Impact of Body Mass Index on In Vitro Fertilization Outcomes

PURPOSE: To determine if body mass index (BMI) impacts IVF outcome. METHODS: Retrospective, cohort study. Main outcome measure was number of oocytes obtained. RESULTS: BMI did not correlate with the prestimulation parameters. There was a significant positive correlation between BMI and the number of follicles on ultrasound prior to egg retrieval. A threshold analysis revealed a significant change in parameters at a BMI > 24 kg/m2. Patients with BMI > 24 kg/m2 demonstrated a significant increase in the number of follicles after stimulation (p = 0.03) and a comparative decrease in the number ampules of gonadotropins used (p = 0.04) and days of stimulation required (p = 0.01). CONCLUSION: These data demonstrated that an elevated BMI significantly correlates with the number of follicles, days of stimulation, and number of ampules of gonadotropins used. Further correlation to an actual increase in number of oocytes and pregnancy rates may be limited by insufficient power in this study.     

Body Mass Index,Follicle-Stimulating Hormone and Their Predictive Value in In Vitro Fertilization

Purpose: The objective was to explore whether body mass and day 3 follicle-stimulating hormone have predictive value on odds of pregnancy after in vitro fertilisation. Few studies show that obesity produces a variety of alterations in the reproductive system, and that women with an elevation of day 3 FSH have declining ovarian function.Methods: The data of one-hundred-seventy-one women who underwent a standard regime of controlled ovarian hyperstimulation was analyzed with particular reference to variations in body mass and hormone levels.Results: By raising BMI and FSH (mIU/mL) by one unit, the odds for pregnancy were decreased by the respective factors 0.84 (95% confidence interval 0.73–0.97) and 0.77 (95% confidence interval 0.59–1.00).Conclusions: The results demonstrate that for the purpose of raising the odds of pregnancy BMI should be reduced. A low FSH value may cause the same effect. Nontheless, obesity and hormonal function may be independent risk factors for failure in assisted reproduction.     

The Effect of Gestational Weight Gain by Body Mass Index on Maternal and Neonatal Outcomes

ObjectiveTo evaluate the effects of gestational weight gain on maternal and neonatal outcomes in different body mass index (BMI) classes.MethodsWe compared maternal and neonatal outcomes based on gestational weight gain in underweight, normal weight, overweight, obese, and morbidly obese (BMI ≥ 40.00) women. The study group was a population-based cohort of women with singleton gestations who delivered between April 1, 2001, and March 31, 2007, drawn from the Newfoundland and Labrador Provincial Perinatal Program Database. Univariate analyses and multivariate logistic regression analyses (controlling for maternal age, parity, smoking status, partnered status, and gestational age) were performed and odds ratios (ORs) were calculated.ResultsOnly 30.6% of women gained the recommended amount of weight during pregnancy; 52.3% of women gained more than recommended, and 17.1% gained less than recommended. In women with normal pre-pregnancy BMI, excess weight gain was associated with increased rates of gestational hypertension (OR 1.27; 95% CI 1.08–1.49), augmentation of labour (OR 1.09; 95% CI 1.01–1.18), and birth weight ≥ 4000 g (OR 1.21; 95% CI 1.10–1.34). In overweight women, excess weight gain was associated with increased rates of gestational hypertension (OR 1.31; 95% CI 1.10–1.55) and birth weight ≥4000 g (OR 1.30; 95% CI 1.15–1.47). In women who were obese or morbidly obese, excess weight gain was associated with increased rates of birth weight ≥4000 g (OR 1.20; 95% CI 1.07–1.34) and neonatal metabolic abnormality (OR 1.31; 95% CI 1.00–1.70). In morbidly obese women, poor weight gain was associated with less use of epidural analgesia (OR 0.34; 95% CI 0.12–0.95). In women who were of normal weight, overweight, or obese, the rate of adverse outcome (Caesarean section, gestational hypertension, birth weight < 2500 g or birth weight ≥4000 g) was lower in women with recommended weight gain than in those with excess weight gain. Adverse outcomes were reduced in nulliparous morbidly obese women who had poor weight gain (OR 0.18; 95% CI 0.04–0.83).ConclusionThe effects of gestational weight gain on pregnancy outcome depend on the woman’s pre-pregnancy BMI. Pregnancy weight gains of 6.7–11.2 kg (15–25lb) in overweight and obese women, and less than 6.7 kg (15lb) in morbidly obese women are associated with a reduction in the risk of adverse outcome.     

Analysis of the Impact of Body Mass Index on the Surgical Outcomes after Robot-Assisted Laparoscopic Myomectomy

Study ObjectiveTo estimate the impact of body mass index (BMI) on surgical outcomes in patients undergoing robotic myomectomy.DesignA retrospective cohort data analysis (Canadian Task Force classification II-2).SettingCommunity-based teaching hospital.PatientsA total of 77 consecutive patients from January 2005 through November 2008 with symptomatic leiomyomata.InterventionRobotic-assisted laparoscopic myomectomy.Measurements and Main ResultsBody mass index ([BMI] expressed as kg/m²) was abstracted from the medical charts of all patients undergoing robotic myomectomy. Data on estimated blood loss, procedure time, length of hospital stay, diameter of the largest fibroid, and specimen weight were also extracted. Overall patient demographics between the groups were similar. Thirty-two patients (41.6%) were obese or morbidly obese (BMI > 30). The parameters analyzed for associations with the continuous measure of BMI included length of postoperative hospital stay (LOS), estimated blood loss (EBL), and procedure duration. Median (range) procedure time among all patients was (195 minutes, 98-653 minutes), estimated blood loss was (100 mL, 10-700 mL), and length of hospital stay was (1 day, 1-5 days). No associations were determined between BMI and LOS (r = 0.14, p = .22), EBL (r = 0.25, p = .03), or procedure duration (r = 0.16, p = .22) with Spearman correlations. The size of the largest leiomyoma diameter did not affect these associations.ConclusionPreoperative obesity is not a risk factor for poor surgical outcome in patients undergoing robotic myomectomy.     

Effect of Maternal Body Mass Index on the Retinal Microvasculature in Pregnancy

OBJECTIVE:: To estimate the effects of maternal body mass index (BMI) and pregnancy weight gain on the retinal microvasculature among pregnant women. METHODS:: We studied 814 pregnant women aged 18-46 years who were recruited as part of the Growing Up in Singapore Toward Health Outcomes study, an ongoing birth cohort study from two government hospitals in Singapore since 2009. Recalled prepregnancy weight was recorded, and maternal anthropometric measurements of weight and height were performed at 26 weeks of gestation together with retinal photography. RESULTS:: In multiple linear regression models, each standard deviation increase of 26-week pregnancy BMI (4.57) was associated with narrower retinal arteriolar caliber (by 1.58 micrometers, P<.001), wider venular caliber (by 1.28 micrometers, P=.02), and increased retinal venular tortuosity (P=.01). Compared with mothers with normal weight, obese mothers (prepregnancy BMI greater than 30.0) had narrower retinal arteriolar caliber (118.81 compared with 123.38 micrometers, P<.001), wider retinal venular caliber (175.81 compared with 173.01 micrometers; P<.01), and increased retinal venular tortuosity (129.92 compared with 121.49×10; P<.01). Pregnant women whose BMI-specific weight gain from prepregnancy to 26 weeks of gestation was above Institute of Medicine recommendations had narrower retinal arteriolar caliber (120.68 micrometers) than women with ideal (121.91 micrometers) and less than ideal weight gain (123.17), respectively (Ptrend=.05). CONCLUSION:: These data indicate that greater prepregnancy BMI and pregnancy BMI are associated with adverse retinal microvascular measures, suggesting that maternal obesity has an effect on her microcirculation. LEVEL OF EVIDENCE:: III.     

胎儿出生体重与孕期体重指数变化的相关性

目的 :探讨胎儿出生体重与孕期母亲体重指数的相关性。方法 :选择 2 0 0 2年 1月至 2 0 0 2年 10月在我院产前检查并分娩且无内科合并症及产科并发症的初产孕妇 190 0例 ,分别测量并计算孕前体重、分娩前体重、孕期体重变化及体重指数变化 ,采用偏相关分析胎儿出生体重与孕期体重指数的相关性。结果 :无论是控制身高、孕前体重还是控制孕期体重变化都发现胎儿出生体重与孕期体重指数的变化均呈正相关。结论 :胎儿出生体重与孕期体重指数的变化有较好的正相关性。     

The Effect of Endometrial Polyps on Outcomes of In Vitro Fertilization (IVF) Cycles

Purpose: Our purpose was to investigate the effect of endometrial polyps on pregnancy outcome in an in vitro fertilization (IVF) program. Methods: Endometrial polyps less than 2 cm in diameter were suspected by transvaginal ultrasound before oocyte recovery in 83 patients. Forty-nine women (Group I) had standard IVF–embryo transfer, while in 34 women (Group II) hysteroscopy and polypectomy were performed immediately following oocyte retrieval, the suitable embryos were all frozen, and the replacement cycle took place a few months later. Results: Of the 32 hysteroscopies, a polyp was diagnosed in 24 cases (75%) and polypoid endometrium in another 5 patients (15.6%). An endometrial polyp was confirmed by histopathological examination in 14 women (58.3%). The pregnancy rate in group I was similar to the general pregnancy rate of our unit over the same period (22.4 vs 23.4%) but the miscarriage rate was higher (27.3 vs 10.7%, P = 0.08). In Group II, the pregnancy and miscarriage rates were similar to those of the frozen embryo cycles at Bourn Hall (30.4 and 14.3 vs 22.3 and 12.1%, respectively). Conclusions: Small endometrial polyps, less than 2 cm, do not decrease the pregnancy rate, but there is a trend toward increased pregnancy loss. A policy of oocyte retrieval, polypectomy, freezing the embryos, and replacing them in the future might increase the take-home baby rate.     

A Retrospective Cohort Study Investigating the Impact of Maternal Pre-Pregnancy Body Mass Index on Pediatric Health Service Utilization

ObjectiveMaternal weight during pregnancy impacts the health of both mother and baby. This project investigated associations between maternal pre-pregnancy body mass index (BMI) and the child's future health service utilization.MethodsThe study population comprised all women who delivered a singleton, live infant in Ontario between 2012 and 2014, and was assembled from data contained in the provincial birth registry. Health service utilization in the 24 months following birth was examined by linking data from the registry with other provincial health administrative databases housed at ICES.ResultsA total of 258 005 records were available for analysis. After adjusting for infant sex and maternal age, smoking status, income quintile, and pre-existing or gestational diabetes or hypertension, children born to mothers who were overweight or had obesity prior to pregnancy had increased rates of hospitalization (overweight adjusted incidence rate ratio [aIRR] 1.09, 95% confidence interval [CI] 1.06–1.12; obesity aIRR 1.20, 95% CI 1.17–1.24), physician visits (overweight aIRR 1.03, 95% CI 1.03–1.04; obesity aIRR 1.05, 95% CI 1.04–1.05) and emergency department visits (overweight aIRR 1.12, 95% CI 1.10–1.13; obesity aIRR 1.27, 95% CI 1.25–1.29) than infants born to mothers with normal pre-pregnancy BMI.ConclusionExcess maternal weight was associated with greater pediatric health service utilization. Rates of health service utilization appeared to increase with maternal pre-pregnancy BMI. Future study of the reasons behind this increase may allow for early education, diagnosis, and intervention in this at-risk population.     

孕前体重指数及孕期体重增长对妊娠结局的影响

目的　探讨孕前体重指数及孕期体重增长对妊娠结局的影响。　方法　将 1998年 6月至1999年 6月间在我院行产前检查并住院分娩的 32 2 5例足月单胎初产妇按孕前体重指数分为低于标准体重、标准体重和高于标准体重三组 ,并随访其妊娠结局。　结果　 (1)高于标准体重组孕产妇的妊娠并发症发生率 (32 .1% ) ,明显高于标准体重组 (18.0 % )和低于标准体重组 (2 0 .0 % ) ,具有统计学意义(P值均 <0 .0 5 ) ,而低于标准体重组和标准体重组孕产妇间的妊娠并发症发生率则差异无显著性 (P>0 .0 5 )。(2 )新生儿体重与三组孕妇的孕期体重增长具有直线相关关系 (相关系数 r分别为 0 .5 96 ,0 .32 8和 0 .2 49,P值均 <0 .0 1)。(3)低于标准体重组和标准体重组孕妇孕期体重增长≥ 18kg时 ,妊娠高血压综合征的发病率明显增加 (10 .5 % ) ;而高于标准体重组孕妇孕期体重增长≥ 9kg时 ,其妊娠高血压综合征发病率就显著增加 (2 0 .2 % )。　结论　 (1)孕前体重指数及孕期体重增长是妊娠并发症发生的重要影响因素。(2 )孕妇的体重增长对新生儿的体重有重要的影响作用 ;3.孕前体重指数不超过2 4,孕期体重增长适宜者 ,可获得良好的妊娠过程和结局。     

Reproductive Outcomes of Segmented In Vitro Fertilization in Patients Diagnosed with Endometriomas

Study Objective

To assess the impact of ovarian endometriomas on endometrial receptivity in frozen embryo transfer (FET) of segmented in vitro fertilization (IVF) cycles.

Effect of Increasing Maternal Body Mass Index on Oxidative and Nitrative Stress in The Human Placenta

Maternal obesity is an increasing problem in obstetrics associated with adverse pregnancy outcomes and delivery complications. As an inflammatory state, where elevated levels of pro-inflammatory cytokines are found, obesity can lead to the increased incidence of oxidative and nitrative stress. These stresses may result in protein oxidation and protein nitration respectively, which are post- translational covalent modifications that can modify the structure and subsequently alter the function of a protein.The objective of this study was to examine whether placental oxidative and nitrative stress increase with increasing maternal body mass index.Placental tissue was collected from three groups of patients categorized as lean, overweight and obese. The presence of nitrotyrosine residues, a marker of nitrative stress, and antioxidant enzymes, as markers of oxidative stress, were assessed by immunohistochemistry, Western blot and ELISA. Protein carbonyl formation, a specific measure of protein oxidation, was measured by OxyBlot? kit.Nitrotyrosine residues were increased in obese compared to lean and overweight groups although localization was unaltered across the three groups. Superoxide dismutase enzyme expression, localization and activity was unaltered between the groups. Protein carbonyl formation was greater in the lean compared to the overweight individuals.This study demonstrates that with increasing maternal body mass index there is an increase in placental nitrative stress. There does not appear to be a corresponding increase in oxidative stress and indeed we demonstrate some evidence of a decrease in oxidative effects in these placenta samples. Potentially the formation of peroxynitrite may be consuming reactive oxygen species and reducing oxidative stress. There may be a shift in the balance between nitrative and oxidative stress, which may be a protective mechanism for the placenta.     

Maternal Lean Body Mass and Birth-Weight

Summary: Maternal lean body mass at booking was estimated according to a formula employing the body mass index and maternal age in a sample of 511 women who booked in the first trimester of pregnancy. The significance of this parameter in comparison with established predictors of birth-weight such as maternal weight, height, smoking, parity, gestational age and sex of the infant was examined using bivariate correlations and multiple regression analysis. Maternal lean body mass was found to be the most important determinant of birth-weight for gestation percentile. Cigarette smoking had a negative effect on birth-weight which was independent of maternal physique. The effect of maternal size on birth-weight is largely mediated through constitutional and genetic factors rather than nutrition.     

Perinatal Outcomes and Satisfaction with Care in Women with High Body Mass Index

Introduction: The majority of studies on pregnant women with high body mass index (BMI) have focused on medical complications and birth outcome, rather than these women's encounters with health care providers. The aims were to identify the proportion of pregnant women with high BMIs (≥30); compare maternal characteristics and pregnancy and birth outcomes; and assess the experiences of prenatal, intrapartum, and postnatal care in women with high (≥30) and lower (<30) BMIs. Methods: Data were collected through questionnaires and antenatal records from 919 women recruited in mid‐pregnancy at 3 hospitals in the north of Sweden, with a follow‐up questionnaire 2 months after birth. Results: The prevalence of obesity was 15.2%. Women with high BMIs were more often aged 35 years or older and less likely to have a university education. They had more negative attitudes regarding being pregnant and reported more childbirth fear compared to women with lower BMIs, but they did not differ in regard to their feelings about the approaching birth or the first weeks with the newborn. They reported more pregnancy complications and had less continuity of caregiver. High BMI was associated with labor induction and emergency cesarean birth. No differences were found in birth complications; birth experience; or satisfaction with prenatal, intrapartum, or postnatal care. Discussion: The findings reveal that women who are obese have more complicated pregnancies and births but are generally satisfied with the care they receive. There are some differences in the way they experience care. Health care providers have a delicate task to provide sufficient information about health risks while still offering respect, encouragement, and support.     

In Vitro Fertilization and Embryo Transfer

The technique of in vitro fertilization and embryo transfer is explained, and nurses are given an overview of this new technique for treating infertility. The role of the nurse in each phase of the process is described, with emphasis on meeting the educational and emotional needs of couples.     

In Vitro Fertilization and Embryo Transfer

In vitro fertilization and embryo transfer now provide an acceptable therapeutic alternative for some infertile couples. The University of Texas/Houston Medical School uses a nurse-coordinated, in vitro fertilization computer program that combines a variety of nursing interventions. The nurse specialist functions to coordinate clinical and laboratory steps and to interpret the complex process to the couple.     

Heterotopic Pregnancy Complicating In Vitro Fertilization

Summary: A review was undertaken of the cases of heterotopic pregnancy resulting from in vitro fertilization/embryo transfer (IVF/ET) and frozen embryo replacement (FER) in a 6-year cohort of women at National Women's Hospital in Auckland. The incidence of heterotopic pregnancy was 2.9% (5 cases) in 173 clinical pregnancies resulting from 901 embryo replacements. Of the 5 women with heterotopic pregnancy, 1 had unilateral tubal patency and 4 had bilateral tubal blockage; 3 had 'high responder' peak serum oestradiol levels (greater than 9,000 pmol/L) prior to oocyte pick-up (OPU); 3 had a serum human chorionic gonadotrophin beta subunit (beta-HCG) level greater than 600 IU/L on Day 14 following embryo transfer (ET) in the absence of a multiple intrauterine gestation on subsequent ultrasound scan. In the 4 women in whom unequivocal diagnosis of heterotopic pregnancy was not made on the initial ultrasound scan, there was delay in appropriate management, in 1 for more than 5 months. In conclusion, early IVF pregnancies require a transvaginal ultrasound scan performed by a sonographer experienced in the diagnosis of ectopic pregnancy and management of early pregnancy complications by clinicians in close consultation with the IVF centre itself. No single risk factor, laboratory test or combination of these is sensitive or specific enough to predict the occurrence of heterotopic pregnancy. The first-line surgical treatment of heterotopic pregnancy should be laparoscopic salpingectomy with excision of all except the intramural portion of the affected Fallopian tube.