Associations between maternal obesity and adverse fetal outcomes are well documented, but the mechanisms involved are largely unknown. Most previous work has focused on postconceptional events, however, our laboratory has shown pre- and periconceptional aberrations in maternal glucose metabolism have adverse effects on oocytes and embryos that carry on to the fetus. To demonstrate effects of maternal obesity in the pre- and periconceptional periods, we compared reproductive tissues from diet-induced obese female mice to those of control mice. Ovaries were either stained for follicular apoptosis or dissected and evaluated for oocyte size and meiotic maturation. Mice were also mated and followed for reproductive outcomes including preimplantation embryonic IGF-I receptor (IGF-IR) immunostaining, midgestation fetal growth, and midgestational placental IGF receptor 2 (Igf2r) mRNA. Delivered pups were followed for growth and development of markers of metabolic syndrome. Compared with controls, obese mice had significantly more apoptotic ovarian follicles, smaller and fewer mature oocytes, decreased embryonic IGF-IR staining, smaller fetuses, increased placental Igf2r mRNA, and smaller pups. All weaned pups were fed a regular diet. At 13 wk pups delivered from obese mice were significantly larger, and these pups demonstrated glucose intolerance and increased cholesterol and body fat suggesting early development of a metabolic-type syndrome. Together, our findings suggest maternal obesity has adverse effects as early as the oocyte and preimplantation embryo stage and that these effects may contribute to lasting morbidity in offspring, underscoring the importance of optimal maternal weight and nutrition before conception.

Objective-To determine if follicular free fatty acid (FFA) levels are associated with cumulus oocyte complex morphology Design-Prospective cohort study Setting-University in vitro fertilization (IVF) practice Patients-102 women undergoing IVF Interventions-Measurement of FFAs in serum and ovarian follicular fluidMain Outcome Measures-Total and specific follicular and serum FFA levels, correlations between follicular and serum FFAs, and associations between follicular FFA levels and markers of oocyte quality including cumulus oocyte complex (COC) morphology Results-Predominant follicular fluid and serum FFAs were oleic, palmitic, linoleic and stearic acids. Correlations between follicular and serum FFA concentrations were weak (r=0.252, 0.288, 0.236, 0.309 respectively for specific FFAs; r=0.212 for total FFAs). A receiver operator characteristic curve determined total follicular FFAs ≥ 0.232 µmol/ml distinguished women with lower versus higher percentage COCs with favorable morphology. Women with elevated follicular FFAs (n=31) were more likely to have COCs with poor morphology than others (n=71) (OR 3.3, 95% CI:1.2-9.2). This relationship held after adjusting for potential confounders including age, BMI, endometriosis and amount of gonadotropin administered (β=1.2; OR 3.4, 95% CI:1.1-10.4).Conclusions-Elevated follicular FFA levels are associated with poor COC morphology. Further work is needed to determine what factors influence follicular FFA levels and if these factors impact fertility.

Objective To describe fertility patients' preferences for disposition of cryopreserved embryos and determine factors important to these preferences Design Cross-sectional survey conducted between June 2006 and July 2007 Setting Nine geographically diverse U.S. fertility clinics Participants 1020 fertility patients with cryopreserved embryos Interventions Self-administered questionnaire Main Outcome Measures Likelihood of selecting each of five conventional embryo disposition options: store for reproduction, thaw and discard, donate to another couple, freeze indefinitely, and donate for research; likelihood of selecting each of two alternative options identified in previous research: placement of embryos in the woman's body at an infertile time, and a disposal ceremony; importance of each of 26 considerations to disposition decisions; and views on the embryo's moral status. Results 54% of respondents with cryopreserved embryos were very likely to use them for reproduction, 21% were very likely to donate for research, 7% or fewer were very likely to choose any other option. Respondents who ascribed high importance to concerns about the health or well-being of the embryo, fetus, or future child were more likely to thaw and discard embryos or freeze them indefinitely. Conclusions Fertility patients frequently prefer disposition options not available to them or find available options unacceptable. Restructuring and standardizing the informed consent process and ensuring availability of all disposition options may benefit patients, facilitate disposition decisions and address problems of long term storage.

The prevalence of obesity is growing among reproductive age women. This is concerning as obesity has significant health related consequences. Aside from long term risks of diabetes, heart disease, and some types of cancer, obesity poses immediate threats for young women including subfertility and adverse early and late pregnancy outcomes. Epidemiologic and experimental studies demonstrate associations between pre-pregnancy obesity and poor reproductive outcomes, however, the mechanisms involved are poorly understood. We discuss current knowledge of the pathophysiology of obesity in early reproductive events and how these events may affect reproductive outcomes including fertility, and miscarriage risk. We also discuss avenues for future research and interventions to improve reproductive outcomes for obese women.

Inflammation is a biologic process that mediates tissue effects including vasodilation, hyperemia, edema, collagenolysis and cell proliferation through complex immunologic pathways. In regards to the ovary, inflammation has key physiologic roles in ovarian folliculogenesis and ovulation. On the other hand inflammatory processes are subject to underlying pathology and if pushed, proinflammatory conditions may have a negative impact on ovarian follicular dynamics. Obesity and polycystic ovary syndrome (PCOS) serve as examples of conditions associated with chronic endogenous production of low-grade pro-inflammatory cytokines. Both conditions negatively impact ovarian folliculogenesis and ovulation. The pages that follow summarize the role of inflammation in normal ovarian follicular dynamics and evidence for its role in mediating the negative effects of obesity and PCOS on ovarian follicular dynamics. The review concludes with a summary supporting a role for lifestyle factors that favorably impact inflammatory process involved in obesity and PCOS to improve ovarian function.