Obesity in young women does not adversely affect clinical pregnancy rates in patients treated with in vitro fertilization.

A major challenge of assisted reproduction technologies (ARTs) is to mimic the natural environment required to sustain oocyte and embryo survival. Herein, we show that the ceramide-metabolizing enzyme, acid ceramidase (AC), is expressed in human cumulus cells and follicular fluid, essential components of this environment, and that the levels of this enzyme are positively correlated with the quality of human embryos formed in vitro. These observations led us to develop a new approach for oocyte and embryo culture that markedly improved the outcome of in vitro fertilization (IVF). The addition of recombinant AC (rAC) to human and mouse oocyte culture medium maintained their healthy morphology in vitro. Following fertilization, the number of mouse embryos formed in the presence of rAC also was improved (from approximately 40 to 88%), leading to approximately 5-fold more healthy births. To confirm these observations, immature bovine oocytes were matured in vitro and subjected to IVF in the presence of rAC. Significantly more high-grade blastocysts were formed, and the number of morphologically intact, hatched embryos was increased from approximately 24 to 70%. Overall, these data identify AC as an important component of the in vivo oocyte and embryo environment, and provide a novel technology for enhancing the outcome of assisted fertilization. Eliyahu, E., Shtraizent, N., Martinuzzi, K., Barritt, J., He, X., Wei, H., Chaubal, S., Copperman, A. B., Schuchman, E. H. Acid ceramidase improves the quality of oocytes and embryos and the outcome of in vitro fertilization.

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INTRODUCTION: Recent studies have underscored the adverse effects of prenatal exposure to bisphenol-A (BPA), pesticides, mercury, and lead. The purpose of this pilot study was to assess the counseling practices and level of comfort discussing prenatal environmental exposures among obstetricians in the state of Georgia. METHODS: We surveyed 100 practicing obstetricians, including Georgia private practice physicians in addition to residents and faculty from the largest residency training program in the state. RESULTS: The majority (72%) of physicians agreed that assessing environmental exposures during prenatal care is important in preventing adverse pregnancy outcomes. While 97.9% felt confident discussing cigarette smoking, few felt confident discussing the impact of other toxin exposures on pregnancy as follows: BPA (48.4%), pesticides (46.2%), mercury (42.1%), and lead (36.8%). Furthermore, less than 1 in 4 obstetricians reported routinely discussing each of these exposures as part of prenatal care: BPA (3.2%), pesticides (16.1%), mercury (22.6%), and lead (8.6%). There was no significant difference in either counseling practices or comfort discussing these topics when stratified by age, years in practice, and percentage of practice dedicated to obstetrics. CONCLUSION: Prenatal exposure to environmental toxins can have a significant impact on reproductive and developmental health, yet many obstetricians are not confident discussing the effect of environmental exposures on health outcomes with their patients. Currently most Georgia obstetricians are only evaluating a fraction of the environmental exposures recommended by the American College of Obstetricians and Gynecologists experts. There is a profound opportunity for improvement in counseling patients and educating reproductive health providers on this topic.