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American Society for Reproductive Medicine (ASRM)
Ob.gyn. residents feel lack of fertility support
HONOLULU – Infertility may be as common among ob.gyn. residents as in the general population, and their residency programs may be providing little support for the problem, a survey of 254 residents suggests.
Investigators e-mailed a Web-based cross-sectional survey to all 233 ob.gyn. residency programs accredited by the Accreditation Council for Graduate Medical Education (ACGME) and received 254 of a possible 5,168 responses, for a 5% response rate.
Of the 220 respondents who answered questions about infertility, 18 (8%) reported experiencing fertility problems themselves. Previous data suggest an infertility prevalence of 9%-18% in the general population, Dr. Lusine Aghajanova and her colleagues reported at the annual meeting of the American Society for Reproductive Medicine.
Of the 18 residents reporting infertility issues, 14 said they sought treatment. The remaining four respondents said they could not afford treatment or did not have time to get it, according to Dr. Aghajanova of the University of California, San Francisco.
Eight of the 14 residents who sought treatment attempted in vitro fertilization and 3 attempted intrauterine insemination. A minority of respondents who sought help for infertility did so at the same clinic where they rotated as residents. More than a third of these respondents said their program administrators and coresidents were aware of their fertility problems, and more than a third reported stigma associated with their infertility.
A majority of respondents with infertility reported some or great difficulty in attending appointments for fertility services because of clinic schedules or other barriers, and only 3 of the 18 residents with fertility issues said they had good support from their residency program for the problem.
Ob.gyn. residents “should be considered a ‘population in need’ due to lack of program support and significant time constraints,” Dr. Aghajanova said.
Among the total cohort, 91% were female and 54% were younger than 30 years old, with 40% aged 30-35 years and the rest over 35. Fifteen percent said they were attempting conception. Twenty-nine percent reported that they had considered oocyte cryopreservation, but 2% had sought a consultation for this.
One physician in the audience questioned the generalizability of the survey results given the low response rate of 5%. Dr. Aghajanova suggested that the findings can be generalized, but with great caution.
Dr. Aghajanova reported having no financial disclosures.
On Twitter @sherryboschert
HONOLULU – Infertility may be as common among ob.gyn. residents as in the general population, and their residency programs may be providing little support for the problem, a survey of 254 residents suggests.
Investigators e-mailed a Web-based cross-sectional survey to all 233 ob.gyn. residency programs accredited by the Accreditation Council for Graduate Medical Education (ACGME) and received 254 of a possible 5,168 responses, for a 5% response rate.
Of the 220 respondents who answered questions about infertility, 18 (8%) reported experiencing fertility problems themselves. Previous data suggest an infertility prevalence of 9%-18% in the general population, Dr. Lusine Aghajanova and her colleagues reported at the annual meeting of the American Society for Reproductive Medicine.
Of the 18 residents reporting infertility issues, 14 said they sought treatment. The remaining four respondents said they could not afford treatment or did not have time to get it, according to Dr. Aghajanova of the University of California, San Francisco.
Eight of the 14 residents who sought treatment attempted in vitro fertilization and 3 attempted intrauterine insemination. A minority of respondents who sought help for infertility did so at the same clinic where they rotated as residents. More than a third of these respondents said their program administrators and coresidents were aware of their fertility problems, and more than a third reported stigma associated with their infertility.
A majority of respondents with infertility reported some or great difficulty in attending appointments for fertility services because of clinic schedules or other barriers, and only 3 of the 18 residents with fertility issues said they had good support from their residency program for the problem.
Ob.gyn. residents “should be considered a ‘population in need’ due to lack of program support and significant time constraints,” Dr. Aghajanova said.
Among the total cohort, 91% were female and 54% were younger than 30 years old, with 40% aged 30-35 years and the rest over 35. Fifteen percent said they were attempting conception. Twenty-nine percent reported that they had considered oocyte cryopreservation, but 2% had sought a consultation for this.
One physician in the audience questioned the generalizability of the survey results given the low response rate of 5%. Dr. Aghajanova suggested that the findings can be generalized, but with great caution.
Dr. Aghajanova reported having no financial disclosures.
On Twitter @sherryboschert
HONOLULU – Infertility may be as common among ob.gyn. residents as in the general population, and their residency programs may be providing little support for the problem, a survey of 254 residents suggests.
Investigators e-mailed a Web-based cross-sectional survey to all 233 ob.gyn. residency programs accredited by the Accreditation Council for Graduate Medical Education (ACGME) and received 254 of a possible 5,168 responses, for a 5% response rate.
Of the 220 respondents who answered questions about infertility, 18 (8%) reported experiencing fertility problems themselves. Previous data suggest an infertility prevalence of 9%-18% in the general population, Dr. Lusine Aghajanova and her colleagues reported at the annual meeting of the American Society for Reproductive Medicine.
Of the 18 residents reporting infertility issues, 14 said they sought treatment. The remaining four respondents said they could not afford treatment or did not have time to get it, according to Dr. Aghajanova of the University of California, San Francisco.
Eight of the 14 residents who sought treatment attempted in vitro fertilization and 3 attempted intrauterine insemination. A minority of respondents who sought help for infertility did so at the same clinic where they rotated as residents. More than a third of these respondents said their program administrators and coresidents were aware of their fertility problems, and more than a third reported stigma associated with their infertility.
A majority of respondents with infertility reported some or great difficulty in attending appointments for fertility services because of clinic schedules or other barriers, and only 3 of the 18 residents with fertility issues said they had good support from their residency program for the problem.
Ob.gyn. residents “should be considered a ‘population in need’ due to lack of program support and significant time constraints,” Dr. Aghajanova said.
Among the total cohort, 91% were female and 54% were younger than 30 years old, with 40% aged 30-35 years and the rest over 35. Fifteen percent said they were attempting conception. Twenty-nine percent reported that they had considered oocyte cryopreservation, but 2% had sought a consultation for this.
One physician in the audience questioned the generalizability of the survey results given the low response rate of 5%. Dr. Aghajanova suggested that the findings can be generalized, but with great caution.
Dr. Aghajanova reported having no financial disclosures.
On Twitter @sherryboschert
AT 2014 ASRM
Plurality main factor in adverse ART outcomes
HONOLULU – Modest increases in the risks of cardiac and noncardiac fetal defects in babies born from assisted reproductive technology are likely due to the increased likelihood of multiple births and not the procedures themselves, an analysis of 335,910 births suggests.
In a separate analysis, certain assisted reproductive technology methods were associated with higher or lower risks of adverse maternal and fetal outcomes, but plurality played a much bigger role in the risk of adverse outcomes.
“ART does not appear to be a major cause of birth defects; however, there are modest increases in both cardiac and noncardiac defects,” Kelly D. Getz, Ph.D., reported at the annual meeting of the American Society for Reproductive Medicine (ASRM). “The relationship between ART and birth defects is mediated through multiple birth,” a factor that may be more important for cardiac and for noncardiac defects.
“Plurality is the predominant ART treatment risk factor associated with excess morbidity for both mothers and infants,” Barbara Luke, Sc.D.said. “Other treatment factors had much less or no effect,” especially the semen source, assisted hatching, or the number of embryos transferred.
The two analyses, presented separately by Dr. Getz and Dr. Luke, were part of the Massachusetts Outcomes Study of Assisted Reproductive Technologies (ART), which linked data on births in Massachusetts between 2004 and 2008 in the Pregnancy to Early Life Longitudinal database with data from the Massachusetts Birth Defects Monitoring Program. Older age was significantly associated with the use of ART and outcomes, so the analyses adjusted for the influence of age.
A comparison of 324,148 births from spontaneous conception and 11,762 births from ART estimated prevalence ratios for patients with ART of 1.6 for any cardiac defect, septal defects, or atrial septal defects; 1.8 for ventricular septal defects; 2.1 for conotruncal and aortic arch; and 3.8 for tetralogy of Fallot.
The estimated prevalence ratios among patients with ART for noncardiac defects included 1.2 for any noncardiac defect, 1.3 for genitourinary defects, 1.5 for gastrointestinal or musculoskeletal defects, and 1.6 for hypospadias, said Dr. Getz of the Massachusetts Department of Public Health, Boston.
The prevalence of defects differed in singletons and multiples. For singletons, the prevalence of cardiac defects was 60 per 10,000 births after ART and 46/10,000 without ART. Among multiples, the prevalence of cardiac defects was 101/10,000 with ART and 91/10,000 without ART. The adjusted prevalence ratios for cardiac defects were higher in multiples with or without ART (2), compared with singletons with ART (1.1) or without ART (1, the reference group), but did not differ significantly within each subgroup based on whether or not ART was used.
Similarly, for noncardiac defects, the prevalence among singletons was 163/10,000 with ART and 133/10,000 without ART, and among multiples was 200/10,000 with ART and 179/10,000 without ART. The adjusted prevalence ratios were 1.4 for multiples with ART, 1.3 for multiples without ART, and 1.2 for singletons with ART.
A separate analysis in the study looked at maternal and fetal outcomes by various ART treatment factors, including autologous or donor oocytes, autologous or donor semen, the use or not of intracytoplasmic sperm injection or assisted zona hatching, fresh or thawed embryos, the number of embryos transferred, fetal heartbeats at 6 weeks of gestation, and plurality at birth.
Rates of adverse maternal outcomes were significantly higher in 2,422 twin pregnancies than in 6,526 singleton pregnancies, including pregnancy-induced hypertension in 25% and 13%, respectively, gestational diabetes in 10% and 8%, and a primary Cesarean section delivery in 78% and 40%, respectively, reported Dr. Luke.
Adverse fetal outcomes also were significantly more likely in twins than singletons, including preterm birth in 61% of twins and 12% of singletons, birth defects in 5% and 2%, respectively, and low birth weight in 48% and 8%. Fourteen percent of twins and 7% of singletons were small for gestational age.
Those risks were only slightly modified with adjustment for each ART treatment parameter, said Dr. Luke of Michigan State University, East Lansing, Mich.
Several ART treatment factors were associated with higher or lower risks of adverse outcomes, she added. Compared with outcomes from the use of autologous oocytes, the adjusted odds ratios with donor oocytes were 1.87 for pregnancy-induced hypertension and 1.87 and 1.43 for primary C-section and preterm birth. Using frozen rather than fresh embryos was associated with a 30% increased risk for pregnancy-induced hypertension, but also a 21% lower risk for low fetal birth weight and a 62% lower likelihood that the baby will be small for gestational age. Hearing two fetal heartbeats instead of one at 6 weeks was associated with a 49% increased risk of prematurity and a 57% increased risk of low birth weight. Hearing three or more heartbeats instead of one was associated with more than a doubling in risk for prematurity, low birth weight, or a small-for-gestational-age baby.
Massachusetts has the highest use of ART procedures per capita of any U.S. state and a higher rate of multiple births than many other states – nearly 5%, or nearly 8% for women aged 35 years or older.
The National Institutes of Health funded the studies. Dr. Getz reported having no financial disclosures. Dr. Luke has been a paid consultant for the Society for Assisted Reproductive Technology.
On Twitter @sherryboschert
“While we need to better understand any relationship between birth defects and infertility, it is comforting to confirm that rates of birth defects remain low among those children conceived using assisted reproductive technologies,” Dr. Charles C. Coddington III said in a statement released by the ASRM.
Dr. Owen K. Davis commented in a separate statement from the ASRM, “There is much to learn from this rich data set. The first step to reducing these complications is to understand what factors may be contributing to them. Hopefully, this will allow us to better care for women based on the specifics of their infertility diagnosis.”
Dr. Charles C. Coddington III is president of the Society for Assisted Reproductive Technology and a professor of ob.gyn. at the Mayo Clinic, Rochester, Minn. Dr. Owen K. Davis is president-elect of the ASRM and a professor of ob.gyn. at Weill Cornell Medical College, N.Y. Their financial disclosures were not available.
“While we need to better understand any relationship between birth defects and infertility, it is comforting to confirm that rates of birth defects remain low among those children conceived using assisted reproductive technologies,” Dr. Charles C. Coddington III said in a statement released by the ASRM.
Dr. Owen K. Davis commented in a separate statement from the ASRM, “There is much to learn from this rich data set. The first step to reducing these complications is to understand what factors may be contributing to them. Hopefully, this will allow us to better care for women based on the specifics of their infertility diagnosis.”
Dr. Charles C. Coddington III is president of the Society for Assisted Reproductive Technology and a professor of ob.gyn. at the Mayo Clinic, Rochester, Minn. Dr. Owen K. Davis is president-elect of the ASRM and a professor of ob.gyn. at Weill Cornell Medical College, N.Y. Their financial disclosures were not available.
“While we need to better understand any relationship between birth defects and infertility, it is comforting to confirm that rates of birth defects remain low among those children conceived using assisted reproductive technologies,” Dr. Charles C. Coddington III said in a statement released by the ASRM.
Dr. Owen K. Davis commented in a separate statement from the ASRM, “There is much to learn from this rich data set. The first step to reducing these complications is to understand what factors may be contributing to them. Hopefully, this will allow us to better care for women based on the specifics of their infertility diagnosis.”
Dr. Charles C. Coddington III is president of the Society for Assisted Reproductive Technology and a professor of ob.gyn. at the Mayo Clinic, Rochester, Minn. Dr. Owen K. Davis is president-elect of the ASRM and a professor of ob.gyn. at Weill Cornell Medical College, N.Y. Their financial disclosures were not available.
HONOLULU – Modest increases in the risks of cardiac and noncardiac fetal defects in babies born from assisted reproductive technology are likely due to the increased likelihood of multiple births and not the procedures themselves, an analysis of 335,910 births suggests.
In a separate analysis, certain assisted reproductive technology methods were associated with higher or lower risks of adverse maternal and fetal outcomes, but plurality played a much bigger role in the risk of adverse outcomes.
“ART does not appear to be a major cause of birth defects; however, there are modest increases in both cardiac and noncardiac defects,” Kelly D. Getz, Ph.D., reported at the annual meeting of the American Society for Reproductive Medicine (ASRM). “The relationship between ART and birth defects is mediated through multiple birth,” a factor that may be more important for cardiac and for noncardiac defects.
“Plurality is the predominant ART treatment risk factor associated with excess morbidity for both mothers and infants,” Barbara Luke, Sc.D.said. “Other treatment factors had much less or no effect,” especially the semen source, assisted hatching, or the number of embryos transferred.
The two analyses, presented separately by Dr. Getz and Dr. Luke, were part of the Massachusetts Outcomes Study of Assisted Reproductive Technologies (ART), which linked data on births in Massachusetts between 2004 and 2008 in the Pregnancy to Early Life Longitudinal database with data from the Massachusetts Birth Defects Monitoring Program. Older age was significantly associated with the use of ART and outcomes, so the analyses adjusted for the influence of age.
A comparison of 324,148 births from spontaneous conception and 11,762 births from ART estimated prevalence ratios for patients with ART of 1.6 for any cardiac defect, septal defects, or atrial septal defects; 1.8 for ventricular septal defects; 2.1 for conotruncal and aortic arch; and 3.8 for tetralogy of Fallot.
The estimated prevalence ratios among patients with ART for noncardiac defects included 1.2 for any noncardiac defect, 1.3 for genitourinary defects, 1.5 for gastrointestinal or musculoskeletal defects, and 1.6 for hypospadias, said Dr. Getz of the Massachusetts Department of Public Health, Boston.
The prevalence of defects differed in singletons and multiples. For singletons, the prevalence of cardiac defects was 60 per 10,000 births after ART and 46/10,000 without ART. Among multiples, the prevalence of cardiac defects was 101/10,000 with ART and 91/10,000 without ART. The adjusted prevalence ratios for cardiac defects were higher in multiples with or without ART (2), compared with singletons with ART (1.1) or without ART (1, the reference group), but did not differ significantly within each subgroup based on whether or not ART was used.
Similarly, for noncardiac defects, the prevalence among singletons was 163/10,000 with ART and 133/10,000 without ART, and among multiples was 200/10,000 with ART and 179/10,000 without ART. The adjusted prevalence ratios were 1.4 for multiples with ART, 1.3 for multiples without ART, and 1.2 for singletons with ART.
A separate analysis in the study looked at maternal and fetal outcomes by various ART treatment factors, including autologous or donor oocytes, autologous or donor semen, the use or not of intracytoplasmic sperm injection or assisted zona hatching, fresh or thawed embryos, the number of embryos transferred, fetal heartbeats at 6 weeks of gestation, and plurality at birth.
Rates of adverse maternal outcomes were significantly higher in 2,422 twin pregnancies than in 6,526 singleton pregnancies, including pregnancy-induced hypertension in 25% and 13%, respectively, gestational diabetes in 10% and 8%, and a primary Cesarean section delivery in 78% and 40%, respectively, reported Dr. Luke.
Adverse fetal outcomes also were significantly more likely in twins than singletons, including preterm birth in 61% of twins and 12% of singletons, birth defects in 5% and 2%, respectively, and low birth weight in 48% and 8%. Fourteen percent of twins and 7% of singletons were small for gestational age.
Those risks were only slightly modified with adjustment for each ART treatment parameter, said Dr. Luke of Michigan State University, East Lansing, Mich.
Several ART treatment factors were associated with higher or lower risks of adverse outcomes, she added. Compared with outcomes from the use of autologous oocytes, the adjusted odds ratios with donor oocytes were 1.87 for pregnancy-induced hypertension and 1.87 and 1.43 for primary C-section and preterm birth. Using frozen rather than fresh embryos was associated with a 30% increased risk for pregnancy-induced hypertension, but also a 21% lower risk for low fetal birth weight and a 62% lower likelihood that the baby will be small for gestational age. Hearing two fetal heartbeats instead of one at 6 weeks was associated with a 49% increased risk of prematurity and a 57% increased risk of low birth weight. Hearing three or more heartbeats instead of one was associated with more than a doubling in risk for prematurity, low birth weight, or a small-for-gestational-age baby.
Massachusetts has the highest use of ART procedures per capita of any U.S. state and a higher rate of multiple births than many other states – nearly 5%, or nearly 8% for women aged 35 years or older.
The National Institutes of Health funded the studies. Dr. Getz reported having no financial disclosures. Dr. Luke has been a paid consultant for the Society for Assisted Reproductive Technology.
On Twitter @sherryboschert
HONOLULU – Modest increases in the risks of cardiac and noncardiac fetal defects in babies born from assisted reproductive technology are likely due to the increased likelihood of multiple births and not the procedures themselves, an analysis of 335,910 births suggests.
In a separate analysis, certain assisted reproductive technology methods were associated with higher or lower risks of adverse maternal and fetal outcomes, but plurality played a much bigger role in the risk of adverse outcomes.
“ART does not appear to be a major cause of birth defects; however, there are modest increases in both cardiac and noncardiac defects,” Kelly D. Getz, Ph.D., reported at the annual meeting of the American Society for Reproductive Medicine (ASRM). “The relationship between ART and birth defects is mediated through multiple birth,” a factor that may be more important for cardiac and for noncardiac defects.
“Plurality is the predominant ART treatment risk factor associated with excess morbidity for both mothers and infants,” Barbara Luke, Sc.D.said. “Other treatment factors had much less or no effect,” especially the semen source, assisted hatching, or the number of embryos transferred.
The two analyses, presented separately by Dr. Getz and Dr. Luke, were part of the Massachusetts Outcomes Study of Assisted Reproductive Technologies (ART), which linked data on births in Massachusetts between 2004 and 2008 in the Pregnancy to Early Life Longitudinal database with data from the Massachusetts Birth Defects Monitoring Program. Older age was significantly associated with the use of ART and outcomes, so the analyses adjusted for the influence of age.
A comparison of 324,148 births from spontaneous conception and 11,762 births from ART estimated prevalence ratios for patients with ART of 1.6 for any cardiac defect, septal defects, or atrial septal defects; 1.8 for ventricular septal defects; 2.1 for conotruncal and aortic arch; and 3.8 for tetralogy of Fallot.
The estimated prevalence ratios among patients with ART for noncardiac defects included 1.2 for any noncardiac defect, 1.3 for genitourinary defects, 1.5 for gastrointestinal or musculoskeletal defects, and 1.6 for hypospadias, said Dr. Getz of the Massachusetts Department of Public Health, Boston.
The prevalence of defects differed in singletons and multiples. For singletons, the prevalence of cardiac defects was 60 per 10,000 births after ART and 46/10,000 without ART. Among multiples, the prevalence of cardiac defects was 101/10,000 with ART and 91/10,000 without ART. The adjusted prevalence ratios for cardiac defects were higher in multiples with or without ART (2), compared with singletons with ART (1.1) or without ART (1, the reference group), but did not differ significantly within each subgroup based on whether or not ART was used.
Similarly, for noncardiac defects, the prevalence among singletons was 163/10,000 with ART and 133/10,000 without ART, and among multiples was 200/10,000 with ART and 179/10,000 without ART. The adjusted prevalence ratios were 1.4 for multiples with ART, 1.3 for multiples without ART, and 1.2 for singletons with ART.
A separate analysis in the study looked at maternal and fetal outcomes by various ART treatment factors, including autologous or donor oocytes, autologous or donor semen, the use or not of intracytoplasmic sperm injection or assisted zona hatching, fresh or thawed embryos, the number of embryos transferred, fetal heartbeats at 6 weeks of gestation, and plurality at birth.
Rates of adverse maternal outcomes were significantly higher in 2,422 twin pregnancies than in 6,526 singleton pregnancies, including pregnancy-induced hypertension in 25% and 13%, respectively, gestational diabetes in 10% and 8%, and a primary Cesarean section delivery in 78% and 40%, respectively, reported Dr. Luke.
Adverse fetal outcomes also were significantly more likely in twins than singletons, including preterm birth in 61% of twins and 12% of singletons, birth defects in 5% and 2%, respectively, and low birth weight in 48% and 8%. Fourteen percent of twins and 7% of singletons were small for gestational age.
Those risks were only slightly modified with adjustment for each ART treatment parameter, said Dr. Luke of Michigan State University, East Lansing, Mich.
Several ART treatment factors were associated with higher or lower risks of adverse outcomes, she added. Compared with outcomes from the use of autologous oocytes, the adjusted odds ratios with donor oocytes were 1.87 for pregnancy-induced hypertension and 1.87 and 1.43 for primary C-section and preterm birth. Using frozen rather than fresh embryos was associated with a 30% increased risk for pregnancy-induced hypertension, but also a 21% lower risk for low fetal birth weight and a 62% lower likelihood that the baby will be small for gestational age. Hearing two fetal heartbeats instead of one at 6 weeks was associated with a 49% increased risk of prematurity and a 57% increased risk of low birth weight. Hearing three or more heartbeats instead of one was associated with more than a doubling in risk for prematurity, low birth weight, or a small-for-gestational-age baby.
Massachusetts has the highest use of ART procedures per capita of any U.S. state and a higher rate of multiple births than many other states – nearly 5%, or nearly 8% for women aged 35 years or older.
The National Institutes of Health funded the studies. Dr. Getz reported having no financial disclosures. Dr. Luke has been a paid consultant for the Society for Assisted Reproductive Technology.
On Twitter @sherryboschert
AT 2014 ASRM
Key clinical point: Higher rates of some adverse outcomes after ART appear to be due to multiple births, not ART itself.
Major finding: Adjusted odds ratios for cardiac defects were 2.0 for multiples with or without ART and 1.1 for singletons with ART, compared with singletons without ART.
Data source: Analyses of data on 335,910 births in the Massachusetts clinical and surveillance databases.
Disclosures: The National Institutes of Health funded the studies. Dr. Getz reported having no financial disclosures. Dr. Luke has been a paid consultant for the Society for Assisted Reproductive Technology.
Ectopic risk rises with more embryos transferred
HONOLULU – The only means of modifying the risk of ectopic pregnancy in fresh nondonor cycles of assisted reproductive technology is to limit the number of embryos transferred, a retrospective cohort study of 553,577 clinical pregnancies found.
Among the 379,023 clinical pregnancies from fresh nondonor cycles, the risk of ectopic pregnancy increased by 33%-49% with the transfer of more than two embryos, compared with transferring one embryo, Dr. Kiran M. Perkins reported at the annual meeting of the American Society for Reproductive Medicine.
The incidence of ectopic pregnancy in pregnancies from fresh nondonor cycles was 1.6% with the transfer of one embryo, 1.7% with the transfer of two embryos, 2.2% with the transfer of three embryos, and 2.5% with the transfer of four or more embryos, said Dr. Perkins of the Centers for Disease Control and Prevention.
The overall incidence of ectopic pregnancy in this cohort of 553,577 clinical pregnancies from assisted reproductive technology (ART) procedures was 1.7%, similar to the 2% incidence among the general U.S. population, she added. From January 2001 to the end of 2011, there was a significant downward trend in the incidence of ectopic pregnancy after ART procedures, from 2% in 2001 to 1.6% in 2011.
Most of the clinical pregnancies from ART occurred after fresh nondonor cycles (68%), followed by frozen-thawed nondonor cycles (15%), fresh donor cycles (12%), and frozen-thawed donor cycles (4%). (Percentages were rounded.)
Fresh nondonor cycles were associated with the highest rate of ectopic pregnancy (2%). Rates of ectopic pregnancy were 1.3% using frozen-thawed nondonor cycles, 1.2% using frozen-thawed donor cycles, and 1% using fresh donor cycles.
The study identified other risk factors for ectopic pregnancy after ART, but these were not things that clinicians could modify. The ectopic pregnancy risk after fresh nondonor cycles increased with age between the ages of 29 and 44 years, with an adjusted risk ratio of 21%-23%. The rates of ectopic pregnancy increased from 1.6% in women younger than 30 years to 1.9% for ages 30-34 years, 2.1% for ages 35-37 years, 2.2% for ages 38-40 years, and 2.4% for ages 41-43 years.
Women with a history of two or more ART cycles had a significantly increased incidence of ectopic pregnancy, compared with women with no prior ART cycles: 2.3% vs. 1.8%, Dr. Perkins reported.
Having one or more prior live births was protective, reducing the risk of ectopic pregnancy by 29% in women with one prior live birth and by 45% in women with two or more prior births, compared with nulliparous women. Ectopic pregnancy rates were 2.1% in women with no prior births, 1.7% in those with one prior live birth, and 1.4% in those with two or more previous births.
The 2.3% incidence of ectopic pregnancy in couples with tubal factor infertility was significantly higher than the 1.8% incidence in couples with male factor infertility.
Data for the study came from the National ART Surveillance System, which contains information on 95% of ART procedures in the United States.
Dr. Perkins reported having no relevant financial disclosures.
On Twitter @sherryboschert
HONOLULU – The only means of modifying the risk of ectopic pregnancy in fresh nondonor cycles of assisted reproductive technology is to limit the number of embryos transferred, a retrospective cohort study of 553,577 clinical pregnancies found.
Among the 379,023 clinical pregnancies from fresh nondonor cycles, the risk of ectopic pregnancy increased by 33%-49% with the transfer of more than two embryos, compared with transferring one embryo, Dr. Kiran M. Perkins reported at the annual meeting of the American Society for Reproductive Medicine.
The incidence of ectopic pregnancy in pregnancies from fresh nondonor cycles was 1.6% with the transfer of one embryo, 1.7% with the transfer of two embryos, 2.2% with the transfer of three embryos, and 2.5% with the transfer of four or more embryos, said Dr. Perkins of the Centers for Disease Control and Prevention.
The overall incidence of ectopic pregnancy in this cohort of 553,577 clinical pregnancies from assisted reproductive technology (ART) procedures was 1.7%, similar to the 2% incidence among the general U.S. population, she added. From January 2001 to the end of 2011, there was a significant downward trend in the incidence of ectopic pregnancy after ART procedures, from 2% in 2001 to 1.6% in 2011.
Most of the clinical pregnancies from ART occurred after fresh nondonor cycles (68%), followed by frozen-thawed nondonor cycles (15%), fresh donor cycles (12%), and frozen-thawed donor cycles (4%). (Percentages were rounded.)
Fresh nondonor cycles were associated with the highest rate of ectopic pregnancy (2%). Rates of ectopic pregnancy were 1.3% using frozen-thawed nondonor cycles, 1.2% using frozen-thawed donor cycles, and 1% using fresh donor cycles.
The study identified other risk factors for ectopic pregnancy after ART, but these were not things that clinicians could modify. The ectopic pregnancy risk after fresh nondonor cycles increased with age between the ages of 29 and 44 years, with an adjusted risk ratio of 21%-23%. The rates of ectopic pregnancy increased from 1.6% in women younger than 30 years to 1.9% for ages 30-34 years, 2.1% for ages 35-37 years, 2.2% for ages 38-40 years, and 2.4% for ages 41-43 years.
Women with a history of two or more ART cycles had a significantly increased incidence of ectopic pregnancy, compared with women with no prior ART cycles: 2.3% vs. 1.8%, Dr. Perkins reported.
Having one or more prior live births was protective, reducing the risk of ectopic pregnancy by 29% in women with one prior live birth and by 45% in women with two or more prior births, compared with nulliparous women. Ectopic pregnancy rates were 2.1% in women with no prior births, 1.7% in those with one prior live birth, and 1.4% in those with two or more previous births.
The 2.3% incidence of ectopic pregnancy in couples with tubal factor infertility was significantly higher than the 1.8% incidence in couples with male factor infertility.
Data for the study came from the National ART Surveillance System, which contains information on 95% of ART procedures in the United States.
Dr. Perkins reported having no relevant financial disclosures.
On Twitter @sherryboschert
HONOLULU – The only means of modifying the risk of ectopic pregnancy in fresh nondonor cycles of assisted reproductive technology is to limit the number of embryos transferred, a retrospective cohort study of 553,577 clinical pregnancies found.
Among the 379,023 clinical pregnancies from fresh nondonor cycles, the risk of ectopic pregnancy increased by 33%-49% with the transfer of more than two embryos, compared with transferring one embryo, Dr. Kiran M. Perkins reported at the annual meeting of the American Society for Reproductive Medicine.
The incidence of ectopic pregnancy in pregnancies from fresh nondonor cycles was 1.6% with the transfer of one embryo, 1.7% with the transfer of two embryos, 2.2% with the transfer of three embryos, and 2.5% with the transfer of four or more embryos, said Dr. Perkins of the Centers for Disease Control and Prevention.
The overall incidence of ectopic pregnancy in this cohort of 553,577 clinical pregnancies from assisted reproductive technology (ART) procedures was 1.7%, similar to the 2% incidence among the general U.S. population, she added. From January 2001 to the end of 2011, there was a significant downward trend in the incidence of ectopic pregnancy after ART procedures, from 2% in 2001 to 1.6% in 2011.
Most of the clinical pregnancies from ART occurred after fresh nondonor cycles (68%), followed by frozen-thawed nondonor cycles (15%), fresh donor cycles (12%), and frozen-thawed donor cycles (4%). (Percentages were rounded.)
Fresh nondonor cycles were associated with the highest rate of ectopic pregnancy (2%). Rates of ectopic pregnancy were 1.3% using frozen-thawed nondonor cycles, 1.2% using frozen-thawed donor cycles, and 1% using fresh donor cycles.
The study identified other risk factors for ectopic pregnancy after ART, but these were not things that clinicians could modify. The ectopic pregnancy risk after fresh nondonor cycles increased with age between the ages of 29 and 44 years, with an adjusted risk ratio of 21%-23%. The rates of ectopic pregnancy increased from 1.6% in women younger than 30 years to 1.9% for ages 30-34 years, 2.1% for ages 35-37 years, 2.2% for ages 38-40 years, and 2.4% for ages 41-43 years.
Women with a history of two or more ART cycles had a significantly increased incidence of ectopic pregnancy, compared with women with no prior ART cycles: 2.3% vs. 1.8%, Dr. Perkins reported.
Having one or more prior live births was protective, reducing the risk of ectopic pregnancy by 29% in women with one prior live birth and by 45% in women with two or more prior births, compared with nulliparous women. Ectopic pregnancy rates were 2.1% in women with no prior births, 1.7% in those with one prior live birth, and 1.4% in those with two or more previous births.
The 2.3% incidence of ectopic pregnancy in couples with tubal factor infertility was significantly higher than the 1.8% incidence in couples with male factor infertility.
Data for the study came from the National ART Surveillance System, which contains information on 95% of ART procedures in the United States.
Dr. Perkins reported having no relevant financial disclosures.
On Twitter @sherryboschert
AT 2014 ASRM
Vigorous Exercise Better in PCOS
HONOLULU – An hour of vigorous exercise per week decreased the risk for metabolic syndrome in women with polycystic ovary syndrome by 22%, a retrospective study of 326 women found.
Moderate-intensity exercise for at least 150 minutes per week also was beneficial, compared with inactivity, but vigorous exercise produced added benefits in risk for metabolic syndrome, body mass index (BMI), cholesterol levels, glucose tolerance, and insulin resistance, Dr. Eleni A. Greenwood said at the annual meeting of the American Society for Reproductive Medicine.
The results point to “the power of sweat” when recommending exercise to women with polycystic ovary syndrome (PCOS), she said.
The observational study of women seen at a single PCOS clinic in 2006-2013 compared three groups: those who reported exercising vigorously for at least 75 minutes per week; those who reported moderate-intensity exercise for at least 150 minutes per week but not vigorous exercise, or “inactive” women who reported neither of these activity levels, which are recommended by the U.S. Department of Health & Human Services.
Patients reported activity on the self-administered International Physical Activity Questionnaire, which defines vigorous exercise as hard physical effort that makes you breathe much harder than normal and moderate-intensity exercise as moderate physical effort that makes you breathe somewhat harder than normal. They were evaluated systematically for evidence of metabolic dysfunction.
Among the 56% of women who reported activity that met HHS recommendations, 83% reported vigorous activity and 17% reported moderate activity. The other 44% were classified as inactive.
The proportion of women with metabolic syndrome was lowest in the vigorous activity group (33%), higher in the moderate activity group (36%), and highest in the inactive group (47%), reported Dr. Greenwood of the University of California, San Francisco, and her associates.
Doing 60 minutes of vigorous exercise per week decreased the odds of metabolic syndrome by 22% after adjusting for the influence of age, BMI, and total volume of exercise as measured by metabolic equivalents, she said.
There was a significant trend toward lower BMI with more intense activity. The mean BMI was 27 kg/m2 in the vigorous activity group, 30 kg/m2 in the moderate activity group, and 31 kg/m2 in the inactive group, she said. The mean HDL cholesterol level was significantly higher in the vigorous exercise group (56 mg/dL), compared with the moderate exercise group (46 mg/dL) or the inactive group (51 mg/dL).
Measures of glucose tolerance using the 2-hour oral glucose tolerance test trended significantly better in the vigorous exercise group – a mean of 93 mg/dL with vigorous exercise, 104 mg/dL with moderate exercise, or 106 mg/dL in the inactive group. Fasting glucose measurements did not differ significantly between groups.
Significant trends toward better measures of insulin resistance were seen with more vigorous activity. Fasting insulin levels were 6.9 mU/L in the vigorous exercise group, 9.8 mU/L with moderate exercise, and 11 mU/L in the inactive group. Scores on the homeostatic model assessment of estimated insulin resistance were 1.5 in the vigorous exercise group, 2.2 in the moderate exercise group, and 2.4 in the inactive group.
Significant trends toward smaller waist circumference and rate of acanthosis nigricans were seen with more vigorous activity. The mean waist circumference was 33 inches in the vigorous exercise group and 35 inches in the other two groups. In the vigorous exercise group, 24% had acanthosis nigricans, compared with 30% in the moderate exercise group and 40% in the inactive group.
The mean age in each group was 28 years.
“Vigorous activity is associated with additional benefits, compared to moderate activity,” Dr. Greenwood said. “Women with PCOS should strive to meet HHS guidelines through vigorous physical activity.”
She reported having no financial disclosures. Her associates reported associations with Nora Therapeutics, Ferring Pharmaceuticals, and Ziva Medical.
HONOLULU – An hour of vigorous exercise per week decreased the risk for metabolic syndrome in women with polycystic ovary syndrome by 22%, a retrospective study of 326 women found.
Moderate-intensity exercise for at least 150 minutes per week also was beneficial, compared with inactivity, but vigorous exercise produced added benefits in risk for metabolic syndrome, body mass index (BMI), cholesterol levels, glucose tolerance, and insulin resistance, Dr. Eleni A. Greenwood said at the annual meeting of the American Society for Reproductive Medicine.
The results point to “the power of sweat” when recommending exercise to women with polycystic ovary syndrome (PCOS), she said.
The observational study of women seen at a single PCOS clinic in 2006-2013 compared three groups: those who reported exercising vigorously for at least 75 minutes per week; those who reported moderate-intensity exercise for at least 150 minutes per week but not vigorous exercise, or “inactive” women who reported neither of these activity levels, which are recommended by the U.S. Department of Health & Human Services.
Patients reported activity on the self-administered International Physical Activity Questionnaire, which defines vigorous exercise as hard physical effort that makes you breathe much harder than normal and moderate-intensity exercise as moderate physical effort that makes you breathe somewhat harder than normal. They were evaluated systematically for evidence of metabolic dysfunction.
Among the 56% of women who reported activity that met HHS recommendations, 83% reported vigorous activity and 17% reported moderate activity. The other 44% were classified as inactive.
The proportion of women with metabolic syndrome was lowest in the vigorous activity group (33%), higher in the moderate activity group (36%), and highest in the inactive group (47%), reported Dr. Greenwood of the University of California, San Francisco, and her associates.
Doing 60 minutes of vigorous exercise per week decreased the odds of metabolic syndrome by 22% after adjusting for the influence of age, BMI, and total volume of exercise as measured by metabolic equivalents, she said.
There was a significant trend toward lower BMI with more intense activity. The mean BMI was 27 kg/m2 in the vigorous activity group, 30 kg/m2 in the moderate activity group, and 31 kg/m2 in the inactive group, she said. The mean HDL cholesterol level was significantly higher in the vigorous exercise group (56 mg/dL), compared with the moderate exercise group (46 mg/dL) or the inactive group (51 mg/dL).
Measures of glucose tolerance using the 2-hour oral glucose tolerance test trended significantly better in the vigorous exercise group – a mean of 93 mg/dL with vigorous exercise, 104 mg/dL with moderate exercise, or 106 mg/dL in the inactive group. Fasting glucose measurements did not differ significantly between groups.
Significant trends toward better measures of insulin resistance were seen with more vigorous activity. Fasting insulin levels were 6.9 mU/L in the vigorous exercise group, 9.8 mU/L with moderate exercise, and 11 mU/L in the inactive group. Scores on the homeostatic model assessment of estimated insulin resistance were 1.5 in the vigorous exercise group, 2.2 in the moderate exercise group, and 2.4 in the inactive group.
Significant trends toward smaller waist circumference and rate of acanthosis nigricans were seen with more vigorous activity. The mean waist circumference was 33 inches in the vigorous exercise group and 35 inches in the other two groups. In the vigorous exercise group, 24% had acanthosis nigricans, compared with 30% in the moderate exercise group and 40% in the inactive group.
The mean age in each group was 28 years.
“Vigorous activity is associated with additional benefits, compared to moderate activity,” Dr. Greenwood said. “Women with PCOS should strive to meet HHS guidelines through vigorous physical activity.”
She reported having no financial disclosures. Her associates reported associations with Nora Therapeutics, Ferring Pharmaceuticals, and Ziva Medical.
HONOLULU – An hour of vigorous exercise per week decreased the risk for metabolic syndrome in women with polycystic ovary syndrome by 22%, a retrospective study of 326 women found.
Moderate-intensity exercise for at least 150 minutes per week also was beneficial, compared with inactivity, but vigorous exercise produced added benefits in risk for metabolic syndrome, body mass index (BMI), cholesterol levels, glucose tolerance, and insulin resistance, Dr. Eleni A. Greenwood said at the annual meeting of the American Society for Reproductive Medicine.
The results point to “the power of sweat” when recommending exercise to women with polycystic ovary syndrome (PCOS), she said.
The observational study of women seen at a single PCOS clinic in 2006-2013 compared three groups: those who reported exercising vigorously for at least 75 minutes per week; those who reported moderate-intensity exercise for at least 150 minutes per week but not vigorous exercise, or “inactive” women who reported neither of these activity levels, which are recommended by the U.S. Department of Health & Human Services.
Patients reported activity on the self-administered International Physical Activity Questionnaire, which defines vigorous exercise as hard physical effort that makes you breathe much harder than normal and moderate-intensity exercise as moderate physical effort that makes you breathe somewhat harder than normal. They were evaluated systematically for evidence of metabolic dysfunction.
Among the 56% of women who reported activity that met HHS recommendations, 83% reported vigorous activity and 17% reported moderate activity. The other 44% were classified as inactive.
The proportion of women with metabolic syndrome was lowest in the vigorous activity group (33%), higher in the moderate activity group (36%), and highest in the inactive group (47%), reported Dr. Greenwood of the University of California, San Francisco, and her associates.
Doing 60 minutes of vigorous exercise per week decreased the odds of metabolic syndrome by 22% after adjusting for the influence of age, BMI, and total volume of exercise as measured by metabolic equivalents, she said.
There was a significant trend toward lower BMI with more intense activity. The mean BMI was 27 kg/m2 in the vigorous activity group, 30 kg/m2 in the moderate activity group, and 31 kg/m2 in the inactive group, she said. The mean HDL cholesterol level was significantly higher in the vigorous exercise group (56 mg/dL), compared with the moderate exercise group (46 mg/dL) or the inactive group (51 mg/dL).
Measures of glucose tolerance using the 2-hour oral glucose tolerance test trended significantly better in the vigorous exercise group – a mean of 93 mg/dL with vigorous exercise, 104 mg/dL with moderate exercise, or 106 mg/dL in the inactive group. Fasting glucose measurements did not differ significantly between groups.
Significant trends toward better measures of insulin resistance were seen with more vigorous activity. Fasting insulin levels were 6.9 mU/L in the vigorous exercise group, 9.8 mU/L with moderate exercise, and 11 mU/L in the inactive group. Scores on the homeostatic model assessment of estimated insulin resistance were 1.5 in the vigorous exercise group, 2.2 in the moderate exercise group, and 2.4 in the inactive group.
Significant trends toward smaller waist circumference and rate of acanthosis nigricans were seen with more vigorous activity. The mean waist circumference was 33 inches in the vigorous exercise group and 35 inches in the other two groups. In the vigorous exercise group, 24% had acanthosis nigricans, compared with 30% in the moderate exercise group and 40% in the inactive group.
The mean age in each group was 28 years.
“Vigorous activity is associated with additional benefits, compared to moderate activity,” Dr. Greenwood said. “Women with PCOS should strive to meet HHS guidelines through vigorous physical activity.”
She reported having no financial disclosures. Her associates reported associations with Nora Therapeutics, Ferring Pharmaceuticals, and Ziva Medical.
AT 2014 ASRM
Vigorous exercise better in PCOS
HONOLULU – An hour of vigorous exercise per week decreased the risk for metabolic syndrome in women with polycystic ovary syndrome by 22%, a retrospective study of 326 women found.
Moderate-intensity exercise for at least 150 minutes per week also was beneficial, compared with inactivity, but vigorous exercise produced added benefits in risk for metabolic syndrome, body mass index (BMI), cholesterol levels, glucose tolerance, and insulin resistance, Dr. Eleni A. Greenwood said at the annual meeting of the American Society for Reproductive Medicine.
The results point to “the power of sweat” when recommending exercise to women with polycystic ovary syndrome (PCOS), she said.
The observational study of women seen at a single PCOS clinic in 2006-2013 compared three groups: those who reported exercising vigorously for at least 75 minutes per week; those who reported moderate-intensity exercise for at least 150 minutes per week but not vigorous exercise, or “inactive” women who reported neither of these activity levels, which are recommended by the U.S. Department of Health & Human Services.
Patients reported activity on the self-administered International Physical Activity Questionnaire, which defines vigorous exercise as hard physical effort that makes you breathe much harder than normal and moderate-intensity exercise as moderate physical effort that makes you breathe somewhat harder than normal. They were evaluated systematically for evidence of metabolic dysfunction.
Among the 56% of women who reported activity that met HHS recommendations, 83% reported vigorous activity and 17% reported moderate activity. The other 44% were classified as inactive.
The proportion of women with metabolic syndrome was lowest in the vigorous activity group (33%), higher in the moderate activity group (36%), and highest in the inactive group (47%), reported Dr. Greenwood of the University of California, San Francisco, and her associates.
Doing 60 minutes of vigorous exercise per week decreased the odds of metabolic syndrome by 22% after adjusting for the influence of age, BMI, and total volume of exercise as measured by metabolic equivalents, she said.
There was a significant trend toward lower BMI with more intense activity. The mean BMI was 27 kg/m2 in the vigorous activity group, 30 kg/m2 in the moderate activity group, and 31 kg/m2 in the inactive group, she said. The mean HDL cholesterol level was significantly higher in the vigorous exercise group (56 mg/dL), compared with the moderate exercise group (46 mg/dL) or the inactive group (51 mg/dL).
Measures of glucose tolerance using the 2-hour oral glucose tolerance test trended significantly better in the vigorous exercise group – a mean of 93 mg/dL with vigorous exercise, 104 mg/dL with moderate exercise, or 106 mg/dL in the inactive group. Fasting glucose measurements did not differ significantly between groups.
Significant trends toward better measures of insulin resistance were seen with more vigorous activity. Fasting insulin levels were 6.9 mU/L in the vigorous exercise group, 9.8 mU/L with moderate exercise, and 11 mU/L in the inactive group. Scores on the homeostatic model assessment of estimated insulin resistance were 1.5 in the vigorous exercise group, 2.2 in the moderate exercise group, and 2.4 in the inactive group.
Significant trends toward smaller waist circumference and rate of acanthosis nigricans were seen with more vigorous activity. The mean waist circumference was 33 inches in the vigorous exercise group and 35 inches in the other two groups. In the vigorous exercise group, 24% had acanthosis nigricans, compared with 30% in the moderate exercise group and 40% in the inactive group.
The mean age in each group was 28 years.
“Vigorous activity is associated with additional benefits, compared to moderate activity,” Dr. Greenwood said. “Women with PCOS should strive to meet HHS guidelines through vigorous physical activity.”
She reported having no financial disclosures. Her associates reported associations with Nora Therapeutics, Ferring Pharmaceuticals, and Ziva Medical.
On Twitter @sherryboschert
HONOLULU – An hour of vigorous exercise per week decreased the risk for metabolic syndrome in women with polycystic ovary syndrome by 22%, a retrospective study of 326 women found.
Moderate-intensity exercise for at least 150 minutes per week also was beneficial, compared with inactivity, but vigorous exercise produced added benefits in risk for metabolic syndrome, body mass index (BMI), cholesterol levels, glucose tolerance, and insulin resistance, Dr. Eleni A. Greenwood said at the annual meeting of the American Society for Reproductive Medicine.
The results point to “the power of sweat” when recommending exercise to women with polycystic ovary syndrome (PCOS), she said.
The observational study of women seen at a single PCOS clinic in 2006-2013 compared three groups: those who reported exercising vigorously for at least 75 minutes per week; those who reported moderate-intensity exercise for at least 150 minutes per week but not vigorous exercise, or “inactive” women who reported neither of these activity levels, which are recommended by the U.S. Department of Health & Human Services.
Patients reported activity on the self-administered International Physical Activity Questionnaire, which defines vigorous exercise as hard physical effort that makes you breathe much harder than normal and moderate-intensity exercise as moderate physical effort that makes you breathe somewhat harder than normal. They were evaluated systematically for evidence of metabolic dysfunction.
Among the 56% of women who reported activity that met HHS recommendations, 83% reported vigorous activity and 17% reported moderate activity. The other 44% were classified as inactive.
The proportion of women with metabolic syndrome was lowest in the vigorous activity group (33%), higher in the moderate activity group (36%), and highest in the inactive group (47%), reported Dr. Greenwood of the University of California, San Francisco, and her associates.
Doing 60 minutes of vigorous exercise per week decreased the odds of metabolic syndrome by 22% after adjusting for the influence of age, BMI, and total volume of exercise as measured by metabolic equivalents, she said.
There was a significant trend toward lower BMI with more intense activity. The mean BMI was 27 kg/m2 in the vigorous activity group, 30 kg/m2 in the moderate activity group, and 31 kg/m2 in the inactive group, she said. The mean HDL cholesterol level was significantly higher in the vigorous exercise group (56 mg/dL), compared with the moderate exercise group (46 mg/dL) or the inactive group (51 mg/dL).
Measures of glucose tolerance using the 2-hour oral glucose tolerance test trended significantly better in the vigorous exercise group – a mean of 93 mg/dL with vigorous exercise, 104 mg/dL with moderate exercise, or 106 mg/dL in the inactive group. Fasting glucose measurements did not differ significantly between groups.
Significant trends toward better measures of insulin resistance were seen with more vigorous activity. Fasting insulin levels were 6.9 mU/L in the vigorous exercise group, 9.8 mU/L with moderate exercise, and 11 mU/L in the inactive group. Scores on the homeostatic model assessment of estimated insulin resistance were 1.5 in the vigorous exercise group, 2.2 in the moderate exercise group, and 2.4 in the inactive group.
Significant trends toward smaller waist circumference and rate of acanthosis nigricans were seen with more vigorous activity. The mean waist circumference was 33 inches in the vigorous exercise group and 35 inches in the other two groups. In the vigorous exercise group, 24% had acanthosis nigricans, compared with 30% in the moderate exercise group and 40% in the inactive group.
The mean age in each group was 28 years.
“Vigorous activity is associated with additional benefits, compared to moderate activity,” Dr. Greenwood said. “Women with PCOS should strive to meet HHS guidelines through vigorous physical activity.”
She reported having no financial disclosures. Her associates reported associations with Nora Therapeutics, Ferring Pharmaceuticals, and Ziva Medical.
On Twitter @sherryboschert
HONOLULU – An hour of vigorous exercise per week decreased the risk for metabolic syndrome in women with polycystic ovary syndrome by 22%, a retrospective study of 326 women found.
Moderate-intensity exercise for at least 150 minutes per week also was beneficial, compared with inactivity, but vigorous exercise produced added benefits in risk for metabolic syndrome, body mass index (BMI), cholesterol levels, glucose tolerance, and insulin resistance, Dr. Eleni A. Greenwood said at the annual meeting of the American Society for Reproductive Medicine.
The results point to “the power of sweat” when recommending exercise to women with polycystic ovary syndrome (PCOS), she said.
The observational study of women seen at a single PCOS clinic in 2006-2013 compared three groups: those who reported exercising vigorously for at least 75 minutes per week; those who reported moderate-intensity exercise for at least 150 minutes per week but not vigorous exercise, or “inactive” women who reported neither of these activity levels, which are recommended by the U.S. Department of Health & Human Services.
Patients reported activity on the self-administered International Physical Activity Questionnaire, which defines vigorous exercise as hard physical effort that makes you breathe much harder than normal and moderate-intensity exercise as moderate physical effort that makes you breathe somewhat harder than normal. They were evaluated systematically for evidence of metabolic dysfunction.
Among the 56% of women who reported activity that met HHS recommendations, 83% reported vigorous activity and 17% reported moderate activity. The other 44% were classified as inactive.
The proportion of women with metabolic syndrome was lowest in the vigorous activity group (33%), higher in the moderate activity group (36%), and highest in the inactive group (47%), reported Dr. Greenwood of the University of California, San Francisco, and her associates.
Doing 60 minutes of vigorous exercise per week decreased the odds of metabolic syndrome by 22% after adjusting for the influence of age, BMI, and total volume of exercise as measured by metabolic equivalents, she said.
There was a significant trend toward lower BMI with more intense activity. The mean BMI was 27 kg/m2 in the vigorous activity group, 30 kg/m2 in the moderate activity group, and 31 kg/m2 in the inactive group, she said. The mean HDL cholesterol level was significantly higher in the vigorous exercise group (56 mg/dL), compared with the moderate exercise group (46 mg/dL) or the inactive group (51 mg/dL).
Measures of glucose tolerance using the 2-hour oral glucose tolerance test trended significantly better in the vigorous exercise group – a mean of 93 mg/dL with vigorous exercise, 104 mg/dL with moderate exercise, or 106 mg/dL in the inactive group. Fasting glucose measurements did not differ significantly between groups.
Significant trends toward better measures of insulin resistance were seen with more vigorous activity. Fasting insulin levels were 6.9 mU/L in the vigorous exercise group, 9.8 mU/L with moderate exercise, and 11 mU/L in the inactive group. Scores on the homeostatic model assessment of estimated insulin resistance were 1.5 in the vigorous exercise group, 2.2 in the moderate exercise group, and 2.4 in the inactive group.
Significant trends toward smaller waist circumference and rate of acanthosis nigricans were seen with more vigorous activity. The mean waist circumference was 33 inches in the vigorous exercise group and 35 inches in the other two groups. In the vigorous exercise group, 24% had acanthosis nigricans, compared with 30% in the moderate exercise group and 40% in the inactive group.
The mean age in each group was 28 years.
“Vigorous activity is associated with additional benefits, compared to moderate activity,” Dr. Greenwood said. “Women with PCOS should strive to meet HHS guidelines through vigorous physical activity.”
She reported having no financial disclosures. Her associates reported associations with Nora Therapeutics, Ferring Pharmaceuticals, and Ziva Medical.
On Twitter @sherryboschert
AT 2014 ASRM
Key clinical point: Tell patients with PCOS that vigorous exercise is better than moderate exercise.
Major finding: Metabolic syndrome was present in 33% with vigorous exercise, 36% with moderate exercise, and 47% with inactivity.
Data source: An analysis of clinical data and questionnaire results from 326 women with PCOS.
Disclosures: Dr. Greenwood reported having no financial disclosures. Her associates reported associations with Nora Therapeutics, Ferring Pharmaceuticals, and Ziva Medical.
Diet, exercise boost ovulation in PCOS
HONOLULU – Preconception diet and exercise, by themselves or in combination with oral contraceptives, improved ovulation rates, compared with birth control pills alone, in a randomized study of 149 women with polycystic ovary syndrome.
The study randomized women with polycystic ovary syndrome (PCOS) who wanted to conceive to 16 weeks of either oral contraceptive pills; lifestyle modification consisting of increased physical activity, brief behavior modification lessons, a weight-loss medication, and caloric restriction using meal replacements; or a combination of both lifestyle interventions and oral contraceptives. All subjects then received four monitored cycles of ovulation induction with clomiphene.
Ovulation rates in the lifestyle intervention group and the combination therapy group were significantly higher (60% and 67%, respectively) than in the oral contraceptives group (46%), Dr. Richard S. Legro and his associates reported in a prize-winning presentation at the 2014 annual meeting of the American Society for Reproductive Medicine.
“Looking at the relative rate of ovulation, there was a 30%-50% improved rate of ovulation if the patient had undergone a preconception lifestyle modification,” compared with oral contraceptives alone, said Dr. Legro, professor of ob.gyn. at Pennsylvania State University in Hershey.
There was a trend toward higher live birth rates in the lifestyle intervention group (26%) and the oral contraceptives group (12%, P = .05), with the live birth rate in the combination group nearing that of the lifestyle intervention group (24%).
Investigators stopped the study before enrolling its goal of 248 women after the two groups with lifestyle intervention separated from the oral contraceptives group and an interim analysis concluded that further data would be unlikely to show a significant difference in results between the two groups employing lifestyle interventions.
Women in the combination therapy group lost 6.5% of body weight on average, compared with a 6.2% loss in the lifestyle interventions group and a 1% loss on oral contraceptives. The weight loss goal was 7% of body weight.
Dr. Legro said he was surprised by marked exacerbation of glucose intolerance in women on oral contraceptives that was ameliorated by lifestyle interventions. After the 16 weeks of preinduction treatment, changes in oral glucose tolerance test areas under the curve showed significant differences between the oral contraceptives group (a mean increase of 24 mg/dL/hour) and the lifestyle modifications group (a decrease of 1 mg/dL per hour) or the combination therapy group (a decrease of 17 mg/dL/hour).
The oral contraceptives group also showed trends toward increased blood pressure and fasting glucose levels plus a significant increase in triglyceride levels. The risk for developing metabolic syndrome during the 16 weeks of treatment more than doubled in the oral contraceptives group, compared with a statistically nonsignificant 20% increased risk in the lifestyle interventions group and a nonsignificant 30% decrease in risk in the combination therapy group, he reported.
The continuous oral contraceptive was ethinyl estradiol 10 mcg/norethindrone acetate 1 mg under the brand name LoEstrin 1/20.
The lifestyle modifications involved meal replacements for all three meals per day using fresh vegetables and fruit for a 500 kcal/day deficit. The goal for physical activity was 150 minutes per week, and the monthly behavioral modification lessons were adapted from the Diabetes Prevention Program. Participants with a body mass index of at least 30 received 5-15 mg/day of the antiobesity drug sibutramine until it was removed from the market, after which obese participants received 60 mg of orlistat with meals.
“Is it worth doing all this?” Dr. Legro asked. To answer that question, he and his associates conducted a post-hoc analysis comparing the results from the lifestyle modifications or combination therapy groups with results from the Pregnancy in Polycystic Ovary Syndrome II (PPCOS II) study of clomiphene citrate or letrozole for ovulation induction without any pretreatment.
Cumulative ovulation rates were 40%-50% higher in the current study’s groups that included lifestyle interventions than in the PPCOS II study’s clomiphene group. The likelihood of a live birth more than doubled in the current study’s groups that included lifestyle interventions, compared with the PPCOS II clomiphene group.
The lifestyle interventions treatment “is very reproducible. It’s simple. It’s safe, and it’s well tolerated,” he said. “Oral contraceptive pills pretreatment likely offers little benefit versus immediate treatment with ovulation induction.”
One serious adverse event in the current study occurred in the oral contraceptive group, an episode of menorrhagia that sent the patient to an emergency department.
Concurrent lifestyle modification should be recommended for overweight or obese women with PCOS who are taking oral contraceptives, whether or not they are seeking fertility treatment, Dr. Legro said.
The National Institutes of Health funded the study. Dr. Legro reported financial associations with AstraZeneca, Euroscreen, Takeda Pharmaceuticals, and Ferring Pharmaceuticals. One of his associates reported financial associations with BAROnova and EnteroMedics.
On Twitter @sherryboschert
These findings emphasize the importance of lifestyle intervention in women with PCOS who are trying to have children. This reasonably large study found that diet and exercise offer advantages to women with PCOS, not only in reversing some of the metabolic effects of PCOS, but also in higher ovulation rates and trends toward improved pregnancy rates.
 |
Bradley J. Van Voorhis |
It’s also noteworthy that simply putting women on birth control pills alone had some negative effects on glucose metabolism and the risk for metabolic syndrome. So, the other significant message is that it’s probably not wise to simply place women with PCOS on oral contraceptives alone, and oral contraceptive therapy should be done in conjunction with lifestyle interventions.
The findings are practice changing in that they’ll motivate me to always counsel patients with PCOS who are starting oral contraceptives on the potential for adverse effects and the need for dietary control and weight loss. It was surprising to me, the effect of a relatively short course of birth control pills on glucose metabolism and metabolic syndrome.
Dr. Bradley Van Voorhis, professor of medicine and director of the division of reproductive endocrinology and infertility at the University of Iowa, Iowa City, made these comments in an interview. He reported having no financial disclosures.
These findings emphasize the importance of lifestyle intervention in women with PCOS who are trying to have children. This reasonably large study found that diet and exercise offer advantages to women with PCOS, not only in reversing some of the metabolic effects of PCOS, but also in higher ovulation rates and trends toward improved pregnancy rates.
|
Bradley J. Van Voorhis |
It’s also noteworthy that simply putting women on birth control pills alone had some negative effects on glucose metabolism and the risk for metabolic syndrome. So, the other significant message is that it’s probably not wise to simply place women with PCOS on oral contraceptives alone, and oral contraceptive therapy should be done in conjunction with lifestyle interventions.
The findings are practice changing in that they’ll motivate me to always counsel patients with PCOS who are starting oral contraceptives on the potential for adverse effects and the need for dietary control and weight loss. It was surprising to me, the effect of a relatively short course of birth control pills on glucose metabolism and metabolic syndrome.
Dr. Bradley Van Voorhis, professor of medicine and director of the division of reproductive endocrinology and infertility at the University of Iowa, Iowa City, made these comments in an interview. He reported having no financial disclosures.
These findings emphasize the importance of lifestyle intervention in women with PCOS who are trying to have children. This reasonably large study found that diet and exercise offer advantages to women with PCOS, not only in reversing some of the metabolic effects of PCOS, but also in higher ovulation rates and trends toward improved pregnancy rates.
|
Bradley J. Van Voorhis |
It’s also noteworthy that simply putting women on birth control pills alone had some negative effects on glucose metabolism and the risk for metabolic syndrome. So, the other significant message is that it’s probably not wise to simply place women with PCOS on oral contraceptives alone, and oral contraceptive therapy should be done in conjunction with lifestyle interventions.
The findings are practice changing in that they’ll motivate me to always counsel patients with PCOS who are starting oral contraceptives on the potential for adverse effects and the need for dietary control and weight loss. It was surprising to me, the effect of a relatively short course of birth control pills on glucose metabolism and metabolic syndrome.
Dr. Bradley Van Voorhis, professor of medicine and director of the division of reproductive endocrinology and infertility at the University of Iowa, Iowa City, made these comments in an interview. He reported having no financial disclosures.
HONOLULU – Preconception diet and exercise, by themselves or in combination with oral contraceptives, improved ovulation rates, compared with birth control pills alone, in a randomized study of 149 women with polycystic ovary syndrome.
The study randomized women with polycystic ovary syndrome (PCOS) who wanted to conceive to 16 weeks of either oral contraceptive pills; lifestyle modification consisting of increased physical activity, brief behavior modification lessons, a weight-loss medication, and caloric restriction using meal replacements; or a combination of both lifestyle interventions and oral contraceptives. All subjects then received four monitored cycles of ovulation induction with clomiphene.
Ovulation rates in the lifestyle intervention group and the combination therapy group were significantly higher (60% and 67%, respectively) than in the oral contraceptives group (46%), Dr. Richard S. Legro and his associates reported in a prize-winning presentation at the 2014 annual meeting of the American Society for Reproductive Medicine.
“Looking at the relative rate of ovulation, there was a 30%-50% improved rate of ovulation if the patient had undergone a preconception lifestyle modification,” compared with oral contraceptives alone, said Dr. Legro, professor of ob.gyn. at Pennsylvania State University in Hershey.
There was a trend toward higher live birth rates in the lifestyle intervention group (26%) and the oral contraceptives group (12%, P = .05), with the live birth rate in the combination group nearing that of the lifestyle intervention group (24%).
Investigators stopped the study before enrolling its goal of 248 women after the two groups with lifestyle intervention separated from the oral contraceptives group and an interim analysis concluded that further data would be unlikely to show a significant difference in results between the two groups employing lifestyle interventions.
Women in the combination therapy group lost 6.5% of body weight on average, compared with a 6.2% loss in the lifestyle interventions group and a 1% loss on oral contraceptives. The weight loss goal was 7% of body weight.
Dr. Legro said he was surprised by marked exacerbation of glucose intolerance in women on oral contraceptives that was ameliorated by lifestyle interventions. After the 16 weeks of preinduction treatment, changes in oral glucose tolerance test areas under the curve showed significant differences between the oral contraceptives group (a mean increase of 24 mg/dL/hour) and the lifestyle modifications group (a decrease of 1 mg/dL per hour) or the combination therapy group (a decrease of 17 mg/dL/hour).
The oral contraceptives group also showed trends toward increased blood pressure and fasting glucose levels plus a significant increase in triglyceride levels. The risk for developing metabolic syndrome during the 16 weeks of treatment more than doubled in the oral contraceptives group, compared with a statistically nonsignificant 20% increased risk in the lifestyle interventions group and a nonsignificant 30% decrease in risk in the combination therapy group, he reported.
The continuous oral contraceptive was ethinyl estradiol 10 mcg/norethindrone acetate 1 mg under the brand name LoEstrin 1/20.
The lifestyle modifications involved meal replacements for all three meals per day using fresh vegetables and fruit for a 500 kcal/day deficit. The goal for physical activity was 150 minutes per week, and the monthly behavioral modification lessons were adapted from the Diabetes Prevention Program. Participants with a body mass index of at least 30 received 5-15 mg/day of the antiobesity drug sibutramine until it was removed from the market, after which obese participants received 60 mg of orlistat with meals.
“Is it worth doing all this?” Dr. Legro asked. To answer that question, he and his associates conducted a post-hoc analysis comparing the results from the lifestyle modifications or combination therapy groups with results from the Pregnancy in Polycystic Ovary Syndrome II (PPCOS II) study of clomiphene citrate or letrozole for ovulation induction without any pretreatment.
Cumulative ovulation rates were 40%-50% higher in the current study’s groups that included lifestyle interventions than in the PPCOS II study’s clomiphene group. The likelihood of a live birth more than doubled in the current study’s groups that included lifestyle interventions, compared with the PPCOS II clomiphene group.
The lifestyle interventions treatment “is very reproducible. It’s simple. It’s safe, and it’s well tolerated,” he said. “Oral contraceptive pills pretreatment likely offers little benefit versus immediate treatment with ovulation induction.”
One serious adverse event in the current study occurred in the oral contraceptive group, an episode of menorrhagia that sent the patient to an emergency department.
Concurrent lifestyle modification should be recommended for overweight or obese women with PCOS who are taking oral contraceptives, whether or not they are seeking fertility treatment, Dr. Legro said.
The National Institutes of Health funded the study. Dr. Legro reported financial associations with AstraZeneca, Euroscreen, Takeda Pharmaceuticals, and Ferring Pharmaceuticals. One of his associates reported financial associations with BAROnova and EnteroMedics.
On Twitter @sherryboschert
HONOLULU – Preconception diet and exercise, by themselves or in combination with oral contraceptives, improved ovulation rates, compared with birth control pills alone, in a randomized study of 149 women with polycystic ovary syndrome.
The study randomized women with polycystic ovary syndrome (PCOS) who wanted to conceive to 16 weeks of either oral contraceptive pills; lifestyle modification consisting of increased physical activity, brief behavior modification lessons, a weight-loss medication, and caloric restriction using meal replacements; or a combination of both lifestyle interventions and oral contraceptives. All subjects then received four monitored cycles of ovulation induction with clomiphene.
Ovulation rates in the lifestyle intervention group and the combination therapy group were significantly higher (60% and 67%, respectively) than in the oral contraceptives group (46%), Dr. Richard S. Legro and his associates reported in a prize-winning presentation at the 2014 annual meeting of the American Society for Reproductive Medicine.
“Looking at the relative rate of ovulation, there was a 30%-50% improved rate of ovulation if the patient had undergone a preconception lifestyle modification,” compared with oral contraceptives alone, said Dr. Legro, professor of ob.gyn. at Pennsylvania State University in Hershey.
There was a trend toward higher live birth rates in the lifestyle intervention group (26%) and the oral contraceptives group (12%, P = .05), with the live birth rate in the combination group nearing that of the lifestyle intervention group (24%).
Investigators stopped the study before enrolling its goal of 248 women after the two groups with lifestyle intervention separated from the oral contraceptives group and an interim analysis concluded that further data would be unlikely to show a significant difference in results between the two groups employing lifestyle interventions.
Women in the combination therapy group lost 6.5% of body weight on average, compared with a 6.2% loss in the lifestyle interventions group and a 1% loss on oral contraceptives. The weight loss goal was 7% of body weight.
Dr. Legro said he was surprised by marked exacerbation of glucose intolerance in women on oral contraceptives that was ameliorated by lifestyle interventions. After the 16 weeks of preinduction treatment, changes in oral glucose tolerance test areas under the curve showed significant differences between the oral contraceptives group (a mean increase of 24 mg/dL/hour) and the lifestyle modifications group (a decrease of 1 mg/dL per hour) or the combination therapy group (a decrease of 17 mg/dL/hour).
The oral contraceptives group also showed trends toward increased blood pressure and fasting glucose levels plus a significant increase in triglyceride levels. The risk for developing metabolic syndrome during the 16 weeks of treatment more than doubled in the oral contraceptives group, compared with a statistically nonsignificant 20% increased risk in the lifestyle interventions group and a nonsignificant 30% decrease in risk in the combination therapy group, he reported.
The continuous oral contraceptive was ethinyl estradiol 10 mcg/norethindrone acetate 1 mg under the brand name LoEstrin 1/20.
The lifestyle modifications involved meal replacements for all three meals per day using fresh vegetables and fruit for a 500 kcal/day deficit. The goal for physical activity was 150 minutes per week, and the monthly behavioral modification lessons were adapted from the Diabetes Prevention Program. Participants with a body mass index of at least 30 received 5-15 mg/day of the antiobesity drug sibutramine until it was removed from the market, after which obese participants received 60 mg of orlistat with meals.
“Is it worth doing all this?” Dr. Legro asked. To answer that question, he and his associates conducted a post-hoc analysis comparing the results from the lifestyle modifications or combination therapy groups with results from the Pregnancy in Polycystic Ovary Syndrome II (PPCOS II) study of clomiphene citrate or letrozole for ovulation induction without any pretreatment.
Cumulative ovulation rates were 40%-50% higher in the current study’s groups that included lifestyle interventions than in the PPCOS II study’s clomiphene group. The likelihood of a live birth more than doubled in the current study’s groups that included lifestyle interventions, compared with the PPCOS II clomiphene group.
The lifestyle interventions treatment “is very reproducible. It’s simple. It’s safe, and it’s well tolerated,” he said. “Oral contraceptive pills pretreatment likely offers little benefit versus immediate treatment with ovulation induction.”
One serious adverse event in the current study occurred in the oral contraceptive group, an episode of menorrhagia that sent the patient to an emergency department.
Concurrent lifestyle modification should be recommended for overweight or obese women with PCOS who are taking oral contraceptives, whether or not they are seeking fertility treatment, Dr. Legro said.
The National Institutes of Health funded the study. Dr. Legro reported financial associations with AstraZeneca, Euroscreen, Takeda Pharmaceuticals, and Ferring Pharmaceuticals. One of his associates reported financial associations with BAROnova and EnteroMedics.
On Twitter @sherryboschert
AT 2014 ASRM
Key clinical point: Lifestyle interventions improve ovulation and health in women with PCOS.
Major finding: Ovulation rates were 46% on oral contraceptives, 60% with lifestyle interventions, or 67% with both.
Data source: A prematurely terminated, randomized study of 149 women with PCOS desiring children.
Disclosures: The National Institutes of Health funded the study. Dr. Legro reported financial associations with AstraZeneca, Euroscreen, Takeda Pharmaceuticals, and Ferring Pharmaceuticals. One of his associates reported financial associations with BAROnova and EnteroMedics.
VIDEO: SERMs move beyond osteoporosis, breast cancer prevention
HONOLULU– Uses for selective estrogen receptor modulators have grown beyond prevention of breast cancer or osteoporosis to treatment of postmenopausal symptoms.
Dr. Cynthia Stuenkel spoke about selective estrogen receptor modifiers (SERMs) and menopause in a keynote address at the annual meeting of the American Society for Reproductive Medicine.
In a video interview, Dr. Stuenkel talks about two of the newer SERM options – ospemifene for dyspareunia and a combination of the SERM bazedoxifene and conjugated equine estrogens that’s available outside of the United States to treat vasomotor symptoms or for prevention of bone loss.
These new tools expand clinical options – but, as with any new therapy – longer and larger studies of the newer agents are needed to more carefully assess long-term safety, said Dr. Stuenkel of the University of California, San Diego.
She reported having no financial disclosures.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
On Twitter @sherryboschert
HONOLULU– Uses for selective estrogen receptor modulators have grown beyond prevention of breast cancer or osteoporosis to treatment of postmenopausal symptoms.
Dr. Cynthia Stuenkel spoke about selective estrogen receptor modifiers (SERMs) and menopause in a keynote address at the annual meeting of the American Society for Reproductive Medicine.
In a video interview, Dr. Stuenkel talks about two of the newer SERM options – ospemifene for dyspareunia and a combination of the SERM bazedoxifene and conjugated equine estrogens that’s available outside of the United States to treat vasomotor symptoms or for prevention of bone loss.
These new tools expand clinical options – but, as with any new therapy – longer and larger studies of the newer agents are needed to more carefully assess long-term safety, said Dr. Stuenkel of the University of California, San Diego.
She reported having no financial disclosures.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
On Twitter @sherryboschert
HONOLULU– Uses for selective estrogen receptor modulators have grown beyond prevention of breast cancer or osteoporosis to treatment of postmenopausal symptoms.
Dr. Cynthia Stuenkel spoke about selective estrogen receptor modifiers (SERMs) and menopause in a keynote address at the annual meeting of the American Society for Reproductive Medicine.
In a video interview, Dr. Stuenkel talks about two of the newer SERM options – ospemifene for dyspareunia and a combination of the SERM bazedoxifene and conjugated equine estrogens that’s available outside of the United States to treat vasomotor symptoms or for prevention of bone loss.
These new tools expand clinical options – but, as with any new therapy – longer and larger studies of the newer agents are needed to more carefully assess long-term safety, said Dr. Stuenkel of the University of California, San Diego.
She reported having no financial disclosures.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
On Twitter @sherryboschert
EXPERT ANALYSIS FROM 2014 ASRM
VIDEO: More gonadotropin, fewer live births
SAN FRANCISCO– The higher the dose of gonadotropin for ovarian stimulation, the lower the live birth rate, a retrospective study of 541,967 cycles of assisted reproductive technology showed.
The inverse correlation was less evident in older patients than in younger patients and in those who might be expected have a more normal response, Dr. Valerie L. Baker and her associates reported at the annual meeting of the American Society for Reproductive Medicine.
The findings were consistent regardless of the number of oocytes retrieved or the woman’s age, said Dr. Baker, chief of the division of reproductive endocrinology and infertility at Stanford (Calif.) University.
In a video interview, she talked about the study and why it has made her think twice about using very high doses of gonadotropins.
Dr. Baker reported financial associations with Good Start Genetics, Ovuline, Roche, the Society for Assisted Reproductive Technologies, and Teva Pharmaceuticals.
On Twitter @sherryboschert
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
SAN FRANCISCO– The higher the dose of gonadotropin for ovarian stimulation, the lower the live birth rate, a retrospective study of 541,967 cycles of assisted reproductive technology showed.
The inverse correlation was less evident in older patients than in younger patients and in those who might be expected have a more normal response, Dr. Valerie L. Baker and her associates reported at the annual meeting of the American Society for Reproductive Medicine.
The findings were consistent regardless of the number of oocytes retrieved or the woman’s age, said Dr. Baker, chief of the division of reproductive endocrinology and infertility at Stanford (Calif.) University.
In a video interview, she talked about the study and why it has made her think twice about using very high doses of gonadotropins.
Dr. Baker reported financial associations with Good Start Genetics, Ovuline, Roche, the Society for Assisted Reproductive Technologies, and Teva Pharmaceuticals.
On Twitter @sherryboschert
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
SAN FRANCISCO– The higher the dose of gonadotropin for ovarian stimulation, the lower the live birth rate, a retrospective study of 541,967 cycles of assisted reproductive technology showed.
The inverse correlation was less evident in older patients than in younger patients and in those who might be expected have a more normal response, Dr. Valerie L. Baker and her associates reported at the annual meeting of the American Society for Reproductive Medicine.
The findings were consistent regardless of the number of oocytes retrieved or the woman’s age, said Dr. Baker, chief of the division of reproductive endocrinology and infertility at Stanford (Calif.) University.
In a video interview, she talked about the study and why it has made her think twice about using very high doses of gonadotropins.
Dr. Baker reported financial associations with Good Start Genetics, Ovuline, Roche, the Society for Assisted Reproductive Technologies, and Teva Pharmaceuticals.
On Twitter @sherryboschert
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
AT 2014 ASRM
VIDEO: Ovarian Function Is Exciting Possible CV Risk Marker
HONOLULU– A woman’s ovarian “clock” is dissociated from her general health, according to widely accepted thinking – but a new study has suggested the opposite.
That study showed greater cardiovascular risk in women with markers of greater ovarian aging. Dr. Marcelle I. Cedars of the University of California, San Francisco, and her associates presented the results at the annual meeting of the American Society for Reproductive Medicine, where the study won an award.
In a video interview, the society’s vice president, Dr. Owen K. Davis, described the potential significance of the study.
Women with cardiovascular disease tend to get diagnosed later and have worse outcomes, compared with men. If markers of ovarian function can help identify cardiovascular risk earlier in some women, the women may be candidates for more intensive surveillance, said Dr. Davis, professor of ob.gyn. and reproductive medicine at Weill Cornell Medical College, New York.
Dr. Davis reported having no financial disclosures.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
HONOLULU– A woman’s ovarian “clock” is dissociated from her general health, according to widely accepted thinking – but a new study has suggested the opposite.
That study showed greater cardiovascular risk in women with markers of greater ovarian aging. Dr. Marcelle I. Cedars of the University of California, San Francisco, and her associates presented the results at the annual meeting of the American Society for Reproductive Medicine, where the study won an award.
In a video interview, the society’s vice president, Dr. Owen K. Davis, described the potential significance of the study.
Women with cardiovascular disease tend to get diagnosed later and have worse outcomes, compared with men. If markers of ovarian function can help identify cardiovascular risk earlier in some women, the women may be candidates for more intensive surveillance, said Dr. Davis, professor of ob.gyn. and reproductive medicine at Weill Cornell Medical College, New York.
Dr. Davis reported having no financial disclosures.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
HONOLULU– A woman’s ovarian “clock” is dissociated from her general health, according to widely accepted thinking – but a new study has suggested the opposite.
That study showed greater cardiovascular risk in women with markers of greater ovarian aging. Dr. Marcelle I. Cedars of the University of California, San Francisco, and her associates presented the results at the annual meeting of the American Society for Reproductive Medicine, where the study won an award.
In a video interview, the society’s vice president, Dr. Owen K. Davis, described the potential significance of the study.
Women with cardiovascular disease tend to get diagnosed later and have worse outcomes, compared with men. If markers of ovarian function can help identify cardiovascular risk earlier in some women, the women may be candidates for more intensive surveillance, said Dr. Davis, professor of ob.gyn. and reproductive medicine at Weill Cornell Medical College, New York.
Dr. Davis reported having no financial disclosures.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
EXPERT ANALYSIS FROM ASRM 2014
VIDEO: Ovarian function is exciting possible CV risk marker
HONOLULU– A woman’s ovarian “clock” is dissociated from her general health, according to widely accepted thinking – but a new study has suggested the opposite.
That study showed greater cardiovascular risk in women with markers of greater ovarian aging. Dr. Marcelle I. Cedars of the University of California, San Francisco, and her associates presented the results at the annual meeting of the American Society for Reproductive Medicine, where the study won an award.
In a video interview, the society’s vice president, Dr. Owen K. Davis, described the potential significance of the study.
Women with cardiovascular disease tend to get diagnosed later and have worse outcomes, compared with men. If markers of ovarian function can help identify cardiovascular risk earlier in some women, the women may be candidates for more intensive surveillance, said Dr. Davis, professor of ob.gyn. and reproductive medicine at Weill Cornell Medical College, New York.
Dr. Davis reported having no financial disclosures.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
On Twitter @sherryboschert
HONOLULU– A woman’s ovarian “clock” is dissociated from her general health, according to widely accepted thinking – but a new study has suggested the opposite.
That study showed greater cardiovascular risk in women with markers of greater ovarian aging. Dr. Marcelle I. Cedars of the University of California, San Francisco, and her associates presented the results at the annual meeting of the American Society for Reproductive Medicine, where the study won an award.
In a video interview, the society’s vice president, Dr. Owen K. Davis, described the potential significance of the study.
Women with cardiovascular disease tend to get diagnosed later and have worse outcomes, compared with men. If markers of ovarian function can help identify cardiovascular risk earlier in some women, the women may be candidates for more intensive surveillance, said Dr. Davis, professor of ob.gyn. and reproductive medicine at Weill Cornell Medical College, New York.
Dr. Davis reported having no financial disclosures.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
On Twitter @sherryboschert
HONOLULU– A woman’s ovarian “clock” is dissociated from her general health, according to widely accepted thinking – but a new study has suggested the opposite.
That study showed greater cardiovascular risk in women with markers of greater ovarian aging. Dr. Marcelle I. Cedars of the University of California, San Francisco, and her associates presented the results at the annual meeting of the American Society for Reproductive Medicine, where the study won an award.
In a video interview, the society’s vice president, Dr. Owen K. Davis, described the potential significance of the study.
Women with cardiovascular disease tend to get diagnosed later and have worse outcomes, compared with men. If markers of ovarian function can help identify cardiovascular risk earlier in some women, the women may be candidates for more intensive surveillance, said Dr. Davis, professor of ob.gyn. and reproductive medicine at Weill Cornell Medical College, New York.
Dr. Davis reported having no financial disclosures.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
On Twitter @sherryboschert
EXPERT ANALYSIS FROM ASRM 2014
