Birth Rate In Women Research Articles

Administration of depot GnRH agonist prior to programmed frozen-thawed embryo transfer does not improve the live birth rate in ovulatory women: A large, multi-center retrospective study.

Despite that gonadotropin-releasing hormone (GnRH) agonist pretreatment has been widely used before programmed frozen-thawed transfer (FET), its impact on live birth rates in ovulatory women remains uncertain. In the present study, we aim to determine if GnRH agonists pretreatment before FET improves live birth rates in women undergoing in vitro fertilization with FET. Programmed FET cycles conducted in four infertility centers were retrospectively collected and reviewed for eligibility from January 2016 and December 2017. Patient’s demographics, ovarian stimulation parameters, and pregnancy outcomes were compared between those given GnRH agonist pretreatment versus no pretreatment in ovulatory women undergoing FET cycles. A total of 6397 programmed cycles were screened for eligibility, of which 5049 cycles were included in the study for analysis. Compared with the group of no GnRH agonist pretreatment (n = 4143), women in the GnRH agonist group (n = 906) were older (33.0 vs 34.0, P < .001), had a higher proportion of subjects with previous transfer attempts and had a higher number of embryos transferred. After controlling for confounders, the logistic regression results showed that GnRH agonist pretreatment did not increase the odds of both clinical pregnancy (OR 0.92, 95% CI [0.70–1.20]), ongoing pregnancy (OR 0.91, 95% CI [0.69–1.19]) and live birth rates (OR 0.84, 95% CI [0.64–1.10]). However, when restricted to women who had no previous transfer attempts, women in the GnRH pretreatment group had lower odds of achieving live birth (OR 0.49, 95% CI [0.30–0.79]). Sensitivity analysis performed in patients with male factor infertility causes showed GnRH agonist pretreated group had lower live birth rates compared to no GnRH agonist pretreatment group (OR = 0.65, 95% CI [0.43–0.97]). Our findings suggested that GnRH agonist pretreatment does not bring additional benefits in live birth rate improvements for ovulatory women undergoing FET cycles. Therefore, the pros of using GnRH agonist to reduce premature ovulation should be weighed against the cons of prolonged time to pregnancy, discomforts resulting from pituitary suppression, and increased medical costs associated with GnRH agonist use.

LAPAROSCOPIC PERITONEAL EXCISION OF ENDOMETRIOSIS IMPROVES IN VITRO FERTILIZATION (IVF) LIVE BIRTH RATES IN WOMEN < 41 YEARS OF AGE WITH DIMINISHED OVARIAN RESERVE

In vitro fertilization (IVF) has become the preferred treatment approach for women with diminished ovarian reserve (DOR). Although there is a high prevalence of endometriosis in this population, data is lacking as it relates to the potential benefits of laparoscopy prior to IVF. The aim of this study is to determine whether laparoscopic peritoneal excision of endometriosis improves IVF live birth rates in women under 41 years of age with DOR.

Live Birth Rates in Women Under 38 Years Old with AMH Level < 1.2ng/ml in the First In Vitro Fertilization + / - Intracytoplasmic Sperm Injection: Retrospective Study and Arguments for Care.

Many studies failed to show a predictive impact of AMH levels on the chances of pregnancy; however, acceptable pregnancy rates for young women with low AMH levels were observed in IVF + / - ICSI. The objectives of this retrospective study were to evaluate the clinical pregnancy and live birth rates in the first IVF + / - ICSI cycle in women under 38years old with AMH level < 1.2ng/ml and to determine the arguments for care. We classified the women into three groups: group A: AMH < 0.4ng/ml (n: 86); group B: AMH: 0.4 to 0.8ng/ml (n: 90); and group C: AMH > 0.8 to < 1.2ng/ml (n: 92). We recorded data on the patients' characteristics, stimulation cycles, embryo cultures, and ongoing pregnancies. No difference was observed between the three groups for the number of embryos transferred, the clinical pregnancy, and the live birth rates (LBR) per embryo transfer (LBR/transfer: 24.1% in group A, 25.9% in group B, and 28.1% in group C). The young age of the women reassures about the oocyte quality, but a low level of AMH may raise concerns about a lower quantitative oocyte yield, leading to accelerated management of the couple in IVF + / - ICSI.

Aromatase inhibitors (letrozole) for ovulation induction in infertile women with polycystic ovary syndrome.

Aromatase inhibitors (letrozole) for ovulation induction in infertile women with polycystic ovary syndrome.

Association of thyroid peroxidase antibodies with the rate of first-trimester miscarriage in euthyroid women with unexplained recurrent spontaneous abortion.

BackgroundUnexplained recurrent spontaneous abortion is a serious reproductive problem of unknown etiology. Thyroid peroxidase antibodies (TPO-Ab) may be associated with pregnancy outcomes in unexplained recurrent spontaneous abortion with normal thyroid function.ObjectiveThis study aimed to investigate the relationship between TPO-Ab and the first trimester miscarriage rate/live birth rate in women of unexplained recurrent spontaneous abortion with normal thyroid function.MethodsWe retrospectively analyzed the clinical data of 297 women who met our strict inclusion criteria, comparing the first trimester miscarriage rate/live birth rate between the TPO-Ab positive and TPO-Ab negative groups. For the same purpose, we also performed subgroup analysis.ResultsOf the included women, 76 (25.6%) were TPO-Ab positive, and 221 (74.4%) were negative. First trimester miscarriage rate differed between the two groups (36.8% vs 24.0%, RR = 1.54, 95% CI: 1.05–2.24, P = 0.030). In the younger subgroup (<35 years) and the primary RSA subgroup, First trimester miscarriage rate was also higher in the TPO-Ab positive group (33.3% vs 19.0%, RR = 1.75, 95% CI: 1.07–2.87, P = 0.030; 36.5% vs 21.7%, RR = 1.69, 95% CI: 1.10–2.58, P = 0.020). While the live birth rate was lower in women with TPO-Ab positive, the difference did not reach statistical significance, even in the subgroup analysis.ConclusionOur results suggest that TPO-Ab is associated with first trimester miscarriage rate in euthyroid women with unexplained recurrent spontaneous abortion.

Comparison of two gonadotropin-releasing hormone agonist suppression protocols for in vitro fertilization in young patients with low body mass index.

To evaluate two different gonadotropin-releasing (pituitary downregulating) hormones used in in vitro fertilization (IVF) on the live birth rate in young patients with low body mass index (BMI) undergoing their first IVF cycle. In a retrospective study in a single public medical center, 555 long gonadotropin-releasing hormone agonist (GnRH-a) protocols were compared with 431 prolonged GnRH-a protocols between 2016 and 2018. All analyses were performed using the SPSS version 22.0. The primary measured outcome was live birth rate. Compared with the long protocol, the prolonged protocol required more doses of gonadotropin and a longer duration of ovarian stimulation. Lower levels of serum luteinizing hormone and serum estrogen were detected on the day of chorionic gonadotropin administration, and a lower fertilization rate was found in the prolonged protocol. Although more oocytes were retrieved and more frozen embryos were recorded in the prolonged protocol, the live birth rate per fresh cycle was comparable between the two protocols (P= 0.057). The incidence of ovarian hyperstimulation syndrome was higher in the prolonged protocol group. In the subgroup of women with antral follicle count (AFC) of 12 or less, there was no difference in the live birth rate between the two protocols (P= 0.688). However, for women with AFC > greater than 12, the prolonged protocol was still a positive predictor of live birth rate. The odds ratio was 1.73 (95% confidence interval 1.04-2.89). The prolonged protocol might not increase the live birth rate in women with low BMI who are undergoing their first IVF cycle. However, for women with AFC greater than 12, a prolonged protocol could be a good choice to improve the live birth rate.

Effect of Dual Trigger In Vitro Fertilization and Intracytoplasmic Sperm Injection During the Gonadotropin-releasing Hormone-Antagonist Cycle on Final Oocyte Maturation and Cumulative Live Birth Rate in Women with Diminished Ovarian Reserve.

It is well known that a dual trigger treatment can improve clinical outcomes of in vitro fertilization (IVF) in high or normal ovarian responders. However, it is not clear whether dual triggering also benefits patients with diminished ovarian reserve (DOR). The aim of this study was to investigate whether a dual trigger treatment of gonadotropin-releasing hormone (GnRH) agonist combined with human chorionic gonadotropin (hCG) for final follicular maturation improves the cumulative live birth rate (CLBR) during the GnRH-antagonist cycle in patients with DOR. This retrospective study included patients with DOR who received a GnRH-antagonist protocol during IVF and intracytoplasmic sperm injection (IVF-ICSI) cycles at Peking University People's Hospital from January 1, 2017 through December 31, 2017. Oocyte maturation was triggered by GnRH combined with hCG (n=110) or hCG alone (n=71). Embryos were transferred on the third day after oocyte retrieval or during a subsequent freeze-thaw cycle. Patients were followed up for 3 years. The dual trigger treatment did not affect CLBR, which is an overall determinant of the success rate of assisted reproductive technology (ART). Women in the dual trigger group had significantly higher rates of fertilization than those in the hCG group (90.1% vs. 83.9%, P=0.040). Dual trigger with GnRH agonist and hCG did not improve CLBR in patients with DOR, but did slightly improve fertilization rate, oocyte count, and embryo quality.

Association between duration of controlled ovarian stimulation and live birth rate in women undergoing In Vitro Fertilization: a SART CORS analysis

Background: In-Vitro Fertilization (IVF) treatment involves synchronization of multiple time-sensitive events, most of which are rate-limiting too. Controlled ovarian stimulation (COS) is one such event. The reproductive outcomes based on the duration of COS (d-COS) in a fresh, IVF embryo transfer (ET) are not well established and therefore, remains largely uncertain. Objective: To evaluate the association between d-COS and live birth rate (LBR) in women undergoing a fresh IVF-ET using autologous oocytes. Methods: A retrospective cohort study was conducted using a US nationwide IVF register – SARTCORS (Society for Assisted Reproductive Technology Clinic Outcomes Reporting System). From a total of 93,889 cycles, we included 56,666 fresh, autologous, IVF - ET treatment cycles from January 2014 through December 2015, with follow-up until October 2016. Adjusted odds and risk ratio with 95% confidence intervals were estimated while controlling for multiple demographic factors and other potential confounders. Variables and outcomes: The primary exposure variable was d-COS defined as the difference in days between gonadotrophin administration and oocyte retrieval. The primary outcome measure was live birth following a fresh IVF-ET. Secondary outcome measures included biochemical pregnancy rate, miscarriage rate, implantation rate and clinical pregnancy rate. Results: A total of 56,666 treatment cycles (mean [SD] age of 33.9 [4.47], BMI of 26.1 [6.02], AMH value of 2.19 [3.37]), and a baseline FSH value of 7.62 [3.49]) underwent a fresh IVF-ET. The LBR after a combined analysis for all ages and all protocols was 44.2 % (n = 25043). In the combined analysis, there was a statistically significant decrease in the live birth rate with LBR with d-COS beyond 10 days. The adjusted OR (95% CI) of LBR for a woman who had 11, 12, 13 and ≥14 days of COS, compared to optimal duration of 10 days was 0.97 (0.87-0.99), 0.94 (0.8-1), 0.83 (0.77-0.89) and 0.73 (0.68-0.79) respectively. The AOR (95% CI) of miscarriage rates for a woman who had 11, 12, 13 and ≥14 days of COS, compared to referent was 1.12 (1-1.26), 0.99 (0.87-1.12), 1.03 (0.90 -1.17) and 1.04 (0.90 - 1.2) respectively. With increasing d-COS, the implantation rate (IR) and clinical pregnancy rate (CPR) also showed a decreasing trend, as with other reproductive outcomes. The RR (95% CI) for implantation rate in a woman who had 11, 12, 13 and ≥14 days of COS, compared to referent was 0.97 (0.93-1), 0.97 (0.93-1.01), 0.91 (0.87-0.95) and 0.86 (0.82-0.9). The adjusted OR (95% CI) of CPR for a woman who had 11, 12, 13 and ≥14 days of COS, compared to referent was 0.95 (0.89-1.01), 0.93 (0.87-0.99), 0.8 (0.75-0.86) and 0.7 (0.65-0.75) respectively. Conclusions and Relevance: In this nationwide cohort study of women undergoing fresh IVF-ET using autologous oocytes, controlled ovarian stimulation lasting approximately 10-days was associated with an optimal live birth rate.

Continuous glucose monitoring: A cost-effective tool to reduce pre-term birth rates in women with type one diabetes.

Women with type one diabetes experience poorer obstetric outcomes than normoglycaemic women in pregnancy. To investigate the cost and clinical effectiveness of continuous glucose monitoring (GCM) compared to self-monitoring of blood glucose in improving obstetric outcomes in women with type one diabetes during pregnancy. This retrospective cohort study included women with type one diabetes referred to a state-wide tertiary obstetric centre before and after the introduction of government-funded CGMs in Australia in March 2019. Forty-nine women using CGMs were propensity matched on a range of clinical features with a historical group of 49 women with type one diabetes who exclusively used intermittent self-monitoring of blood in the year prior to the introduction of funding of sensors. Medical records and administrative cost data were audited to quantify cost and clinical effectiveness. There were significantly lower pre-term (95% CI 0.39-0.922; P=0.026) and very pre-term birth rates (95% CI 1.002-1.184; P=0.041) in the CGM group. There was a significant reduction in the length of antenatal inpatient hospital stay (P < 0.01) and adult special care unit stay (P=0.013) and neonatal admission to the neonatal intensive care unit (P=0.0262) in the continuous glucose monitoring group. CGMs represented a net cost saving to the health care sector of $12 063 per pregnancy where the device was used, with an incremental cost-effectiveness ratio of $3275 per prevented pre-term birth. CGM use in pregnancy is a cost-effective intervention for reducing the risk of pre-term birth in women with type one diabetes, resulting in a net cost benefit to the health sector.

Mode of Delivery and Caesarean Indications Among Women with Hypertensive Disorders in Pregnancy at Korle Bu Teaching Hospital

Objective: To determine the relative proportions of vaginal and caesarean deliveries, and the common caesarean indications among women with hypertensive disorders in pregnancy (HDP).Materials and methods: A cross sectional study conducted at the Maternity unit of Korle Bu Teaching Hospital in Accra from 1st January to 28th February 2013.Results: A total of 368 women with HDP were recruited with 168 (45.7%) and 200 (54.3%) having caesarean and vaginal deliveries respectively. Regarding the caesarean delivery, 31 (18.5%) had gone into labour prior to the surgery whiles 137 (81.5%) were not in labour. Among the 368 women 68 (18.5%) had induction of labour out of which 46 (67.6%) achieved vaginal delivery. The risk of caesarean section was significanty higher in preeclampsia [(adjusted odds ratio 2.898 (1.741-4.824), p-value &lt;0.001] and chronic hypertension [(adjusted odds ratio 2.474 (1.194-5.128), p-value =0.015] with reference to gestational hypertension. The Commoncaesarean indications among women with HDP were previous caesarean birth (26.2%), unfavourable cervix (22.6%), fetal distress (14.9%), failure to progress (10.7%), fetal malpresentation (9.5%), failed induction (7.1%) and placental abruption (3.0%). A total of 65(17.7%) women with HPD had had a prior caesarean birth.Conclusion: This study has determined a high caesarean birth rate in women with HDP with the highest and lowest caesarean rates occurring in chronic hypertension and gestational hypertension respectively. The common caesarean indications among women with HDP were previous caesarean birth, unfavourable cervix, fetal distress, failure to progress, fetal malpresentation, failed induction of labour and placental abruption.

P-581 Live birth rates in women under 38 years old with AMH level &amp;lt; 1.2 ng/ml in in-vitro fertilization/intracytoplasmic sperm injection: arguments for care

Abstract Study question To evaluate the clinical pregnancy and live birth rates in the first IVF/ICSI cycle in women under 38 years old with AMH level &amp;lt; 1.2 ng/ml. Summary answer Our findings argue to propose IVF for those patients. What is known already Many studies failed to show a predictive impact of AMH levels on the chances of pregnancy, however acceptable pregnancy rates for young women with low AMH levels were observed in IVF/ICSI. The definition of early ovarian failure is based on two classifications, Bologna and Poseidon, where an AMH level of 1.2 ng/ml appears to be the threshold for determining ovarian failure. According to La Marca's curve, this level of 1.2 ng/ml corresponds to an ovarian reserve of a 38 year-old woman. Study design, size, duration The primary objective of this study was to compare the live birth rates between these three groups of women. The secondary objective was to compare the rate of positive βhCG level, clinical pregnancy rate and live birth rate in women under 38 years of age during the 1st cycle of IVF+/-ICSI, regardless of whether the AMH is &amp;lt; 1.2 ng/ml or ≥ 1.2 ng/ml. Participants/materials, setting, methods We analyzed the first cycle of IVF/ICSI in women under 38 years old with AMH level &amp;lt; 1.2 ng/ml under long GnRH agonist or GnRH antagonist protocols. We classified the women into three groups: group A: AMH &amp;lt; 0.4 ng/ml; group B: AMH: 0.4 to 0.8 ng/ml; group C: AMH &amp;gt; 0.8 ng/ml. Main results and the role of chance Between January 2017 and September 2020, we retained 227 cycles for analysis (group A: 50 cycles, B: 85 cycles and C: 92 cycles). No significant difference was found between the three groups for clinical pregnancy and live birth rates, either per stimulation cycle, oocyte puncture or embryo transfer. Thus, the birth rates per embryo transfer are 23.5% in group A, 25.4% in group B and 28.1% in group C. When we compared the two groups of women under 38 years of age during the 1st cycle of IVF+/-ICSI, according to AMH levels &amp;lt; 1.2 ng/ml (n: 227) or ≥ 1.2 ng/ml (n: 325), the only significant difference was the positive βhCG level rate per oocyte puncture (p &amp;lt; 0.01). Biochemical pregnancy rates were significantly different in women with AMH &amp;lt; 1.2 ng/ml (40.8%) compared to those with AMH ≥ 1.2 ng/ml (16.6%; p &amp;lt; 0.01), but the rate of first trimester miscarriage was identical in both groups (14.6% and 6.1% respectively). Limitations, reasons for caution Our retrospective study and the small sample size limited the level of scientific proof. The woman and male ages were significantly different between the AMH groups, but these data lead to reduce the impact of low AMHs on pregnancy rates. Wider implications of the findings The young age of the women (&amp;lt; 38 y.o) reassures about the oocyte quality, but a low level of AMH may raise concerns about a lower quantitative oocyte yield, leading to accelerated management of the couple in IVF/ICSI. Trial registration number B2020CE.43

P-427 Pregnancy outcomes following recurrent first-trimester miscarriage: a retrospective cohort study

Abstract Study question What are the subsequent pregnancy outcomes (livebirths, miscarriages or other adverse pregnancy outcomes) in a cohort of women with recurrent miscarriage (RM)? Summary answer The overall live birth rate in women with RM was 62% (466/748), falling to 44% in women aged &amp;gt;40 and 54% in women with infertility. What is known already RM affects approximately 1% of women of reproductive age. RM is recognized as a prognostic indicator for subsequent pregnancies and adverse pregnancy outcomes including ante-partum hemorrhage, diabetes, preterm birth, small for gestational age and perinatal death. While RM has known associations with advanced maternal age, obesity, diabetes, thyroid dysfunction and endometriosis, approximately 50% of women/couples will be left without an explanation for their pregnancy loss, even after completing investigations. Study design, size, duration A retrospective cohort study was undertaken to identify subsequent pregnancy outcomes in women with RM, where RM referral criteria are 3 consecutive first-trimester miscarriages. Women attending the pregnancy loss clinic at a tertiary university hospital in the Republic of Ireland over a 12-year period (2008 - 2020) with a confirmed diagnosis of primary or secondary first-trimester RM were eligible for inclusion. In total, 923 charts were identified for review against the eligibility criteria. Participants/materials, setting, methods Women with non-consecutive first trimester miscarriages or ectopic pregnancy were excluded. Epidemiological and clinical information was gathered from paper and electronic medical records. Data were analysed descriptively using SPSS (Version 27). Main results and the role of chance Of 748 women identified, 332(44%) had primary RM, 416(56%) had secondary RM. The median age was 36(range 19-47) years with 12% aged under 29 and 64% of women aged ≥35. 142(19%) had a history of infertility with 43(5.7%) attending for ART. 12% of women had anti-nuclear antibodies(89/742), 8% had abnormal thyroid function tests(60/742), 4.7% were heterozygous carriers of the Factor V Leiden gene mutation(35/737), 1.5% had positive anti-cardiolipin antibodies(11/733), 2% were carriers of a Prothrombin gene mutation(7/343) and 1% had elevated HbA1c levels(7/742). Fetal karyotype was recorded in 141 pregnancies, with 111 abnormal results(78%;111/141). Trisomy(T) 16 was most common(17/111; 15%) followed by T21 and T22(n = 14; 13%). Parental karyotyping of 697 sets of parents identified 28 balanced translocations(4%; 28/697). Prescribed pharmacological treatments included high dose folic acid(75%; n = 548/728), aspirin(96%; 696/726), progesterone (52%; 389/728), tinzaparin(24%; 175/727), prednisolone(4%; 28/726), metformin(2%; 12/727) and hydroxychloroquine(1%; 7/727). 573 women had a subsequent pregnancy (76.6%); 359(62%; 359/573) had a live birth, 190 had a miscarriage(33%) and 18(3%) had an adverse pregnancy outcome such as ectopic pregnancy, stillbirth or second-trimester miscarriage. Including successive pregnancies over the study period, the overall live birth rate was 62%(466/748), falling to 44% in women aged &amp;gt;40 and 54% in women with infertility. Limitations, reasons for caution This work covers a 12-year period, and while the RM clinic staffing is largely unchanged, some changes in management of RM patients has occurred in this time, reflecting up-to-date evidence and greater public awareness. Furthermore, the adoption of an electronic health chart in 2017 may have affected data availability. Wider implications of the findings Our findings confirm RM occurs more frequently in women aged &amp;gt;35. Aneuploidy remains a leading cause of miscarriage. Age is a prognostic indicator for livebirth after RM. These findings will facilitate counselling in this cohort. The substantial rates of prescribed medications and infertility in women with RM merit further exploration. Trial registration number N/A

P-540 Is there a necessity to process preimplantation genetic aneuploidy testing (PGT-A) of embryos in all patients undergoing Assisted Reproductive Technology (ART) programs?

Abstract Study question Should each embryo undergo preimplantation genetic testing for aneuploidy (PGT-A), or a personalized approach following indications such as age should be applied? Summary answer PGT-A does not increase clinical pregnancy and live birth rates in women under 35, however results are significantly improved for female patients over 35 years. What is known already PGT is a powerful tool in standard IVF practice however, despite all the benefits of the technology, it remains one of the most controversial topics that continue to generate interest, discussion, and debate in the field of reproductive medicine. Proponents believe that the potential of PGT-A allows effectively selecting a euploid embryo based on its genetic status and achieving a result in a short time regardless of the patient's age. Opponents consider that PGT-A cannot reflect the chromosomal status of the entire embryo with 100% accuracy, and embryo manipulation is inherently invasive and traumatic, which may reduce the life-birth potential. Study design, size, duration The retrospective single-center study included 2164 ART cycles performed from 2017 to 2020 at the Institute of Reproductive Medicine, Almaty, Kazakhstan. Clinical pregnancy rates (CPR), live birth rates (LBR), and pregnancy losses were analyzed. Results of frozen embryo transfer (FET) cycles with PGT-A as Group A (n = 637), FET without PGT-A as Group B (n = 705) and fresh cycle transfer as Group C (n = 822) have been compared. Moreover, selection were categorized by female age: ≤35 and &amp;gt;35. Participants/materials, setting, methods In the “fresh” IVF cycle (Group C), day 5 blastocysts of excellent/good quality according to the Gardner classification were selected for transfer. Trophectoderm (TE) biopsy of about 5-10 cells was performed on day 5/6 followed by vitrification (Kitazato). PGT-A was processed by comparative genomic hybridization (aCGH) on the Agilent platform. The transfer of thawed embryos of Group A (with PGT-A) and Group B (without PGT-A) was conducted into the uterine cavity under ultrasound control. Main results and the role of chance A total of 2318 blastocysts have been analyzed for the study. The proportion of euploid/aneuploid embryos in females under 35 years was 60.5/39.5%, respectively. In the category of over 35, this ratio was inverse - 41.9/58.1%. The results of the study haven't revealed statistical differences in age category under 35 years in CPR between Groups A, B, and C and amounted to 58.9% (227/385), 58.7% (637/1084), and 58.9% (482/936), respectively. However, in the category of women over 35 CPR was significantly higher (p &amp;lt; 0.001) in Group A - 53.2% (134/252) compared with Groups B - 40.9% (167/408) and C - 39.0% (185/474). Early pregnancy losses in patients under 35 in Group B were remarkably higher compared to Group A and composed to 12.2% (16/227) vs 7.1% (78/637), respectively (p &amp;lt; 0.05). A similar trend was traced in these groups in females over 35 -14.4% (24/167) vs 8.9% (12/134). The percentage of LBR in women over 35 years was significantly higher (p &amp;lt; 0.001) in Group A - 48.4%, compared to Groups B and C (35 and 34.2%). We did not find a notable difference between the two groups in women aged under 35. Relationships between variables were assessed by Student’s T-test. Limitations, reasons for caution The current study is limited due to the results of mosaic embryo transfers were excluded. Wider implications of the findings Although using PGT-A is growing each year, a significant increase in the rate of CPR and LBR was noted only in women over 35 years of age. However, concerning safety, in patients undergoing PGT-A, the risk of having a child with chromosomal diseases is significantly reduced. Trial registration number NA

O-021 Levothyroxine in Euthyroid Thyroid Peroxidase Antibody positive Women with Recurrent Pregnancy Loss: a multicentre, randomised, double-blind trial (T4LIFE trial)

Abstract Study question Does levothyroxine treatment increase live birth rates in thyroid peroxidase antibodies (TPO-Ab) positive women with recurrent pregnancy loss (RPL) and normal thyroid function? Summary answer Levothyroxine treatment did not result in higher live birth rates in women with RPL positive for TPO-Ab and a normal thyroid function, compared to placebo. What is known already Women positive for TPO-Ab have a higher risk of RPL. Levothyroxine supplementation has been proposed to reduce the risk of pregnancy complications. Evidence is limited whether levothyroxine treatment improves pregnancy outcomes in TPO-Ab positive women with RPL. Study design, size, duration We conducted an international double-blind trial. Between January 2013 and September 2019, we randomly assigned 187 women to receive levothyroxine (94 women) or placebo (93 women). Before conception, women were randomly assigned in a 1:1 ratio to levothyroxine or placebo orally once daily. The daily dose of levothyroxine was based on preconception TSH concentration and ranged from 0.5 to 1.0 µg/kg bodyweight. Levothyroxine or placebo was continued until the end of pregnancy. Participants/materials, setting, methods Patients with two or more pregnancy losses underwent diagnostic testing for RPL. Women with a normal TSH level and positive for TPO-Ab were eligible for the study. Antiphospholipid syndrome was an exclusion criterion. The primary outcome was live birth, defined as the birth of a living child beyond 24 weeks of gestation. Secondary outcomes included ongoing pregnancy, pregnancy loss, preterm delivery, adverse events and time to conception leading to live birth. Main results and the role of chance Live birth occurred in 47 women (50%) in the levothyroxine group and in 45 women (48%) in the placebo group (risk ratio, 1.03; 95% confidence interval [CI], 0.77 to 1.38; absolute risk difference 1.6%; 95% CI, -12.7% to 15.9%). There were no significant differences in any secondary outcomes. In both groups seven adverse events were reported, none of them directly related to the study procedure. Limitations, reasons for caution The slow recruitment forced us to stop the trial prematurely. With this sample size we are not able to fully account for dropouts and the estimates have wide 95% confidence intervals. Detection of a difference of 5% in live birth rate would have required inclusion of more than 3000 women. Wider implications of the findings Routine use of levothyroxine in women with RPL and normal thyroid function positive for TPO-Ab is not recommended. Our results are in line with previous trials in TPO-Ab positive women with a history of infertility or pregnancy loss or undergoing in vitro fertilization. Trial registration number Netherlands Trial Register (NTR3364).

Association of ABO blood groups and ART outcomes among subfertile South Asian women: a retrospective cohort study

BackgroundBlood groups are expressed on the surface of the red cells, and their association with the ovarian reserve and pregnancy outcomes has been an area of interest. The aim of the current study is to study the association of blood groups with live birth rates among South Asian women undergoing assisted reproductive technology treatment. It is a retrospective cohort analysis of women undergoing assisted reproductive technology (ART) at Christian Medical College and Hospital, India, between January 2007 and June 2017. All women ≤ 40 years undergoing the first ART cycle with fresh embryo transfer were included and stratified into four groups (A, B, AB, and O) based on the blood group type. The ART outcomes were analyzed among the groups.ResultsA total of 2524 women underwent fresh embryo transfer cycles during the study period, among whom 2079 women were analyzed. There was no statistically significant difference in the live birth rates for women with blood group B (odds ratio, OR 0.96, confidence interval, CI, 95% 0.74–1.24), blood group AB (OR 0.89, 95% CI 0.58–1.35), and blood group O (OR 0.87, 95% CI 0.68–1.12) with blood group A as the reference. After adjusting for important confounders, there was no statistically significant difference in the live birth rates for women with blood group B, AB, and O in comparison with blood group A.ConclusionThe current study showed no association of blood groups with the ART treatment outcomes in South Asian women.

Low molecular weight heparin and pregnancy outcomes in women with inherited thrombophilia: A systematic review and meta-analysis.

To determine whether the use of low molecular weight heparin (LMWH) improves the pregnancy outcomes in women with inherited thrombophilia by conducting a meta-analysis of randomized controlled trials and observational studies. A systematic literature search of several databases was conducted through September 19, 2020 to identify relevant studies. The outcomes of interest included live birth and adverse pregnancy outcomes (APOs). The overall risk estimates were pooled using random-effects meta-analysis. Ten randomized controlled trials and 12 cohort studies were included. In the meta-analyses of randomized controlled trials, the effectiveness of LMWH-treatment was found to be statistically significant in decreasing the risk of APOs (risk ratio [RR]=0.76; 95% confidence interval [CI]: 0.61-0.95; p=0.020), rather than in increasing the rate of live birth (RR=1.12; 95% CI: 0.93-1.34; p=0.230). In the meta-analyses of cohort studies, results showed that the use of LMWH was associated with a significantly higher proportion of live birth (RR=1.86; 95% CI: 1.09-3.19; p=0.020) as well as a significantly lower ratio of APOs (RR=0.46; 95% CI: 0.31-0.69; p < 0.001) in women with inherited thrombophilia. The use of LMWH may have a potentially beneficial effect on reducing the risk of APOs and even increasing the live birth rate in women with inherited thrombophilia. Further well-designed clinical trials with large samples are needed to address the role of LMWH in improving pregnancy outcomes among pregnant women with inherited thrombophilia.

General and age-specific fertility rates in non-affective psychosis: population-based analysis of Scottish women

PurposeWomen diagnosed with non-affective psychosis have a lower general fertility rate (GFR) and age-specific fertility rate (ASFR) than women in the general population. Contemporary data on GFR in this group remain limited, despite substantive changes in prescribing and management. We calculated contemporary estimates of the GFR and ASFR for women diagnosed with non-affective psychosis compared with the general population of women without this diagnosis.MethodsA population-based design combined routinely collected historical maternity and psychiatric data from two representative areas of Scotland. Women were included from the NHS Grampian or Greater Glasgow and Clyde areas and were aged 15–44 between 2005 and 2013 inclusive. The ‘exposed’ group had a diagnosis of non-affective psychosis (ICD-10 F20–F29) and was compared to the general population of 'unexposed' women in the same geographical areas.ResultsAnnual GFR between 2005 and 2013 for women with non-affective psychosis varied from 9.6 to 21.3 live births/1000 women per year in the exposed cohort and 52.7 to 57.8 live births/1000 women per year in the unexposed cohort, a rate ratio (RR) of 0.28 [p < 0.001; 95% CI (0.24, 0.32)]. ASFR for all 5-year age groups was lower in the exposed cohort than amongst unexposed women.ConclusionWe highlight continued low fertility rates in women with a diagnosis of non-affective psychosis, despite widespread availability of prolactin-sparing atypical antipsychotics. Accurate estimation of fertility rates remains crucial in developing needs-matched perinatal care for these women. Methodological improvements using routine datasets to investigate perinatal mental health are also urgently needed.

Risk of Congenital Heart Defects in Offspring of Affected Mothers and Fathers.

Background:Smaller studies have reported a higher offspring risk of congenital heart defects (CHDs) for mothers with CHDs than for fathers with CHDs. In a large population-based study, we investigated whether offspring risk of CHD differed for mothers and fathers with CHDs.Methods:All people born in Denmark, 1977 to 2011, with at least 1 registered parent, were included in our cohort (n=2 341 061). Parent-child recurrence of CHDs was evaluated using risk ratios (RRs) comparing risks of CHDs in individuals with and without a parent with a CHD, estimated using log-linear binomial regression.Results:The RRs for any CHD in offspring were 5.39 (95% CI, 4.88–5.96) for mothers and 3.04 (95% CI, 2.59–3.57) for fathers affected with any CHD; the ratio of RRs for mothers versus fathers was 1.82 (P<0.0001). Recurrence RRs for the same cardiac phenotype in parent and offspring were significantly stronger for mothers than for fathers for conotruncal defects (ratio of RRs, 4.98), left ventricular outlet tract obstruction (ratio of RRs, 4.98), and ventricular septal defects (ratio of RRs, 2.51) but not for atrioventricular septal defects (ratio of RRs, 1.06). Birth rates among people with CHDs, relative to the general population, were 18% higher for women than for men, regardless of parental cardiac phenotype.Conclusions:Recurrence risks of CHDs were significantly greater in the offspring of affected women than in the offspring of affected men. The excess maternal recurrence risks could not be explained by the slightly higher birth rates in women with CHDs.

P300 Comparison of birth rates, gestational diabetes and non-standard maternal deliveries between Takayasu arteritis patients and the England and Wales population

Abstract Background/Aims Takayasu arteritis (TAK) is a chronic, inflammatory vasculitis of the aorta and primary branches, particularly prevalent in women of childbearing age. We studied pregnancy outcomes for women with TAK compared to the general population. Methods All people in England with an ICD-10 diagnostic code for TAK 1997/98 to 2020/21 were identified from Hospital Episode Statistics (HES) using National Congenital Abnormality and Rare Disease Registration Service (NCARDRS) data (CAG 10-02(d)/2015). To improve precision of estimated date of diagnosis, we used an English hospital case register of 122 TAK patients. We analysed all HES admissions occurring after their clinician-confirmed diagnosis date and before their first TAK ICD code in HES to identify codes which indicated likely TAK-related activity, and then applied these to the whole NCARDRS cohort. Maternity-related ICD-10 and OPCS-4 code admissions after the estimated diagnosis date were extracted and age-specific values were calculated for number of births, TAK patient years and birth rates. ONS published national data was used for comparison. Results We identified 1,437 people with TAK. Between 2001 and 2021, there were 133 babies born (129 singleton, 2 twin births, no stillbirths) to 85 mothers. Mean maternal age at first delivery was 32.2 years (SD 5.3, median 33.2), above the UK mean of 27.8, with age-specific birth rates compared to the 2019 general population (see table). Overall birth rate in women with TAK was 68% of the national England/Wales rate. Gestational diabetes (GDM) was present in 13/131 (9.9%) but large variation in UK prevalence estimates makes national comparison difficult. Mothers with GDM had a median age of 37 and delivery was by C-section in 9/13 cases. For non-GDM, 50% (95% CI: 41%, 59%) were C-section; this is significantly higher than the UK level of 26%. 12% were vacuum and/or forceps assisted deliveries, approximately equal to the general population. Conclusion The birth rate in women with TAK is lower than the general population and C-section rates higher. Causes are complex and might include patient choice, reduced fertility related to cytotoxic treatment, or physician recommendation, highlighting the importance of equitable access to specialist pre-conception counselling for people with rare autoimmune diseases. Disclosure D.J. Groves: None. M. Rutter: None. P.C. Lanyon: None. M. Odingo: None. M.J. Grainge: None. M. Bythell: None. J. Aston: None. S. Stevens: None. J.R. Hannah: None. J. Mason: None. F.A. Pearce: None.

Economic Precariousness and the Transition to Parenthood: A Dynamic and Multidimensional Approach

Economic precariousness has taken on a central role in explanations of the postponement of childbearing in developed societies. However, most studies conceptualize and operationalize precariousness as being static and one-dimensional, which provides only a partial perspective on the links between precariousness and fertility. In this paper, we study precariousness as a dynamic and multidimensional concept, distinguishing between past and current precariousness as well as between precariousness relating to income and to employment. Analyses are based on Dutch full-population register data. We select all inhabitants of the Netherlands who left education in 2006 and follow them until 2018. Event history analyses show that current and past income and employment precariousness all have independent negative effects on the first birth rate for men. Current and past employment precariousness and past income precariousness also reduce the first birth rate for women, but current income precariousness increases women’s probability of first conception. When precariousness is both persistent and multidimensional, it is associated with a threefold decrease in the monthly probability of conceiving a first child for men and almost a halving of the probability for women. Our analyses show the need for going beyond static and one-dimensional analyses in order to understand how economic precariousness may affect fertility behaviour.