Objective-Hypothesizing that levels of 25OH-D in body fluids are reflective of vitamin repletion status, we aimed to determine if 25OH-D levels in the follicular fluid (FF) of infertile women undergoing in vitro fertilization (IVF) demonstrate a relationship with IVF cycle parameters and outcome. Design-Prospective Cohort study Setting-Academic tertiary care center Patients-84 infertile women undergoing IVFInterventions-FF from follicles ≥14mm; serum (n=10) and FF levels of 25OH-D Main outcome measures-Clinical pregnancy (CP) (defined as evidence of intrauterine gestation sac on ultrasound) following IVF; IVF cycle parameters.Results-Serum and FF levels of 25OH-D were highly correlated (r=0.94, p<0.001). In a predominantly Caucasian population (66%), significantly lower FF 25OH-D levels were noted in Black versus non-Black patients (p=0.001). Significant inverse correlations were seen between FF 25OH-D levels and BMI (r−0.25, p=0.035). Significantly higher CP and implantation rates were observed across tertiles of FF25OH-D (p=0.029 and p=0.041 respectively); patients achieving CP following IVF (n=26) exhibited significantly higher FF levels of 25OH-D (p=0.005). Multivariable logistic regression analysis confirmed FF 25OH-D levels as an independent predictor to success of an IVF cycle; adjusting for age, BMI, ethnicity and number of embryos transferred (ET) each ng/ml increase in FF 25OH-D increased the likelihood for achieving CP by 6% (p=0.030). Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Conclusion-Our findings that women with higher vitamin D level in their serum and FF are significantly more likely to achieve CP following IVF-ET are novel. A potential for benefit of vitamin D supplementation on treatment success in infertile patients undergoing IVF is suggested that merits further investigation. NIH Public Access

Purpose To evaluate if elevated male body mass influences success after assisted reproductive technologies Methods Retrospective study of 290 cycles. Results Male body mass index greater than 25.0 kg/m 2 was associated with significantly lower clinical pregnancy (53.2% vs. 33.6%). Multivariable logistic regression indicated that the likelihood of clinical pregnancy was decreased if the male partner was overweight after in vitro fertilization but not after intracytoplasmic sperm injection (odds ratios: 0.21 [0.07-0.69] vs. 0.75 [0.38-1.49], respectively) after adjustment for number of embryos transferred, sperm concentration, female age and body mass. Conclusion In this cohort, overweight status of the male partner was independently associated with decreased likelihood of clinical pregnancy after in vitro fertilization but not after intracytoplasmic sperm injection. A detrimental impact of higher male body mass was observed after adjusting for sperm concentration, suggesting that intracytoplasmic sperm injection may overcome some obesity related impairment of sperm-egg interaction.

Leptin may program abnormal AMH signaling, thereby resulting in ovarian dysfunction. This study opens a new perspective for understanding the low ovarian reserve seen in obese women and provides new insights into potential mechanisms that explain the lower AMH seen in obese women. Whether our findings explain the worse response to ovulation induction observed in obese women needs to be further elucidated.

Better trophectoderm morphology, younger patient age and further blastocyst progression all result in higher clinical pregnancy and live birth rates. Therefore, trophectoderm morphology and blastocyst stage should preferentially be used as the most important factors in choosing the best embryo for transfer.

The A blood group antigen appears to be protective for ovarian reserve, whereas blood type O appears to be associated with DOR, in a relationship that is independent of advancing age. Further studies are needed to establish causality and identify the underlying mechanisms for the association.

Objective Previous studies regarding the effect of obesity on serum anti-müllerian hormone (AMH) levels have been conflicting. Our aim was to determine the effect of obesity on serum AMH levels among women from different racial backgrounds. Methods The medical records of 350 women (159 Caucasian, 99 African-American, 58 Hispanic, 34 Asian with ages 16-46) evaluated for infertility at an academic-affiliated center and who had AMH levels measured as part of their evaluation were reviewed. Age, AMH, body mass index (BMI), selfreported race, etiology of infertility, smoking history, maximum serum early follicular follicle-stimulating hormone (FSH) levels, antral follicle count (AFC), and history of ovarian surgery, chemotherapy, or radiotherapy were recorded. Results Age correlated negatively with AMH and antral follicle count across all races (p<0.05). After adjusting for age, polycystic ovary syndrome diagnosis, and smoking, elevated BMI had a negative correlation with AMH in Caucasian women (β=0.17, p=0.01) but not in African-American, Hispanic, or Asian women. Conclusion Elevated BMI correlates negatively with AMH in Caucasian women but not in African-American, Hispanic, or Asian women. Additional studies are needed to elucidate further the effect of race on the interaction between obesity and ovarian reserve.

Our data add to the accruing literature suggesting adverse influences of excess gonadotropin use on IVF outcomes. Although an aggressive approach to controlled ovarian hyperstimulation results in a statistically significant reduction in cycle cancellations, the excessive use of gonadotropins detrimentally influences live birth after IVF.

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