IVF outcomes in patients with a history of bariatric surgery: a multicenter retrospective cohort study

STUDY QUESTION

How does a history of dramatic weight loss linked to bariatric surgery impact IVF outcomes?

SUMMARY ANSWER

Women with a history of bariatric surgery who had undergone IVF had a comparable cumulative live birth rate (CLBR) to non-operated patients of the same BMI after the first IVF cycle.

WHAT IS KNOWN ALREADY

In the current context of increasing prevalence of obesity in women of reproductive age, weight loss induced by bariatric surgery has been shown to improve spontaneous fertility in obese women. However, little is known on the clinical benefit of bariatric surgery in obese infertile women undergoing IVF.

STUDY DESIGN, SIZE, DURATION

This exploratory retrospective multicenter cohort study was conducted in 10 287 IVF/ICSI cycles performed between 2012 and 2016. We compared the outcome of the first IVF cycle in women with a history of bariatric surgery to two age-matched groups composed of non-operated women matched on the post-operative BMI of cases, and non-operated severely obese women.

PARTICIPANTS/MATERIALS, SETTING, METHODS

The three exposure groups of age-matched women undergoing their first IVF cycle were compared: Group 1: 83 women with a history of bariatric surgery (exposure, mean BMI 28.9 kg/m2); Group 2: 166 non-operated women (non-exposed to bariatric surgery, mean BMI = 28.8 kg/m2) with a similar BMI to Group 1 at the time of IVF treatment; and Group 3: 83 non-operated severely obese women (non-exposed to bariatric surgery, mean BMI = 37.7 kg/m2). The main outcome measure was the CLBR. Secondary outcomes were the number of mature oocytes retrieved and embryos obtained, implantation and miscarriage rates, live birth rate per transfer as well as birthweight.

MAIN RESULTS AND THE ROLE OF CHANCE

No significant difference in CLBR between the operated Group 1 patients and the two non-operated Groups 2 and 3 was observed (22.9%, 25.9%, and 12.0%, in Groups 1, 2 and 3, respectively). No significant difference in average number of mature oocytes and embryos obtained was observed among the three groups. The implantation rates were not different between Groups 1 and 2 (13.8% versus 13.7%), and although lower (6.9%) in obese women of Group 3, this difference was not statistically significant. Miscarriage rates in Groups 1, 2 and 3 were 38.7%, 35.8% and 56.5%, respectively (P = 0.256). Live birth rate per transfer in obese patients was significantly lower compared to the other two groups (20%, 18%, 9.3%, respectively, in Groups 1, 2 and 3, P = 0.0167). Multivariate analysis revealed that a 1-unit lower BMI increased the chances of live birth by 9%. In operated women, a significantly smaller weight for gestational age was observed in newborns of Group 1 compared to Group 3 (P = 0.04).

LIMITATIONS, REASONS FOR CAUTION

This study was conducted in France and nearly all patients were Caucasian, questioning the generalizability of the results in other countries and ethnicities. Moreover, 950 women per group would be needed to achieve a properly powered study in order to detect a significant improvement in live birth rate after bariatric surgery as compared to infertile obese women.

WIDER IMPLICATIONS OF THE FINDINGS

These data fuel the debate on the importance of pluridisciplinary care of infertile obese women, and advocate for further discussion on whether bariatric surgery should be proposed in severely obese infertile women before IVF. However, in light of the present results, infertile women with a history of bariatric surgery can be reassured that surgery-induced dramatic weight loss has no significant impact on IVF prognosis.

STUDY FUNDING/COMPETING INTEREST(S)

This work was supported by unrestricted grants from FINOX-Gédéon Richter and FERRING Pharmaceuticals awarded to the ART center of the Clinique Mathilde to fund the data collection and the statistical analysis. There are no conflicts of interest to declare.

TRIAL REGISTRATION NUMBER

NCT02884258.

Ecotoxicological evaluation of pig slurry

Swine sewage could be source of nutrients and pollutants. This work estimates the environmental risk in nine samples from different farm treatment systems based on the evaluation of their effects in Daphnia magna acute test, and on the assessment of Cu, Zn and ammonia as main contributors. NH3 and Cu were responsible for LC50 results (1-5% of dilution). Organic compounds were quantified through several extraction methods (SPMDs, SPE and solvent extraction). A more exhaustive extraction was performed in an additional sample, which showed indole and phenol recoveries much higher than the previous ones. This method also includes PCBs (430 ppb) and fatty acids (approximately =150 ppm) quantification.

Risk stratification for dissemination of tuberculosis in HIV-infected patients

The location of tuberculosis (TB) early in the course of HIV-induced immunosuppression was located, and an attempt was made to determine the correlation between the degree of immune suppression and prognostic variables to stratify the risk for dissemination of TB in HIV-infected patients. Clinical and laboratory characteristics were reviewed in 73 HIV-infected patients with TB admitted between 1984 and 1990. The presence of Mycobacterium tuberculosis was investigated in different clinical samples to verify the diagnostic yield of different sources. TB was extrapulmonary in 46.6 per cent of patients in whom it was their first opportunistic infection, and in 46.7 per cent of patients with previously diagnosed AIDS (p = NS). TB was frequently associated with other opportunistic infections, particularly oesophageal candidiasis (p = 0.006). Patients with localized extrapulmonary or disseminated TB presented more often with cytopenias, hypoalbuminaemia and oral thrush. The existence of extrapulmonary TB or another opportunistic coinfection allowed AIDS to be diagnosed in the same admission in 30 patients and a mean of 8.4 months later in another eight. Extrapulmonary TB was found to be as common in early HIV infection as in patients with established AIDS. Haematological derangements were common in these patients, and cytopenias, hypoalbuminaemia and oral thrush were useful predictors of TB dissemination. The location of TB and its dissemination were not significantly linked to a more advanced CDC stage of HIV infection or a more profound fall in CD4 count.(ABSTRACT TRUNCATED AT 250 WORDS)

[Cimetidine in the treatment of the active duodenal ulcer]

Thirty six patients with active duodenal ulcers were studied in this double blind work. 19 received placebo and 17 Cimetidine: 1 gr./day. The endoscopic control after 21 days, showed healing in 81,2% of the cases treated with Cimetidine and in 22,2% of those with placebo. After 42 days of continous treatment with Cimetidine the healing of duodenal ulcers was 82,3% against 50% with placebo; the difference being highly statestically significant; p less than 0.01. The symptoms improved with Cimetidine revealing less diurnal and nocturnal pain complete disappearance of nausea and vomit and a significant decreased ingestion of alkali tablets.