Frequency of euploid miscarriage is increased in obese women with recurrent early pregnancy loss

Capsule:
Based on a cohort of 372 women with a history of recurrent early pregnancy loss, obesity was associated with euploid miscarriage, which is a known risk factor for subsequent miscarriage.

Authors:
Christina E. Boots, M.D., Lia A Bernardi, M.D., Mary D Stephenson, M.D., M.Sc.

Volume 102, Issue 2, Pages 455–459

Abstract:

Objective:
To determine whether the frequency of euploid miscarriage is increased in obese women with recurrent early pregnancy loss (REPL).

Design:
Observational cohort study using prospectively collected data.

Setting:
Academic RPL program.

Patient(s):
A total of 372 women with REPL, defined as ≥2 pregnancy losses <10 weeks, and at least one ultrasound-documented miscarriage with chromosome results.

Intervention(s):
Body mass index (BMI) was measured at the initial consultation and at each subsequent pregnancy. Conventional cytogenetic analysis and, when indicated, microsatellite analysis and/or comparative genomic hybridization was performed.

Main Outcome Measure(s):
Frequency of euploid miscarriage in obese (BMI ≥30 kg/m2) and nonobese (BMI <30 kg/m2) subjects, before and subsequent to REPL evaluation.

Result(s):
There were 578 miscarriages with chromosome results. Of the subjects, 18% were obese at the time of miscarriage. The mean maternal age at miscarriage was similar between the obese and nonobese groups. Due to the high rate of maternal cell contamination in the prior miscarriages, only subsequent miscarriages with chromosome results were included in the primary analysis. Of the 117 subsequent miscarriages, the frequency of an euploid miscarriage among obese women was 58% compared with 37% of nonobese women (relative risk = 1.63; 95% confidence interval 1.08–2.47).

Conclusion(s):
Obese women with REPL have an increased frequency of euploid miscarriage, which is a known risk factor for subsequent miscarriage.

Pregnancy rates in donor oocyte cycles compared to similar autologous in vitro fertilization cycles An analysis of 26457 fresh cycles from the Society for Assisted Reproductive Technology

Capsule:
We discuss how data from the Society for Assisted Reproductive Technology registry suggests that fresh autologous stimulation decreases endometrial receptivity in a model that compares donor oocyte cycles with similar autologous cycles.

Authors:
Jason S. Yeh, M.D., Ryan G. Steward, M.D., Annie M. Dude, M.D., Ph.D., Anish A. Shah, M.D., M.H.S., James M. Goldfarb, M.D., Suheil J. Muasher, M.D.

Volume 102, Issue 2, Pages 399–404

Abstract:

Objective:
To use a large US IVF database and compare pregnancy outcomes in fresh donor oocyte versus autologous IVF cycles in women age 20–30 years.

Design:
Retrospective cohort study.

Setting:
Not applicable.

Patient(s):
Women undergoing fresh autologous ovarian stimulation, and oocyte donors and recipients in the United States between 2008 and 2010.

Intervention(s):
None.

Main Outcome Measure(s):
Implantation, clinical pregnancy (CP), and live birth (LB) rates.

Result(s):
Despite similar demographics, stimulation, and embryo parameters, donor oocyte recipients had significantly higher rates of implantation, CP, and LB compared to those undergoing fresh autologous cycles. Odds ratios for implantation, CP, and LB significantly favored the donor oocyte group in all comparisons, including those limited to intracytoplasmic sperm injection cycles, intracytoplasmic sperm injection with male factor, unexplained infertility, cleavage stage embryo transfer, blastocyst transfer, elective single blastocyst transfer, and autologous patients with prior tubal ligation.

Conclusion(s):
Recent US data suggest that the hormonal environment resulting from autologous ovarian stimulation lowers IVF success rates. Further research is needed to determine when to avoid fresh embryo transfer in autologous patients.

Youth varicocele and varicocele treatment A meta analysis of semen outcomes

Capsule:
A meta-analysis of the literature regarding youth varicocele and semen outcomes demonstrates an overall negative effect of varicocele on semen, and improvement of semen parameters following varicocele treatment.

Authors:
Justin J. Nork, D.O., Jonathan H. Berger, M.D., Donald S. Crain, M.D., Matthew S. Christman, M.D.

Volume 102, Issue 2, Pages 381–387.e6

Abstract:

Objective:
To study youth who have a varicocele or are undergoing varicocele treatment, in relation to changes in semen, as measured by semen analysis (SA).

Design:
Meta-analysis of studies identified via a search of PubMed, Medline, and the Cochrane Library covering the last 40 years.

Setting:
Not applicable.

Patient(s):
Youth from studies that assessed the presence and/or treatment of varicocele with SA.

Intervention(s):
Selected studies were analyzed in two separate meta-analyses: one for the effect of varicocele on semen, as measured by SA (hypothesis #1), the other for the effect of treatment on semen, as measured by SA (hypothesis #2).

Main Outcome Measure(s):
A random-effects model was used to calculate weighted mean difference (WMD) of semen outcomes. Heterogeneity was calculated. Bias was assessed with funnel plots and Egger’s test.

Result(s):
The initial literature search returned 1,180 potentially relevant articles. For hypothesis #1, 10 studies with a total of 357 varicocele and 427 control subjects were included. Sperm density, motility, and morphology were significantly decreased when associated with a varicocele, with a WMD of −24.0 × 106/mL (95% confidence interval [CI; −39.5 to −8.6]), −7.5% (95% CI [−12.3% to −2.7%]), and −1.7% (95% CI [−2.4% to −1.1%]), respectively. Another 10 studies with 379 treated and 270 untreated subjects were analyzed for hypothesis #2. Sperm density and motility were significantly improved following treatment, with a WMD of 14.6 × 106/mL (95% CI [7.1–22.1]) and 6.6% (95% CI [2.1%–11.2%]), respectively.

Conclusion(s):
The presence of varicocele in youth appears to negatively affect sperm density, motility, and morphology. Treatment appears to result in moderate improvement of sperm density and mild improvement in sperm motility.

Articles of Special Interest

Frequency of euploid miscarriage is increased in obese women with recurrent early pregnancy loss

Wednesday, July 30, 2014
Based on a cohort of 372 women with a history of recurrent early pregnancy loss, obesity was associated with euploid miscarriage, which is a known risk factor for subsequent miscarriage.

Pregnancy rates in donor oocyte cycles compared to similar autologous in vitro fertilization cycles An analysis of 26457 fresh cycles from the Society for Assisted Reproductive Technology

Wednesday, July 30, 2014
We discuss how data from the Society for Assisted Reproductive Technology registry suggests that fresh autologous stimulation decreases endometrial receptivity in a model that compares donor oocyte cycles with similar autologous cycles.

Youth varicocele and varicocele treatment A meta analysis of semen outcomes

Wednesday, July 30, 2014
A meta-analysis of the literature regarding youth varicocele and semen outcomes demonstrates an overall negative effect of varicocele on semen, and improvement of semen parameters following varicocele treatment.

Efficacy and safety of intrauterine insemination and assisted reproductive technology in populations serodiscordant for human immunodeficiency virus A systematic review and meta analysis

Wednesday, July 30, 2014
A systematic review and meta-analysis for outcomes with intrauterine insemination and in vitro fertilization for HIV-serodiscordant couples found no seroconversions and similar outcomes to HIV-seronegative infertility patients.