Obesity may have an adverse effect on the outcome of IVF/intracytoplasmic sperm injection (ICSI) treatment. In this study, the effects of increased body mass index (BMI) on oocyte and embryo quality during IVF cycles were studied. A retrospective analysis of 426 IVF/ICSI cycles was performed. Cycles were classified according to the BMI: normal BMI (19-24.9 kg/m(2)), overweight (25-29.9 kg/m(2)) and obese (> or = 30 kg/m(2)). Cycles were further stratified based on age (group 1, < 35 years; group 2, > or = 35 years). Markers of oocyte quality (number of oocytes inseminated and fertilization rate) and embryo quality (utilization rate, number of embryos discarded and cryopreserved, and mean embryo grade) were examined. In group 1, obesity had a significant adverse effect on the mean embryo grade (P = 0.02), the embryo utilization rate (P = 0.01), number of embryos discarded (P = 0.007) and cryopreserved (P < 0.05). In group 2, there was no difference in markers of embryo quality between the three BMI ranks. Obesity did not have any significant effect on markers of oocyte quality or clinical pregnancy rates. In conclusion, obesity may adversely affect embryo quality in young women (<35 years) undergoing IVF/ICSI, while the oocyte quality is not affected.

The study tests the hypothesis that small ovaries measured on transvaginal sonography (TVS) are associated with a poor response to ovulation induction by human menopausal gonadotrophin (HMG) for in-vitro fertilization (IVF). A total of 140 infertile patients with morphologically normal ovaries undergoing IVF was studied. The mean ovarian volume of each patient was measured on TVS before starting HMG. Subsequent routine IVF management was conducted without knowledge of the results of TVS. The mean ovarian volume was 6.3 cm3 (range 0.5-18.9, SD= 3.1). Patients (n = 17; group A) with small ovaries of < 3 cm3 (i.e. overall mean volume - 1 SD) were compared to patients (n = 123; group B) with ovaries > or = 3 cm3. Both groups were of similar age (mean 35.8 versus 34.4 years). Early basal FSH concentrations were increased in group A (9.5 versus 7.0 mIU/ml, P = 0.025). The cycle was abandoned before planned oocyte recovery in nine patients (52.8%) from group A and in 11 patients (8.9%) from group B because of poor response to ovulation induction (P < 0.001). Increased age and ovarian volume were associated independently with cancellation of the cycles. The remaining eight patients from group A who had oocytes retrieved required higher doses of HMG (87.5 versus 53.8 ampoules, P < 0.01), yielded fewer follicles (10.3 versus 14.5, P < 0.05) and fewer oocytes were recovered from them (6.8 versus 11.0, P < 0.05) compared with group B. There was no difference in the fertilization or pregnancy rates or the number of embryos available for transfer in either group. Our results indicate a strong association between ovarian volume and ovarian reserve. Small ovaries are associated with poor response to HMG and a very high cancellation rate during IVF. Assessment of ovarian size should be an integral part of infertility evaluation.

This group of at-risk patients had a high rate of poor response to simulation and cancellation. Although several measures of ovarian reserve were able to predict cycle cancellation, none were able to predict pregnancy. AMH was predictive of both cycle cancellation and poor response with little inter-cycle variability.

This review has found that a wide range of internal and external factors impact the FP decision-making process. Key external issues related to current service delivery such as the provision and timing of FP information, and lack of referral from oncology to the fertility clinic. However, internal issues such as women's fears concerning the perceived risks associated with pursuing FP also hindered decision-making but these 'risks' were typically overestimated and non-evidence based. These findings suggest that the implementation of a range of decision support interventions may be of benefit within the clinical care pathway of FP and cancer. Women would benefit from the provision of more evidence-based FP information, ideally received at cancer diagnosis, in advance of seeing a fertility specialist, for example through the implementation of patient decision aids. Healthcare professionals in both oncology and fertility services may also benefit from the implementation of training programmes and educational tools targeted at improving the communication skills needed to improve collaborative decision-making and deliver care that is patient-centred. Exploration of the current barriers, both intellectual and practical, that prevent some patients from accepting FP will help care providers to do better for their patients in the future. Finally, the extent to which a poorer prognosis and moral, ethical and religious beliefs influence the FP decision-making process also warrant further research.