Obese women have fewer oocytes retrieved, an increased cancelation rate, a higher miscarriage rate, and a lower live birth rate after assisted reproductive technology (ART) treatment compared with ...women with normal weight. Weight loss before ART treatment can significantly improve pregnancy rates and/or live births. An orlistat plus diet intervention could promote weight loss, but there is no evidence from randomized clinical trials evaluating the effect of orlistat preconceptional treatment on pregnancy outcome in overweight and obese women.
We are conducting a multicenter, randomized placebo-controlled, double-blind clinical trial in overweight and obese women aged 20-40 years undergoing in-vitro fertilization and embryo transfer (IVF-ET) with or without intracytoplasmic sperm injection, to evaluate whether orlistat treatment for 1-3 months before IVF-ET can improve the live birth rate. The primary outcome is live birth.
The results of this study will provide evidence for the effect of preconceptional orlistat treatment on IVF outcome in overweight/obese women.
Chinese Clinical Trial Registry, ChiCTR-IPR-17011629 . Registered on 11 June 2017.
IntroductionExisting randomised controlled trials (RCTs) comparing a freeze-all embryo transfer strategy and a fresh embryo transfer strategy have shown conflicting results. A freeze-all or a fresh ...transfer policy may be preferable for some couples undergoing in-vitro fertilisation (IVF), but it is unclear which couples would benefit most from each policy, how and under which protocols. Therefore, we plan a systematic review and individual participant data meta-analysis of RCTs comparing a freeze-all and a fresh transfer policy.Methods and analysisWe will search electronic databases (Medline, Embase, PsycINFO and CENTRAL) and trial registries (ClinicalTrials.gov and the International Clinical Trials Registry Platform) from their inception to present to identify eligible RCTs. We will also check reference lists of relevant papers. The search was performed on 23 September 2020 and will be updated. We will include RCTs comparing a freeze-all embryo transfer strategy and a fresh embryo transfer strategy in couples undergoing IVF. The primary outcome will be live birth resulting from the first embryo transfer. All outcomes listed in the core outcome set for infertility research will be reported. We will invite the lead investigators of eligible trials to join the Individual participant data meta-analysis of trials comparing frozen versus fresh embryo transfer strategy (INFORM) collaboration and share the deidentified individual participant data (IPD) of their trials. We will harmonise the IPD and perform a two-stage meta-analysis and examine treatment–covariate interactions for important baseline characteristics.Ethics and disseminationThe study ethics have been granted by the Monash University Human Research Ethics Committee (Project ID: 30391). The findings will be disseminated via presentations at international conferences and publication in peer-reviewed journals.PROSPERO registration numberCRD42021296566.
To study the association between two single-nucleotide polymorphisms (SNPs) variants (rs2241766 and rs1501299) of the adiponectin gene (ADIPOQ) and polycystic ovary syndrome (PCOS) in PCOS family ...trios.
Family-based study.
University hospital.
A total of 224 unrelated PCOS probands, their biologic parents, and 204 control subjects.
Anthropometric, hormonal, and metabolic assessment; genotype detection.
Basic endocrine, serum fasting glucose (FG), fasting insulin (FINS), total cholesterol (TC), triglycerides (TG), and low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol levels were measured. The transmission disequilibrium test (TDT) was used to analyze the association between two SNPs of ADIPOQ and PCOS.
A significant positive association was detected between SNP rs1501299 and PCOS. Compared with AA genotype, AC and CC genotypes had increased risk for PCOS, and the difference remained significant after adjustment for age, body mass index, and testosterone (T). The levels of T, TG, HDL cholesterol, and FINS were significantly higher in obese PCOS patients. However, we failed to find significant overtransmission of the other SNP, rs2241766, from parents to PCOS offspring. The genotype frequencies of rs2241766 and rs1501299 were not different in obese and lean PCOS patients and their parents.
TDT confirms that SNP rs1501299 in the ADIPOQ is significantly associated with the risk of PCOS in the Chinese Han population. The present data may provide a basis for further studies of the role of the ADIPOQ in the etiology of PCOS.
To investigate the relationship between androgen level and body adipose tissue content and distribution via a cross sectional survey in healthy women aged 40 to 60 years.
A total of 222 women were ...divided into 4 groups according menstruation status, i.e. reproductive stage, early perimenopausal stage, late perimenopausal stage and postmenopausal stage. Serum level of dehydroepiandrosterone (DHEA), total testosterone (TT) and sex hormone binding globulin (SHBG) were measured. Free androgen index (FAI) was calculated. Body adipose tissue content and distribution were measured by dual-energy X-ray absorptiometry.
In women aged 40 to 60 years, DHEA, TT and FAI level of reproductive stage women was (12.3 ± 4.1) nmol/L, (0.56 ± 0.22) nmol/L and 1.15 (quartile: 0.71 to 1.85), respectively. DHEA, TT and FAI level of early perimenopausal stage women was (12.0 ± 3.4) nmol/L, (0.56 ± 0.24) nmol/L and 1.37 (quartile: 0.89 to 1.61), respectively. DHEA, TT and FAI level of late perimenopausal stage women was (14.2 ± 4.7) n
Abstract
STUDY QUESTION
Is the total dose of exogenous gonadotropins associated with blastocyst aneuploidy or live-birth rates in PGS cycles in Chinese women?
SUMMARY ANSWER
The total dose of ...exogenous gonadotropins is not significantly associated with blastocyst aneuploidy or live-birth rates in PGS cycles in Chinese women.
WHAT IS KNOWN ALREADY
The administration of gonadotropins in ovarian stimulation leads to supraphysiological steroid concentrations compared with those seen during natural cycles. The rate of euploid blastocytes is negatively associated with female age.
STUDY DESIGN, SIZE, DURATION
This is a retrospective study using anonymised data on PGS cycles performed in China from 2013 to 2017. Data from 1088 PGS cycles and 3219 embryos were analysed by array-comparative genomic hybridization (array-CGH).
PARTICIPANTS/MATERIALS, SETTING, METHODS
The study included 944 women who underwent PGS cycles with COH. All cycles were analysed by the total dose of exogenous gonadotropins (<1500, 1500-3000 and >3000 IU), patient age (<35 and ≥35 y.o.) and number of oocytes retrieved (1-5, 6-10, 11-15 and >15 oocytes).
MAIN RESULTS AND THE ROLE OF CHANCE
In the group of younger women (<35 y.o., 537 PGS cycles), the incidence of aneuploidy ranged from 36.9 to 43.4% when data was stratified by gonadotropins dose. After adjusting for confounding factors, the dose of exogenous gonadotropins was not associated with the blastocyst aneuploidy rate. Similar results were shown in the group of women with advanced maternal age (≥35 y.o., 551 PGS cycles), with no difference in the rate of blastocyst aneuploidy among different gonadotropins dose groups (<1500 IU, 58.0%; 1500-3000 IU, 59.8%; and >3000 IU, 59.8%; P = 0.86). The live-birth rates after single cryopreserved blastocyst transfers were also not significantly associated with the gonadotropins dose.
LIMITATIONS, REASONS FOR CAUTION
Limitations include the retrospective study design and the heterogeneity of the included patients. Additionally, array-CGH may not be able to correctly identify mosaicism.
WIDER IMPLICATIONS OF THE FINDINGS
The finding that gonadotropin dosage is not associated with embryonic aneuploidy or live-birth rates in Chinese women suggests that the high doses of gonadotropins used in ART cycles may be safe. The findings are consistent with those of prior studies in other populations.
STUDY FUNDING/COMPETING INTEREST(S)
This study was supported by the National Natural Science Foundation of China (81671522) and National Key Research and Development Program of China (2016YFC1000202).
TRIAL REGISTRATION NUMBER
N/A.
Which factors are associated with the risk of clinical pregnancy loss in women with polycystic ovary syndrome (PCOS) undergoing IVF?
Case–control study nested in a multicentre randomized trial ...comparing live birth rates between fresh and frozen embryo transfer in women with PCOS. Women with the outcome of clinical pregnancy loss were selected as the case group, those with live birth as the control group. Parameters before IVF treatment and variables during ovarian stimulation and embryo transfer were compared.
Women with clinical pregnancy loss had higher maternal body mass index (BMI, P = 0.010), anti-Müllerian hormone (AMH, P = 0.032), 2-h glucose concentration after 75 g oral glucose tolerance test (OGTT, P = 0.025), and a higher proportion of fresh embryo transfers (P = 0.001). There were significant interactions between the types of transfer and antral follicle count (AFC, P = 0.013), 2-h glucose concentration after OGTT (P = 0.024) on clinical pregnancy loss in PCOS, indicating that these factors may have different effects on pregnancy loss after fresh versus frozen embryo transfer. When the multivariable logistic regression analysis was stratified by the fresh or frozen embryo transfer, AFC (adjusted odds ratio aOR 1.03, 95% confidence interval CI 1.01–1.05) was a risk factor for clinical pregnancy loss after fresh embryo transfer, while 2-hour glucose concentration after OGTT (aOR 1.13, 95% CI 1.01–1.25) was associated with clinical pregnancy loss in frozen embryo transfer (FET) cycles.
In women with PCOS, fresh embryo transfer, higher BMI, AFC and 2-h glucose concentration after OGTT were risk factors for clinical pregnancy loss. FET may be a better choice to decrease the risk of clinical pregnancy loss, especially for those with higher AFC. During FET, 2-h glucose after OGTT appears to be associated with clinical pregnancy loss and warrants close monitoring.
Abstract
STUDY QUESTION
Are meiotic segregation patterns of reciprocal translocations affected by the combined effect of chromosome type and carrier's sex?
SUMMARY ANSWER
Interaction of an ...acrocentric chromosome (Acr-ch) involved in the translocation and sex of the carrier influences the proportion of alternate segregation for normal or balanced chromosome contents during meiotic segregation in autosomal reciprocal translocations.
WHAT IS KNOWN ALREADY
Carriers of reciprocal translocations are at a significantly increased risk of fertility problems due to the generation of unbalanced gametes in meiotic segregation of a quadrivalent. Previous studies have reported that meiotic segregation patterns of a quadrivalent can be affected by factors such as a carrier's sex and age and the chromosome type. However, the reported proportion of alternate segregation does not differ significantly, except in one study, and whether combined effects between these factors exist is unclear.
STUDY DESIGN, SIZE, DURATION
A retrospective study of array comparative genomic hybridization (aCGH) outcome data from patients with autosomal reciprocal translocations was conducted to analyse meiotic segregation patterns and blastocyst euploidy rates. We enroled 473 couples whose embryos were tested between January 2013 and September 2016.
PARTICIPANTS/MATERIALS, SETTING, METHODS
Meiotic segregation patterns of 2101 blastocysts from 243 female carriers, including 76 cases with translocations involving Acr-ch, and 230 male carriers, including 88 cases with translocations involving Acr-ch, were analysed according to chromosome type, carrier's sex and age.
MAIN RESULTS AND THE ROLE OF CHANCE
In cases with translocations involving the Acr-ch subgroup, the proportion of alternate segregation (53.9 vs 33.4%, P < 0.0001) was significantly higher in male carriers than in female carriers, with the proportion of 3:1 segregation (6.8 vs 16.3%, P < 0.0001) being significantly lower. The proportions of alternate segregation were similar between sexes in cases with translocations not involving the Acr-ch subgroup. Meanwhile, in the female carrier subgroup, the proportion of alternate segregation (33.4 vs 45.2%, P < 0.001) was significantly lower and the proportion of 3:1 segregation (16.3 vs 8.2%, P < 0.001) was significantly higher in cases with translocations involving Acr-ch than in those not. In the male carrier subgroup, the proportion of alternate segregation (53.9 vs 46.9%, P = 0.031) was higher and the proportion of adjacent-1 segregation (27.1 vs 37.3%, P < 0.001) was significantly lower in cases with translocations involving Acr-ch than in those not. Carrier's age did not affect the meiotic segregation patterns. However the euploidy rates were significantly lower in couples with advanced compared to young maternal age respectively.
LIMITATIONS, REASONS FOR CAUTION
Mosaic embryos were not identified using aCGH in this study. Patients with complex chromosome rearrangements and translocations involving sex chromosomes were excluded. Interchromosomal effect was not analysed.
WIDER IMPLICATIONS OF THE FINDINGS
The findings of this study provide detailed information for genetic counselling of couples with autosomal reciprocal translocations on their chances of producing euploid gametes.
STUDY FUNDING/COMPETING INTEREST(S)
This research was supported by the National Key Research and Development Program of China (2016YFC1000202); the National Natural Science Foundation of China (81671522); the Natural Science Foundation of Shandong Province in China (ZR2016HP09); and the Innovative Foundation of Reproductive Hospital Affiliated to Shandong University (20171114, 20171111). No competing interests are declared.
TRIAL REGISTRATION NUMBER
N/A.
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