https://www.fertstert.org/article/S0015-0282(14)02371-1/pdf

Oocyte environment: follicular fluid and cumulus cells are critical for oocyte health

There is conflicting evidence regarding the effect of raised body mass index (BMI) on the outcome of assisted reproductive technology In particular, there is insufficient evidence to describe the effect of BMI on live birth rates We carried out a systematic review and meta-analysis of studies to evaluate the effect of raised BMI on treatment outcome following IVF/ICSI treatment Subgroup analysis on overweight and obese patients was performed Literature searches were conducted on MEDLINE, EMBASE and the Web of Science from 1966 to 2010 Thirty-three studies including 47,967 treatment cycles were included Results indicated that women who were overweight or obese (BMI ≥ 25) had significantly lower clinical pregnancy (RR=090, P<00001) and live birth rates (RR=084, P=00002) and significantly higher miscarriage rate (RR=131, P < 00001) compared to women with a BMI < 25 following treatment A subgroup analysis of overweight women (BMI ≥ 25-299) revealed lower clinical pregnancy (RR=091, P=00003) and live birth rates (RR=091, P=001) and higher miscarriage rate (RR=124, P < 000001) compared to women with normal weight (BMI < 25) In conclusion, raised BMI is associated with adverse pregnancy outcome in women undergoing IVF/ICSI treatment, including lower live birth rates This effect is present in overweight as well as obese women

https://www.rbmojournal.com/article/S1472-6483(11)00422-6/pdf

Effect of body mass index on IVF treatment outcome: an updated systematic review and meta-analysis

The World Health Organisation sponsored a multicentre, collaborative investigation of a standard approach to evaluating infertile couples. The study was conducted between 1979 and 1984 in thirty-three medical centres in twenty-five countries throughout the developed and developing world. Over 5800 couples completed the investigation. African centres had a pattern of infertility different from those in other developing regions or the developed countries. African couples were more likely than those from elsewhere to have secondary infertility or longer duration, a history of sexually transmitted diseases or pregnancy complications, and infertility diagnoses (such as bilateral tubal occlusion or pelvic adhesions) suggestive of previous genital infections.

Worldwide Patterns of Infertility: Is Africa Different?

Over-nutrition in females causes altered fetal growth during pregnancy and permanently programs the metabolism of offspring; however, the temporal and mechanistic origins of these changes, and whether they are reversible, are unknown. We now show that, in obese female mice, cumulus-oocyte complexes exhibit endoplasmic reticulum (ER) stress, high levels of intracellular lipid, spindle abnormalities and reduced PTX3 extracellular matrix protein production. Ovulated oocytes from obese mice contain normal levels of mitochondrial (mt) DNA but have reduced mitochondrial membrane potential and high levels of autophagy compared with oocytes from lean mice. After in vitro fertilization, the oocytes of obese female mice demonstrate reduced developmental potential and form blastocysts with reduced levels of mtDNA. Blastocysts transferred to normal weight surrogates that were then analyzed at E14.5 showed that oocytes from obese mice gave rise to fetuses that were heavier than controls and had reduced liver and kidney mtDNA content per cell, indicating that maternal obesity before conception had altered the transmission of mitochondria to offspring. Treatment of the obese females with the ER stress inhibitor salubrinal or the chaperone inducer BGP-15 before ovulation increased the amount of the mitochondrial replication factors TFAM and DRP1, and mtDNA content in oocytes. Salubrinal and BGP-15 also completely restored oocyte quality, embryo development and the mtDNA content of fetal tissue to levels equivalent to those derived from lean mice. These results demonstrate that obesity before conception imparts a legacy of mitochondrial loss in offspring that is caused by ER stress and is reversible during the final stages of oocyte development and maturation.

/pdf/mitochondrial-dysfunction-in-oocytes-of-obese-mothers-31snisjnrw.pdf

Mitochondrial dysfunction in oocytes of obese mothers: transmission to offspring and reversal by pharmacological endoplasmic reticulum stress inhibitors

The prevalence of obesity and overweight are increasing and have become an epidemic worldwide. Obesity has detrimental influences on all systems, including reproductive health. The prevalence of obesity in infertile women is high, and it is well known that there is an association between obesity and infertility. The relationship between obesity and reproductive functions is still being explored. Overweight women have a higher incidence of menstrual dysfunction and anovulation. Overweight and obese women are at a high risk for reproductive health. The risk of subfecundity and infertility, conception rates, miscarriage rates, and pregnancy complications are increased in these women. They have poor reproductive outcomes in natural as well as assisted conception. These poor reproductive outcomes include assisted reproduction such as ovulation induction, in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI), and ovum donation cycles. Weight loss has beneficial effects on the reproductive outcomes in these patients.

Impact of obesity on infertility in women.

BACKGROUND Debate exists regarding the effect of raised BMI on the outcome of pregnancies after assisted reproduction technology. We assessed the effect of BMI on the risk of miscarriage in women conceiving following single blastocyst transfer (SBT) after controlling for confounding factors. METHODS Fresh and cryo-thawed cycles of SBT that resulted in a pregnancy between January 2006 and March 2010 were included. Patients with BMI < 18.5 kg/m(2) or older than 40 years were excluded. Patients were grouped according to their BMI at the start of treatment cycle. The main outcome measure was the miscarriage rate before 23 weeks gestation. Confounding variables examined included female age, duration and cause of infertility, previous miscarriage, smoking status and quality of blastocyst replaced. RESULTS A total of 413 women conceived following SBT in fresh (n = 325) or cryo-thawed (n = 88) IVF cycles, of whom 244 had a normal BMI (18.5-24.9) and 169 had a raised BMI of ≥ 25. Overall, 27% (113/413) of women miscarried before 23 weeks gestation. Women with a BMI of ≥ 25 had more than double the risk of miscarriage compared with women who had normal BMI [38 versus 20%, odds ratio (OR): 2.4, 95% confidence interval (CI) 1.6-3.8, P < 0.001, respectively]. After adjusting for confounding variables, having a BMI of ≥ 25 significantly increased the risk of clinical miscarriage before 23 weeks gestation in both fresh (adjusted OR = 2.7, 95% CI 1.5-4.9, P = 0.001) and cryo-thawed IVF cycles (OR = 6.8, 95% CI 1.5-31.1, P = 0.012). CONCLUSIONS Raised BMI is independently associated with higher miscarriage rate after IVF treatment.

Influence of BMI on risk of miscarriage after single blastocyst transfer

Although male factors contribute to approximately half of all cases of infertility, no specific cause can be found to explain the majority of abnormalities found in semen parameters. Specific and effective medical treatment is restricted to rare endocrine disorders. As a consequence, various empirical medical treatments are often used to treat idiopathic male infertility, with limited success. This review focuses on the rationale and current evidence on the efficacy of medical treatment of male infertility. Unless new studies provide high quality evidence in favour of medical treatment, assisted reproductive technologies will remain the mainstay of treatment of male infertility.

Medical treatment of male infertility

/pdf/session-18-miscarriage-treatment-and-prognostic-factors-3r87a7hj0n.pdf

V. Rittenberg

Papers

Effect of body mass index on IVF treatment outcome: an updated systematic review and meta-analysis

Influence of BMI on risk of miscarriage after single blastocyst transfer

Medical treatment of male infertility

Session 18: Miscarriage: Treatment and Prognostic Factors

O-083 High birth rates for donors and recipients treated in a long term egg sharing programme