Obesity in Relation to Ovarian Response in IVF Treatment

Introduction: The effect of Body Mass Index (BMI), which reflects the woman’s obesity, in IVF treatment cycle, remains unclear. In 1997, the World Health Organization (WHO) provided authoritative refinements to the over-weight terminology and BMI cutoffs [1]. Objective: To verify the relationship between BMI and ovarian response in IVF treatment cycle. Design: Retrospective study. Materials & Methods: The study includes 2625 IVF treatment cycles performed in our IVF center in the period of 4 years. Patients were divided into five groups using the WHO criteria according to their BMI [2]. Cancellation rate, mean last E2 before hCG administration, mean endometrial thickness, mean duration of stimulation, number of eggs retrieved, fertilization rate, pregnancy and abortion rates were analyzed. The unpaired t-test was used in statistical analysis. Results: There was statistically significant less mean oestradiol level prior to hCG, less endometrial thickness and less number of simulation days as BMI gets higher. In contrast, there was a positive relationship between cancellation rate and higher BMI except with BMI >39 which was not, possibly due to lower number of patients available. But if we look at the cause of cancellation, it was 100% due to insufficient number of follicles obtained for this group (BMI >39). Also, days of stimulation are significantly lower for the same group of patients in comparison with the other groups. Retrieval, fertilization and pregnancy rates were not significant between all groups. Abortion rate gets significantly higher as BMI increased. Conclusion: Overweight affects ovulation, if we consider the cause of cancellation being insufficient number of follicles reflects the poor response. The fertilization and pregnancy rate were not affected once oocytes retrieved. The reduction of weight is an important part of infertility treatment in obese women with regards to the ovarian response and abortion rate in IVF cycle.

Does Leukocytospermia Considered as an Indicator of Infection?

Background: The acceptable count of Leukocytospermia in semen sample has been defined by the World Health Organization (WHO) as ≤1 × 106 WBC/ml. The presence of more than one million peroxidase positive white blood cells (WBC) per ml is considered abnormal and is labeled as “leukocytospermia” [1]. But, is there any deterioration in the semen parameters in cases where the number of leukocytes is higher than “normal”, or is it an indication for infection? Objective: To test the significance of the presence of leukocytes in the semen sample. Design: A retrospective randomised study. Materials and Methods: 6481 semen samples were divided into two groups according to the availability of the leukocytes. Group I includes samples with ≤1 × 106 leukocyte/ml (n = 3948) and group II includes samples with >1 × 106 leukocyte/ml (n = 2533). Semen samples were from partners of couples undergoing infertility evaluation. Specimens were collected by masturbation, and subjected to routine semen analysis including count, motility, sperm morphology (assessments were performed according to the Tygerberg strict criteria), number of leukocytes present (identification of Leukocytes was done using peroxidase staining) and Mixed Antiglobin Reaction (MAR) test was done for detection of sperm surface antibodies. All semen samples from group II were sent for culture. Results: A comparison in the mean ± standard deviation (mean ± SD) between the two groups showed statistical significant differences in the mean ± SD motility (55.9 ± 27.8 vs 53.4 ± 27.3, P Conclusion: From the results obtained, we support the studies showing that the presence of leukocytes may not be linked to infection. Future studies are needed to verify the effect of lipoperoxidation process as a result of leukocytes’ presence and to determine the cut off number of leukocytes in semen to be considered of importance since the semen parameters were affected significantly.