CONTEXT:Various components of follicular fluid are suggested as biochemical predictors of oocyte quality. Previous studies of follicular steroid hormone levels have shown disparate results when related with fertilization outcomes.AIM:The objective of the study was to relate the levels of steroid hormones of each individual follicle with oocyte maturation, fertilization results, embryo quality, and pregnancy rates.SETTINGS AND DESIGN:Prospective cohort study in a university hospital.METHODS:In 31 patients, who underwent intracytoplasmic sperm injection, it was performed an ultrasound guided aspiration of follicular fluid of the first two mature follicles from each ovary. Follicular levels of estradiol, progesterone, testosterone, and dehydroepiandrosterone sulfate were measured by chemiluminescent immunoassay.STATISTICAL ANALYSIS:Generalized estimating equation model.RESULTS:In follicular fluids with mature oocyte presence, in normal as well as in failed fertilization, there was a positive correlation between follicular testosterone and progesterone (r = 0.794, P = 0.0001 and r = 0.829, P = 0.0001). Progesterone levels were higher in cases of normal fertilization compared to failed fertilization (P = 0.003). B quality embryos came from oocytes immersed in follicular fluids with higher estradiol values and higher estradiol/progesterone and estradiol/testosterone ratios than those of C quality (P = 0.01; P = 0.0009; P = 0.001). Estradiol levels were higher in patients who achieved pregnancy (P = 0.02).CONCLUSION:The analysis of follicular hormone composition could be considered as an additional tool in oocyte selection.

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RESUMENObjetivo: Comprobar si el sobrepeso y la obesidad materna son factores de riesgo de complicaciones perinatales. Método: Estudio transversal de 1.223 gestantes nulíparas atendidas en el Hospital La Paz entre agosto 2007 y abril 2008. Las gestantes se dividieron en tres grupos según el índice de masa corporal (IMC) al inicio del embarazo: 482 con peso normal (IMC: 18,5-24,9 Kg/m 2 ); 419 con sobrepeso (IMC: 25-29,9Kg/m 2 ) y 322 con obesidad (IMC: ≥30Kg/m 2 ). Se estudiaron las complicaciones obstétricas, semanas de gestación en el momento del parto, tipo de parto y peso fetal. Resultados: El riesgo de cesárea en las gestantes con sobrepeso fue casi el doble que el de las gestantes de peso normal (OR: 1,9; IC95% 1,4-2,5) Las gestantes obesas sufrieron el triple de cesáreas que las de peso normal (OR: 3,1; IC95% 2,8-4,3). El número de inducciones del parto fue mayor en las gestantes con sobrepeso (OR: 1,7; IC95% 1,4-1,9) y el doble en las obesas (OR: 2,0; IC95% 1,8-2,9) con respecto a las de peso normal. El riesgo de macrosomía fetal (>4.000 gramos) fue mayor en las gestantes con sobrepeso (OR: 1,5; IC95% 1,4-2,2) y en las obesas (OR: 1,9; IC95% 1,3-2,8) que en las de peso normal. En el análisis de regresión logística multivariante (ajustando por edad, diabetes e hipertensión gestacionales) persistió la asociación entre sobrepeso y cesárea (OR: 2,1; IC95% 1,7-2,7) y entre obesidad y cesárea (OR: 3,0; IC95% 2,8). Conclusiones: El sobrepeso y la obesidad materna al inicio del embarazo están asociados con un aumento del número de cesáreas y de inducciones del parto. Este riesgo es mayor a medida que aumenta el IMC materno.PALABRAS CLAVE: Sobrepeso, obesidad, gestación, cesárea, inducción del parto SUMMARYObjective: The objective of this study is to determine if the maternal prepregnancy overweight and obesity are related to risk of cesarean delivery and other obstetrical complications. Methods: Transversal study of 1223 nulliparous women that delivered in our maternity between August 2007 and April 2008. Women were categorized by the body mass index (BMI): 482 normal weight (BMI: 18.5-24.9 Kg/m 2 ), 419 overweight (BMI: 25-29.9 Kg/m 2 ) and 322 obesity (BMI: ≥30 Kg/m 2 ). Obstetrical complications, labor and its complications, and neonatal weight were studied. Results: Women who were overweight was nearly twice as likely to deliver by cesarean section as women with normal weight (OR: 1.8; 95%CI 1.4-2.9). Obese women experienced a three-fold increase in risk of cesarean section in comparison to normal weight women (OR: 3.02; 95%CI 2.6-4.5). Number of labor inductions was higher in overweight and obese group (OR: 1.6; 95%CI 1.3-1.9) and (OR: 2.1; 95%CI 1.7-2.9) respectively in comparison to control group. The highest risk of fetal macrosomia (weight >4000 g) was in the overweight (OR: 1.5; 95%CI 1.4-2.2) and obese women (OR: 1.9;

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CONTEXT:There is disagreement as to whether the concentration of a substance in follicular fluid is related to the quality of the follicle as a possible reflection of the oocyte quality or whether this concentration is related to the clinical characteristics of the patient.AIM:To establish the variability of steroid hormone levels in follicular fluids from different follicles of the same patient and between patients.SETTINGS AND DESIGN:Prospective cohort study.MATERIALS AND METHODS:In 31 patients who underwent intracytoplasmic sperm injection it was performed an ultrasound guided aspiration of follicular fluid of the first two mature follicles from each ovary. Chemiluminescent microparticle immunoassays were performed to determine the levels of estradiol, progesterone, testosterone, and dehydroepiandrosterone sulfate (DHEA-S).STATISTICAL ANALYSIS:Unconditional mixed model.RESULTS:Variation in estradiol levels between follicles in the same patient was approximately twice the variation between subjects (P = 0.05). In the case of progesterone, the intra-subject variation was similar to the inter-subject variation (P = 0.006). The testosterone levels had a slightly smaller intra-subject variation than inter-subject variation (P = 0.002), and the intra-subject variation in DHEA-S levels was approximately one-fifth of the inter-subject variation (P = 0.0003).CONCLUSIONS:The variations in the levels of follicular progesterone and testosterone were similar between patients and between a given patient's follicles; however, the estradiol levels variability was higher among different follicles. The amount of follicular estradiol may be considered a selection tool between the follicles of a given patient.