Background: Infertile women might get pregnant sometime after fertility treatment, but today, there is no prediction model on who will eventually have children. The objective of the present study was to characterize hormone levels in an arbitrary menstrual cycle in women with unexplained infertility and male infertility, and to determine the predictive value for long-term possibility of live birth. Methods: In this cross-sectional study, with 71 infertile women with diagnosis unexplained infertility and male infertility, blood samples were obtained during the proliferative and secretory phases of an arbitrary menstrual cycle. Serum concentrations of FSH, LH, AMH, inhibin B, estradiol, progesterone, PRL and TSH were determined. The predictive value of ovulation and hormonal analysis was determined by identifying the proportion of women with at least one live birth. Mann Whitney U test, chi2 test and Spearman's correlation were used for statistical analysis. A value of p < 0.05 was considered statistically significant. Results: There were no differences in hormone values and live birth rates between women with unexplained infertility and male infertility. The best sole predictors of live birth were age of the women, followed by ovulatory cycle, defined as serum progesterone concentration of greater than or equal to 32 nmol/L, and a serum TSH concentration of less than or equal to 2.5 mIU/L. Combining the age with the ovulatory cycle and serum TSH less than or equal to 2.5 mIU/L or serum AMH greater than or equal to 10 pmol/L the predictive value was close to 90%. Conclusions: Age in combination with the presence of an ovulatory cycle and serum TSH or serum AMH is predictive for long-term live birth. The advantage of serum AMH compared with serum TSH is the very little variation throughout the menstrual cycle, which makes it a useful tool in infertility diagnosis.

Folic acid supplements are commonly used by infertile women and lead to a positive folate status. However, the effect of folic acid supplements on pregnancy outcome in women with unexplained infertility has not been well investigated. This study evaluated folic acid supplement use and folate status in women with unexplained infertility in relation to pregnancy outcome. In addition, use of folic acid supplements and folate status were compared between women with unexplained infertility and fertile, nonpregnant control women. Women with unexplained infertility used significantly more folic acid supplements and had higher median total folic acid intake from supplements compared with fertile control women (both P < 0.001). Women with unexplained infertility also had significantly higher median plasma folate and lower median plasma homocysteine concentrations than fertile women (both P < 0.001), but folic acid supplementation or folate status were not related to pregnancy outcome in women with unexplained infertility. In conclusion, folic acid supplementation or good folate status did not have a positive effect on pregnancy outcome following infertility treatment in women with unexplained infertility.

Objective:

To study folic acid intake, folate status and pregnancy outcome afterinfertility treatment in women with different infertility diagnoses in relation tomethylenetetrahydrofolate reductase (MTHFR) 677C>T, 1298A>C and 1793G>A genevariations. Also the use of folic acid supplements, folate status and the frequency ofdifferent gene variations were studied in women undergoing infertility treatment andfertile women.

Design:

Observational study. Setting: University hospital. Population:Women undergoing infertility treatment and healthy, fertile, non-pregnant women.

Methods:

A questionnaire was used to assess general background data and use ofdietary supplements. Blood samples were taken to determine plasma folate andhomocysteine levels, and for genomic DNA extraction. A meta-analysis of four studieswas performed to assess pregnancy outcome in relation to MTHFR 677 TT vs. CC, and1298 CC vs. AA polymorphisms.

Main outcome measures:

Folic acid supplementintake, and plasma folate, homocysteine and genomic assays.

Results:

Women in theinfertility group used significantly more folic acid supplements and had better folatestatus than fertile women, but pregnancy outcome after fertility treatment was notdependent on folic acid intake, folate status or MTHFR gene variations. However, ameta-analysis demonstrated that MTHFR 1298AA polymorphism was related topregnancy outcome.

Conclusion:

Folic acid supplementation seems to play only a minorrole in the context of pregnancy outcome after in vitro fertilisation, and other variablesin folate metabolism are of more importance. In particular, MTHFR 1298AA genevariation appears to have a positive association with the success of fertility treatment

Background: Socioeconomic and lifestyle factors are considered to be associated with folic acid supplement use and intake in the general population, but studies on infertile women are lacking. When investigating dietary supplement intake, the validity of the assessment of reported supplement use and actual intake is crucial. The objective of the study was to investigate socioeconomic, lifestyle and dietary factors in relation to folic acid supplement use and folate status in infertile and fertile women. In addition, a sub-analysis was performed to validate the used questionnaire. Methods: In this observational study, 340 infertile women and 188 fertile women were investigated. A questionnaire was used to assess lifestyle and dietary habits and use of dietary supplements. Blood samples were obtained for analyses of plasma folate and homocysteine levels. 24-hour recall interviews were performed to validate the questionnaire. Results: Folic acid supplement use was related to marital status, educational level and employment status. Infertile women had significantly higher mean folic acid daily intake and better folate status. However, folate status did not correlate with socioeconomic or lifestyle factors. The infertile women were physically more active, smoked less and had better employment status, but they were also more obese than fertile women. Socioeconomic and lifestyle factors were not related to in vitro fertilization outcome. Dietary data from the questionnaires showed good validity compared with the data from the 24-hour recall interviews, but data regarding folic acid supplement use showed only fair agreement between these methods. Conclusions: Highly educated, employed, married and infertile women were most prone to using folic acid supplements. Only a few socioeconomic and lifestyle factors differed between infertile and fertile women, and these were not related to folate status or IVF outcome. Methods other than a questionnaire are recommended when investigating folic acid supplement use.