effects of maternal and paternal body mass index on live birth rate after intracytoplasmic sperm injection cycles

Background: We designed the present study to evaluate the simultaneous effect of obesity in couples on in vitro fertilization/intracytoplasmic sperm injection [IVF/ICSI] outcomes

Materials and Methods: In this cross-sectional study, performed at Royan Institute between January 2013 and January 2014, we evaluated the recorded data of all patients during this time period. The study population was limited to couples who underwent ICSI or IVF/ICSI cycles with autologous oocytes and fresh embryo transfers. We recorded the heights and weights of both genders and divided them into groups according to body mass index [BMI]. Multilevel logistic regression analysis was used to determine the odds ratio for live births following ICSI or IVF/ICSI

Results: In total, 990 couples underwent IVF/ICSI cycles during the study period. Among the ovulatory women, a significant difference existed between the BMI groups. There was a 60% decrease [95% confidence interval [CI]: 0.11-0.83] in the odds of a live birth among overweight subjects and 84% [95% CI: 0.02-0.99] decrease among obese subjects. Among the anovulatory women, the association between the BMI and live births presented no clear tendencies. We did not observe any significant relationship between male BMI and live birth rate. The results demonstrated no significant association between the couples' BMI and live birth rate

Conclusion: Based on the present findings, increased female BMI independently and negatively influenced birth rates after ICSI. However, increased male BMI had no impact on live births after ICSI, either alone or combined with in- creased female BMI

Diagnostic accuracy of body mass index and fasting glucose for the prediction of gestational diabetes mellitus after assisted reproductive technology

Background: The aim of the present study was to determine the maternal pre-pregnancy body mass index [BMI], first-trimester fasting blood sugar [FBS], and the combination of [BMI+FBS] cut-points for at-risk pregnant women conceived by assisted reproductive technology [ART] to better predict the risk of developing gestational diabetes mellitus [GDM] in infertile women

Materials and Methods: In this nested case-control study, 270 singleton pregnant women consisted of 135 [GDM] and 135 [non-GDM] who conceived using ART were assessed. The diagnosis of GDM was confirmed by a one-step glucose tolerance test [O-GTT] using 75 g oral glucose. BMI was classified base on World Health Organization [WHO] criteria. The relationship between BMI, FBS, and BMI+FBS with the risk of GDM development was deter- mined by logistic regression and adjusted for confounding factors. Receiver operating characteristic [ROC] curve analysis was performed to assess the value of BMI, FBS, and BMI+FBS for the prediction of GDM

Results: The GDM group had significantly higher age, BMI, family history of diabetes, and history of polycystic ovary syndrome in comparison with the non-GDM group [P<0.05]. Overweight and obese women had 3.27, and 5.14 folds increase in the odds of developing GDM, respectively. There was a 17% increase in the risk of developing GDM with each 1 mg/dl increase in fasting glucose level. The cut points for FBS 84.5 mg/dl [72.9% sensitivity, 74.4% specificity], BMI 25.4 kg/m2 [68.9% sensitivity, 62.8% specificity], and BMI+FBS 111.2 [70.7% sensitivity, 80.6% specificity] was determined

Conclusion: The early screening and high-quality prenatal care should be recommended upon the co-occurrence of high FBS [>/=84.5 mg/dl] in the first-trimester of the pregnancy and the BMI [=25.4 kg/m2] in pre-pregnancy period in women undergone ART. The combination of BMI and FBS is considered a better prediction value

Accuracy of two-dimensional transvaginal sonography and office hysteroscopy for detection of uterine abnormalities in patients with repeated implantation failures or recurrent pregnancy loss

Background: We sought to compare diagnostic values of two-dimensional transvaginal sonography [2D TVS] and office hysteroscopy [OH] for evaluation of endometrial pathologies in cases with repeated implantation failure [RIF] or recurrent pregnancy loss [RPL]

Materials and Methods: This prospective study was performed at Royan Institute from December 2013 to January 2015. TVS was performed before hysteroscopy as part of the routine diagnostic work-up in 789 patients with RIF or RPL. Uterine biopsy was performed in cases with abnormal diagnosis in TVS and/or hysteroscopy. We compared the diagnostic accuracy values of TVS in detection of uterine abnormalities with OH by receiver operating characteristic [ROC] curve analysis

Results: TVS examination detected 545 [69%] normal cases and 244 [31%] pathologic cases, which included 84 [10.6%] endometrial polyps, 15 [1.6%] uterine fibroids, 10 [1.3%] Asherman's syndrome, 9 [1.1%] endometrial hypertrophy, and 126 [15.9%] septate and arcuate uterus. TVS and OH concurred in 163 pathologic cases, although TVS did not detect some pathology cases [n=120]. OH had 94% sensitivity, 95% specificity, 62% positive predictive value [PPV], and 99% negative predictive value [NPV] for detection of endometrial polyps. In the diagnosis of myoma, sensitivity, specificity, PPV, and NPV were 100%. TVS had a sensitivity of 50% and specificity of 98% for the diagnosis of myoma. For polyps, TVS had a sensitivity of 54% and specificity of 80%. Area under the ROC curve [AUROC] was 70.69% for the accuracy of TVS compared to OH

Conclusion: TVS had high specificity and low sensitivity for detection of uterine pathologies in patients with RIF or RPL compared with OH. OH should be considered as a workup method prior to treatment in patients with normal TVS findings

Gestational diabetes mellitus and metabolic disorder among the different phenotypes of polycystic ovary syndrome

Objectives: Polycystic ovary syndrome [PCOS] is a common endocrine disorder related to several metabolic consequences. However, there remains uncertainty regarding the metabolic features of various phenotypes. The aim of this study was to explore the relationship between the prevalence of gestational diabetes mellitus [GDM] and metabolic disorders among the four different phenotypes of PCOS

Methods: A crosssectional study was performed in Royan Institute including 208 pregnant women with a history of infertility and PCOS. Using the diagnostic criteria of the American Diabetes Association [ADA], pregnant women with a documented diagnoses of PCOS were further categorized into four different phenotypes [A, B, C, and D] as defined by the Rotterdam criteria

Results: The prevalence of GDM failed to demonstrate a significant relationship among the four phenotypes of PCOS. The mean levels of fasting blood sugar, plasma glucose concentrations at three hours [following the 100 g oral glucose tolerance test] and triglyceride levels were significantly higher in phenotype B compared to the remaining phenotypes [p < 0.050]. There was a statistically significant difference between the mean free testosterone level and phenotypes A and C groups [1.8+/-1.6 vs. 1.1+/-1.0, p = 0.003]

Conclusions: Women with a known diagnosis of PCOS who exhibited oligo/ anovulation and hyperandrogenism demonstrated an increase of metabolic disorders. These results suggest that metabolic screening, before conception or in the early stages of pregnancy, can be beneficial particularly in women with PCOS phenotypes A and B. Early screening and identification may justify enhanced maternal fetal surveillance to improve maternal and fetal morbidity among women affected with PCOS

Factors that influence the occurrence of multiple pregnancies after intracytoplasmic injection cycles with two or three fresh embryo transfers

Background: Multiple pregnancies are an important complication of assisted reproductive technology [ART]. The present study aims to indentify the risk factors for multiple pregnancies independent of the number of transferred embryos

Materials and Methods: This retrospective study reviewed the medical records of patients who underwent intracy topi asm ic sperm injection [ICSI] cycles in Royan Institute between October 2011 and January 2012. We entered 12 factors that affected the number of gestational sacs into the poisson regression [PR] model. Factors were obtained from two study populations-cycles with double embryo transfer [DET] and cycles that transferred three embryos [TET]. We sought to determine the factors that influenced the number of gestational sacs. These factors were entered into multivariable logistic regression [MLR] to identify risk factors for multiple pregnancies

Results: A total of 1000 patients referred to Royan Institute for ART during the study period. We included 606 eligible patients in this study. PR analysis demonstrated that the quality of transferred embryos and woman's age had a significant effect on the number of observed sacs in patients who underwent ICSI with DET. There was no significant predictive variable for multiple pregnancies according to MLR analysis. Our findings demonstrated that both regression models [PR and MLR] had the same outputs. A significant relation existed between age and fertilization rate with multiple pregnancies in patients who underwent ICSI with TET

Conclusion: Single embryo transfer [SET] should be considered with the remaining embryos cryopreserved to prevent multiple pregnancies in women younger than 35 years of age who undergo ICSI cycles with high fertilization rates and good or excellent quality embryos. However, further prospective studies are necessary to evaluate whether SET in women with these risk factors can significantly decrease multiple pregnancies and improve cycle outcomes

Oxidative stress statues in serum and follicular fluid of women with endometriosis

Objective: This study aimed to evaluate the levels of two oxidative stress [OS] markers including lipid peroxide [LPO] and total antioxidant capacity [TAC] in both serum and follicular fluid [FF] of women with endometriosis after puncture

Materials and Methods: In this cross-sectional study, a total number of sixty-three women younger than 40 years old with laparoscopy [gold standard for endometriosis diagnosis] indication underwent in vitro fertilization [IVF] program in the Royan Institute, Tehran, Iran from September 2013 to October 2014. About forty-three patients were diagnosed with endometriosis after laparoscopy. Blood and FF from the leading follicle in each stimulated ovary were obtained at the time of egg retrieval; samples were centrifuged and frozen until assessment. At the time of sample assessment, serum and FF samples were evaluated for the levels of LPO and TAC on spectrophotometery

Results: We observed that women with endometriosis had significantly higher LPO and lower TAC levels in the serum and FF as compared with the control group [P<0.05]

Conclusion: It has observed that FF of women with endometriosis, regardless of disease stage, increases the proliferation power of endometrial cells in vitro, we presume that inflammatory reactions-induced OS in ovary may be responsible for proliferation induction ability in FF obtained from women with endometriosis

Relationships between serum luteinizing hormone level, endometrial thickness and body mass index in polycystic ovary syndrome patients with and without endometrial hyperplasia

Background: The endometrial hyperplasia measured by ultrasound in poly cystic ovary syndrome [PCOS] women is strongly related to pathologic endometrial thickness, but there is no consensus on the relation between serum luteinizing hormone [LH] and either of these factors: pathologic endometrial hyperplasia and body mass index [BMI]

Materials and Methods: In this observational cross-sectional study, three hundred fifty infertile PCOS women were involved in this research. An endometrial biopsy was taken by using a pipelle instrument, regardless of menstrual cycle's day and all samples were reported by the same pathologist. Basal serum LH level was compared between two subgroups [hyperplasia and non-hyperplasia]. The intended population was divided into three groups according to BMI and basal serum LH, later on the comparison was made in three groups. Chi-square test was applied to compare nominal variables between groups. Mann-Whitney U, and one way ANOVA tests were used to compare means on the basis of the result of normality test

Results: The frequency of endometrial hyperplasia was 2.6%. Endometrial thickness in the patients with endometrial hyperplasia was significantly higher than that of a normal endometrium [10.78 +/- 3.70 vs. 7.90 +/- 2.86 respectively, P=0.020]. There was no relation between endometrial hyperplasia and serum LH [P=0.600]. The ANOVA test showed serum LH levels were not the same among three BMI groups [P=0.007]. Post hoc test was also performed. It showed that the LH level in normal BMI group was significantly higher than those of other groups [P=0.005 and P=0.004], but there was no statistical difference between overweight and obese groups [P=0.8]. We found no relationship between BMI and endometrial thickness in PCOS patients [P=0.6]

Conclusion: Sonographic endometrial stripe thickness is predictive for endometrial hyperplasia in PCOS women. We could not find out any relationship between serum LH level and BMI with endometrial thickness in PCOS patients. However, our study confirmed a diverse relationship between serum LH level and BMI in PCOS patients

Increasing the number of embryos transferred from two to three, does not increase pregnancy rates in good prognosis patients

To compare the pregnancy outcomes after two embryos versus three embryos transfers [ETs] in women undergoing in vitro fertilization [IVF] intracytoplasmic sperm injection [ICSI] cycles. This retrospective study was performed on three hundred eighty seven women with primary infertility and with at least one fresh embryo in good quality in order to transfer at each IVF/ICSI cycle, from September 2006 to June 2010. Patients were categorized into two groups according to the number of ET as follows: ET2 and ET3 groups, indicating two and three embryos were respectively transferred. Pregnancy outcomes were compared between ET2 and ET3 groups. Chi square and student t tests were used for data analysis. Clinical pregnancy and live birth rates were similar between two groups. The rates of multiple pregnancies were 27 and 45.2% in ET2 and ETS groups, respectively. The rate of multiple pregnancies in young women was significantly increased when triple instead of double embryos were transferred. Logistic regression analysis indicated two significant prognostic variables for live birth that included number and quality of transferred embryos; it means that the chance of live birth following ICSI treatment increased 3.2-fold when the embryo with top quality [grade A] was transferred, but the number of ET had an inverse relationship with live birth rate; it means that probability of live birth in women with transfer of two embryos was three times greater than those who had three ET. Due to the difficulty of implementation of the elective single-ET technique in some infertility centers in the world, we suggest transfer of double instead of triple embryos when at least one good quality embryo is available for transfer in women aged 39 years or younger. However, to reduce the rate of multiple pregnancies, it is recommended to consider the elective single ET strategy

Behavioral intervention program versus vaginal cones on stress urinary incontinence and related quality of life: a randomized clinical trial

To compare the efficacy of behavioral intervention program and vaginal cones on stress urinary incontinence. In this randomized clinical trial, 60 women aged 25-65 years with stress urinary incontinence were randomly divided into two groups, those who participated in a behavioral intervention program [n=30] and those who used vaginal cones [n=30]. The women in the behavioral intervention group were instructed on pelvic floor exercise and bladder control strategies. In the other group, pelvic floor exercises were performed using the vaginal cones. All participants were treated for 12 weeks and folio wed-up every 2 weeks. The subjective changes in severity of stress urinary incontinence were measured using a detection stress urinary incontinence severity questionnaire, leakage index, and a 3-day urinary diary. The objective changes were measured by pad test. For better evaluation of the effects, two questionnaires were used: Incontinence Quality of Life and King's Health Questionnaire. Among the 51 women who completed the study, 25 subjects were in the vaginal cones group and 26 participated in the behavioral intervention program. The changes in leakage rate on pad test and leakage index in the behavioral intervention program group were significantly higher than in the vaginal cones group [p=0.001 and p=0.008, respectively], but the severity of stress urinary incontinence was not significantly different between the two groups [p=0.2]. The changes in strength of the pelvic floor, Incontinence Quality of Life, and Kings Health Questionnaire scores showed no significant differences between the two groups after 12 weeks of intervention. Vaginal cones and behavioral intervention programs are both effective methods of treatment for mild to moderate stress urinary incontinence, but the behavioral intervention program is superior to vaginal cones in terms of cost-effectiveness and side effects

role of infertility etiology in success rate of intrauterine insemination cycles: an evaluation of predictive factors for pregnancy rate

The objective of this study was to identify the prognostic factors that influence the outcome of ovarian stimulation with intrauterine insemination [IUI] cycles in couples with different infertility etiology. This retrospective study was performed in data of 1348 IUI cycles with ovarian stimulation by clomiphene citrate [CC] and/or gonadotropins in 632 women with five different infertility etiology subgroups at Akbarabbadi Hospital, Tehran, Iran. The pregnancy rate [PR]/ cycle was highest [19.9%] among couples with unexplained infertility and lowest [10.6%] in couples with multiple factors infertility. In cases of unexplained infertility, the best PR[s] were seen after CC plus gonadotropins stimulation [26.3%] and with inseminated motile sperm count>30×10[6] [21.9%], but the tendency didn't reach statistical significant. In the ovarian factor group, the best PR[s] were observed in women aged between 30 and 34 years [20.8%], with 2-3 preovulatory follicles [37.8%] and infertility duration between 1and 3 years [20.8%], while only infertility duration [p=0.03] and number of preovulatory follicles [p=0.01] were statistically significant. Multiple logistic regression analysis determined that number of preovulatory follicles [p=0.02], duration of infertility [p=0.015], age [p=0.019], infertility etiology [p=0.05] and stimulation regimen [p=0.01] were significant independent factors in order to predict overall clinical PR. The etiology of infertility is important to achieve remarkable IUI success. It is worth mentioning that within different etiologies of infertility, the demographic and cycles characteristics of couples did not show the same effect. Favorable variables for treatment success are as follows: age <40, duration of infertility

Comparison of intracytoplasmic sperm injection outcomes between oligozoospermic, obstructive azoospermic and non-obstructive azoospermic patients

To determine the differences in sperm quality and results of intracyto-plasmic sperm injection [ICSI] cycles between three groups of male factor infertile couples: oligozoospermic, obstructive azoospermic and non-obstructive azoospermic. In this prospective cohort study, 628 male factor infertile couples who underwent ICSI cycles from April 2004 to March 2006 were enrolled. Three hundred fourteen oligozoospermic patients [group I], 180 obstructive azoospermic patients [group II] and 134 non-obstructive azoospermic patients [group III] were included. Fertilization, cleavage, implantation and clinical pregnancy, early abortion rates were assessed. Chi-square and analysis of variances with Post Hoc [Tukey test] were used for data analysis. Fertilization rates were significantly different in the three groups [group I: 66.6%; group II: 51.8%; group III: 47.7%; p=0.004]. There were differences in the implantation rates [I: 19.5%; II: 17.6%; III: 6.4%; p=0.001]. The cleavage rates were found to be 55.1% [group I], 47.5% [group II], 45.5% [group III], respectively. The clinical pregnancy rate was the lowest in the third group [I: 37.6%; II: 28.9%; III: 13.4%; p=0.001]. There was no significant difference in early abortion rates between the three groups: [I: 10.7%; II: 9.8%; III: 8%; p=0.776]. It can be concluded that patients with oligozoospermia may benefit the most from ICSI treatment. ICSI cycles which use spermatozoa from non-obstructive azoospermic patients have a lower chance for successful outcome. The results of this study suggest, in cases of failure to achieve pregnancy after 1 or 2 cycles in non-obstructive azoospermic patients, embryo donation would be a better alternative