American association of clinical endocrinologists and american college of endocrinology comprehensive clinical practice guidelines for medical care of patients with obesity.

Ovarian hyperstimulation syndrome.

Direct evidence on age patterns of infecundity and sterility cannot be obtained from contemporary populations because such large fractions of couples use contraception or have been sterilized. Instead, historical data are exploited to yield upper bounds applicable to contemporary populations on the proportions sterile at each age. Examination of recent changes in sexual behavior that may increase infecundity indicates that sexually transmitted infections, the prime candidate for hypothesized rises in infertility, are unlikely to have added to infecundity to any great extent. These results imply that a woman in a monogamous union faces only moderate increases in the probability of becoming sterile (or infecund) until her late thirties. Nevertheless, it appears that recent changes in reproductive behavior were guaranteed to result in the perception that infecundity is on the rise.

Age and infertility

http://s2.medicina.uady.mx/observatorio/docs/ee/ac/EE2012_Ac_Jungheim.pdf

Obesity and reproductive function.

BACKGROUND:

Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic and potentially life threatening condition resulting from excessive ovarian stimulation. Its reported incidence varies from 1% to 10% of in vitro fertilization (IVF) cycles. The factors leading to this syndrome have not been completely explained. It seems likely that the release of vasoactive substances, secreted by the ovaries under human chorionic gonadotropin (hCG) stimulation plays a key role in triggering this syndrome. The hallmark of this condition, is a massive shift of fluid from the intra-vascular compartment to the third space resulting in profound intra-vascular depletion and hemoconcentration.
OBJECTIVES:

The objective of this review is to assess the effect of "coasting" (withholding gonadotrophins) as a preventative strategy in the management of OHSS following superovulation in assisted reproduction treatment on the incidence of all clinical grades of OHSS, in comparison with "early unilateral follicular aspiration (EUFA)" or other interventions.
SEARCH STRATEGY:

Publications in the literature that described randomised controlled trials (RCTs) in which "coasting" was used as a preventative strategy to OHSS were included. The Cochrane Menstrual Disorders and Subfertility Review Group specialised register of controlled trials was searched. In addition, MEDLINE (PUBMED) 1985 to 2002, EMBASE (1985 to 2001), CINHAL (1985 to 2001) and National Research Register were also searched.
SELECTION CRITERIA:

Randomised controlled trials (RCTs) in which coasting was used as a preventative strategy to OHSS were included.
DATA COLLECTION AND ANALYSIS:

Two reviewers, Mr N.N. Amso (NNA) and Dr A. D'Angelo (ADA) scanned the titles and the abstracts of the reports identified by electronic searching in order to find relevant papers. One reviewer (ADA) obtained copies of the full text articles and made copies for the other reviewer (NNA) in which details of authors, institution, results and discussion were removed in order to assess their eligibility for inclusion. Then, both reviewers extracted data independently using forms designed according to Cochrane guidelines. Disagreements were resolved by discussion. Additional information on the trial methodology or data were requested by writing twice to the corresponding authors directly. The interventions compared were "coasting" versus "early unilateral follicular aspiration (EUFA)" or no "coasting" or other interventions. Statistical analysis was performed in accordance with the Cochrane Menstrual Disorders and Subfertility Group guidelines.
MAIN RESULTS:

This review identified thirteen studies but only one trial met our inclusion criteria. There was no difference in the incidence of moderate and severe OHSS (n=30, OR 0.76, 95% CI 0.18, 3.24)and in the clinical pregnancy rate (n=30, OR 0.75, 95% CI 0.17, 3.33) between the groups.
REVIEWER'S CONCLUSIONS:

There is a lack of randomised controlled trials for where coasting is compared with no coasting or other interventions such as embryo freezing or intra-venous albumin infusion for prevention of OHSS. There is insufficient evidence to determine if coasting is an effective strategy for preventing OHSS.

Coasting (withholding gonadotrophins) for preventing ovarian hyperstimulation syndrome

Purpose
Comparing the effects of metformin or orlistat on hormone, lipid profile and ovulation status in obese women with polycystic ovary syndrome.

/pdf/the-effects-of-metformin-or-orlistat-on-obese-women-with-3owyxiii0o.pdf

The effects of metformin or orlistat on obese women with polycystic ovary syndrome: a prospective randomized open-label study

Background: Female age and basal FSH level are independently associated with IVF outcome. They are both related to the same phenomenon, namely ovarian reserve. Objective: To evaluate the effective role of serum FSH concentration at the start of treatment cycle on ART outcome. Materials and Methods: A total of 207 women undergoing IVF and ICSI cycles were included in this study. Basal FSH concentrations were measured and the women's ages were calculated before they were undergoing pituitary desensitization and its correlation with ART outcome was evaluated. Results: Increasing FSH was associated significantly with reduced number of follicles > 15mm, oocytes retrieved, and embryos obtained. Conclusion: Age is the most important prognostic factor but basal serum FSH can be used to identify women who are very likely to perform poorly in ART, probably because of diminished ovarian reserve.

/pdf/age-and-basal-fsh-as-a-predictor-of-art-outcome-1mzu27a6nx.pdf

Age and basal fsh as a predictor of art outcome

Background: One of the major and life-threatening side effects of Assisted Reproductive Technique (ART) is ovarian hyperstimulation syndrome (OHSS). The available data however, have been showed that both Cabergoline (anti VEGF) and coasting reduce the severity of OHSS. Objective: We aimed to compare coasting and Cabergoline administration in prevention of severe OHSS. Materials and Methods: A total of 60 IVF/ICSI cycles were selected. Patients at risk of developing OHSS were divided into two groups as patient's convenience. For 30 patients in coasting group, exogenous gonadotropins were withheld to allow E2 to decrease while GnRH-a was maintained. Then 10,000 unit hCG was administrated and oocyte retrieval was performed 36 hours later. In Cabergoline group, 30 patients were administered with 0.5mg Cabergoline tablet on day of hCG injection, continued for 8 days. Results: The mean number of retrieved, good quality, mature oocytes and the mean number of embryos were significantly different in two groups (p 0.05). The incidence of severe OHSS was similar in two groups. Conclusion: The Cabergoline was as effective as coasting in the prevention of early severe OHSS in high risk patients, but yielded more retrieved oocytes.

/pdf/comparison-of-coasting-with-cabergoline-administration-for-44k93esk7h.pdf

Comparison of coasting with Cabergoline administration for prevention of early severe OHSS in ART cycles

BACKGROUND: Although heterotopic gestation is common in assisted reproductive techniques, it is very rare in natural conception and clomiphene induced pregnancy. Diagnosis and appropriate intervention of heterotopic pregnancy requires a high index of suspicious.

CASE: In this paper a case of heterotopic pregnancy in a 30-year old woman with hemoperitoneum from ruptured tubal pregnancy with live intrauterine gestation at 9 weeks of gestation is reported.

CONCLUSION: This case suggests that a heterotopic pregnancy must always be considered particularly after the induction of ovulation by clomiphene citrate or assisted reproductive technology. Every clinician treating women of reproductive age should keep this diagnosis in mind. It also demonstrates that early diagnosis is essential in order to salvage the intrauterine pregnancy and avoid maternal morbidity and mortality.

/pdf/heterotopic-pregnancy-following-induction-of-ovulation-with-fy3fhafh6t.pdf

Heterotopic pregnancy following induction of ovulation with clomiphene citrate

Objective: This study evaluated the effect of age on ovarian response to gonadotropin stimulation and the success of IVF & ICSI cycles. Methodology: In this retrospective analytic study, 280 women undergoing first IVF & ICSI cycles were collected. Patients were divided in three groups: 0.05). Clinical pregnancy rate were 21.8% in patients < 35, 13.2% in patients 35–39 and 5.9% in e”40 ( p= 0.157 ) and live birth rate were 14.2% in patients < 35, 7.9% in 35–39 and 5.9% in e”40 years old . (p= 0.50) Conclusions: Clinical pregnancy rate & live birth rate diminished with increasing age.

Sedigheh Ghandi

Papers

The effects of metformin or orlistat on obese women with polycystic ovary syndrome: a prospective randomized open-label study

Age and basal fsh as a predictor of art outcome

Comparison of coasting with Cabergoline administration for prevention of early severe OHSS in ART cycles

Heterotopic pregnancy following induction of ovulation with clomiphene citrate

Age as a predictor of assisted reproductive techniques outcome