The aim of this work was to evaluate the effects of extreme body mass index (BMI) on assisted reproductive treatment outcome and pregnancy outcome. This is a descriptive cohort study that evaluated 8,145 consecutive in-vitro fertilisation/intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET) cycles in which BMI were known, from July 1997 to June 2005 in an inner London major fertility clinic. The data were collected prospectively and analysed retrospectively on women undergoing IVF/ICSI and ET. Patients' weight and height were established prior to treatment. IVF/ICSI treatment was then started using either a long or an antagonist protocol. Patients were divided into five groups: Group A (BMI < 19); Group B (BMI between 19 and 25.9); Group C (BMI between 26 and 30.9); Group D (BMI between 31 and 35.9); Group E (BMI > 36). The main outcomes measured were number of eggs collected, fertilisation rate, number of embryos available for transfer, pregnancy rate (PR), live-birth rate (LBR) and miscarriage rate (MR). The results showed no significant difference in the average number of days taking follicle stimulating hormone (FSH) for ovarian stimulation, the average amount of gonadotrophin used for stimulation, number of eggs collected and fertilisation rate. The pregnancy rate, miscarriage rate and the live-birth rate were not statistically different between all groups. However, in group E the miscarriage rate was significantly higher and the LBR was statistically lower compared with group B. We concluded that extreme BMI did not affect the super-ovulation outcome fertilisation rate and pregnancy rate. Women with a BMI > 35 had a higher miscarriage rate and hence a lower live-birth rate, but a reasonable pregnancy and live-birth rate can be achieved. For women with a BMI < 20 there was no difference in assisted reproduction treatment (ART) outcome and pregnancy outcome when compared with women with a normal BMI. This information should be used to advise patients who wish to embark on ART with extreme BMI.

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One of the 21st century learning skills needed is communication skills. Communication skills have crucial roles to help students in facing global competitive and digital era nowadays. However, most of learnings at the middle and senior high schools ignore it but teachers still apply conventional learning methods to achieve it.  Due to the problems, this study aims to build students' communication skills, and to find out the implementation of lesson study on students’ communication skills in learning English at senior high school through lesson study. It is a descriptive qualitative study conducted at Senior High School of 10 Kota Ternate. 100 students were selected through purposive sampling as the research samples. Data were collected by applying lesson study activities in 4 cycles through direct observation in learning process using communication skills instruments developed by the Ministry of Education and Culture. Communication skill indicators focus on 6 indicators. Data were analysed using a Likert scale of 5-1. Based on the result of analysis, the study showed that students’ communication skills are improved and developed gradually. In addition, lesson study has given a positive impact toward students ‘communication skills in learning English. It was proven that students’ communication skill develops significantly and linearly from cycle I (43.33) into cycle II (63, 33). Thus, the students’ communicative skills were improved as well from cycle III (76, 66) into cycle IV (93,33).  Therefore, this study can be concluded lesson study activities in learning English are alternative solution to build students' communication skills, learning English through the implementation of lesson study has a positive impact on the development of communication skills, and students' communication skills through lesson study develop gradually and linearly and convey significant development.

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