A Note from the Editor-in-Chief
Lawrence D. Devoe, M.D.
Welcome to the May 2008 Editor-in-Chief’s page. The articles that have been selected as this month’s “Editor's Choice” address problems that have proved difficult in terms of either management or diagnostic interventions. It has been recognized that over-nutrition resulting in obesity (BMI >30 kg/m2) is a risk factor for primary infertility, as addressed by Miller and colleagues. Almost equally vexing to clinicians is the problem of undernutrition due to intractable nausea and vomiting in early pregnancy, as investigated by Abraham et al. We hope that these articles will provide useful insight into these conditions for our readers.
In This Issue: Editor's Choice
Effect of Short-Term Diet and Exercise on Hormone Levels and Menses in Obese, Infertile Women
P. B. Miller, D. A. Forstein and S. Styles
The authors have conducted a study that takes a
proactive intervention with a small cohort of obese, infertile women by
enrolling them in a lifestyle–altering program intended to improve physical and metabolic health. A primary endpoint of achieving regular menstrual cycles is important as oligomenorrhea secondary to infrequent ovulation is a known impediment to pregnancy among obese women. It is worth noting that a combination of diet and exercise sustained for 3 months made some important metabolic and reproductive cycle changes in the majority of their subjects. Although it is not known how these changes will affect future fertility, one could speculate that their direction would augur well for improved reproductive potential. Behaviorists have demonstrated that it takes approximately one month to either break an old habit or acquire a new one. It was encouraging to see the level of continued compliance with these “new habits” in this select patient group. It is also encouraging that making conscious changes in diet and physical activity is not a costly intervention when compared with the variety of sophisticated infertility treatments currently available.
Clinical Utility of Esophagogastroduodenoscopy in the Management of Recurrent and Intractrable Vomiting in Pregnancy
A. Debby, A. Golan, O. Sadan, M. Glezerman and H. Shirin
First trimester nausea and vomiting severe enough to prompt a diagnosis of hyperemesis gravidarum is an uncommon but challenging clinical problem for obstetricians. Part of the problem stems from its multiple etiologies and overlap with other primary upper gastrointestinal (GI) disorders. While most therapies begin with antiemetic treatment, they may progress in refractory cases to supportive parenteral nutrition, which is both expensive and not without complications. It has been recognized that a subset of hyperemesis patients will have other GI disorders that are amenable to diagnosis and more specific therapy. Debby and colleagues have conducted a retrospective review of patients who were admitted with intractable vomiting (Group 1) and/or GI bleeding (Group 2). All patients received esophagogastroduodenoscopy (EGD). A remarkably high percentage of patients in both groups had underlying GI pathology that might not have been detected without EGD and for whom more specific therapy might be indicated. A valuable aspect of this study is the discovery of a high prevalence of conditions which might improve with proton pump inhibition. The authors suggest that therapeutic trial with proton pump inhibitors might be warranted as front line therapy in patients with hyperemesis prior to further investigation. This is an intriguing consideration, and hopefully, future and larger prospective studies will be undertaken to assess its validity.