Biological clock is real, unexplained infertility — not so. My first weekly roundup of studies on fertility and preconception.
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Overweight and obese mothers have higher OR (odds ratio) of serious complications, such as GDM (OR 2.18–3.94), pre-eclampsia (OR 1.44–3.00), and an increased risk of admission to the NICU (OR 1.12–2.29). That’s what a meta-analysis of 86 studies, representing 20,328,777 pregnant women, found.
Action tip: Maintaining a healthy pre-pregnancy weight may lower the odds of complications such as gestational diabetes, pre-eclampsia, NICU admission, and other.
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20% of men with unexplained infertility and 40-50% of men with idiopathic infertility have abnormal sperm DNA fragmentation (SDF). The SDF index, when found to be around 20-30%, decreases the chance of natural pregnancy.
Action tip: Include a sperm DNA fragmentation (SDF) test in fertility evaluations. If SDF is elevated, strategies such as lifestyle changes (diet, exercise, reducing toxins), targeted antioxidant supplements, or varicocele repair can help improve sperm DNA integrity and boost conception odds.
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44% of women with unexplained infertility were diagnosed with endometriosis (range 33–65%).
11 studies evaluating the prevalence of endometriosis were included in this systematic review, n≈1,200 total participants.
Action tip: Consider diagnostic laparoscopy to identify hidden pelvic lesions. Confirming a cause not only guides targeted treatment but can also ease the uncertainty and emotional stress of an “unexplained” diagnosis.
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In women with PCOS using Clomid or Letrozole to induce ovulation, miscarriage rates hit 29–32% (vs. ~25% in spontaneous-conception PCOS pregnancies and ~15% in the general population). The double-blind, multicenter trial included 750 women, in a 1:1 ratio, to receive letrozole or clomiphene for up to five treatment cycles.
Action tip: Consider first pursuing approaches that restore natural ovulation, such as targeted lifestyle modifications, insulin-sensitizing treatments, and other, before moving to pharmacologic induction.
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Women under 36 who froze at least 8–10 mature eggs saw live-birth rates above 50% per transfer. Undergoing egg freezing at 40+ yo is unlikely to result in successful reproductive outcomes, as per study. 483 stimulation cycles were undertaken amongst 373 women.
Action tip: To maximize the chances of a successful live birth, women considering egg freezing should ideally undergo the procedure before the age of 36. The study indicates that success rates decline significantly for those who freeze their eggs at 40 or older.