Introduction: The impact of the obesity pandemic on female reproductive capability is a factor that needs to be investigated. In addition, the link between endometrial thickness and in vitro fertilization (IVF) outcomes is contentious.Goal: Our goal was to analyze the association among endometrium development, hormone levels, embryo quality, clinical pregnancy, anamnestic parameters, and body mass index (BMI) in women receiving IVF treatment.Patients and methods: 537 participants undergoing IVF/ICSI cycles with successful oocyte retrieval were enrolled. Subjects were divided into four BMI based groups: underweight (UW; n=32), normal weight (NW; n=324), overweight (OW; n= 115), obesity (OB; n=66). Anthropometric and anamnestic parameters, characteristics of stimulation, endometrial thickness on the day of hCG injection, at puncture, at embryo transfer, FSH, LH, AMH, partner’s age and the semen analysis indicators, embryo quality, clinical pregnancy, were recorded and analyzed. Support Vector Machine (SVM) was built to predict potential pregnancies based on medical data using 22 dimensions.Results: In accordance with BMI categories, when examining pregnant/non-pregnant division, the average age of pregnant women was significantly lower in the UW (30.9 ± 4.48 vs. 35.3 ± 5.49 years, p=0.022), NW (34.2 ± 4.25 vs. 36.3 ± 4.84 years, p<0.001), and OW (33.8 ± 4.89 vs. 36.3 ± 5.31 years, p=0.009) groups. Considering FSH, LH, and AMH levels in each BMI category, a statistically significant difference was observed only in the NW category FSH was significantly lower (7.8 ± 2.99 vs. 8.6 ± 3.50 IU/L, p=0.032) and AMH (2.87 ± 2.40 vs. 2.28 ± 2.01 pmol/L, p=0.021) was higher in pregnant women. There were no further statistically significant differences observed between the pregnant and non-pregnant groups across any BMI categories, especially concerning endometrial development. Surprisingly, BMI and weight correlated negatively with FSH (r=-0.252, p<0.001; r=-0.206, p<0.001, respectively) and LH (r= -0.213, p<0.001; r= -0.195, p<0.001) in the whole population. SVM model average accuracy on predictions was 61.71%.Discussion: A convincing correlation between endometrial thickness development and patients’ BMI could not be substantiated. However, FSH and LH levels exhibited a surprising decreasing trend with increasing BMI, supporting the evolutionary selective role of nutritional status. Our SVM model outperforms previous models; however, to confidently predict the outcome of embryo transfer, further optimization is necessary.

Objectives: We aimed to develop and validate a per-cycle prediction model for in vitro fertilization (IVF) success using only preprocedural clinical variables available at the first consultation. Methods: We retrospectively analysed 1243 IVF/ICSI cycles (University of Szeged, 21 January 2022–12 December 2023). An Extreme Gradient Boosting (XGBoost version 1.7.7.1) classifier was trained on 14 baseline predictors (e.g., female age, AMH, BMI, FSH, LH, sperm concentration/motility, and infertility duration). A parsimonious 9-variable model was derived by feature importance. Model performance was assessed on the untouched test set and, as a final step, on an independent same-centre external validation cohort (n = 92) without re-fitting or recalibration. Results: The 9-variable model achieved an AUC of 0.876 on the internal test set, with an accuracy of 81.70% (95% CI 76.30–86.30%), sensitivity of 75.60%, specificity of 84.40%, PPV of 68.60%, and NPV of 88.50%. In external validation, the model maintained strong performance with an accuracy of 78.30%, confirming consistent discrimination on an independent same-centre cohort. Female age was the dominant high-impact feature, while AMH and BMI acted as “workhorse” predictors, and male factors added incremental value. Conclusions: IVF outcome can be predicted at the first visit using routinely collected preprocedural data. The model showed consistent discrimination internally and in external validation, supporting its potential utility for early, individualized counselling and treatment planning.

Introduction: A higher incidence of neural dysfunction in people with obesity has been described. We determined the prevalence of neuropathic lesions in obese women and evaluated their potential association with anthropometric and laboratory parameters.Patients and methods: In our cross-sectional study, we enrolled female patients with obesity and without diabetes before obesity treatment. Voluntary female subjects were controls with a normal body mass index (BMI). Autonomic function was assessed by Ewing’s cardiovascular reflex tests, while comprehensive peripheral neuropathic assessments were conducted utilizing the Neurometer®, Tiptherm®, Monofilament®, and Rydel-Seiffer tuning fork tests. Sudomotor function was assessed by the Neuropad®-test. Body composition was examined using the InBody 770.Results: 71 patients (mean ± SD; age: 36.1 ± 8.3 years; BMI: 40.2 ± 8.5 kg/m²) and 36 controls (age: 36.4 ± 13.3 years; BMI: 21.6 ± 2.1 kg/m²) were enrolled. Patients had significantly higher systolic (patients vs. controls; 137.5 ± 16.9 vs. 114.6 ± 14.8 mmHg, p<0.001) and diastolic (83.0 ± 11.7 vs.69.8 ± 11.2 mmHg, p<0.001) blood pressure compared to controls. Among autonomic tests, only the heart rate response to Valsalva maneuver (Valsalva-ratio) revealed significant impairment in patients (1.4 ± 0.2 vs. 1.7 ± 0.4, p<0.001). Neurometer® at the median nerve revealed increased current perception threshold (CPT) values at all stimulating frequencies in patients (CPT at 2000 Hz: 204.6 ± 70.9 vs. 168.1 ± 66.9, p=0.013; 250 Hz: 84.4 ± 38.9 vs. 56.5 ± 34.8, p<0.001; CPT at 5 Hz: 58.5 ± 31.2 vs 36.9 ± 29.1, p<0.001). The Rydel-Seiffer tuning fork test has revealed a significant impairment of vibrational sensing on the lower limb in patients (right hallux: 6.8 ± 0.9 vs. 7.4 ± 0.8, p=0.030; left hallux: 6.9 ± 0.8 vs. 7.3 ± 0.9, p=0.029). The Neuropad® testing showed a significant impairment of sudomotor function in women with obesity. A negative correlation was found in patients between BMI and the 25-hydroxy-D3/D2-vitamin levels (r=-0.41, p=0.00126) and a positive correlation between the BMI and resting systolic blood pressure (r=0.26, p=0.0325).Conclusion: Peripheral sensory neuronal and sudomotor function impairments were detected in female patients with obesity compared to the controls with normal BMI. Cardiovascular autonomic dysfunction was also revealed by the Valsalva-ratio in these patients, suggesting the presence of parasympathetic dysfunction. The negative correlation between BMI and the 25-hydroxy-D3/D2-vitamin highlights the potential deficiency of vitamin D in the population affected by obesity.

Background: Thyroid disorders, particularly thyroid autoimmunity, are increasingly prevalent among women of reproductive age and have been linked to fertility outcomes. While current endocrinology guidelines define distinct thyroid-stimulating hormone (TSH) target values for women undergoing assisted reproductive technology (ART), the optimal preconception TSH range for in vitro fertilization (IVF) success remains a topic of debate. Objectives: This study aimed to assess the impact of baseline TSH levels within the recommended normal range on IVF outcomes, specifically clinical pregnancy and live birth rates. Additionally, we assessed the predictive value of procedural and preprocedural factors, including maternal body mass index (BMI) and TSH, using machine learning models. Methods: We conducted a retrospective, single-center cohort study at the Institute of Reproductive Medicine, University of Szeged, involving 996 women who underwent IVF, with or without intracytoplasmic sperm injection. Biometric, medical history, laboratory, and procedural factors were analyzed. Pregnancy and live birth predictions were modeled using support vector machine (SVM), random forest (RF), and extreme gradient boosting (XGBoost) algorithms. The significance of features in the RF and XGBoost models was assessed. Results: SVM models achieved a mean accuracy of 72.26% in predicting pregnancy but were less effective for live birth classification. RF and XGBoost models demonstrated an area under the receiver operating characteristic curve of 0.76 and 0.74 for pregnancy and 0.67 and 0.61, respectively, for live birth. Key predictors included embryo score, maternal age, BMI, and specific hormone levels. Notably, male factors also contributed to outcome prediction. Analysis suggested that variations in maternal TSH within the normal range (0.3–4.0 mIU/L) had no significant impact on IVF success. Conclusions: Our study suggests that preconception TSH levels within the reference range do not significantly influence IVF success, which indirectly supports the validity of the current recommendations on this matter. While machine learning models demonstrated promising predictive performance, larger prospective studies are needed to refine thyroid function targets in ART, with a separate analysis of women with thyroid autoimmunity.

Cardiovascular disorders are the leading cause of death in the world. Many organ diseases (kidney, heart, and brain) are substantially more prone to develop in people with hypertension. In the treatment of hypertension, first‐line medications are recommended, while imidazoline receptor agonists are not first‐line antihypertensives. Our goal was to conduct a network meta‐analysis to assess the efficacy and safety of imidazoline receptor agonists. The meta‐analysis was performed following the PRISMA guidelines using the PICOS format, considering the CONSORT recommendations. Studies were collected from four databases: PubMed, Cochrane Library, Web of Science, and Embase. A total of 5960 articles were found. After filtering, 27 studies remained eligible for network meta‐analysis. Moxonidine reduced blood pressure in sitting position statistically significantly after 8 weeks of treatment (SBP MD: 23.80; 95% CI: 17.45–30.15; DBP MD: 10.90; 95% CI: 8.45–13.35) compared to placebo. Moreover, moxonidine reduced blood pressure more effectively than enalapril; however, this difference was not significant (SBP MD: 3.10; 95% CI: −2.60–8.80; DBP MD: 1.30; 95% CI: −1.25–3.85). Dry mouth was experienced as a side effect in the case of all imidazoline receptor agonists. After 8 weeks of treatment, the appearance of dry mouth was highest with clonidine (OR: 9.27 95% CI: 4.70–18.29) and lowest with rilmenidine (OR: 6.46 95% CI: 0.85–49.13) compared to placebo. Somnolence was less frequent with moxonidine compared to rilmenidine (OR: 0.63 95% CI: 0.17–2.31). Imidazoline receptor agonists were nearly as effective as the first‐line drugs in the examined studies. However, their utility as antihypertensives is limited due to their side effects. As a result, they are not first‐line antihypertensives and should not be used in monotherapy. However, in the case of resistant hypertension, they are a viable option. According to our findings, from the point of view of safety and efficacy, moxonidine appears to be the best choice among imidazoline receptor agonists.

Introduction: The global rise in obesity is linked to metabolic disorders, such as neuropathy and infertility. Our study aimed to analyze the effects of preconceptional weight loss in infertile women with obesity on peripheral sensory and cardiovascular autonomic nerve function, metabolic parameters, and the success of in vitro fertilization (IVF).Methods: A retrospective cohort study included women with obesity and infertility undergoing weight optimization before IVF, alongside age-matched controls. Clinical and laboratory parameters, cardiovascular autonomic and peripheral sensory function, and body composition were evaluated before and following weight loss therapy.Results: Patients with obesity [n=58; mean ± SD; age: 33.1 ± 5.42 years; body mass index (BMI): 39.3 ± 6.90 kg/m²] had higher resting blood pressure, prevalence of metabolic disorders, and medication usage than controls (n=45; age: 32.1 ± 7.67 years; BMI: 21.1 ± 2.02 kg/m²). Laboratory findings indicated differences in blood cell counts, glucose metabolism markers, kidney and liver functions, and lipid profile between the groups. Cardiovascular autonomic function tests indicated impairment in Valsalva-ratio (1.4 ± 0.22 vs. 1.5 ± 0.23, p<0.001) and 30/15 ratio (1.07 ± 0.12 vs. 1.12 ± 0.13, p<0.05) in patients with obesity. Peripheral sensory function tests revealed significant deterioration in vibration sense and the current perception threshold of the median nerve at 2000 Hz in patients with obesity, as compared to controls. Before and following weight loss therapy no statistically significant difference was found on cardiovascular autonomic and peripheral sensory function. Following weight loss therapy with lifestyle/dietary intervention and liraglutide, 16 female patients with obesity attended the follow-up measurement. They achieved significant weight reduction (104.3 ± 16.64 vs. 89.1 ± 15.74 kg; p<0.05) and 8 became pregnant (5 via IVF, 3 spontaneously).Conclusion: Peripheral sensory neuronal impairments were detected in infertile women with obesity compared to the controls with normal BMI. Cardiovascular autonomic dysfunction was revealed by 30/15 and Valsalva-ratio in patients with obesity, suggesting the presence of parasympathetic dysfunction. Preconceptional weight loss improved metabolic parameters. Of the infertile female patients with obesity who reached their preconceptional target weight, 18.75% achieved spontaneous pregnancy without IVF, and 62.5% of those who underwent IVF successfully conceived.