Objective-To determine if follicular free fatty acid (FFA) levels are associated with cumulus oocyte complex morphology Design-Prospective cohort study Setting-University in vitro fertilization (IVF) practice Patients-102 women undergoing IVF Interventions-Measurement of FFAs in serum and ovarian follicular fluidMain Outcome Measures-Total and specific follicular and serum FFA levels, correlations between follicular and serum FFAs, and associations between follicular FFA levels and markers of oocyte quality including cumulus oocyte complex (COC) morphology Results-Predominant follicular fluid and serum FFAs were oleic, palmitic, linoleic and stearic acids. Correlations between follicular and serum FFA concentrations were weak (r=0.252, 0.288, 0.236, 0.309 respectively for specific FFAs; r=0.212 for total FFAs). A receiver operator characteristic curve determined total follicular FFAs ≥ 0.232 µmol/ml distinguished women with lower versus higher percentage COCs with favorable morphology. Women with elevated follicular FFAs (n=31) were more likely to have COCs with poor morphology than others (n=71) (OR 3.3, 95% CI:1.2-9.2). This relationship held after adjusting for potential confounders including age, BMI, endometriosis and amount of gonadotropin administered (β=1.2; OR 3.4, 95% CI:1.1-10.4).Conclusions-Elevated follicular FFA levels are associated with poor COC morphology. Further work is needed to determine what factors influence follicular FFA levels and if these factors impact fertility.

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Objective To determine if morbid obesity is associated with decreased pregnancy and live birth rates after IVF in women with PCOS Design Retrospective cohort study Setting University-based fertility center Patients 72 women with PCOS who completed their first IVF cycle between 2001 and 2007 Interventions IVF outcomes were compared between women with a BMI of less than 40 kg/m2 versus those women with a BMI of 40 kg/m2 or greater Main outcome measures Clinical pregnancy rate, live birth rate Results Morbidly obese women with PCOS (n=19) had significantly lower clinical pregnancy rates after IVF than PCOS patients who were not morbidly obese (n=53) (32% vs. 72%, RR 0.44, 95% confidence interval 0.22 to 0.87). Their live birth rates were lower too, although this difference was not statistically significant (32% vs. 60%, RR 0.52, 95% confidence interval 0.26 to 1.05). Conclusions Morbid obesity is associated with lower pregnancy rates in women with PCOS after IVF raising the question if weight loss may improve IVF success rates for morbidly obese PCOS patients.

Recent evidence indicates that mammalian gametogenesis and preimplantation development may be adversely affected by both assisted reproductive and stem cell technologies. Thus, a better understanding of the developmental regulation of the underlying epigenetic processes that include DNA methylation is required. We have, therefore, monitored the expression, by PCR, of the mRNAs of DNA methyltransferases (DNMTs), methyl-CpG-binding domain proteins (MBDs), and CpG binding protein (CGBP) in a developmental series of amplified cDNA samples derived from staged human ovarian follicles, oocytes, preimplantation embryos, human embryonic stem (hES) cells and in similar murine cDNA samples. Transcripts of these genes were detected in human ovarian follicles (DNMT3A, DNMT3b1, DNMT3b4, DNMT1, MDBs1-4, MeCP2, CGBP), germinal vesicle (GV) oocytes (DNMT3A, DNMT3b1, DNMT1, MDBs1-4, MeCP2, CGBP), mature oocytes (DNMT3A, DNMT3b1, DNMT1, CGBP), and preimplantation embryos (DNMT3A, DNMT3b1, DNMT1, DNMT3L, MBD2, MDB4, CGBP). Differential expression of DNMT3B gene transcripts in undifferentiated (DNMT3b1) and in vitro differentiated human ES cells (DNMT3b3) further demonstrated an association of the DNMT3b1 transcript variant with totipotent and pluripotent human cells. Significantly, whilst the murine Dnmt3L gene is both expressed and essential for imprint establishment during murine oogenesis, transcripts of the human DNMT3L gene were only detected after fertilisation. Therefore, the mechanisms and/or the timing of imprint establishment may differ in humans.