performed by an Architect Abbott unit. During the IVF program, the growth of follicules was controlled by the use of ultrasonography, microcirculation of the ovaries and the uterus was marked by a power-pulsating color Doppler, and hormonal examination was performed starting from the day of stimulation up to the day of injecting Pregnyl. The patient was administered Suprefact (buserelin) sc from the 21st day of the menstrual cycle, as well as from the 3rd day of the cycle, for totally 11 days. The patient was given 29 ampoules of Gonal F (recombinant human FSH) 75 IJ im and 15 ampoules of Menopur (menotrophin) im. Due to a modified pelvic anatomy, the left ovary aspiration was disabled, while the right ovary aspired seven oocytes successfully. Three embryos were inserted in the uterus. The delivery was performed by cesarean section. CONCLUSION: In the reported patient with a modified pelvic anatomy due to four corrective surgeries of anal atresia, and tubal infertility in the reproductive period, the method of choice for the realization of pregnancy was the IVF procedure. The realized pregnancy and the delivery could be considered highly successful in regard to possible risks.

[Results of modem tuboperitoneal infertility treatment].

BACKGROUND/AIM: A modem approach to surgical treatment of tuboperitoneal infertility is based on laporascopic techniques. The aim of this study was to compare results of tuboperitoneal infertility treatment by the use of laparoscopy and classical laparotomy. METHODS: A retrospective-prospective study on 66 women treated operatively for tuboperitoneal infertility was performed. Data from patient's anemnesis and those related to the surgical treatment results, obtained by the use of an inquiry, were used in retrospective and prospective analysis, respectively. Chi-square test was used in statistical analysis. P value < 0.05 was considered significant. RESULTS: Classical laparotomy was used on 34 women in a period from 1996 to 1997, while 32 women were operated laparoscopically in a period from 1999 to 2000. The results were as follows: a total number of conceived women was 16 (24%), seven in the group I (20.6%) and nine in the group II (28.1%); 13 women were with one pregnancy, six in the group I (17.6%) and seven in the group II (22%). Twice pregnant were three women, one in the group I (2.9%) and two in the group II (6.2%). The resulting pregnancies were: five women with abortion spontaneous, two in the group I (5.9%) and three in the group II (9.40/%); two women with extrauterine pregnancy in the group I (5.9%); three with pretemporal birth, one in the group I (2.9%) and two in the group II (6.2%), while six women were with the temporal birth, two in the group I (5.9%) and four in the group II (12.5%). Statistical analysis showed that there was no significant difference in the results between these two groups. CONCLUSION: Surgical treatment of tubeperitoneal infertility, regardless of the used methods (classical laparotomy or laparoscopy) was successful in a great number of women. These methods have a great advantage over in vitro fertilization, and they should not be ignored.