Losing weight before IVF may increase chance of pregnancy

Embargoed for release until 5:00 p.m. ET on Monday 11 August 2025   

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Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.   

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1. Losing weight before IVF may increase chance of pregnancy

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-24-01025

Editorial: https://www.acpjournals.org/doi/10.7326/ANNALS-25-02742

URL goes live when the embargo lifts             

A systematic review and meta-analysis of randomized controlled trials (RCTs) assessed whether weight loss interventions before in vitro fertilization (IVF) improved reproductive outcomes. The review found that weight loss interventions before IVF could increase the chances of pregnancy, especially in unassisted conception, although the effect on live births was unclear. The findings are published in Annals of Internal Medicine.  

Researchers from the University of Oxford reviewed 12 RCTs comprising 1,921 patients conducted between 1980 through 27 of May 2025. Inclusion criteria included studies conducted on women at least 18 years old with a BMI of 27 kg/m2 or greater who were seeking IVF with or without intracytoplasmic sperm injection treatment for infertility. Outcomes of interest were number of participants achieving pregnancy without IVF (unassisted pregnancy), with IVF (treatment-induced pregnancy), overall (unassisted plus treatment-induced) and those delivering a live infant. The researchers found that participants were typically women in their early 30s with a median baseline BMI of 33.6 kg/m2. Weight loss interventions studied included low-energy diets, an exercise program accompanied by healthy eating advice, and pharmacotherapy accompanied by diet and physical activity advice. Overall, weight loss interventions before IVF were associated with greater unassisted pregnancy rates. Evidence was inconclusive on the effect of weight loss interventions on treatment-induced pregnancies. Evidence on the association between weight loss interventions before IVF and live births was uncertain, although there was moderate certainty of no association with pregnancy loss. The findings suggest that weight loss interventions before IVF increase total pregnancies, mainly through an increase in unassisted pregnancy rates. However, further high-quality clinical trials testing different weight loss interventions, particularly those known to achieve greatest weight losses (e.g. low-energy total diet replacement programs) are needed.

Media contacts: For an embargoed PDF, please contact Gabby Macrina at gmacrina@acponline.org. To contact corresponding author Moscho Michalopoulou, DPhil (Oxon), please email Gavin Hubbard at communications@phc.ox.ac.uk (or news.office@admin.ox.ac.uk if out of hours).
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2. Cancer care from oncology subspecialists has doubled since 2008

Despite an increase in oncology subspecialist care, difference in utilization among high- and low-income areas reveal gaps in cancer care

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-25-00102

URL goes live when the embargo lifts             

A retrospective cohort study aimed to quantify trends in oncologist subspecialization and assess differences in subspecialized cancer care utilization in the U.S. The researchers found that between 2008 and 2020, oncology subspecialization increased significantly, however, gaps in utilization between high- and low- income areas have grown despite higher cancer mortality in low-income areas. These differences in utilization could reflect systematic barriers to care. The study is published in Annals of Internal Medicine. 

Researchers from Harvard T.H. Chan School of Public Health and colleagues studied Medicare claims data from over 3.2 million fee-for-service Medicare beneficiaries initiating chemotherapy between 2008 and 2020. The five most common cancer categories among beneficiaries were breast, gastrointestinal, hematologic, prostate/genitourinary, and thoracic. The researchers assessed trends in subspecialization of oncologists by classifying them based on the proportion of chemotherapy episodes they managed for specific cancer types annually. To assess changes over time in the proportion of chemotherapy episodes, by cancer type and across hospital referral regions (HRRs), that were treated by subspecialists, the researchers examined the proportion of chemotherapy episodes each year that were managed by a subspecialist of the relevant cancer type. The researchers found that between 2008 and 2020, the proportion of chemotherapy episodes managed by subspecialists increased from 9% to 18%. The proportion of chemotherapy episodes treated by subspecialists varied across the five most common cancer types in 2008; however, by 2020, the proportion of cancer types managed by subspecialists increased significantly. The gap between the number of chemotherapy episodes managed by subspecialists in the largest HRRs versus smaller HRRs grew significantly between 2008 and 2020, with the largest HRRs having 33.4% of episodes managed by subspecialists, whereas the smallest HRRs had only 9.6%. Most HRRs experienced increases in subspecialist involvement over time; however, HRRs in the rural Mountain West and Northern Great Plains reported fewer than 5% of chemotherapy episodes managed by subspecialists in 2020. They also found that subspecialist utilization did not align with local cancer burden as measured by county-level mortality, suggesting that areas with higher cancer burden had lower utilization of subspecialist care. While subspecialization within oncology has increased significantly, differences in the utilization of subspecialists mirror broader patterns of delayed adoption of medical innovations among physicians serving rural, low-income, and minority populations.

Media contacts: For an embargoed PDF, please contact Gabby Macrina at gmacrina@acponline.org. To contact corresponding author Michael L. Barnett, MD, MS please email michael_barnett@brown.edu.

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3. ACP provides recommendations to resolve current prescription drug shortages

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-25-00607

URL goes live when the embargo lifts             

In a new policy paper published in Annals of Internal Medicine, the American College of Physicians (ACP) offers recommendations to resolve current prescription drug shortages and suggests measures that policymakers can take to prevent shortages in the future. 

ACP’s paper calls out medication shortages as a public health crisis that leads to poor health outcomes and places significant strain on physicians and hospitals. To resolve and present future medication shortages, the paper suggests entities such as policymakers and health systems collaborate and prioritize public policy approaches and research. Equitable access to medications is a pillar of patient care, and ACP recommends establishing procedures to impartially distribute essential medications during a drug shortage.

Policymakers and relevant entities should make reasonable accommodations that reduce physician and patient administrative burden brought on by medication shortages, such as extra billing and documentation requirements. ACP supports public policy approaches that strengthen medication supply chains, working to prevent future shortages while also implementing monitoring processes for existing or emerging shortages. Public and private entities procuring medication should use sustainable procurement practices that minimize and deter medication shortages, creating incentives that reward quality and transparency over low cost.  

During drug shortages, compound drugs can play an important role in meeting patient needs, particularly in the case that lifesaving treatment is needed. However, the mass distribution of compound drugs during shortages should be time-limited to the duration of the shortage and not a fundamental component of the US strategy to reduce drug shortages.

ACP supports the importation of medications during periods of shortage in a safe and timely manner to address immediate need and recommends that any program to do so contains processes necessary to ensure quality and safety of imported medications. Finally, to mitigate business and market factors that contribute to shortages, ACP urges federal regulators to address anticompetitive business practices and promote a diversified manufacturing base.

Media contacts: For an embargoed PDF, please contact Gabby Macrina at gmacrina@acponline.org. To speak with someone at ACP, please email Jacquelyn Blaser at jblaser@acponline.org.

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4. Experts debate treatment of tricuspid valve infective endocarditis in a patient who uses injection drugs
This ‘Beyond the Guidelines’ feature is based on a discussion held at the Medical Grand Rounds conference held on 13 February 2025.

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-25-02049

URL goes live when the embargo lifts  

In a new Annals “Beyond the Guidelines” feature, an infectious diseases specialist and a cardiac surgeon discuss medical management, interventional approaches, and the value of multidisciplinary care for tricuspid valve endocarditis in a person who uses injection drugs. The experts discuss the treatment within the context of the American Heart Association’s 2022 scientific statement on infective endocarditis (IE) in people who inject drugs (PWID) that focuses on addiction, antibiotic therapy, and surgical management. Compared with native valve IE in non-PWID, IE in PWID is associated with higher rates of systemic embolism and more commonly involves right-sided valves such as the tricuspid valve. As such, asking ‘How would you treat tricuspid valve infective endocarditis in a patient who uses injection drugs?’ is an important clinical question.

They reviewed the case of Mr. Y, a 30-year-old man with a history of epilepsy and treated substance use disorder (SUD) who relapsed. An overdose on intranasal heroin led to a hospitalization for rhabdomyolysis and acute renal failure. He was discharged with a tunneled subclavian catheter for dialysis but faced hospital scheduling delays when trying to get it removed. He developed fevers and was admitted to an outside hospital with sepsis and methicillin-sensitive Staphylococcus aureus bacteremia, bilateral septic pulmonary emboli, a large pleural effusion, and multiple large tricuspid valve vegetations. He was treated with antibiotics and chest tubes were placed for a complicated parapneumonic effusion. After receiving a percutaneous mechanical aspiration (PMA), he was discharged with a midline catheter to complete the remaining two weeks of outpatient parenteral antibiotic therapy through the infectious diseases service.

The first discussant, Wendy Stead, MD, is a member of the Division of Infectious Diseases in the Department of Medicine and Program Director of the Infectious Diseases Fellowship at Beth Israel Deaconess Medical Center and Assistant Professor of Medicine at Harvard Medical School, Boston, Massachusetts. She emphasizes that antimicrobial care of IE in PWID starts with open, nonjudgmental, and early patient-centered communication about the diagnosis and a description of IE treatment strategies. She notes that hospitalization for IE is a “reachable moment” for physicians to provide essential prevention, screening, and harm reduction. She agrees with the choice to discharge Mr. Y with OPAT and continued SUD treatment, pursuing PMA for source control, and sees benefit in the multidisciplinary approach to his care.

The second discussant, Arminder Jassar, MBBS, is a cardiac surgeon at the Massachusetts General Hospital and Associate Professor of Surgery at Harvard Medical School, Boston, Massachusetts. Dr. Jassar agrees with Dr. Stead that effective treatment of injection drug use should be considered “source control.” He argues that surgical intervention can often trade one set of problems for another; however, he notes that wide variation in surgical practice can be improved by multidisciplinary teams. He highlights his institution’s formal multidisciplinary team for the care of PWID with IW, which has been associated with improvements in patient outcomes. He agrees with Mr. Y’s medical management, would not recommend valvular surgery but finds PMA reasonable, and favors a multidisciplinary team in line with that at his own hospital.

All “Beyond the Guidelines” features are based on selected clinical conferences at Beth Israel Deaconess Medical Center (BIDMC) and include multimedia components published in the Annals of Internal Medicine.  

Media contacts: For an embargoed PDF, please contact Gabby Macrina at gmacrina@acponline.org. To speak with one of the discussants, please contact Kendra McKinnon at Kmckinn1@bidmc.harvard.edu.

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Also new this issue:

Irritable Bowel Syndrome

Katarina B. Greer, MD, MS and Shahnaz Sultan, MD, MHSc

In the Clinic

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-25-01965