P–787 Impact of delaying ART to promote weight loss: a large multicentre study accounting for the combined effect of female/male age and body mass index (BMI)

Study question Is postponing the start of ART (to promote a reduction in female BMI) beneficial for cumulative live birth rates (CLBR) when accounting for the female/male ageing this delay will cause? Summary answer Postponing ART treatment in one year to promote female weight loss could be detrimental in women of advanced maternal age (AMA, >35 years-old). What is known already Overweight/obese couples are frequently encouraged to lose weight prior to infertility treatment to enhance ART outcomes. However, a meaningful weight loss is often difficult to achieve for these couples, frequently taking at least one year to accomplish. Given that both female and male ageing are also important for ART success, we were interested in understanding the combined impact on CLBR of BMI reduction and ageing following a one-year delay. Study design, size, duration A retrospective study including patients performing their first ART cycle using autologous gametes between 2013–2018 in one of 39 participating ART centres. Only GnRH antagonist cycles were included (n = 14260). CLBR was the primary outcome. Secondary outcomes included time-to-pregnancy, birthweight and gestational age. Participants/materials, setting, methods Patients were subdivided according to female BMI (Kg/m2) in either underweight (<18.5), normal-weight (18.5–24.9), overweight (BMI 25.0–29.9 kg/m2) and obese (≥30 kg/m2). Meaningful and extreme weight loss were defined as a reduction from obesity to either overweight or normal-weight, respectively. We performed multivariable regression analysis to account for potential confounding. Main results and the role of chance Overweight (36.8%) and obese (33.0%) women had significantly lower CLBR when compared to the underweight (42.6%) and normal-weight (41.4%). When assessing the confounder-adjusted net-effect of male/female age and BMI, the predicted benefit of promoting a meaningful BMI reduction was lower than the estimated hindrance due to male/female ageing as soon as women reached AMA (n = 8365, 58.6%). This absence of benefit was especially important in women >38 years-old, in which even extreme weight-loss did not compensate for the age-related reduction in CLBR caused by the one-year delay. Moreover, male weight-loss failed to provide any additional benefit when accounted for in the regression models. Finally, obesity was also associated with a modest but statistically significant one-month delay in time-to-pregnancy and a 96.1 g (95% confidence interval: 39.9–152.4) increase in birth weight. The diagram of predicted outcomes presented in this study may serve as a useful tool to counsel patients before treatment, namely when recommending treatment postponement to promote short-term (i.e. 3–6 months) or long-term (i.e. 1 year) weight loss. Limitations, reasons for caution Caution is recommended when extrapolating these results into everyday practice owing to the retrospective nature of the study and the fact that only GnRH antagonist cycles were included. Wider implications of the findings: Patients are frequently confronted with the dilemma to either postpone treatment (and promote weight loss) or start treatment immediately (to avoid further ageing). Our results seem to show that women in AMA may have hindered CLBR if recommended to delay treatment even if the desired weight loss is ultimately achieved. Trial registration number Not applicable

Male ageing is negatively associated with the chance of live birth in IVF/ICSI cycles for idiopathic infertility

STUDY QUESTION Is male age associated with the clinical outcomes of IVF/ICSI cycles for idiopathic infertility after adjustment for female age? SUMMARY ANSWER Male ageing is negatively associated with clinical IVF/ICSI outcomes in couples with idiopathic infertility independent of female age. WHAT IS KNOWN ALREADY The effect of male age on the outcomes of infertility treatments is controversial and poorly explored. In contrast, fertility is known to decline significantly with female age beyond the mid-30s, and reduced oocyte quality plays an important role. The negative effect of male age on sperm quality is largely associated with an increasing susceptibility to sperm DNA damage. Although increasing maternal age has been linked with poorer oocyte quality, studies on the effect of male age have disregarded the need to control for female age making it difficult to define clearly the role of male age in infertile couples. STUDY DESIGN, SIZE, DURATION This retrospective cohort study analysed 2425 cycles of couples with idiopathic infertility selected from a total of 24 411 IVF/ICSI cycles performed at Monash IVF in Australia between 1992 and 2017. The primary outcome was live birth and secondary outcomes were clinical pregnancy and miscarriage. PARTICIPANTS/MATERIALS, SETTING, METHODS Couples with primary/secondary infertility who underwent IVF/ICSI cycles with male partners classified as normozoospermic were selected (inclusion criteria). Couples in which the female partner had endometriosis, tubal factors, polycystic ovarian syndrome, ovarian hyperstimulation syndrome, poor responders (≤3 mature oocytes retrieved) and couples with more than 15 cumulus oocyte complexes retrieved or who used cryopreserved gametes were excluded. Binary logistic multilevel modelling was used to identify the effect of male age and female age on clinical outcomes after controlling for confounding factors. Male age and female age were examined as continuous and categorical (male age: <40, 40–44, 45–49, 50–54, ≥55; female age:<30, 30–34, 35–39, ≥40) predictors. MAIN RESULTS AND THE ROLE OF CHANCE There was a negative effect of male age and female age on live birth as odds ratios (OR) with 95% CI for each additional year of age (OR-male age: 0.96 [0.94–0.98]; OR-female age: 0.90 [0.88–0.93] P < 0.001). Potential interactions with male age such as type of treatment (IVF/ICSI), embryo transfer day (Day 3/Day 5) and female age did not have significant associations with outcomes (P > 0.05). Secondary outcomes showed a significant reduction in the odds of clinical pregnancy (OR-male age: 0.97 [0.96–0.99]; OR-female age: 0.92 [0.89–0.94] P < 0.001) and an increase in the odds of miscarriage with older age: male age (OR: 1.05 [1.01–1.08]; P = 0.002); female age (OR: 1.11 [1.05–1.18]; P < 0.001). Worse outcomes were associated with more cycles (clinical pregnancy-OR: 0.96 [0.93–0.99] P = 0.03; live birth-OR: 0.96 [0.92–0.99] P = 0.023) while more inseminated oocytes were associated with better outcomes (clinical pregnancy-OR: 1.06 [1.03–1.06] P < 0.001; live birth-OR: 1.07 [1.04–1.11] P < 0.001). Analyses for age categories showed a gradual worsening of clinical outcomes with increasing male age, with a significantly worse live birth and clinical pregnancy outcomes in males aged older than 50 years compared to males younger than 40 years (P < 0.05). LIMITATIONS, REASONS FOR CAUTION This study is limited to the information on confounding factors included. The study may also be limited in its generalizability to a wider population due the strict selection criteria. Age as a category could potentially result in residual confounding due to categorizing a continuous variable. WIDER IMPLICATIONS OF THE FINDINGS This study provides information for counselling of couples with idiopathic infertility. STUDY FUNDING/COMPETING INTEREST(S) Funded by the Education Program in Reproduction and Development, Department of Obstetrics and Gynaecology, Monash University. None of the authors has any conflict of interest to report. TRIAL REGISTRATION NUMBER N/A.

The ageing male

For over 40 years, physicians have been aware of the importance of hormonal changes associated with male ageing. As patients now expect to live full and rewarding lives into their eighties and nineties, it has become less acceptable to merely dismiss bothersome symptoms such as excessive tiredness, poor concentration, altered mood, depression, and sexual dysfunction as merely a consequence of the normal ageing process. Androgens are now known to play important roles in cardiometabolic disease, but little attention has been paid to this within current medical and urological education. The wide range of symptoms associated with the hormonal aspects of ageing spans many medical specialities with the result that no single discipline currently deals with these issues. Just as ageing women will remain under the care of gynaecologists, it is likely that the field of andrology must deal with the demands of this growing population of ageing men.

Declining to Decline: Aged Tough Guys in 'The Expendables' and 'The Expendables 2'

Old age in western cultures under current neo-liberal ideology is increasingly linked to notions of decline, frailty and dependence as it is often equated with being unproductive and a burden to society. This case study is based on the belief that in order to change socio-cultural patterns one must first understand them. Consequently, this article aims to analyse the socio-cultural (re)production of narratives of ageing in general and particularly of narratives of male ageing – a topic often neglected in academic debates of ageing.Mass media represent today a major source for the development and maintenance of hegemonic socio-cultural standards. As such their products need to be taken seriously even if their content might seem superficial and frivolous. A critical analysis of the commercially highly successful Hollywood action films The Expendables and The Expendables 2 will shed light on the cultural narratives of male ageing revealed in the two films and subsequently support a better understanding of the strategies used to transform narratives of decline commonly linked to ageing into stories of success and progress.