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Attributes not known to cause infertility: a leading perceived etiology of infertility of African-American participants in the study of women's health across the nation (SWAN)
MATERIALS AND METHODS: Lipoaspirate was obtained from SC abdominal adipose of postmenopausal non-obese women. ASCs were isolated and then cultured in DMEM/FCS until confluency. ASCs were incubated in adipogenic medium (with FCS, insulin, dexamethasone, IBMX and PPARg agonist) for 0.5, 3 and 7 days with or without 50 nM T (based on dose-response studies [0-100 nM T]). In some studies, these cells also were treated with the androgen receptor (AR) antagonist flutamide. Preadipocyte development was assessed by immunofluorescence using Nile Red and DAPI. Expression of adipogenic gene markers, including BBS4, PPARg, C/EBPa and AP2, were determined by qRT-PCR. RESULTS: Exposure of ASCs to T for 0.5, but not 3 or 7 days, suppressed ASC differentiation to preadipocytes, with ASCs retaining a spindle shape and fewer lipid droplets vs. controls. T inhibition of ASC differentiation to preadipocytes was accompanied by significant suppression of BBS4, PPARg, C/EBPa and AP2 gene expressions by 86%, 47%, 61% and 53%, respectively, and was reversed by flutamide. CONCLUSION: In SC abdominal adipose, T acts through the AR to inhibit differentiation of ASCs to preadipocytes. The ability of androgen excess to inhibit adipogenesis at the early stage of cell differentiation could reduce the capacity of this adipose depot to safely store fat, promoting insulin resistance through ectopic lipid accumulation. Supported by: Depart OB/GYN, UCLA.
P-20 Tuesday, October 18, 2011 ATTRIBUTES NOT KNOWN TO CAUSE INFERTILITY: A LEADING PERCEIVED ETIOLOGY OF INFERTILITY OF AFRICANAMERICAN PARTICIPANTS IN THE STUDY OF WOMEN’S HEALTH ACROSS THE NATION (SWAN). A. E. Karmon, S. Hailpern, G. Neal-Perry, R. Green, N. Santoro, A. J. Polotsky. Obstetrics and Gynecology, University of Colorado, Aurora, CO; Obstetrics and Gynecology, Albert Einstein College of Medicine, Bronx, NY. OBJECTIVE: Is ethnicity linked with self-perceived difficulties in becoming pregnant? DESIGN: Cross-sectional. MATERIALS AND METHODS: 3302 SWAN participants (mean age 45.8) were asked ‘‘Have you ever had a period of 12 months when you could not get pregnant although you were attempting or were letting yourself get pregnant?’’ Affirmative responders were asked to fill in a reason for not getting pregnant which was abstracted as an etiology of infertility. Some entries were attributes not known to cause infertility (such as ‘tipped uterus’). Logistic models were done with perceived etiology of infertility as an outcome while adjusting for study site, insurance, and marital and socio-economic status with Caucasian women used as a reference. RESULTS: 747 subjects had a history of infertility. 302 women stated a reason for not getting pregnant. Perceived Etiology for Infertility by Ethnicity AfricanCaucasian American Chinese Hispanic Japanese Unexplained Tubal Male Anovulation Diminished Ovarian Reserve Endometriosis Uterine Attributes not known to cause infertility
p
3.7 (6) 20.7 (34) 24.4 (40) 16.5 (27) 6.7 (11)
1.2 (1) 30.5 (25) 8.5 (7) 13.4 (11) 4.9 (4)
6.7(1) 13.3(2) 6.7(1) 6.7(1) 13.3(2)
5.0(1) 20.0(4) 5.0(1) 15.0(3) 5.0(1)
9.5(2) 23.8(5) 23.8(5) 4.8(1) 14.3(3)
0.20 0.45 <0.01 0.67 0.36
7.9 (13) 1.8 (3) 18.3 (30)
6.1 (5) 3.7 (3) 31.7 (26)
6.7(1) 6.7(1) 40.0(6)
0 5.0(1) 45.0(9)
4.8(1) 4.8(1) 14.3(3)
0.85 0.31 <0.01
Presented as % (n), p value from Fisher’s exact 74 women (24.5%) reported attributes not known to cause infertility, with African-Americans having been most likely to report these attributes (OR 2.81; 95% CI 1.26-6.28) as the perceived reason for not becoming pregnant. CONCLUSION: Self-perceived difficulties in becoming pregnant significantly vary by ethnicity. Misattribution of causes of infertility is common and merits further consideration with respect to likelihood to seek treatment, language or cultural barriers as well as possible physician misattribution. Supported by: NIH/DHHS NR004061, AG012505, AG012535, AG012531, AG012539, AG012546, AG012553, AG012554, AG012495.
FERTILITY & STERILITYÒ
P-21 Tuesday, October 18, 2011 HOW LONG DOES IT TAKE THE AVERAGE COUPLE TO GET PREGNANT? A SYSTEMATIC REVIEW OF WHAT WE KNOW. C. D. Lynch. Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH. OBJECTIVE: To estimate the cumulative probability of pregnancy at six months and one year among couples trying to conceive. DESIGN: Systematic review with targeted follow-up of authors. MATERIALS AND METHODS: We conducted a systematic review of the literature to identify all studies reporting the distribution of time to pregnancy. In May 2002, we conducted a search of MEDLINE using the following terms: prospective studies [MeSH term] and (fertility or fecundity or time to pregnancy or urine or pregnancy). Over the next few years, we contacted each of the study authors with a detailed list of questions based on data abstracted from their published reports. The search has been updated annually since 2002 and additional studies have been identified through manual review of references. RESULTS: Of the 18 originally identified studies, five were excluded due to small sample size or because they involved a clinical study of a select population. Two additional studies were identified after the initial search resulting in a total of 15 relevant manuscripts. In an effort to produce cumulative probability of pregnancy estimates in an unselected population, we excluded two additional studies among semiconductor workers, two studies involving use of fertility awareness methods and three studies in which time to pregnancy data were not available. The eight remaining studies that encompassed 2,357 women were used to calculate pooled estimates of the cumulative probability of pregnancy. By the end of six months, 66.3% of women in these studies (range 47.4-85.1%) were pregnant. By the end of 12 months, the pregnancy rate was 81.3% (range 61.8-89.7%). CONCLUSION: The cumulative probability of pregnancy has not changed markedly since Guttmacher reported his estimates based on data from 5,574 women in 1956. A little over 80% of women can expect to become pregnant within 12 months of beginning to try to conceive. Supported by: Intramural research program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development.
P-22 Tuesday, October 18, 2011 THE INFLUENCE OF BODY MASS INDEX (BMI) ON PREGNANCY OUTCOMES AMONG JAPANESE INFERTILE WOMEN. M. Funabiki, S. Taguchi, T. Hayashi, Y. Tada, K. Kitaya, Y. Nakamura. Oak Clinic, Osaka, Japan. OBJECTIVE: The World Health Organization defines obesity as BMI R30 kg/m2. Japan Society for the Study of Obesity (JASSO) defines obesity as BMIR25 kg/m2. The objective of this study was to examine the effect of BMI on infertility treatment among Japanese women based on JASSO criteria. DESIGN: Retrospective study MATERIALS AND METHODS: 859 patients undergoing infertility treatment from June 2006 to March 2010 were allocated into 3 main groups according to JASSO criteria:low (n ¼ 152), normal (n ¼ 648), and high (n ¼ 59) BMI. They were further subdivided by treatment into 2 subgroups: no in vitro fertilization (IVF) (n ¼ 421) and IVF (n ¼ 438). The main outcome measures were pregnancy rate (PR), ongoing pregnancy rate (OPR), and miscarriage rate (MR). Statistics testing included Student’s t-test, Pearson’s chi square test. RESULTS: PR was significantly lower in the high BMI group (32/59, 54.2%) than in the normal BMI group (440/648,67.9%; P<0.05). Low BMI group showed no significant impact on fertility. Compared to IVF patients with normal BMI (n ¼ 332), IVF patients with high BMI (n ¼ 34) had a tendency towards lower PR (11/34, 32.3% vs. 117/ 332, 35.2%), OPR (6/11, 54.5% vs. 99/117, 84.6%), higher MR (5/11,45.4% vs.18/117, 15.3%), lower fertilization rate (164/301, 52.5% vs. 2257/3898, 57.9%); a significant reduction in the number of oocytes retrieved (8.8 vs. 11.7 ;P<0.05), in the number of good quality embryos (47/116, 40.5% vs. 873/1517,57.5%; P<0.05) and a significant increase in the number of bad quality embryos (29/116, 25% vs. 173/1517, 11.4%; P<0.05). CONCLUSION: Obesity has a deleterious effect on fertility. This is clearly obvious among high BMI women seeking IVF, who showed fewer retrieved oocetes, a deterioration in embryo quality. No significant difference was observed in the implantation rate between normal BMI and high BMI women. However, the bad quality embryos may explain the poor outcomes in high BMI women.
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P-20 Tuesday, October 18, 2011 ATTRIBUTES NOT KNOWN TO CAUSE INFERTILITY: A LEADING PERCEIVED ETIOLOGY OF INFERTILITY OF AFRICANAMERICAN PARTICIPANTS IN THE STUDY OF WOMEN’S HEALTH ACROSS THE NATION (SWAN). A. E. Karmon, S. Hailpern, G. Neal-Perry, R. Green, N. Santoro, A. J. Polotsky. Obstetrics and Gynecology, University of Colorado, Aurora, CO; Obstetrics and Gynecology, Albert Einstein College of Medicine, Bronx, NY. OBJECTIVE: Is ethnicity linked with self-perceived difficulties in becoming pregnant? DESIGN: Cross-sectional. MATERIALS AND METHODS: 3302 SWAN participants (mean age 45.8) were asked ‘‘Have you ever had a period of 12 months when you could not get pregnant although you were attempting or were letting yourself get pregnant?’’ Affirmative responders were asked to fill in a reason for not getting pregnant which was abstracted as an etiology of infertility. Some entries were attributes not known to cause infertility (such as ‘tipped uterus’). Logistic models were done with perceived etiology of infertility as an outcome while adjusting for study site, insurance, and marital and socio-economic status with Caucasian women used as a reference. RESULTS: 747 subjects had a history of infertility. 302 women stated a reason for not getting pregnant. Perceived Etiology for Infertility by Ethnicity AfricanCaucasian American Chinese Hispanic Japanese Unexplained Tubal Male Anovulation Diminished Ovarian Reserve Endometriosis Uterine Attributes not known to cause infertility
p
3.7 (6) 20.7 (34) 24.4 (40) 16.5 (27) 6.7 (11)
1.2 (1) 30.5 (25) 8.5 (7) 13.4 (11) 4.9 (4)
6.7(1) 13.3(2) 6.7(1) 6.7(1) 13.3(2)
5.0(1) 20.0(4) 5.0(1) 15.0(3) 5.0(1)
9.5(2) 23.8(5) 23.8(5) 4.8(1) 14.3(3)
0.20 0.45 <0.01 0.67 0.36
7.9 (13) 1.8 (3) 18.3 (30)
6.1 (5) 3.7 (3) 31.7 (26)
6.7(1) 6.7(1) 40.0(6)
0 5.0(1) 45.0(9)
4.8(1) 4.8(1) 14.3(3)
0.85 0.31 <0.01
Presented as % (n), p value from Fisher’s exact 74 women (24.5%) reported attributes not known to cause infertility, with African-Americans having been most likely to report these attributes (OR 2.81; 95% CI 1.26-6.28) as the perceived reason for not becoming pregnant. CONCLUSION: Self-perceived difficulties in becoming pregnant significantly vary by ethnicity. Misattribution of causes of infertility is common and merits further consideration with respect to likelihood to seek treatment, language or cultural barriers as well as possible physician misattribution. Supported by: NIH/DHHS NR004061, AG012505, AG012535, AG012531, AG012539, AG012546, AG012553, AG012554, AG012495.
FERTILITY & STERILITYÒ
P-21 Tuesday, October 18, 2011 HOW LONG DOES IT TAKE THE AVERAGE COUPLE TO GET PREGNANT? A SYSTEMATIC REVIEW OF WHAT WE KNOW. C. D. Lynch. Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH. OBJECTIVE: To estimate the cumulative probability of pregnancy at six months and one year among couples trying to conceive. DESIGN: Systematic review with targeted follow-up of authors. MATERIALS AND METHODS: We conducted a systematic review of the literature to identify all studies reporting the distribution of time to pregnancy. In May 2002, we conducted a search of MEDLINE using the following terms: prospective studies [MeSH term] and (fertility or fecundity or time to pregnancy or urine or pregnancy). Over the next few years, we contacted each of the study authors with a detailed list of questions based on data abstracted from their published reports. The search has been updated annually since 2002 and additional studies have been identified through manual review of references. RESULTS: Of the 18 originally identified studies, five were excluded due to small sample size or because they involved a clinical study of a select population. Two additional studies were identified after the initial search resulting in a total of 15 relevant manuscripts. In an effort to produce cumulative probability of pregnancy estimates in an unselected population, we excluded two additional studies among semiconductor workers, two studies involving use of fertility awareness methods and three studies in which time to pregnancy data were not available. The eight remaining studies that encompassed 2,357 women were used to calculate pooled estimates of the cumulative probability of pregnancy. By the end of six months, 66.3% of women in these studies (range 47.4-85.1%) were pregnant. By the end of 12 months, the pregnancy rate was 81.3% (range 61.8-89.7%). CONCLUSION: The cumulative probability of pregnancy has not changed markedly since Guttmacher reported his estimates based on data from 5,574 women in 1956. A little over 80% of women can expect to become pregnant within 12 months of beginning to try to conceive. Supported by: Intramural research program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development.
P-22 Tuesday, October 18, 2011 THE INFLUENCE OF BODY MASS INDEX (BMI) ON PREGNANCY OUTCOMES AMONG JAPANESE INFERTILE WOMEN. M. Funabiki, S. Taguchi, T. Hayashi, Y. Tada, K. Kitaya, Y. Nakamura. Oak Clinic, Osaka, Japan. OBJECTIVE: The World Health Organization defines obesity as BMI R30 kg/m2. Japan Society for the Study of Obesity (JASSO) defines obesity as BMIR25 kg/m2. The objective of this study was to examine the effect of BMI on infertility treatment among Japanese women based on JASSO criteria. DESIGN: Retrospective study MATERIALS AND METHODS: 859 patients undergoing infertility treatment from June 2006 to March 2010 were allocated into 3 main groups according to JASSO criteria:low (n ¼ 152), normal (n ¼ 648), and high (n ¼ 59) BMI. They were further subdivided by treatment into 2 subgroups: no in vitro fertilization (IVF) (n ¼ 421) and IVF (n ¼ 438). The main outcome measures were pregnancy rate (PR), ongoing pregnancy rate (OPR), and miscarriage rate (MR). Statistics testing included Student’s t-test, Pearson’s chi square test. RESULTS: PR was significantly lower in the high BMI group (32/59, 54.2%) than in the normal BMI group (440/648,67.9%; P<0.05). Low BMI group showed no significant impact on fertility. Compared to IVF patients with normal BMI (n ¼ 332), IVF patients with high BMI (n ¼ 34) had a tendency towards lower PR (11/34, 32.3% vs. 117/ 332, 35.2%), OPR (6/11, 54.5% vs. 99/117, 84.6%), higher MR (5/11,45.4% vs.18/117, 15.3%), lower fertilization rate (164/301, 52.5% vs. 2257/3898, 57.9%); a significant reduction in the number of oocytes retrieved (8.8 vs. 11.7 ;P<0.05), in the number of good quality embryos (47/116, 40.5% vs. 873/1517,57.5%; P<0.05) and a significant increase in the number of bad quality embryos (29/116, 25% vs. 173/1517, 11.4%; P<0.05). CONCLUSION: Obesity has a deleterious effect on fertility. This is clearly obvious among high BMI women seeking IVF, who showed fewer retrieved oocetes, a deterioration in embryo quality. No significant difference was observed in the implantation rate between normal BMI and high BMI women. However, the bad quality embryos may explain the poor outcomes in high BMI women.
S115