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.

Hypothesis regarding the effects of gonadotropins on the level of free fatty acids and phospholipids in serum and follicular fluid during controlled ovarian stimulation.

Controlled ovarian stimulation (COS) is used to augment the number of retrieved oocytes in in vitro fertilization (IVF). Follicular fluid (FF) contributes significantly to oocyte quality. Since the FF is composed of follicular secretions and plasma exudation, it reflects alterations in granulosa and thecal cells secretion as well as changes in the level of plasma constituents. Phospholipids (PL) and free fatty acids (FFA) are important constituents of both, FF and serum. Our hypothesis is that COS affects the level of PL and FFA in serum. Furthermore, since the level of PL and FFA in FF partially depends on their levels in serum, as a collaterally of our hypothesis is that the existing level of PL and FFA in serum correlates with the levels of PL and FFA in FF, and that the dose of applied gonadotropins during COS will correlate with the levels of PL and FFA in serum and FF. In addition, we assume that the level of PL and FFA in serum and in FF after COS will correlate with the retrieved number of GQ oocytes, one of the most important outcomes of COS. .

Relationship between mid-trimester ultrasound fetal liver length measurements and gestational diabetes mellitus.

BACKGROUND: The aim of the present study was to investigate the relationship between mid-trimester ultrasound fetal liver length (FLL) and gestational diabetes mellitus (GDM) in a high-risk population. METHODS: A prospective study was performed in 331 women with singleton pregnancies who were at high risk of GDM and were undergoing a mid-trimester ultrasound examination. The ultrasound scan at 23 weeks gestation was followed by a 100-g oral glucose tolerance test (OGTT) at 24 weeks gestation. Correlations between FLL and OGTT results at different time points were tested. Receiver operating characteristic (ROC) analysis of FLL as a potential prognostic factor for GDM was also performed. RESULTS: In GDM patients, there was a significant positive correlation (P < 0.01) between FLL and OGTT glycemia immediately before and 60, 120, and 180 min after glucose intake. Mean FLL in GDM was significantly higher than in healthy subjects (41.04 vs 31.09 mm, respectively; P < 0.001). When tested as a potential prognostic factor for GDM, fetal liver measurements showed excellent diagnostic performance. The ROC analysis established a cut-off value of FLL of 39 mm for the prediction GDM, with sensitivity of 71.76%, specificity 97.56%, positive predictive value 91.0%, and negative predictive value 90.9%. The usefulness of FLL measurements was supported by a high area under the ROC curve (90.5%). CONCLUSION: In conclusion, there is a strong correlation between FLL and OGTT results, with FLL possibly serving as a valid marker for the prediction of GDM in high-risk populations.