Objective:
To assess the effects of both male and female body mass index (BMI), individually and combined, on IVF outcomes.
Design:
Prospective cohort study.
Setting:
University fertility center.
Patient(s):
All couples undergoing first fresh IVF cycles, 2005–2010, for whom male and female weight and height information were available (n=721 couples).
Intervention(s):
None.
Main Outcome Measure(s):
Embryologic parameters, clinical pregnancy, and live birth incidence.
Result(s):
The average male BMI among the study population was 27.5±4.8 kg/m2 (range, 17.3–49.3 kg/m2), while the average female BMI (n=721) was 25.2±5.9 kg/m2 (range, 16.2–50.7 kg/m2). Neither male nor female overweight (25–29.9 kg/m2), class I obese (30–34.9 kg/m2), or class II/III obese (≥35 kg/m2) status was significantly associated with fertilization rate, embryo score, or incidence of pregnancy or live birth compared with normal weight (18.5–24.9 kg/m2) status after adjusting for male and female age, partner BMI, and parity. Similar null findings were found between combined couple BMI categories and IVF success.
Conclusion(s):
Our findings support the notion that weight status does not influence fecundity among couples undergoing infertility treatment. Given the limited and conflicting research on BMI and pregnancy success among IVF couples, further research augmented to include other adiposity measures is needed.
Endometriomas are common in reproductive-aged women, but controversy exists regarding their management. PubMed was searched to identify pertinent studies on outcomes of medical and surgical management of endometrioma, with focus on randomized controlled trials and meta-analyses. Surgical excision is more effective than fenestration/coagulation of endometrioma for pelvic pain but decreases antimullerian hormone. It may modestly improve the chances of spontaneous pregnancy, but does not impact chances of success with in vitro fertilization. Oral contraceptive pills improve dysmenorrhea but not dyspareunia or noncyclic pelvic pain. Management of the patient with endometrioma should be individualized based on each patient's particular symptoms and short-term and long-term fertility goals.
When cytologic and colposcopic findings are atypical during pregnancy, a differentiated diagnostic approach is necessary for the sake of an undisturbed course of pregnancy. Scraping of the portio with cervical curettage--a procedure with a low complication rate--for provisional diagnosis (to rule out an invasive carcinoma) permits a definitive diagnosis to be established after lying-in. Problems are pointed out.
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