Monocyte chemotactic protein-1 plays a role in ovarian dysfunction related to high-fat diet-induced obesity.

Obesity, known to cause a systemic elevation in monocyte chemotactic protein-1 (MCP-1), adversely affects normal ovarian function. The aim of this study was to determine whether MCP-1 plays a role in ovarian dysfunction that is related to obesity induced by high-fat (HF) diet intake. Wild type (WT) C57BL/6J mice were fed either normal chow (NC) (Group 1, control group) or HF diet (Group 2). To assess whether MCP-1 is involved in HF-diet-induced ovarian dysfunction, MCP-1 knock-out mice were fed HF diet (Group 3). Body weight, body fat composition, number of oocytes collected following ovarian superovulation with gonadotropins, ovarian macrophage markers and expression of genes important in folliculogenesis and steroidogenesis were quantified in the 3 groups of animals. Animals in Group 2 gained significant body weight and body mass, produced the fewest number of oocytes following superovulation, and had significant alterations in ovarian genes involved in folliculogenesis and steroidogenesis as well as genes involved in inflammation. Although animals in Group 3 had the highest body weight and body fat composition, they produced similar number of oocytes compared to animals in Group 1 but had different ovarian gene expression compared to Group 2. These findings suggest that MCP-1 gene knockout could reverse some of the adverse effects of obesity induced by HF diet intake. Future studies assessing ovarian histology in MCP-1 knock out mouse model will confirm our findings. MCP-1 inhibition could represent a future therapeutic target to protect ovarian health from the adverse effects of HF diet ingestion.

Serum and follicular fluid monocyte chemotactic protein-1 levels are elevated in obese women and are associated with poorer clinical pregnancy rate after in vitro fertilization: a pilot study.

OBJECTIVE: To determine whether monocyte chemotactic protein-1 (MCP-1), a proinflammatory chemokine important in ovulation, is abnormally elevated in obese women undergoing IVF and whether serum and follicular fluid (FF) levels of MCP-1 are associated with IVF outcome. DESIGN: Prospective pilot study. SETTING: Academic center. PATIENT(S): Women undergoing IVF. INTERVENTION(S): Serum and FF were collected from women undergoing IVF. MAIN OUTCOME MEASURE(S): Correlation between MCP-1 and other inflammatory markers with adiposity and pregnancy outcome after IVF. RESULT(S): Obese women had significantly higher serum and FF MCP-1 levels compared with overweight and normal weight women. Serum MCP-1, granulocyte colony stimulating factor, catalase, and C-reactive protein (CRP) were positively correlated with body mass index (BMI). After adjusting for age and baseline FSH, these correlations remained significant for serum MCP-1, granulocyte colony stimulating factor, and CRP. In the FF, only MCP-1 was positively correlated with BMI. Women who became pregnant had significantly lower serum MCP-1 and CRP levels compared with those who did not become pregnant; this difference was more pronounced among women with diminished ovarian reserve. Receiver operating characteristic curve demonstrated that serum MCP-1 levels >373.0 pg/mL in all women and >362.6pg/mL in women with diminished ovarian reserve predicted failure to achieve a clinical pregnancy. CONCLUSION(S): Elevations in serum and FF MCP-1 levels are positively correlated with adiposity and negatively correlated with pregnancy rates (PRs) in women undergoing IVF.

Access to infertility care in the developing world: the family promotion gap.

Infertility in resource-poor settings is an overlooked global health problem. Although scarce health care resources must be deployed thoughtfully, prioritization of resources may be different for recipient and donor countries, the latter of whom focus on maternal health care, prevention, and family planning. For women and couples with involuntary childlessness, the negative psychosocial, sociocultural, and economic consequences in low-income countries are severe, possibly more so than in most Western societies. Despite the local importance of infertility, few resources are committed to help advance infertility care in regions like sub-Saharan Africa. The worldwide prevalence of infertility is remarkably similar across low-, middle-, and high-income countries. The World Health Organization (WHO) recognizes infertility as a global health problem and established universal access to reproductive health care as one of the United Nation's Millennium Developmental Goals for 2015. Currently, access to infertility care is varied and is usually only attainable by the very wealthy in low-income countries. We provide an overview on the current state of access to infertility care in low-income countries such as in sub-Saharan Africa and a rationale for providing comprehensive reproductive care and possible solutions for providing cost-effective infertility services in these settings.

Actinomycosis pelvic abscess after in vitro fertilization.

OBJECTIVE: To report a case of pelvic actinomycosis presenting as large, multiloculated abscesses after an in vitro fertilization (IVF) cycle for male factor infertility. DESIGN: A case report and literature review. SETTING: University hospital. PATIENT(S): A 31-year-old nulligravid woman presenting with urinary retention, pelvic pain, and fever 6 days after transvaginal oocyte retrieval and an embryo transfer for male factor infertility. INTERVENTION(S): Intravenous and oral antimicrobial therapy, and computed tomography (CT)-guided drainage of pelvic abscesses. MAIN OUTCOME MEASURE(S): Clinical and radiologic resolution of symptoms and infection. RESULT(S): The CT scan revealed several large, multiloculated pelvic and tuboovarian abscesses. The patient defervesced after 6 days of intravenous antibiotics, but the pelvic pain did not improve. After CT-guided drainage of the pelvic abscesses, the patient's symptoms improved. The drained material was cultured, and the patient was diagnosed with pelvic actinomycosis tuboovarian abscesses, an infrequent cause of tuboovarian abscess and a rare complication of assisted reproductive technology (ART). The patient was switched from intravenous to oral antibiotics and discharged home. CONCLUSION(S): Pelvic Actinomyces israelii presenting as pelvic abscesses may occur as a rare complication of ART. Physicians should consider a diagnosis of tuboovarian abscess in a patient reporting fever and pelvic pain after IVF and embryo transfer.

Candida glabrata complicating in vitro pregnancy: successful management of subsequent pregnancy.

OBJECTIVE: To report the occurrence of Candida glabrata chorioamnionitis complicating an in vitro fertilization (IVF) pregnancy. DESIGN: Case report. SETTING: University hospital. PATIENT(S): A 30-year-old woman, primagravida, with an IVF dichorionic-diamniotic pregnancy who presented at 15 weeks with vaginal bleeding. INTERVENTION(S): Before embryo transfer in next IVF cycle, vaginal culture from the patient revealed colonization with C. glabrata, which was treated with boric acid. MAIN OUTCOME MEASURE(S): Subsequent pregnancy after eradication of fungal organisms. RESULT(S): The patient's first pregnancy was treated with indomethacin and broad-spectrum antibiotics, but her membranes ruptured, and she delivered both twins at 16 weeks; the autopsy and pathology reports were consistent with C. glabrata chorioamnionitis. After boric acid treatment eradicated the organisms, two embryos were transferred in subsequent IVF treatment; the second pregnancy was uncomplicated, with dichorionic-diamniotic twins, delivered by cesarean section at 38 weeks. CONCLUSION(S): Eradication of vaginal colonization with C. glabrata may prevent infection of the next IVF pregnancy.

Retained viable single intrauterine pregnancy after vacuum aspiration for a dichorionic-diamniotic twin pregnancy.

BACKGROUND: Retained viable intrauterine pregnancy is an infrequent complication of vacuum aspiration. We report a case of a retained single intrauterine pregnancy after an elective vacuum aspiration of a dichorionic-diamniotic twin gestation. CASE: A patient presented to the emergency department reporting vaginal spotting, breast engorgement, and lower abdominal cramping for the previous 2 weeks. The patient had had an elective abortion 2 months previously. Transvaginal ultrasonography revealed an apparent twin gestational sac within the uterus. The presenting gestational sac contained a mixture of blood clot and tissue with no discernible fetal parts. The second sac contained a live fetus of approximately 15 weeks of gestation. CONCLUSION: An underreported complication of vacuum aspiration is a retained viable intrauterine pregnancy. There is a role for postoperative ultrasonography in complicated cases such as twin gestations or in very early pregnancies to avoid retained products of conception or the infrequent case of retained viable intrauterine pregnancy.