IVF outcomes in patients with a history of bariatric surgery: a multicenter retrospective cohort study.

STUDY QUESTION: How does a history of dramatic weight loss linked to bariatric surgery impact IVF outcomes? SUMMARY ANSWER: Women with a history of bariatric surgery who had undergone IVF had a comparable cumulative live birth rate (CLBR) to non-operated patients of the same BMI after the first IVF cycle. WHAT IS KNOWN ALREADY: In the current context of increasing prevalence of obesity in women of reproductive age, weight loss induced by bariatric surgery has been shown to improve spontaneous fertility in obese women. However, little is known on the clinical benefit of bariatric surgery in obese infertile women undergoing IVF. STUDY DESIGN, SIZE, DURATION: This exploratory retrospective multicenter cohort study was conducted in 10 287 IVF/ICSI cycles performed between 2012 and 2016. We compared the outcome of the first IVF cycle in women with a history of bariatric surgery to two age-matched groups composed of non-operated women matched on the post-operative BMI of cases, and non-operated severely obese women. PARTICIPANTS/MATERIALS, SETTING, METHODS: The three exposure groups of age-matched women undergoing their first IVF cycle were compared: Group 1: 83 women with a history of bariatric surgery (exposure, mean BMI 28.9 kg/m2); Group 2: 166 non-operated women (non-exposed to bariatric surgery, mean BMI = 28.8 kg/m2) with a similar BMI to Group 1 at the time of IVF treatment; and Group 3: 83 non-operated severely obese women (non-exposed to bariatric surgery, mean BMI = 37.7 kg/m2). The main outcome measure was the CLBR. Secondary outcomes were the number of mature oocytes retrieved and embryos obtained, implantation and miscarriage rates, live birth rate per transfer as well as birthweight. MAIN RESULTS AND THE ROLE OF CHANCE: No significant difference in CLBR between the operated Group 1 patients and the two non-operated Groups 2 and 3 was observed (22.9%, 25.9%, and 12.0%, in Groups 1, 2 and 3, respectively). No significant difference in average number of mature oocytes and embryos obtained was observed among the three groups. The implantation rates were not different between Groups 1 and 2 (13.8% versus 13.7%), and although lower (6.9%) in obese women of Group 3, this difference was not statistically significant. Miscarriage rates in Groups 1, 2 and 3 were 38.7%, 35.8% and 56.5%, respectively (P = 0.256). Live birth rate per transfer in obese patients was significantly lower compared to the other two groups (20%, 18%, 9.3%, respectively, in Groups 1, 2 and 3, P = 0.0167). Multivariate analysis revealed that a 1-unit lower BMI increased the chances of live birth by 9%. In operated women, a significantly smaller weight for gestational age was observed in newborns of Group 1 compared to Group 3 (P = 0.04). LIMITATIONS, REASONS FOR CAUTION: This study was conducted in France and nearly all patients were Caucasian, questioning the generalizability of the results in other countries and ethnicities. Moreover, 950 women per group would be needed to achieve a properly powered study in order to detect a significant improvement in live birth rate after bariatric surgery as compared to infertile obese women. WIDER IMPLICATIONS OF THE FINDINGS: These data fuel the debate on the importance of pluridisciplinary care of infertile obese women, and advocate for further discussion on whether bariatric surgery should be proposed in severely obese infertile women before IVF. However, in light of the present results, infertile women with a history of bariatric surgery can be reassured that surgery-induced dramatic weight loss has no significant impact on IVF prognosis. STUDY FUNDING/COMPETING INTEREST(S): This work was supported by unrestricted grants from FINOX-Gédéon Richter and FERRING Pharmaceuticals awarded to the ART center of the Clinique Mathilde to fund the data collection and the statistical analysis. There are no conflicts of interest to declare. TRIAL REGISTRATION NUMBER: NCT02884258.

[Medical beliefs and practices in Algeria. Study of various therapeutic routes]. / Pratiques et croyances médicales en Algérie. Etude de quelques itinéraires thérapeutiques.

In Algeria, the official health policy is based on a constant principle: the implementation of a health care system patterned on the Western model. As the country is rooted in a non-Western tradition, two paradigms are competing. The article is aimed at measuring the degree of adhesion given to each paradigm (and system of reference) by the people. In short its objective is to determine how a patient believes respectively in the "western" medicine and the "traditional" on and how he accepts they coexist for alleviating his sufferings. In a society predominantly religious and rural, the therapeutic relation is evaluated firstly on the basis of the kindness and warmth of the care providers. It is also appreciated by its religious surroundings. These two elements are absent in Western-style hospitals. Other factors contribute to strengthen the traditional medicine among the people.

[Tuberculous anal fistulas. 13 cases]. / Fistules anales tuberculeuses. A propos de treize cas.

Our retrospective study concerns 13 cases of anal tuberculosis fistulas, studied over a period of 12 years, between January 1980 and December 1991. The mean age of our patients was 24 years and they were predominantly male. The diagnosis, which was suspected clinically, was confirmed histologically, either by ridge biopsies of the external orifice of the fistula or by surgical removal of the fistular passage in patients having undergone an initial surgical intervention. In 5 cases, we noted an associated pulmonary tuberculosis involvement. The treatment comprised 2 phases: an antibacillary medical treatment in all cases and a surgical treatment depending on whether the diagnosis was initially based on the ridge biopsies of the external orifice--6 cases (46.15%)--or after removal of the fistular passage--7 cases (53.85%). The outcome was good in all cases.

[Cancer of the gastric stump]. / Le cancer du moignon gastrique.

Among a series of 266 cases of gastric cancer operated on between 1981 and 1991, 8 cases were developed on gastric stump after gastro-duodenal surgery. A post operative delay of 10 years has been insisted upon. We note an exclusive masculine series. The main age was 61 years. Clinical aspects were univoque and treatment was always surgical with a resecability rate of 37%. Pathological analysis of operatory specimen and biopsies has shown everywhere an adenocarcinoma. The only way to improve the prognosis and to lay the live based on the yearly histoendoscopic supervision since the tenth year after initial intervention of these operated patients of the stomach with high neoplastic risk.

[Peritoneal tuberculosis in adults. Study of 207 cases]. / La tuberculose péritonéale chez l'adulte. Etude de 207 cas.

The authors report their experience about 207 cases of peritoneal tuberculosis in the adult, diagnosed and treated at the University Hospital Ibn Rochd in Casablanca, between january 1976 and october 1986. It concerned 139 women and 68 men--mean age 29.5 years. The most frequent clinical form was painful and febrile ascites (70% of the cases). The diagnosis was established most of the time by laparoscopy (180 examinations) which disclosed peritoneal granulations in 87% of the cases. Laparoscopy was impossible in 27 cases. Evolution was favorable in all patients except 5: 3 deaths, one relapse and one evolution to a fibro-adhesive form. During the long-term evolution in 50 patients (follow-up exceeding two years): one patient developed an occlusion and 7 had gynecological complications.