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The relationship of bariatric surgery to Mullerian Inhibiting Substance
OBESITY AND METABOLISM P-238 NORMALIZATION OF REPRODUCTIVE HORMONES, INSULIN RESISTANCE AND ADIPOKINES AFTER BARIATRIC SURGERY OCCURS IN THE ABSENCE OF A RISE IN REVERSE T3. A. J. Polotsky, D. Rochester, A. Jain, G. Zeitlian, K. Gibbs, N. Santoro. Albert Einstein College of Medicine, Bronx, NY. OBJECTIVE: To determine the effects of large weight reduction on reproductive hormones and adipokines in adult women. DESIGN: Longitudinal observational study. MATERIALS AND METHODS: 11 eumenorrheic adult women (age 37.0 7.4) were sampled before and 6 months after bariatric surgery with daily, first morning urine collection for an entire menstrual cycle. Serum was collected in the early follicular phase at baseline and 3 and 6 months after surgery. Urine was assayed for LH, FSH, estrone conjugates (E1c) and pregnanediol glucuronide (Pdg) using established ELISAs. Hormones were summed across cycles, adjusted for creatinine and normalized to a 28 day cycle length. Group means were compared using paired t tests and repeated measures ANOVA as appropriate. RESULTS: Significant increases in Pdg and LH occurred in parallel with weight reduction. Among the adipokines, leptin was observed to decrease most dramatically, along with improvement of the fasting glucose/insulin ratio and increases in SHBG. Ghrelin was unaffected by bariatric surgery in our study sample. Throughout the rapid weight loss period, no significant change in TSH or reverse T3 were observed. TABLE 1. Urinary hormone excretion and adipokine changes before and after weight lose
Weight, kg BMI, kg/m2 Pdg, mg/mg Cr LH, mU/mg Cr FSH, mU/mg Cr E1c, ng/mg Cr Adiponectin, mg/mL Fasting Insulin, mU/mL Glucose/Insulin Leptin, ng/mL Ghrelin, pg/mL SHBG, nmol/L TSH, mIU/mL reverse T3, pg/mL
Baseline
3 months post-op
6 months post-op
P value
123.1 19.3 48.3 5.7 33.7 14.1 181.2 158.1 153.2 66.2 824.7 417.1 7.24 2.3 45.2 22.8 2.5 1.2 85.7 18.1 1298.7 520 54.1 21.4 1.71 0.6 0.24 0.06
102.7 18.3 40.2 5.2
89.8 18.3 35.4 5.6 78.6 32.0 292.1 112.6 178.4 84.1 605.4 236.3 10.2 3.4 13.0 6.0 9.3 7.5 44.2 38.1 1265.1 181 82.2 39.9 1.57 .8 0.26 0.04
<0.001 <0.001 0.008 0.009 0.47 0.06 0.02 0.003 <0.008 <0.001 0.6 0.02 0.45 0.06
8.7 3.1 16.6 7.2 6.2 2.2 48.9 29.9 1262.6 309 82.7 39.8 1.53 0.7 0.36 0.17
All values are mean SD. CONCLUSIONS: Large weight loss improved the adipokine profile and significantly increased Pdg and LH. Unlike normal weight women, very obese, ovulatory women who lose weight rapidly do not demonstrate increases in reverse T3. The data suggest that dynamic changes in adipose tissue-derived factors may serve as a permissive signal to the hypothalamic-pituitary-ovarian axis in the face of acute weight reduction in the very obese; alternatively fat-derived fuels may prevent disruption of the HPO axis despite rapid weight loss. Supported by: T32 HD040135 (AP), R21 DK 069349 (NS), K24 41978 (NS), RR 95261064 (GCRC) and Novo-Nordisk (NS). We gratefully acknowledge Dr. Philipp Scherer for running adiponectin assay and Barbara Isaac, RN for assistance with patient recruitment and study coordination. P-239 ARE IVF PATIENTS WITH AN INCREASED BODY MASS INDEX LESS LIKELY TO HAVE GOOD QUALITY EMBRYOS? D. M. Davies, A. Finn, I. Hardy, J. A. Hill. Embryology, Fertility Centers of New England, Reading, MA. OBJECTIVE: To determine whether a rising BMI has a negative effect on embryo quality based on the amount of embryos available for cryopreservation after selection for transfer. Each IVF cycle will ideally result in a cohort of 1–2 good quality embryos for transfer with excess embryos for cryopreservation. Factors that may influence embryo quality include the amount of stimulating drug administered as well as the length of time the patient is exposed to these medications. Patients with a high BMI require both increased
FERTILITY & STERILITYÒ
dosage and increased time on medication because of the impaired response of the ovaries to gonadotropin therapy. The purpose of this study was to test the hypothesis that there will be a gradual decline in number of embryos cryopreserved as BMI increased. DESIGN: Retrospective analysis of patients undergoing IVF/ICSI from January 2004–December 2006. All PGD, donor egg, patients with a BMI > 40.0, age > 42 and patients with embryos cryopreserved for reasons other than good quality after ET were excluded. MATERIALS AND METHODS: 1870 patients were analyzed between January 2004 and December of 2006. BMI was defined as: underweight <20, normal 20–24.9, overweight 25–29.9, obese class I 30–34.9 and obese class II 35–39.9 (WHO criteria). Chi square was used for statistical analysis. RESULTS: The number of good quality embryos available for cryopreservation after ET selection did not gradually decrease as patients BMI increases. Although not significant, there was a decrease from the obese class I category (28%) to obese class II (19%). The number of 7–8 cell embryos on day 3 did not decrease with a rising BMI. There was a significant decrease from the obese class I to obese class II (P<0.01). Also, a significant decrease in implantation rate from the normal weight group to the overweight group (P<0.001). TABLE. BMI and embryo quality
% embryos cryopreserved % 7–8 cell % Implantation rate % SAB
<19.9
20–24.9
29
26
25
28
19
38 25 4
36 24 4
39* 15A 4
40 15 4
34** 12 6
25–29.9
30–34.9
35–39.9
* P%0.025 **P%0.01AP%0.001. CONCLUSIONS: There was a significant decrease in the % of 7–8 cells from obese class I to obese class II, although, there was no significance in the amount of cryopreservation, suggesting that embryo quality was not negatively effected by a rise in BMI. A rise in BMI was correlated with decreased implantation potential and increased pregnancy loss. Further studies are needed to determine the cause of pregnancy loss and implantation failure in obese patients. Supported by: None.
P-240 THE RELATIONSHIP OF BARIATRIC SURGERY TO MULLERIAN INHIBITING SUBSTANCE. Z. O. Merhi, H. Minkoff, J. Feldman, J. Macura, D. B. Seifer. Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY; Department of Preventive Medicine and Community Health, SUNY Health Sciences Center at Brooklyn, Brooklyn, NY. OBJECTIVE: Mullerian Inhibiting Substance (MIS) is emerging as a predictor of ovarian reserve, and the frequency of bariatric surgical procedures have increased dramatically in reproductive aged women. The purpose of this study is to assess changes in plasma MIS after ‘‘dramatic’’ weight loss by bariatric surgery in morbidly obese reproductive aged women. DESIGN: A prospective study. MATERIALS AND METHODS: Sixteen patients, who underwent bariatric surgery, were enrolled in a prospective study evaluating MIS levels preoperatively and postoperatively. Since women aged less than 35 have the most reproductive potential and since women aged more than 35 and postmenopausal women have minimally detectable MIS, we have divided the participants into three groups. Group 1 included patients aged less than 35, group 2 included women aged more than 35 but not menopausal, and group 3 contained postmenopausal women. At the time of MIS sampling, a questionnaire was completed. Postoperative samples were taken between 43 and 151 days (mean SD ¼ 87 30) after the surgery. The blood was centrifuged and the plasma was stored at 80 C until assayed. The study was approved by the IRB of Maimonides Medical Center, and participants signed an informed consent. RESULTS: Seven participants were under 35 years old, four were above 35 years old and five were post-menopausal. Table 1 summarizes the demographic data and the clinical profile of the participants. MIS concentrations showed a 23.9% decrease (P¼0.034) in group 1 while BMI decreased by 14.5%.
S187
TABLE. Demographics and clinical profile
Group 1 (N ¼ 7) Age (years) [mean ( SD)] Ethnicity White Hispanic Black Other Irregular menses Yes No History of infertility Yes No History of PCOS Yes No Parity 0 1–2 >2 BMI Preoperative BMI (kg/m2) [mean ( SD)] Postoperative BMI (kg/m2) [mean ( SD)] MIS MIS preoperatively (ng/mL) (mean) MIS postoperatively (ng/mL) (mean)
29.6 (2.82)
Group 2 (N ¼ 4)
Group 3 (N ¼ 5)
40.5 (4.8)
51.2 (6.46)
4 3 0 0
4 0 0 0
3 1 1 0
1 6
1 3
2 5
0 4
0 5
1 6
1 3
0 5
1 2 4
0 2 2
0 3 2
NA NA
whereas fewer were aware of the risks of stillbirth (41.2%), cesarean section (62.7%), maternal death (47.1%), and having a child with a birth defect (41.2%). Overall, the subjects were most well-informed (>90%) about the effects of obesity on general health (increase in overall morbidity and mortality, hypertension, and diabetes). Most women were concerned about their weight (86.2%) and had attempted weight loss (94%). Only 15.7% had seen a nutritionist and 3.9% were following the AHA recommended daily exercise regimen. Currently 51% were not interested in losing weight before initiating infertility treatment secondary to the immediate desire to have a child. CONCLUSIONS: Our pilot study shows that women understand the risks of obesity on general health but are less knowledgeable of its effects on reproduction and pregnancy. Given the significant obesity-related reproductive health risks, patients should be aggressively educated and information on nutrition and exercise should be provided. Supported by: None. P-242 CORRELATION OF BODY MASS INDEX (BMI) WITH 2-HOUR GLUCOSE TOLERANCE TEST (GTT) RESULTS AMONG OBESE WOMEN WITH POLYCYSTIC OVARIAN SYNDROME (PCOS). S. Nagy, M. Nam Menke, N. W. Karjane, D. W. Stovall. Department of Obstetrics and Gynecology, VCU Medical Center, Richmond, VA.
50.3 (9.79)
44.4 (6.77)
48.7 (9.42)
43.0 (10.943)
35.8 (2.762)
42.9 (6.803)
3.8
.63
.10
2.89 (P¼0.034)
.80
.10
NA ¼ Not Applicable.
OBJECTIVE: To correlate the results of 2-hour GTT with BMI among obese women with PCOS. DESIGN: Retrospective chart review of 34 women with a BMI > 27 kg/m2 referred to the PCOS clinic of an academic medical center between 2003 and 2007. MATERIALS AND METHODS: BMI and 2-hour GTT were obtained on initial clinic visit. Scatterplots of blood glucose levels were charted against BMI and correlation coefficients calculated. Diagnosis of impaired glucose tolerance was based on a fasting blood sugar (FBS) R110 mg/dl and <126 mg/dl or 2-hour GTT R140 mg/dl. Patients met criteria for diabetes mellitis with a FBS R 126 mg/dl or 2-hour GTT R 200 mg/dl. RESULTS: Patients had a mean BMI of 40 6.9 kg/m2, FBS of 92 15.9 mg/dl, and 2-hour GTT of 109 35.8 mg/dl. No apparent correlation was seen between increasing BMI and blood glucose levels (Figures 1 and 2). Correlation coefficients between BMI vs. FBS and BMI vs. 2-hour GTT were 0.11 and 0.17 respectively.
CONCLUSIONS: Preliminary data suggests that surgical weight loss among women under 35 is associated with a decrease in plasma MIS. These findings may contribute to a greater understanding of the complex relationship between obesity and female reproduction. Supported by: The study was funded by Maimonides Research and Development Foundation. P-241 OVERWEIGHT AND OBESE INFERTILE WOMEN LACK ADEQUATE KNOWLEDGE OF THE EFFECTS OF OBESITY ON REPRODUCTIVE HEALTH. M. R. Thomas, B. J. Van Voorhis, J. Blaine, A. Dokras. Obstetrics and Gynecology, University of Iowa, Iowa City, IA. OBJECTIVE: Obesity has become an epidemic in the US. Despite its adverse effects on reproductive health few women are successful in achieving weight loss prior to initiation of fertility treatment. It is unclear if this is due to a lack of knowledge regarding the adverse effects of obesity or lack of desire/ resources to lose weight. We conducted a study to determine if overweight/ obese women with infertility were aware of the effects of increased weight on reproductive outcomes and to assess their weight loss strategies to reduce these risks. DESIGN: Questionnaire. MATERIALS AND METHODS: Infertile women (18–45 yrs) with BMI > 25 seen in the REI clinic were administered questionnaires during their office visit to obtain demographic information and assess knowledge of obesity with true/false questions. They were then given an educational packet on the adverse effects of obesity. RESULTS: 51 women with a mean age of 30.9 0.6 yrs, BMI of 33.0 0.8, and infertility of 37 4.8 months participated in the study (projected recruitment 200). They were primarily Caucasian (96.1%) and 92.2% had some college education. Most subjects (>98%) knew that obesity affects menstrual regularity and fertility, but only 75% recognized its effect on miscarriage rate. Fewer women (39.2%) were aware of the increased risk of IVF cycle cancellation and medication needs in obese women. The majority (>90%) knew the increased obstetric risks of preeclampsia and gestational diabetes,
S188
Abstracts
Figure 1.
Figure 2.
One patient (3%) met criteria for diabetes mellitus based on both FBS and 2-hour GTT. Two patients (6%) met criteria for impaired glucose tolerance by either FBS or both FBS and 2-hour GTT.
Vol. 88, Suppl 1, September 2007
Weight, kg BMI, kg/m2 Pdg, mg/mg Cr LH, mU/mg Cr FSH, mU/mg Cr E1c, ng/mg Cr Adiponectin, mg/mL Fasting Insulin, mU/mL Glucose/Insulin Leptin, ng/mL Ghrelin, pg/mL SHBG, nmol/L TSH, mIU/mL reverse T3, pg/mL
Baseline
3 months post-op
6 months post-op
P value
123.1 19.3 48.3 5.7 33.7 14.1 181.2 158.1 153.2 66.2 824.7 417.1 7.24 2.3 45.2 22.8 2.5 1.2 85.7 18.1 1298.7 520 54.1 21.4 1.71 0.6 0.24 0.06
102.7 18.3 40.2 5.2
89.8 18.3 35.4 5.6 78.6 32.0 292.1 112.6 178.4 84.1 605.4 236.3 10.2 3.4 13.0 6.0 9.3 7.5 44.2 38.1 1265.1 181 82.2 39.9 1.57 .8 0.26 0.04
<0.001 <0.001 0.008 0.009 0.47 0.06 0.02 0.003 <0.008 <0.001 0.6 0.02 0.45 0.06
8.7 3.1 16.6 7.2 6.2 2.2 48.9 29.9 1262.6 309 82.7 39.8 1.53 0.7 0.36 0.17
All values are mean SD. CONCLUSIONS: Large weight loss improved the adipokine profile and significantly increased Pdg and LH. Unlike normal weight women, very obese, ovulatory women who lose weight rapidly do not demonstrate increases in reverse T3. The data suggest that dynamic changes in adipose tissue-derived factors may serve as a permissive signal to the hypothalamic-pituitary-ovarian axis in the face of acute weight reduction in the very obese; alternatively fat-derived fuels may prevent disruption of the HPO axis despite rapid weight loss. Supported by: T32 HD040135 (AP), R21 DK 069349 (NS), K24 41978 (NS), RR 95261064 (GCRC) and Novo-Nordisk (NS). We gratefully acknowledge Dr. Philipp Scherer for running adiponectin assay and Barbara Isaac, RN for assistance with patient recruitment and study coordination. P-239 ARE IVF PATIENTS WITH AN INCREASED BODY MASS INDEX LESS LIKELY TO HAVE GOOD QUALITY EMBRYOS? D. M. Davies, A. Finn, I. Hardy, J. A. Hill. Embryology, Fertility Centers of New England, Reading, MA. OBJECTIVE: To determine whether a rising BMI has a negative effect on embryo quality based on the amount of embryos available for cryopreservation after selection for transfer. Each IVF cycle will ideally result in a cohort of 1–2 good quality embryos for transfer with excess embryos for cryopreservation. Factors that may influence embryo quality include the amount of stimulating drug administered as well as the length of time the patient is exposed to these medications. Patients with a high BMI require both increased
FERTILITY & STERILITYÒ
dosage and increased time on medication because of the impaired response of the ovaries to gonadotropin therapy. The purpose of this study was to test the hypothesis that there will be a gradual decline in number of embryos cryopreserved as BMI increased. DESIGN: Retrospective analysis of patients undergoing IVF/ICSI from January 2004–December 2006. All PGD, donor egg, patients with a BMI > 40.0, age > 42 and patients with embryos cryopreserved for reasons other than good quality after ET were excluded. MATERIALS AND METHODS: 1870 patients were analyzed between January 2004 and December of 2006. BMI was defined as: underweight <20, normal 20–24.9, overweight 25–29.9, obese class I 30–34.9 and obese class II 35–39.9 (WHO criteria). Chi square was used for statistical analysis. RESULTS: The number of good quality embryos available for cryopreservation after ET selection did not gradually decrease as patients BMI increases. Although not significant, there was a decrease from the obese class I category (28%) to obese class II (19%). The number of 7–8 cell embryos on day 3 did not decrease with a rising BMI. There was a significant decrease from the obese class I to obese class II (P<0.01). Also, a significant decrease in implantation rate from the normal weight group to the overweight group (P<0.001). TABLE. BMI and embryo quality
% embryos cryopreserved % 7–8 cell % Implantation rate % SAB
<19.9
20–24.9
29
26
25
28
19
38 25 4
36 24 4
39* 15A 4
40 15 4
34** 12 6
25–29.9
30–34.9
35–39.9
* P%0.025 **P%0.01AP%0.001. CONCLUSIONS: There was a significant decrease in the % of 7–8 cells from obese class I to obese class II, although, there was no significance in the amount of cryopreservation, suggesting that embryo quality was not negatively effected by a rise in BMI. A rise in BMI was correlated with decreased implantation potential and increased pregnancy loss. Further studies are needed to determine the cause of pregnancy loss and implantation failure in obese patients. Supported by: None.
P-240 THE RELATIONSHIP OF BARIATRIC SURGERY TO MULLERIAN INHIBITING SUBSTANCE. Z. O. Merhi, H. Minkoff, J. Feldman, J. Macura, D. B. Seifer. Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY; Department of Preventive Medicine and Community Health, SUNY Health Sciences Center at Brooklyn, Brooklyn, NY. OBJECTIVE: Mullerian Inhibiting Substance (MIS) is emerging as a predictor of ovarian reserve, and the frequency of bariatric surgical procedures have increased dramatically in reproductive aged women. The purpose of this study is to assess changes in plasma MIS after ‘‘dramatic’’ weight loss by bariatric surgery in morbidly obese reproductive aged women. DESIGN: A prospective study. MATERIALS AND METHODS: Sixteen patients, who underwent bariatric surgery, were enrolled in a prospective study evaluating MIS levels preoperatively and postoperatively. Since women aged less than 35 have the most reproductive potential and since women aged more than 35 and postmenopausal women have minimally detectable MIS, we have divided the participants into three groups. Group 1 included patients aged less than 35, group 2 included women aged more than 35 but not menopausal, and group 3 contained postmenopausal women. At the time of MIS sampling, a questionnaire was completed. Postoperative samples were taken between 43 and 151 days (mean SD ¼ 87 30) after the surgery. The blood was centrifuged and the plasma was stored at 80 C until assayed. The study was approved by the IRB of Maimonides Medical Center, and participants signed an informed consent. RESULTS: Seven participants were under 35 years old, four were above 35 years old and five were post-menopausal. Table 1 summarizes the demographic data and the clinical profile of the participants. MIS concentrations showed a 23.9% decrease (P¼0.034) in group 1 while BMI decreased by 14.5%.
S187
TABLE. Demographics and clinical profile
Group 1 (N ¼ 7) Age (years) [mean ( SD)] Ethnicity White Hispanic Black Other Irregular menses Yes No History of infertility Yes No History of PCOS Yes No Parity 0 1–2 >2 BMI Preoperative BMI (kg/m2) [mean ( SD)] Postoperative BMI (kg/m2) [mean ( SD)] MIS MIS preoperatively (ng/mL) (mean) MIS postoperatively (ng/mL) (mean)
29.6 (2.82)
Group 2 (N ¼ 4)
Group 3 (N ¼ 5)
40.5 (4.8)
51.2 (6.46)
4 3 0 0
4 0 0 0
3 1 1 0
1 6
1 3
2 5
0 4
0 5
1 6
1 3
0 5
1 2 4
0 2 2
0 3 2
NA NA
whereas fewer were aware of the risks of stillbirth (41.2%), cesarean section (62.7%), maternal death (47.1%), and having a child with a birth defect (41.2%). Overall, the subjects were most well-informed (>90%) about the effects of obesity on general health (increase in overall morbidity and mortality, hypertension, and diabetes). Most women were concerned about their weight (86.2%) and had attempted weight loss (94%). Only 15.7% had seen a nutritionist and 3.9% were following the AHA recommended daily exercise regimen. Currently 51% were not interested in losing weight before initiating infertility treatment secondary to the immediate desire to have a child. CONCLUSIONS: Our pilot study shows that women understand the risks of obesity on general health but are less knowledgeable of its effects on reproduction and pregnancy. Given the significant obesity-related reproductive health risks, patients should be aggressively educated and information on nutrition and exercise should be provided. Supported by: None. P-242 CORRELATION OF BODY MASS INDEX (BMI) WITH 2-HOUR GLUCOSE TOLERANCE TEST (GTT) RESULTS AMONG OBESE WOMEN WITH POLYCYSTIC OVARIAN SYNDROME (PCOS). S. Nagy, M. Nam Menke, N. W. Karjane, D. W. Stovall. Department of Obstetrics and Gynecology, VCU Medical Center, Richmond, VA.
50.3 (9.79)
44.4 (6.77)
48.7 (9.42)
43.0 (10.943)
35.8 (2.762)
42.9 (6.803)
3.8
.63
.10
2.89 (P¼0.034)
.80
.10
NA ¼ Not Applicable.
OBJECTIVE: To correlate the results of 2-hour GTT with BMI among obese women with PCOS. DESIGN: Retrospective chart review of 34 women with a BMI > 27 kg/m2 referred to the PCOS clinic of an academic medical center between 2003 and 2007. MATERIALS AND METHODS: BMI and 2-hour GTT were obtained on initial clinic visit. Scatterplots of blood glucose levels were charted against BMI and correlation coefficients calculated. Diagnosis of impaired glucose tolerance was based on a fasting blood sugar (FBS) R110 mg/dl and <126 mg/dl or 2-hour GTT R140 mg/dl. Patients met criteria for diabetes mellitis with a FBS R 126 mg/dl or 2-hour GTT R 200 mg/dl. RESULTS: Patients had a mean BMI of 40 6.9 kg/m2, FBS of 92 15.9 mg/dl, and 2-hour GTT of 109 35.8 mg/dl. No apparent correlation was seen between increasing BMI and blood glucose levels (Figures 1 and 2). Correlation coefficients between BMI vs. FBS and BMI vs. 2-hour GTT were 0.11 and 0.17 respectively.
CONCLUSIONS: Preliminary data suggests that surgical weight loss among women under 35 is associated with a decrease in plasma MIS. These findings may contribute to a greater understanding of the complex relationship between obesity and female reproduction. Supported by: The study was funded by Maimonides Research and Development Foundation. P-241 OVERWEIGHT AND OBESE INFERTILE WOMEN LACK ADEQUATE KNOWLEDGE OF THE EFFECTS OF OBESITY ON REPRODUCTIVE HEALTH. M. R. Thomas, B. J. Van Voorhis, J. Blaine, A. Dokras. Obstetrics and Gynecology, University of Iowa, Iowa City, IA. OBJECTIVE: Obesity has become an epidemic in the US. Despite its adverse effects on reproductive health few women are successful in achieving weight loss prior to initiation of fertility treatment. It is unclear if this is due to a lack of knowledge regarding the adverse effects of obesity or lack of desire/ resources to lose weight. We conducted a study to determine if overweight/ obese women with infertility were aware of the effects of increased weight on reproductive outcomes and to assess their weight loss strategies to reduce these risks. DESIGN: Questionnaire. MATERIALS AND METHODS: Infertile women (18–45 yrs) with BMI > 25 seen in the REI clinic were administered questionnaires during their office visit to obtain demographic information and assess knowledge of obesity with true/false questions. They were then given an educational packet on the adverse effects of obesity. RESULTS: 51 women with a mean age of 30.9 0.6 yrs, BMI of 33.0 0.8, and infertility of 37 4.8 months participated in the study (projected recruitment 200). They were primarily Caucasian (96.1%) and 92.2% had some college education. Most subjects (>98%) knew that obesity affects menstrual regularity and fertility, but only 75% recognized its effect on miscarriage rate. Fewer women (39.2%) were aware of the increased risk of IVF cycle cancellation and medication needs in obese women. The majority (>90%) knew the increased obstetric risks of preeclampsia and gestational diabetes,
S188
Abstracts
Figure 1.
Figure 2.
One patient (3%) met criteria for diabetes mellitus based on both FBS and 2-hour GTT. Two patients (6%) met criteria for impaired glucose tolerance by either FBS or both FBS and 2-hour GTT.
Vol. 88, Suppl 1, September 2007