No abstract

STUDY QUESTION For a woman with infertility and overweight/obesity, can infertility treatment be postponed to first promote weight loss? SUMMARY ANSWER Advice regarding a delay in IVF treatment to optimize female weight should consider female age, particularly in women over 38 years for whom only substantial weight loss in a short period of time (3 months) seems to provide any benefit. WHAT IS KNOWN ALREADY Body weight excess and advanced age are both common findings in infertile patients, creating the dilemma of whether to promote weight loss first or proceed to fertility treatment immediately. Despite their known impact on fertility, studies assessing the combined effect of female age and BMI on cumulative live birth rates (CLBRs) are still scarce and conflicting. STUDY DESIGN, SIZE, DURATION We performed a multicentre retrospective cohort study including 14 213 patients undergoing their first IVF/ICSI cycle with autologous oocytes and subsequent embryo transfers, between January 2013 and February 2018 in 18 centres of a multinational private fertility clinic. BMI was subdivided into the following subgroups: underweight (<18.5 kg/m2), normal weight (18.5–24.9 kg/m2), overweight (25.0–29.9 kg/m2), and obesity (≥30.0 kg/m2). PARTICIPANTS/MATERIALS, SETTING, METHODS The primary outcome was CLBR. The secondary outcome was time to pregnancy. To assess the influence of female age and BMI on CLBR, two multivariable regression models were developed with BMI being added in the models as either an ordinal categorical variable (Model 1) or a continuous variable (Model 2) using the best-fitting fractional polynomials. CLBR was estimated over 1-year periods (Model 1) and shorter timeframes of 3 months (Model 2). We then compared the predicted CLBRs according to BMI and age. MAIN RESULTS AND THE ROLE OF CHANCE When compared to normal weight, CLBRs were lower in women who were overweight (adjusted odds ratio (aOR) 0.86, 95% CI 0.77–0.96) and obese (aOR 0.74, 95% CI 0.62–0.87). A reduction of BMI within 1 year, from obesity to overweight or overweight to normal weight would be potentially beneficial up to 35 years old, while only a substantial reduction (i.e. from obesity to normal BMI) would be potentially beneficial in women aged 36–38 years. Above 38 years of age, even considerable weight loss did not compensate for the effect of age over a 1-year span but may be beneficial in shorter time frames. In a timeframe of 3 months, there is a potential benefit in CLBR if there is a loss of 1 kg/m2 in BMI for women up to 33.25 years and 2 kg/m2 in women aged 33.50–35.50 years. Older women would require more challenging weight loss to achieve clinical benefit, specifically 3 kg/m2 in women aged 35.75–37.25 years old, 4 kg/m2 in women aged 37.50–39.00 years old, and 5 kg/m2 or more in women over 39.25 years old. LIMITATIONS, REASONS FOR CAUTION This study is limited by its retrospective design and lower number of women in the extreme BMI categories. The actual effect of individual weight loss on patient outcomes was also not evaluated, as this was a retrospective interpatient comparison to estimate the combined effect of weight loss and ageing in a fixed period on CLBR. WIDER IMPLICATIONS OF THE FINDINGS Our findings suggest that there is potential benefit in weight loss strategies within 1 year prior to ART, particularly in women under 35 years with BMI ≥25 kg/m2. For those over 35 years of age, weight loss should be considerable or occur in a shorter timeframe to avoid the negative effect of advancing female age on CLBR. A tailored approach for weight loss, according to age, might be the best course of action. STUDY FUNDING/COMPETING INTEREST(S) No specific funding was obtained for this study. All authors have no conflicts to declare. TRIAL REGISTRATION NUMBER N/A.

Background and study aim: Surveillance after gastric endoscopic submucosal dissection (ESD) is recommended for all patients due to the persistent risk of metachronous gastric lesions (MGLs). We aimed to develop and validate a prediction score to estimate MGL risk after ESD for early neoplastic gastric lesions, to define an individualized and cost saving approach. Patients and methods: Clinical predictors and a risk score were derived from meta-analysis data. A retrospective, single centre, cohort study including patients with >3 years standardized surveillance after ESD was conducted for score validation. Predictive accuracy of the score by the receiver operating characteristic curve was assessed and cumulative probabilities of MGL were estimated. Results: The risk score (0-9 points) included 6 clinical predictors (scored 0-3): positive family history of gastric cancer, older age, male gender, corpus intestinal metaplasia, synchronous gastric lesions and persistent Helicobacter pylori infection. Study population included 263 patients; the MGL rate was 16%. The score diagnostic accuracy for predicting MGL at 3 years of follow-up as measured by the AUC was 0.704 (95% CI 0.603-0.806). At 3 years and a cut-off <2, it achieved maximal sensitivity and negative predictive value; 15% patients could be assigned to a low-risk group, in which the progression to MGL was significantly lower than for the high-risk group (p=0.037). Conclusion: The FAMISH score might be a concise and useful tool, accurately identifying patients with low-to-intermediate risk for MGL at 3 years of follow-up, who might expand the surveillance interval to reduce the burden of care.