Randomized Trial of a Lifestyle Program in Obese Infertile Women.

BACKGROUND: Small lifestyle-intervention studies suggest that modest weight loss increases the chance of conception and may improve perinatal outcomes, but large randomized, controlled trials are lacking. METHODS: We randomly assigned infertile women with a body-mass index (the weight in kilograms divided by the square of the height in meters) of 29 or higher to a 6-month lifestyle intervention preceding treatment for infertility or to prompt treatment for infertility. The primary outcome was the vaginal birth of a healthy singleton at term within 24 months after randomization. RESULTS: We assigned women who did not conceive naturally to one of two treatment strategies: 290 women were assigned to a 6-month lifestyle-intervention program preceding 18 months of infertility treatment (intervention group) and 287 were assigned to prompt infertility treatment for 24 months (control group). A total of 3 women withdrew consent, so 289 women in the intervention group and 285 women in the control group were included in the analysis. The discontinuation rate in the intervention group was 21.8%. In intention-to-treat analyses, the mean weight loss was 4.4 kg in the intervention group and 1.1 kg in the control group (P<0.001). The primary outcome occurred in 27.1% of the women in the intervention group and 35.2% of those in the control group (rate ratio in the intervention group, 0.77; 95% confidence interval, 0.60 to 0.99). CONCLUSIONS: In obese infertile women, a lifestyle intervention preceding infertility treatment, as compared with prompt infertility treatment, did not result in higher rates of a vaginal birth of a healthy singleton at term within 24 months after randomization. (Funded by the Netherlands Organization for Health Research and Development; Netherlands Trial Register number, NTR1530.).

[A parasitic myoma: unexpected finding after laparoscopic hysterectomy]. / Een parasitair myoom: onverwachte bevinding na laparoscopische hysterectomie.

UNLABELLED: During laparoscopic hysterectomy the uterus can be morcellated in order to remove it from the abdominal cavity. This technique carries a risk of tissue fragments being retained in the abdomen with recurring growth in the future. CASE DESCRIPTION: A 48-year-old woman with a history of hysterectomy presented with a swelling in her lower abdomen. Ultrasound investigation showed a solid tumour with a benign appearance. Differential diagnosis included an ovarian tumour or leiomyoma. Laparoscopic investigation revealed a preperitoneal tumour which was removed by laparotomy. Histologic examination showed a benign leiomyoma. CONCLUSION: A patient with a history of hysterectomy is less likely to present with a myoma, however, in this case the diagnosis was correct. Due to the increasing use of a morcellator in laparoscopic hysterectomy in recent decades, we will be confronted with the diagnosis 'parasitic myoma' more frequently. Patients will have to be informed of the risk of this complication.

Predictors of ongoing pregnancy after single-embryo transfer following mild ovarian stimulation for IVF.

OBJECTIVE: To develop a prognostic model for the prediction of ongoing pregnancy after single-embryo transfer (SET) following mild stimulation for IVF in women less than 38 years of age. DESIGN: Prospective cohort study. SETTING: Two fertility centers in tertiary referral university hospitals. PATIENT(S): A total of 152 women with an elective SET following mild ovarian stimulation (cycle day 5 start of 150 IU/day recombinant FSH and late follicular phase GnRH antagonist cotreatment). INTERVENTION(S): Database analysis. MAIN OUTCOME MEASURE(S): Ongoing pregnancy. RESULT(S): The ongoing pregnancy rate per elective SET was 28% (42 of 152). In a multivariate logistic regression analysis, body mass index, the total gonadotrophin dose needed, and number of oocytes retrieved were negatively correlated whereas the availability of a top-quality embryo was positively correlated with ongoing pregnancy. The predictive ability of the model assessed by the area under the receiver operating characteristic curve was 0.68. At a probability cut-off level of 0.20 the model showed a sensitivity of 37% and a specificity of 90%. CONCLUSION(S): The developed prediction model for ongoing pregnancy provides an evidence-based strategy for guidance under which conditions SET may be performed. After external validation, application of the model may help to improve overall singleton pregnancy rates.