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High prevalence of hypogonadism, obesity and hypertension in patients presenting to an andrology clinic
this issue. The study objective was to assess public opinion regarding provision of ART to obese women in the United States. DESIGN: Internet-based survey of U.S. residents ages 18-75 consisting of 12 questions regarding use of ART in obese women and 25 demographic questions. MATERIALS AND METHODS: Descriptive statistics illustrate demographics of the population. Multivariate odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using unconditional logistic regression to describe predictors of response based on demographic characteristics. RESULTS: 1049 individuals completed the survey. 60.7% of respondents supported the use of ART in obese women. Adjusting for age and gender, the odds of supporting ART for obese women were over twice as high in participants with BMIR40 kg/m2 as compared to normal weight respondents (OR¼2.87, 95% CI¼1.28-6.44). 55% of participants supported the implementation of a BMI limit for access to ART services. Increasing education (P-value¼0.02) and BMI (P-value¼0.01) were inversely associated with support of a BMI limit. Individuals who had themselves used ART were also less likely (OR¼0.27, 95% CI¼0.07-0.99) to support implementation of a limit. CONCLUSION: While a majority of the American public supports the use of ART in obese women, greater than 50% also support implementation of a BMI limit for access to these services.
P-316 Wednesday, October 24, 2012 HIGH PREVALENCE OF HYPOGONADISM, OBESITY AND HYPERTENSION IN PATIENTS PRESENTING TO AN ANDROLOGY CLINIC. A. Mehta, P. Stahl, D. A. Paduch. Urology, Weill Cornell Medical College, New York, NY. OBJECTIVE: To assess the prevalence of and relationships between hypogonadism, obesity and hypertension in the outpatient andrology clinical setting. DESIGN: Retrospective chart review. MATERIALS AND METHODS: A chart review of consecutive new patients presenting to our andrology clinic from 2005 to present was performed. Men aged 18-80 yrs, with baseline serum hormone analyses prior to intervention, were identified. Those with prior history of testosterone (T) supplementation, aromatase inhibitor use, gonadotropin therapy, Klinefelter syndrome, orchiectomy or prostatectomy were excluded. Data on demographics, serum hormone profiles, and medical comorbidites was abstracted, and analyzed by ANOVA and linear regression using JMP statistical software. RESULTS: 381 men were included in the final analysis. Mean age was 43 yrs (95% CI: 41.5-44.5). 43% (165/381) of patients were overweight and 25% (94/381) were obese. Systolic and/or diastolic blood pressure was elevated in 19% and 58% of patients, respectively. Hypogonadism, defined as serum T<300 ng/dL was noted in 34% (128/381) of men. Age was significantly correlated with BMI. Men with normal BMI were younger than overweight or obese men (36.8 vs. 41.8 vs. 44.6 yrs, respectively, P¼0.001). Obese men were more likely to have systolic and/or diastolic dysfunction compared to overweight or normal men (P<0.01). Serum T was significantly negatively correlated with BMI (Pearson’s r¼-0.41, R2¼0.17; P¼0.048), but not with age, LH, FSH, or estradiol levels. CONCLUSION: Men presenting to our andrology clinic were at high risk for obesity, hypertension and hypogonadism. A significant, negative correlation was found between serum T and BMI, but not between serum T and age. These data suggest that the increased incidence of hypogonadism with age is more likely due to a concomitant increase in medical comorbidities than age alone. The andrological evaluation is an important opportunity for identification of significant and modifiable medical conditions in young men.
P-317 Wednesday, October 24, 2012 EMBRYO MORPHOKINETICS IS NOT AFFECTED BY FEMALE OBESITY. J. Bellver, A. Mifsud, N. Grau, J. M. De los Santos, L. Privitera, M. Meseguer. Instituto Valenciano de Infertilidad, Valencia, Spain. OBJECTIVE: To analyze whether exact timing of main embryo development events (morphokinetics) is affected by women obesity. DESIGN: Retrospective analysis of 89 women and 424 embryos from IVF by time-lapse technology (EmbryoViewer workstation; Unisense FetiliTech, Aarhus, Denmark).
S206
ASRM Abstracts
MATERIALS AND METHODS: Three groups of women were compared: a) Normoweight (body mass index (BMI)¼20-24.9 kg/m2) donors < 35 years old; n¼31, 111 embryos; b) Normoweight infertile patients; n¼45, 242 embryos; c) Obese (BMI > 30 kg/m2) infertile patients; n¼13, 71 embryos). In groups b) and c) patients presented tubal pathology, intrauterine insemination failure or unknown infertility, < 38 years, no endometriosis, and underwent a first IVF cycle. No severe sperm alteration or male obesity was present. ICSI was employed for fertilization and embryos were followed until day 3. The precise timing of cell divisions, duration of cell cycles between divisions, and categories of dynamic embryo quality were assessed. Student’s ttest was used for comparison of means of timings and the Chi-squared test for comparison of proportions. A P-value <0.05 was considered significant. RESULTS: Maternal age was significantly higher in infertile patients than in donors. Times to 2, 3, 4, and 5 cell divisions (t2, t3, t4, and t5) were similar in both groups of infertile patients, but significantly lower than in donors. The duration and the synchrony of the second cycle (cc2 (t3-t2) and s2 (t4-t3)) was similar among groups. Moreover, when a hierarchical classification of embryo quality was performed according to parameters of embryo division obtaining five grades (A, B, C, D, E), the proportion of embryos included in each category was also similar among the three groups studied (P¼0.467). CONCLUSION: Despite the quicker cell division observed in oocyte donors, the percentage of optimal embryos was not affected by the origin of oocytes or the presence of obesity. Supported by: CDTI-EUREKA E!4503 (Spanish Government and European Community) grant. OVARIAN FUNCTION P-318 Wednesday, October 24, 2012 EFFECTS OF PIOGLITAZONE ON FOLLICULAR DEVELOPMENT AND STEROIDOGENESIS IN IN VITRO MOUSE PREANTRAL FOLLICLE CULTURE. S. Hara, T. Takahashi, K. Matsuo, H. Igarashi, H. Kurachi. Department of Obstetrics and Gynecology, Yamagata University Faculty of Medicine, Yamagata, Japan. OBJECTIVE: Pioglitazone is a thiazolidinedione derivative that acts by improving an insulin resistance via peroxisome proliferator-activated receptor-g (PPAR-g) pathway. It is reported that pioglitazone improves the anovulation status in polycystic ovary syndrome (PCOS) patients. However, the direct effects of pioglitazone on the ovarian follicular development are unclear. In the present study, we examined whether pioglitazone directly affects ovarian follicular development and steroidogenesis. DESIGN: Animal model study. MATERIALS AND METHODS: Preantral follicles from the mice ovaries were subjected to in vitro culture to examine the effects of various compounds on the FSH-induced follicle development and steroidogenesis. We assessed the follicle survival rate, antral-like cavity formation rate, the levels of E2 in the culture medium, and the ovulation rate. As it is known that the serum levels of tumor necrosis factor-a (TNF-a) are increased in PCOS women, we examined the effects of TNF-a on follicular development and steroidogenesis. Next, we examined whether pioglitazone could rescue the inhibition of FSH-induced follicular development and steroidogenesis by TNF-a. We examined the expressions of PPAR subtypes in mouse preantral follicles. RESULTS: TNF-a inhibited the FSH-induced follicle survival, antral-like cavity formation, E2 concentration, and the ovulation rate. 5 mM of pioglitazone treatment significantly improved the inhibition of follicle survival (29 vs 56%), antral-like cavity formation (29 vs 48%), E2 secretion (211 vs 291 pg/ml), and ovulation rate (9 vs 28%) by TNF-a. While the mRNA expressions of PPAR-a and -g were observed, the protein of PPAR-g was only expressed in the mouse preantral follicles. CONCLUSION: Pioglitazone improved the inhibition of FSH-induced follicle development and steroidogenesis by TNF-a in the in vitro mouse follicle culture. The results suggest that pioglitazone may directly affect the follicular development and steroidogenesis through the PPAR-g pathway in PCOS patients. P-319 Wednesday, October 24, 2012 POST-GENOMIC MOLECULAR FINGERPRINTS AND THEIR ASSOCIATION TO POOR OVARIAN RESPONSE IN WOMEN SUBMITTED TO IVF. T. Regiani,a L. do V. T. da Costa,a E. J. Pilau,b R. P. Bertolla,b F. C. Gozzo,b E. G. Lo Turco.a aSurgery/Urology-Human Reproduction Section, S~ao Paulo Federal University, S~ao Paulo, SP, Brazil; b Organic Chemistry, Institute of Chemistry, Campinas, SP, Brazil.
Vol. 98, No. 3, Supplement, September 2012
P-316 Wednesday, October 24, 2012 HIGH PREVALENCE OF HYPOGONADISM, OBESITY AND HYPERTENSION IN PATIENTS PRESENTING TO AN ANDROLOGY CLINIC. A. Mehta, P. Stahl, D. A. Paduch. Urology, Weill Cornell Medical College, New York, NY. OBJECTIVE: To assess the prevalence of and relationships between hypogonadism, obesity and hypertension in the outpatient andrology clinical setting. DESIGN: Retrospective chart review. MATERIALS AND METHODS: A chart review of consecutive new patients presenting to our andrology clinic from 2005 to present was performed. Men aged 18-80 yrs, with baseline serum hormone analyses prior to intervention, were identified. Those with prior history of testosterone (T) supplementation, aromatase inhibitor use, gonadotropin therapy, Klinefelter syndrome, orchiectomy or prostatectomy were excluded. Data on demographics, serum hormone profiles, and medical comorbidites was abstracted, and analyzed by ANOVA and linear regression using JMP statistical software. RESULTS: 381 men were included in the final analysis. Mean age was 43 yrs (95% CI: 41.5-44.5). 43% (165/381) of patients were overweight and 25% (94/381) were obese. Systolic and/or diastolic blood pressure was elevated in 19% and 58% of patients, respectively. Hypogonadism, defined as serum T<300 ng/dL was noted in 34% (128/381) of men. Age was significantly correlated with BMI. Men with normal BMI were younger than overweight or obese men (36.8 vs. 41.8 vs. 44.6 yrs, respectively, P¼0.001). Obese men were more likely to have systolic and/or diastolic dysfunction compared to overweight or normal men (P<0.01). Serum T was significantly negatively correlated with BMI (Pearson’s r¼-0.41, R2¼0.17; P¼0.048), but not with age, LH, FSH, or estradiol levels. CONCLUSION: Men presenting to our andrology clinic were at high risk for obesity, hypertension and hypogonadism. A significant, negative correlation was found between serum T and BMI, but not between serum T and age. These data suggest that the increased incidence of hypogonadism with age is more likely due to a concomitant increase in medical comorbidities than age alone. The andrological evaluation is an important opportunity for identification of significant and modifiable medical conditions in young men.
P-317 Wednesday, October 24, 2012 EMBRYO MORPHOKINETICS IS NOT AFFECTED BY FEMALE OBESITY. J. Bellver, A. Mifsud, N. Grau, J. M. De los Santos, L. Privitera, M. Meseguer. Instituto Valenciano de Infertilidad, Valencia, Spain. OBJECTIVE: To analyze whether exact timing of main embryo development events (morphokinetics) is affected by women obesity. DESIGN: Retrospective analysis of 89 women and 424 embryos from IVF by time-lapse technology (EmbryoViewer workstation; Unisense FetiliTech, Aarhus, Denmark).
S206
ASRM Abstracts
MATERIALS AND METHODS: Three groups of women were compared: a) Normoweight (body mass index (BMI)¼20-24.9 kg/m2) donors < 35 years old; n¼31, 111 embryos; b) Normoweight infertile patients; n¼45, 242 embryos; c) Obese (BMI > 30 kg/m2) infertile patients; n¼13, 71 embryos). In groups b) and c) patients presented tubal pathology, intrauterine insemination failure or unknown infertility, < 38 years, no endometriosis, and underwent a first IVF cycle. No severe sperm alteration or male obesity was present. ICSI was employed for fertilization and embryos were followed until day 3. The precise timing of cell divisions, duration of cell cycles between divisions, and categories of dynamic embryo quality were assessed. Student’s ttest was used for comparison of means of timings and the Chi-squared test for comparison of proportions. A P-value <0.05 was considered significant. RESULTS: Maternal age was significantly higher in infertile patients than in donors. Times to 2, 3, 4, and 5 cell divisions (t2, t3, t4, and t5) were similar in both groups of infertile patients, but significantly lower than in donors. The duration and the synchrony of the second cycle (cc2 (t3-t2) and s2 (t4-t3)) was similar among groups. Moreover, when a hierarchical classification of embryo quality was performed according to parameters of embryo division obtaining five grades (A, B, C, D, E), the proportion of embryos included in each category was also similar among the three groups studied (P¼0.467). CONCLUSION: Despite the quicker cell division observed in oocyte donors, the percentage of optimal embryos was not affected by the origin of oocytes or the presence of obesity. Supported by: CDTI-EUREKA E!4503 (Spanish Government and European Community) grant. OVARIAN FUNCTION P-318 Wednesday, October 24, 2012 EFFECTS OF PIOGLITAZONE ON FOLLICULAR DEVELOPMENT AND STEROIDOGENESIS IN IN VITRO MOUSE PREANTRAL FOLLICLE CULTURE. S. Hara, T. Takahashi, K. Matsuo, H. Igarashi, H. Kurachi. Department of Obstetrics and Gynecology, Yamagata University Faculty of Medicine, Yamagata, Japan. OBJECTIVE: Pioglitazone is a thiazolidinedione derivative that acts by improving an insulin resistance via peroxisome proliferator-activated receptor-g (PPAR-g) pathway. It is reported that pioglitazone improves the anovulation status in polycystic ovary syndrome (PCOS) patients. However, the direct effects of pioglitazone on the ovarian follicular development are unclear. In the present study, we examined whether pioglitazone directly affects ovarian follicular development and steroidogenesis. DESIGN: Animal model study. MATERIALS AND METHODS: Preantral follicles from the mice ovaries were subjected to in vitro culture to examine the effects of various compounds on the FSH-induced follicle development and steroidogenesis. We assessed the follicle survival rate, antral-like cavity formation rate, the levels of E2 in the culture medium, and the ovulation rate. As it is known that the serum levels of tumor necrosis factor-a (TNF-a) are increased in PCOS women, we examined the effects of TNF-a on follicular development and steroidogenesis. Next, we examined whether pioglitazone could rescue the inhibition of FSH-induced follicular development and steroidogenesis by TNF-a. We examined the expressions of PPAR subtypes in mouse preantral follicles. RESULTS: TNF-a inhibited the FSH-induced follicle survival, antral-like cavity formation, E2 concentration, and the ovulation rate. 5 mM of pioglitazone treatment significantly improved the inhibition of follicle survival (29 vs 56%), antral-like cavity formation (29 vs 48%), E2 secretion (211 vs 291 pg/ml), and ovulation rate (9 vs 28%) by TNF-a. While the mRNA expressions of PPAR-a and -g were observed, the protein of PPAR-g was only expressed in the mouse preantral follicles. CONCLUSION: Pioglitazone improved the inhibition of FSH-induced follicle development and steroidogenesis by TNF-a in the in vitro mouse follicle culture. The results suggest that pioglitazone may directly affect the follicular development and steroidogenesis through the PPAR-g pathway in PCOS patients. P-319 Wednesday, October 24, 2012 POST-GENOMIC MOLECULAR FINGERPRINTS AND THEIR ASSOCIATION TO POOR OVARIAN RESPONSE IN WOMEN SUBMITTED TO IVF. T. Regiani,a L. do V. T. da Costa,a E. J. Pilau,b R. P. Bertolla,b F. C. Gozzo,b E. G. Lo Turco.a aSurgery/Urology-Human Reproduction Section, S~ao Paulo Federal University, S~ao Paulo, SP, Brazil; b Organic Chemistry, Institute of Chemistry, Campinas, SP, Brazil.
Vol. 98, No. 3, Supplement, September 2012