Chance Of Spontaneous Pregnancy Research Articles

Deep endometriosis – impact on infertility, endometriosis fertility index, and reproductive prognosis (comparative study)

Introduction Deep infiltrating endometriosis (DIE) is the most severe form of endometriosis, contributes to pelvic pain syndrome, extragenital symptoms, fertility problems, and diminished reproductive prognosis for affected individuals. It is recommended to use the Endometriosis Fertility Index (EFI) to assess reproductive prognosis and conduct clinical research to compare reproductive prognosis in different forms of endometriosis. Objective Comparison of the impact of the DIE and others forms of endometriosis on EFI, patients' fertility and on reproductive prognosis to understand the management approach. Materials and methods A cohort study included 190 reproductive-age women, divided according to the #Enzian classification: the main group - 85 patients with DIE, the control group - 105 women with other forms of endometriosis. The EFI was utilized for reproductive prognosis. Pain was evaluated with Visual Analog Scale (VAS). Statistical analyses were performed using SPSS, with calculation of the Mann-Whitney U and Pearson's chi-square test (χ²). Results In main group, the frequency of infertility was 83.5% compared to the control group's 71.4% (p > 0.05). The EFI in main group was 7.18±0.25 points vs the control group's 7.13±0.28 points (p = 0.852). Patients in the main group suffered from intense pelvic pain (>7 points by the VAS, p < 0.01), including severe dyspareunia (7.85±0.33 points vs 2.18±0.46 points in control group, p < 0.01). Conclusions Our results suggest that infertility in women with DIE may be more often associated with sexual abstinence due to significant dyspareunia rather than organic impairments. Thus, EFI in patients with DIE does not reflect all aspects of infertility and has reservations, and consideration of both physical symptoms and sexual health is crucial in managing DIE to optimize fertility outcomes. These findings open the way to the feasibility of surgical treatment of DIE to improve sexual quality of life, which will reduce the need for IVF and increase the chances of spontaneous pregnancy in patients, but this conclusion requires further investigation in randomized clinical trials.

Minimally invasive surgery for ovarian endometriosis as a mean of improving fertility: Cystectomy vs. CO2 fiber laser ablation what do we know so far?

Minimally invasive surgery emerged in the 1980s as a safe and effective technique which requires smaller incisions and, usually, a shorter hospital stay compared to traditional surgery. Since then, minimally invasive surgery has expanded in many surgical specialties. One of its newest application in gynecology stands in the infertility management of young women with unexplained infertility or suspected endometriosis. In these cases, laparoscopy allows to diagnose and treat the disease aiming to increase at best the chances of spontaneous pregnancy or trough assisted reproductive technology. Nowadays, minimally invasive surgical approach of ovarian endometriosis consists of either laparoscopic cystectomy or ablative techniques such as laparoscopic CO2 fiber laser vaporization. Although cystectomy represents the gold standard according to the latest Cochrane review, some endometriosis experts are worried about its detrimental effect on healthy ovarian parenchyma and suggest preferring a less aggressive approach such as CO2 fiber laser vaporization. The aim of this review is to give an overview of the available evidences about the impact of the two surgical procedures on ovarian reserve markers and pregnancy outcome.

7344 Effect of Unilateral Hydrosalpinx on Chances of Spontaneous Conception

<h3>Study Objective</h3> The aim of the study is to present a successful surgical management of a case of unilateral hydrosalpinx resulting after cesarean delivery that appeared to have interfered with spontaneous conception from a healthy patent contralateral fallopian tube. <h3>Design</h3> Case report with 6-month post-operative follow-up. <h3>Setting</h3> Operative laparoscopy was done in a teaching hospital operation room with the patient in dorsal lithotomy position. <h3>Patients or Participants</h3> 30 years- old female with a history of primary cesarean section which was complicated by postoperative infection. She presented with a history of secondary infertility of 5 years duration and was found to have a right hydrosalpinx and a patent left fallopian tube on hysterosalpingogram. <h3>Interventions</h3> Minimally invasive preservation of the left fallopian tube was done by performing neosalpingostomy instead of salpingectomy. <h3>Measurements and Main Results</h3> The patient conceived spontaneously after two <i>months,</i> and she is currently at 14 weeks gestation. <h3>Conclusion</h3> Minimally invasive neosalpingostomy in selected patients with unilateral hydrosalpinx can increase the chances of spontaneous pregnancy by eliminating the unfavorable effect of the hydrosalpinx.

Fertility Awareness and Attitudes Among Women Embarking on a Career in Medicine

Background: Previous international studies suggest professional women are more likely to delay childbearing whilst pursuing career goals. Due to prolonged education and training pathways, female medical students may be particularly at risk of fertility difficulties from delayed childbearing. Aim: To explore, among female medical students, the understanding of age-related fertility decline, attitudes toward prophylactic fertility interventions, and beliefs about potential effects of childbearing on training and career opportunities. Method: Cross-sectional online survey of female medical students at The University of Queensland, Brisbane, Australia. Results: The average response rate was 81% (n=113). 95% of respondents were aged 18 to 29, and most (98%) did not have children. 72% intend to have children; 24% within five years, and over 60% intending to delay for 10-15 years. 62% of respondents intend to undertake specialty training, 29% planning to delay childbearing until after training. Of these, 50% perceive that having children sooner would negatively impact career prospects or compromise financial security. Half of respondents reported their fertility knowledge as sound or high. Age of significant fertility decline was well understood, although 90% overestimated the chance of spontaneous pregnancy at age 30. 88% respondents recognise oocyte cryopreservation in their 20’s as a fertility preservation option, though only 28% would consider this in next 10 years with 21% not considering it at all. Respondents strongly believe they should be informed of age-related fertility decline (100%) and of fertility preservation options (98%). 79% believe medical students should seek individualised assessment. Conclusion: Future fertility is important to these at-risk women, who intend to undertake a prolonged education and training pathway. Despite reasonable understanding of age-related fertility decline, most intend to delay childbearing, perceiving financial and career disadvantages of earlier childbearing. Information about age-related fertility decline and fertility preservation strategies is strongly desired by this group.

P-632 Evaluation of low AMH levels in young women

Abstract Study question The primary objective was to evaluate impact of a low AMH level on the live birth rate in a population of young women IVF/ICSI . Summary answer Low AMH level in young women in FIV/ICSI is not expected to have an impact on the live birth. What is known already AMH is an important criterion for defining ovarian reserve. The majority of studies have shown that the AMH level in the general population is not correlated with the chances of spontaneous pregnancy. The management remains a challenge and must be individualized taking into account the new quantitative and qualitative criteria to be defined (POSEIDON classification). Finally, we know that the pregnancy rate is correlated to the rate of euploid embryos, and that the rate is higher before 35 years of age. Study design, size, duration In this single-center retrospective study from January 2015 to December 2020, 1824 IVF/ICSI attempts were analyzed. We analyzed the live birth rate according to 2 categories of young women matched by AMH level. Participants/materials, setting, methods We analyzed the live birth rate according to 2 categories of young women managed in IVF/ICSI protocol. A first group was ≤30 years old and a second group was between 31 and 35 years old. Then, we matched each of these groups to an AMH level, AMH&amp;lt;1ng/mL and AMH ≥1ng/mL. We analyzed the live birth rate of 4 groups of young women. Main results and the role of chance 1824 IVF/ICSI attempts were analyzed in this study. We have 539 women under 30 years of age and 1285 women between 31 and 35 years of age. For women aged ≤30 years, the group with AMH&amp;lt;1ng/mL had a non-statistically significant live birth rate compared to those with AMH≥1ng/mL (31% vs 32.7% p = 1). For women aged 31-35 years, the group with AMH&amp;lt;1ng/mL, has a statistically significant lower live birth rate compared to those with AMH≥1ng/mL (14.5% vs 29.3% p = 0.001). Limitations, reasons for caution The main limitation of our study is the few number of patients. Wider implications of the findings This study tries to demonstrate that low AMH levels in young women do not predict a poor IVF/ICSI success rate. Conclusions should not be drawn too quickly for low AMH in this population. However, the threshold AMH level is still debated in the studies and should be further adjusted. Trial registration number not applicable

Necrozoospermia: The tree that hides the forest.

Necrozoospermia is a condition found in 0.2%-0.4% of male infertility cases. The causes of necrozoospermia are multiple: they can be related to testicular and/or post-testicular damage. Additionally, these causes most often involve the production of reactive oxygen species (ROS) and/or sperm DNA fragmentation (SDF) which can reduce the chances of spontaneous pregnancy or affect the outcome of assisted reproductive technologies. To focus on potential etiologies of necrozoospermia, its diagnosis and its therapeutic management especially before the employment of ICSI. Authors searched PubMed/Medline, Web of Science, Cochrane Library, Google and Institutional websites for medical subheading terms and free text words referred to "necrozoospermia", "sperm vitality", "sperm viability", SDF and "ICSI". We identified 12 main etiologies of necrozoospermia responsible for either a decrease of sperm vitality, a mild, a moderate or a severe necrozoospermia. In case of a confirmed decreased vitality, a thorough check-up should be conducted and if available, etiological treatment should be proposed. Therapeutic management could also include repeated ejaculations, drug treatments, the use of ICSI with ejaculated or surgically extracted spermatozoa in case of a non-treatable necrozoospermia. The potential causes of necrozoospermia should be investigated because many of them could be corrected, thus avoiding the use of ICSI. Moreover, if ICSI procedure remains necessary, the therapeutic management of necrozoospermia could also improve the chances of success by reducing oxidative stress and/or SDF.

Restoration of Fertility in Patients with Spontaneous Premature Ovarian Insufficiency: New Techniques under the Microscope.

Premature ovarian insufficiency (POI), a condition affecting up to 1% of women by the age of 40 years, is characterized by an extremely low chance of spontaneous pregnancy. Currently, fertility restoration options are virtually nonexistent for this population. To become pregnant, the only solution is egg donation. Interestingly, animal studies have provided encouraging results in terms of fertility restoration, and consequently, research has begun into the most promising approaches for women suffering from POI. The PubMed database was searched for studies in which techniques aiming at restoring fertility in women with spontaneous POI were tested. Although robust studies are lacking, the literature suggests a positive effect of certain techniques on fertility restoration in women with POI. The most promising approaches seem to be intraovarian injection of autologous platelet-rich plasma or of mesenchymal stem cells. In addition to these, in vitro and mechanical activation of dormant follicles and etiology-driven therapies have also been studied with mixed results. No safety concerns were raised in these studies. The absence of robust studies does not allow us to draw meaningful conclusions on the efficacy or superiority of any single technique at this stage, and so research in this area should continue using robust study designs, i.e., multicenter randomized controlled trials including sufficient subjects to achieve statistical power.

PET-Guided Strategy Improves the Safety of Beacopp-Based Treatment in Advanced Hodgkin Lymphoma: Prolonged Follow-up of the Lysa Ahl 2011 Phase 3 Study

PET-Guided Strategy Improves the Safety of Beacopp-Based Treatment in Advanced Hodgkin Lymphoma: Prolonged Follow-up of the Lysa Ahl 2011 Phase 3 Study

In vitro activation of ovarian cortex and autologous transplantation: A novel approach to primary ovarian insufficiency and diminished ovarian reserve.

BACKGROUNDPrimary ovarian insufficiency (POI) and diminished ovarian reserve are two conditions that affect women’s fertility. Oocyte donation remains an option for these patients; however, the development of certain novel technologies, such as in vitro activation of ovarian cortex (IVA), enables the possibility of activating the pool of resting primordial follicles, increasing the chance of pregnancy.OBJECTIVE AND RATIONALEHere, we review the main pathways (PI3K and Hippo signaling) that govern the activation of primordial follicles and its application through the development of culture systems that support ovarian cortex for autologous transplantation. We also review the available data from case reports regarding outcomes of pregnancy and live birth rates with IVA.SEARCH METHODSA PubMed search was conducted using the PubMed-NCBI database to identify literature pertinent to the pathways involved in the activation of primordial follicles and the outcomes of IVA techniques from 2013 to the present.OUTCOMESWomen with POI have around a 5% chance of spontaneous pregnancy. Recently, novel techniques involving the activation of primordial follicles through molecular pathways have been developed, thus increasing the odds of these patients. More recently, the introduction of a drug-free IVA technique has shown to increase the number of antral follicles with successful oocyte maturation after gonadotropin treatment, reaching pregnancy rates over 30%, either through spontaneous conception or by the implementation of assisted reproductive technology.LIMITATIONSThe evidence of this review is based on a few small series, so data should be interpreted with caution, and only randomized controlled trials could estimate the real magnitude and success of the procedure.REASONS FOR CAUTION IVA technique remains an experimental strategy, with limited available data and the requirement of invasive procedures. Moreover, possible carcinogenic effects not yet determined after transplantation require special caution.WIDER IMPLICATIONSIn view of the results achieved, IVA could provide a promising option for the preservation of fertility in some cancer patients and prepuberal girls where the only alternative is tissue cryopreservation.STUDY FUNDING/COMPETING INTERESTSThe authors received no specific funding for this work and declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Are women and men well informed about fertility? Childbearing intentions, fertility knowledge and information-gathering sources in Portugal

BackgroundThe postponement of parenthood may increase the number of couples experiencing infertility and prolonged time to pregnancy. Previous research has revealed that childless people are not well informed regarding fertility, which may threat their childbearing intentions. This study aimed to examine fertility knowledge and childbearing intentions held by Portuguese people and their use and perceived usefulness of information sources on fertility.MethodsParticipants were recruited using a random-route domiciliary approach. A total of 2404 individuals aged 18–45 were asked to complete a structured questionnaire evaluating socio-demographic characteristics, childbearing intentions, fertility knowledge and information-gathering sources regarding fertility.ResultsIn total, 95.5% of the participants indicated the desire to have children in the future, and 61.7% reported that having children would contribute to life satisfaction. Most of the participants expressed the desire to have two children in the future. The discrepancy between the numbers of planned and desired children was higher in men, in participants with lower education levels, in professionally active participants and in the unemployed participants. Relationship stability seemed to be more important in influencing childbearing decisions than financial stability or family support.Participants’ knowledge regarding fertility was poor. Women, the participants who were older than 25, the participants with longer education and the participants with higher income exhibited the greatest levels of knowledge of fertility, although this knowledge was only slightly enhanced in these subgroups. Also, the participants overestimated both the chances of spontaneous pregnancy and the success rates of assisted reproduction techniques. Finally, the results revealed that websites were the main information sources used by the participants and only 18.0% of the participants had previously discussed fertility issues with their doctors.ConclusionsAlthough Portuguese men and women reported the desire to have children in the future, their knowledge regarding fertility and infertility risk was poor. In addition, participants used more general sources of information, such as website, but not specialized sources, such as their doctors. There is a real need to work with general practitioners to empower them to provide adequate fertility information to every childless patient.

OP22.08: Hysterosalpingo‐foam sonography (HyFoSy) with tubal flushing increase chances of spontaneous pregnancy

OP22.08: Hysterosalpingo‐foam sonography (<scp>HyFoSy</scp>) with tubal flushing increase chances of spontaneous pregnancy

Controversies in the Management of Endometrioma: To Cure Sometimes, to Treat Often, to Comfort Always?

Endometriomas are common in reproductive-aged women, but controversy exists regarding their management. PubMed was searched to identify pertinent studies on outcomes of medical and surgical management of endometrioma, with focus on randomized controlled trials and meta-analyses. Surgical excision is more effective than fenestration/coagulation of endometrioma for pelvic pain but decreases antimullerian hormone. It may modestly improve the chances of spontaneous pregnancy, but does not impact chances of success with in vitro fertilization. Oral contraceptive pills improve dysmenorrhea but not dyspareunia or noncyclic pelvic pain. Management of the patient with endometrioma should be individualized based on each patient's particular symptoms and short-term and long-term fertility goals.

Reproductive and obstetric outcomes in mosaic Turner's Syndrome: a cross-sectional study and review of the literature.

BackgroundTurner’s syndrome (TS) is depicted as a total or partial absence of one X chromosome that results in ovarian dysgenesis. Chances of spontaneous pregnancy in TS are rare and the outcome of the pregnancies is known to be poor with an increased risk of miscarriage and stillbirths. Our aim is to evaluate reproductive and obstetric outcomes of natural conception and in-vitro fertilization (IVF) cycles in mosaic TS patients.MethodsA total of 22 mosaic TS cases (seventeen 45,X/46,XX and five 45,X/46,XX/47,XXX karyotypes) were evaluated.ResultsLive birth and abortion rates were found as 32.7 % and 67.3 %, respectively in 52 pregnancies. Implantation, clinical pregnancy and take home baby rates were detected as 3.7 %, 8.6 % and 5.7 %, respectively per IVF cycle as a result of 35 cycles. Fecundability analysis revealed that 5 % of the cases experienced first pregnancy within 6 months and 8 % within the first 2 years. Mosaicism ratio did not have an effect on the time to the first pregnancy (p = .149).ConclusionOnly a small proportion of the mosaic TS patients conceive in the first 2 years of the marriage. Age of menarche and age of marriage appear not to have any impact on the chance of conceiving. Mosaic TS cases should counseled about the low odds of pregnancy and high miscarriage rates.

Fertility preservation in female classic galactosemia patients.

Almost every female classic galactosemia patient develops primary ovarian insufficiency (POI) as a diet-independent complication of the disease. This is a major concern for patients and their parents, and physicians are often asked about possible options to preserve fertility. Unfortunately, there are no recommendations on fertility preservation in this group. The unique pathophysiology of classic galactosemia with a severely reduced follicle pool at an early age requires an adjusted approach. In this article recommendations for physicians based on current knowledge concerning galactosemia and fertility preservation are made. Fertility preservation is only likely to be successful in very young prepubertal patients. In this group, cryopreservation of ovarian tissue is currently the only available technique. However, this technique is not ready for clinical application, it is considered experimental and reduces the ovarian reserve. Fertility preservation at an early age also raises ethical questions that should be taken into account. In addition, spontaneous conception despite POI is well described in classic galactosemia. The uncertainty surrounding fertility preservation and the significant chance of spontaneous pregnancy warrant counseling towards conservative application of these techniques. We propose that fertility preservation should only be offered with appropriate institutional research ethics approval to classic galactosemia girls at a young prepubertal age.

The fertility myth: Israeli students' knowledge regarding age-related fertility decline and late pregnancies in an era of assisted reproduction technology

As in many advanced societies, the age at first birth and the rate of post-menopausal pregnancies in Israel are constantly increasing. Since Israeli university students are the most likely population to postpone parenthood, this study aims at evaluating their awareness of: (i) women's age-related fertility decline; (ii) age-dependent success rates of IVF technology and (iii) medical procedures allowing late and post-menopausal pregnancies. Israeli undergraduate students (n= 410), attending four academic institutions and studying in different fields, completed a structured questionnaire in the 2009/2010 academic year. Students overestimated women's chances of spontaneous pregnancy in all age groups, whereas women's chances of achieving a live birth following IVF treatment were overestimated only for ages 40 years and above. Regarding both spontaneous and IVF pregnancies, success rates of very late pregnancies (beyond 45 years and after menopause) were greatly overestimated. Only 11% of the students knew that genetic motherhood is unlikely to be achieved from the mid-40s onward, unless using oocytes frozen in advance. The findings demonstrate entrenched fertility myths among Israeli students, particularly the false belief in the possibility of late (beyond 35 years) and very late genetic motherhood. This can be explained by technological 'hype' and favorable media coverage of very late pregnancies. Since this may culminate in involuntary childlessness, it is highly important to increase the awareness of the Israeli public on the subject of fertility. However, as our sample is not representative of the Israeli student population, our findings should be tested in future studies.

Reassessing the value of varicocelectomy as a treatment for male subfertility with a new meta-analysis

To determine the efficacy of varicocelectomy as a treatment for male factor infertility by improving the chance of spontaneous pregnancy. Meta-analysis. Cleveland Clinic's Glickman Urological Institute. Infertile men with abnormal results on semen analyses and a palpable varicocele. Surgical varicocelectomy. Spontaneous pregnancy outcome. The odds of spontaneous pregnancy after surgical varicocelectomy, compared with no or medical treatment for palpable varicocele, were 2.87 (95% confidence interval [CI], 1.33-6.20) with use of a random-effects model or 2.63 (95% CI, 1.60-4.33) with use of a fixed-effects model. The number needed to treat was 5.7 (95% CI, 4.4-9.5). Surgical varicocelectomy in infertile men with palpable lesions and at least one abnormal semen parameter improves the odds of spontaneous pregnancy in their female partners. Five studies were included (two randomized, three observational). All were scored for bias. Our study suggests that varicocelectomy in selected patients does indeed have beneficial effects on fertility status.

Influence of sperm surface antibodies on spontaneous pregnancy rates

Objective: To determine the rates of spontaneous pregnancies among women whose infertile male partners had sperm surface antibodies. Design: Retrospective analysis. Setting: Infertility clinic of a university referral center. Patient(s): One hundred fifty-seven infertile couples; the male partner had IgA and/or IgG sperm surface antibody concentrations of >10%. Intervention: None. Main Outcome Measure(s): Spontaneous pregnancy rates (PRs) over 6 years. Result(s): Spontaneous PRs correlated negatively with antibody concentrations. Conclusion(s): Although the chance of spontaneous pregnancy among women whose partners had sperm antibody concentrations of <50% was good, intracytoplasmic sperm injection should be recommended to patients with concentrations of >90%.

Salpingoscopy is an important part of the infertility work-up

Study Objectives. To assess the efficacy of salpingoscopy as a routine part of the infertility work-up by comparing laparoscopic findings with salpingoscopic findings, and to match the pregnancies achieved by the patients with findings obtained from the endoscopic evaluation. Design. A retrospective study conducted between January 1990 and June 30, 1994. Patients. One hundred twenty-four women undergoing infertility investigations. Two were suspected of having pelvic inflammatory disease, and one had an extrauterine pregnancy. Setting. The Jan Palfijn General Hospital, Antwerp, Belgium. Interventions. Video hysteroscopy, laparoscopy, and salpingoscopy were performed in every patient. Adhesiolysis was done in 46 and neosalpingostomy in 5. Salpingoscopy was performed on 188 fallopian tubes; 60 tubes (24.15%) could not be cannulated. Drilling of polycystic ovaries was done in eight patients, ovarian cystectomy in five, and myomectomy in one. Endometriosis lesions were treated in 38 women. Measurements and Main Results. In 3 of 13 women who were diagnosed as having endometritis at hysteroscopy, salpingoscopy revealed severe lesions of the mucosal folds. Of the normal-looking tubes at laparoscopy, 25.8% had mucosal lesions. Of the abnormal looking tubes at laparoscopy, only 13.5% had normal mucosal folds. More than one-fourth (28.5%) of patients with endometriosis AFS I and II had mucosal lesions. The number of pregnancies achieved by these women correlated well with salpingoscopy except in those with class III lesions. Conclusion. This study confirms that tubes that look normal externally can have lesions of the endosalpinx. A maximum possibility of spontaneous pregnancy exists when the mucosal folds are normal. Class III lesions are compatible with fertility, although the probability is reduced. With severe mucosal lesions the chances of spontaneous pregnancy are very remote.

The ultrasound diagnosis and clinical significance of varicocele.

A study was carried out to determine the relationship between clinically diagnosed and ultrasound-diagnosed varicoceles in 151 men with normal and abnormal semen analysis. In only 60 cases (40%) was the clinical diagnosis confirmed by ultrasound. Of the men with ultrasound-diagnosed varicocele, 14% were found to have a normal semen analysis compared to 31% of men without a varicocele, and this difference was statistically significant (p < 0.05). Bilateral varicoceles were associated with an even greater chance of having an abnormal semen analysis (p < 0.01), and with a significantly (p 0.05) decreased chance of spontaneous pregnancy. These men and also men with unilateral varicocele, whose partners have a relative cause of female subfertility, may benefit from earlier intervention for the treatment of their subfertility.