Higher Pregnancy Rates Research Articles

Multidimensional Analysis of Adolescent Fertility in Latin America: Trends and Determinants

Adolescent pregnancy in Latin America constitutes a complex issue with significant consequences. High pregnancy rates among individuals under 20 years old impact education, personal development, and future opportunities. It is imperative to pay closer attention to sexual education, access to contraceptive methods, and reproductive health services to prevent unintended pregnancies and ensure the well-being of both adolescents and their children. The study aimed to elucidate the determinants influencing the adolescent fertility rate, thus providing an academic contribution for the formulation of public policies in Latin America. The period covered was 1990-2019, and the analyzed data were sourced from the World Population Prospects 2019 report. The main findings indicate that the adolescent pregnancy rate is alarming, attributed to the absence of effective public policies for control and prevention in response to this phenomenon. Received: 10 February 2024 / Accepted: 27 April 2024 / Published: 5 May 2024

Evaluation of intrinsic and extrinsic factors affecting pregnancy rate in dual-purpose cows under tropical conditions.

Embryo transfer (ET) in bovines was created with the purpose of increasing the pregnancy rate (PR) of animals with high genetic value; however, multiple factors have been found to affect the success of this reproductive biotechnology. These factors are frequently grouped in intrinsic and extrinsic factors. Thus, the objective of the present experiments was to assess the effect of intrinsic and extrinsic factors on the pregnancy rate under tropical conditions. To do this a total of 648 embryo transfer (ET) procedures were performed between January and December 2021. The intrinsic factors were size and location of the corpus luteum, body condition, genetic group, age and parity; while extrinsic factors were location of the farm, environmental comfort, season in which the ET was carried out, prevailing weather conditions, and the preservation, quality, and the development stage of embryos at the time of ET. A χi2 was used for analysis of main effects, and logistic regression analysis to calculate the probability of pregnancy and the association between intrinsic or extrinsic factors; additionally, a multivariate analysis of data clusters was used to find a linkage between the effects. While recipient female age had a negative effect (Odds ratio = 0.345-0.871) on PR (p < 0.05), being higher in younger cows, the rest of the intrinsic factors did not affect the PR. The significant (p < 0.05) extrinsic factors were THI category, season of year and type of embryo preservation, showing that the highest PR (p < 0.05) was obtained in the comfort THI category, during the winter season and using fresh embryos for transfer. The clustering analysis did not show any linkage between PR and intrinsic factors, while a linkage (p < 0.05) was found with season of the year and embryo preservation as extrinsic factors. It is concluded that age of the recipient cow and environmental conditions at the time of the embryo transfer are key factors to be considered for a successful pregnancy rate from in-vitro ET programs using dual-purpose cows under tropical conditions.

Implementation of coaching methods to decrease the parenting stress levels among teenage mothers in Indonesia: A quasi-experimental study.

The high rate of early marriage, teenage pregnancy, and teenage mothers increases the prevalence of emotional and mental disorders, depression, parenting stress, and child stunting. Parenting coaching is among the effective ways to overcome parenting stress and improve parents' knowledge, skills, and behaviors, thereby avoiding child stunting. However, studies on parenting coaching are not widely conducted, particularly in Indonesia. This study aimed to present the current status of parenting stress among teenage mothers and assess whether parenting coaching effectively reduces parenting stress among teenage mothers. A quasi-experimental design was used. The participants were randomly selected into two groups: the intervention group receiving parenting coaching intervention and the control group receiving standard education using a leaflet. Data were collected in June 2021 in Takalar Regency, South Sulawesi, Indonesia. Statistical Program for Social Science version 21 (Armonk, NY, USA) was employed for all statistical analyses. The parenting coaching intervention had a significant effect on parenting stress (p <0.001), with significant positive changes in knowledge, attitude (p <0.001), behavior (p <0.001), self-efficacy (p <0.001), and maternal function (p <0.001). Additionally, a significant difference in the achievement of z-score values was observed between the intervention and control groups based on Body Weight/Age (BW/A) (p <0.001) and Body Length/Age (BL/A) (p <0.001). However, Body Weight/Body Length (BW/BL) did not show a significant difference in the achievement of z-score (p = 0.34) in the third month. Parenting coaching can reduce parenting stress among teenage mothers and improve their knowledge, attitudes, behavior, self-efficacy, and maternal function; hence, this intervention can be used as a reference in the nursing process to reduce parenting stress and prevent child stunting.

Superovulation with an anti-inhibin monoclonal antibody improves the reproductive performance of rat strains by increasing the pregnancy rate and the litter size

Rats are multiparous rodents that have been used extensively in research; however, the low reproductive performance of some rat strains hampers the broader use of rats as a biomedical model. In this study, the possibility of increasing the litter size after natural mating in rats through superovulation using an anti-inhibin monoclonal antibody (AIMA) was examined. In outbred Wistar rats, AIMA increased the number of ovulated oocytes by 1.3-fold. AIMA did not affect fertilization and subsequent embryonic development, resulting in a 1.4-fold increase in litter size and a high pregnancy rate (86%). In contrast, conventional superovulation by eCG/hCG administration decreased the pregnancy rate to 6–40% and did not increase the litter size. In inbred Brown Norway rats, AIMA increased the litter size by 1.2-fold, and the pregnancy rate increased more than twice (86% versus 38% in controls). AIMA also increased the litter size by 1.5-fold in inbred Tokai High Avoiders and Fischer 344 rats. AIMA increased the efficiency of offspring production by 1.5-, 2.7-, 1.4-, and 1.4-fold, respectively, in the four rat strains. Thus, AIMA may consistently improve the reproductive performance through natural mating in rats, which could promote the use of AIMA in biomedical research.

Exploring actors' collaborations and involvement in the Namibian learner pregnancy policy

IntroductionThe Namibia Education Sector Policy on the Prevention and Management of Learner Pregnancy (ESPPMLP) aims to reduce the cases of learners falling pregnant and increase learner-parent completion of education. The ESPPMLP addresses the fact that learner pregnancy and school drop-out are collaborative efforts between parents, the community, schools, and non-governmental organizations. However, Namibia continues to have had a problem with the high rate of learner pregnancy and school drop-out for many years. Previous studies reported the absences and limitations of both internal and external actors' collaboration in its implementation. This paper aims to clarify the lack of stakeholder involvement and cooperation in the ESPPMLP activities within selected rural schools in Namibia.MethodsUsing the qualitative approach mixed with phenomenological and content data analysis, the study conducted 19 individual interviews with schoolteachers, one school board member, one NGO representative, and six focus group discussions with 27 parents.Results and findingsAmong others, results show the limited life skills of teachers in schools, the attitude of the community toward schoolteachers, making them feel devoid of influence in collaborations, and the lack of sexual reproductive activities programs in school settings. The findings reveal the reliance of the activities of prevention and management of learner pregnancy on donor-driven initiatives, the lack of task forces at the community level, the shortage of knowledge and understanding about the ESPPMLP and the lack of policy implementation guidelines. Establish learner pregnancy leadership structures at the community level for coordination, introduce community parenting, and execute partnership of monitoring activities to boost stakeholder collaborations.

Utilization of modern contraceptives among female health care workers at Gulu university teaching hospitals in Northern Uganda

BackgroundThe global high rate of unintended pregnancy is a direct result of underutilization of contraceptives methods. Healthcare workers (HCWs) play a pivotal role in promoting and facilitating access to modern family planning services. By examining the extent to which healthcare providers practice what they preach, this research aimed to shed light on the prevalence and factors associated with modern contraceptive use among female HCW at two university teaching hospitals in northern Uganda.MethodsA cross-sectional survey was conducted among qualified female healthcare workers (FHCWs) at Gulu Regional Referral Hospital (GRRH) and St. Mary’s Hospital-Lacor in Gulu, Uganda. Convenient consecutive sampling was used to enroll study participants. Linear regression analysis was employed to determine factors independently associated with modern contraceptive use. P < 0.005 was considered statistically significant.ResultsWe enrolled 201 female HCWs, with a median age 31 (interquartile range: 27–38) years. Overall, 15 (7.5%, 95% Confidence Interval [CI]: 4.4 —11.1) participants utilized modern methods of family planning in the last 3 months while lifetime use was at 73.6% (n = 148, 95%CI: 67.3 — 79.4%). Most common method utilized was intra-uterine devices [IUDs] (51%, n = 76), followed by sub-dermal implants (15.4%, n = 23). Eighty-five (42.3%, n = 85) participants had desire to get pregnant. Factors independently associated with utilization of modern methods contraceptives were working at GRRH (adjusted odds ratio (aOR): 5.0, 95% CI: 1.59 — 10.0, p = 0.003), and being single (aOR: 3.3, 9%CI: 1.02 —10.57, p = 0.046).ConclusionsUtilization of modern methods of contraceptive among female HCWs in this study is lower than the Uganda national estimates for the general female population. Most utilized method is IUDs followed by sub-dermal implants. More studies are recommended to see if this finding is similar among FHCWs in other regions of Uganda and the rest of Africa while also considering Male Healthcare Workers.

Post-cooling semen processing and sperm re-suspension as an alternative method to circumvent poor semen cooling in stallions.

Artificial insemination with cooled-shipped semen is the primary method used in the equine breeding industry; yet, sperm quality and fertility can be suboptimal for some stallions when standard techniques are used. Therefore, there is a critical need to develop alternative approaches for these stallions. To assess sperm quality parameters and fertility of cooled-stored stallion semen processed by SpermFilter® or centrifugation and resuspended in three extenders. Controlled and field study. In Experiment 1, semen was collected from 21 stallions classified as having good ('Good-coolers', n = 8) or poor ('Bad-coolers', n = 13) semen cooling. The semen was extended at 30 million spermatozoa/mL in a skimmed milk-based (SM) diluent, and refrigerated for 24 h. Then, the cooled-stored semen was processed through SpermFilter® or centrifugation, and the resulting sperm pellets were resuspended in SM, SM containing pentoxifylline (SM-P), or an egg yolk-based (EY) extender. Unprocessed cooled-stored semen served as control. Sperm motility parameters, plasma membrane integrity (PMI), and mitochondrial membrane potential (HMMP) were assessed in cooled-semen pre- and post-processing. Experiment 2, cooled semen from 9 stallions classified as Bad-coolers was used to inseminate 18 embryo donor mares at 66 cycles (Unprocessed, n = 22; SpermFilter®/SM-P, n = 16; or SpermFilter®/EY, n = 28). Data were analysed with a mixed model and Tukey's as posthoc, and logistic regression. Processed semen resuspended in EY had superior sperm motility compared to unprocessed, SM and SM-P (p < 0.0001). Semen processed by SpermFilter® resuspended in SM-P was similar to EY (p > 0.05). Pellet resuspension with EY and SM-P improved the HMMP of Bad-cooler stallions (p = 0.0010). Semen processed by SpermFilter® had superior PMI to centrifuged semen (p < 0.0001). Mares inseminated with SpermFilter®/SM-P (50%, 8/16) or SpermFilter®/-EY (68%, 9/28) had higher pregnancy rates than mares bred with unprocessed semen (14%, 3/22) (p < 0.001). Low number of mares in the fertility trial. Sperm quality and fertility of Bad-cooler stallions can be enhanced by SpermFilter® and pellet resuspension with either EY or SM-P.

Assessing perspectives on an intervention connecting adolescents in outpatient psychiatry care to contraceptive counseling in the United States.

Adolescents with psychiatric disorders have high rates of unintended pregnancy and experience barriers to accessing sexual and reproductive health (SRH) care. Outpatient psychiatry visits are potential opportunities to connect adolescents to SRH care. This study informs the development of the Link2BC intervention which links adolescents in outpatient psychiatry care to SRH care. We conducted group interviews with adolescents (3 groups, 7 total participants) and caregivers (3 groups, 9 total participants) and individual interviews with 8 psychiatry providers who received or provided outpatient psychiatric treatment in clinics in a pediatric hospital in a city in the Midwestern United States. We asked questions about the acceptability of Link2BC, potential implementation needs, and implementation determinants. Using consensus-building techniques, two coders analyzed transcriptions using a codebook informed by the Consolidated Framework for Implementation Research 2.0. Participants agreed on the need for interventions that expand access to SRH care. Adolescents emphasized that services should be confidential and accessible and were open to their psychiatrists introducing SRH topics during appointments. Providers expressed preference for training and clear workflows. Participants agreed that psychiatry providers could serve as liaisons between adolescents and their caregivers to facilitate conversations about contraception. Participants had concerns about time constraints during visits but mentioned few other barriers to the intervention. This study demonstrates the acceptability of connecting adolescents in outpatient psychiatry care to contraceptive counseling and informs the refinement and implementation of Link2BC. Integrating contraception counseling in outpatient psychiatry settings is an innovative approach to prevent unintended pregnancy among adolescents by increasing access to SRH care services.

Discovery of Knowledge and Perception among the Indigenous People Related to Teenage Pregnancy and Sexual Education

This study examined the knowledge and perceptions of sexual education and teenage pregnancy among Indigenous people in Pekan, Malaysia. The research aimed to address the high rates of teenage pregnancy, particularly among unmarried teenagers, in the country. Through qualitative methods, including semistructured interviews with Indigenous participants, several themes emerged. These themes included the sources of sexual education, such as formal and informal channels, first sexual experiences, safe-sex beliefs, and the importance of sexual education for children. The study also explored perceptions of teenage pregnancy, identifying factors like young marriage and premarital dating. Participants shared their views on premarital motherhood among those under 20 years old, as well as the acceptance and responses of parents and the responsibility of the baby’s father. The study highlighted the complications of teenage pregnancy for both the baby and mother. The findings revealed a lack of sexual education knowledge among Indigenous participants, attributed to limited access to facilities like mobile phones and limited interaction with outsiders. The study recommends further research and the dissemination of awareness and knowledge about sexual education, particularly through campaigns and outreach efforts to Indigenous communities, while also emphasise the need to review the effectiveness of these initiatives.

Lipidomic profiling of cervical mucus reveals the potential role of pro-inflammatory derived metabolites on sperm transport across the ovine cervix

Internationally, cervical artificial insemination (AI) in sheep yields low pregnancy rates when frozen-thawed semen is used. An exception to this is in Norway where vaginal AI of frozen-thawed semen to a natural oestrus yields non-return rates in excess of 60%, which has been attributed to the ewe breed used in Norway. This study used both metabolomics and an RNA-sequencing approach to assess the lipid production and composition from cervical mucus and tissue of four European ewe breeds (n = 28–30 ewes per breed) with previously reported differences in pregnancy rates following cervical AI with frozen-thawed semen. These breeds included Suffolk (exhibiting low fertility), Belclare (medium fertility) as well as Norwegian White Sheep and Fur (both with high fertility and pregnancy rates > 60%) at both a synchronised and natural oestrous cycle. The aim was to explore the differences between ewe breeds in the lipidomic profile and to identify candidate biomarkers associated with an optimal environment for cervical sperm transport. The results revealed the identification of 255 lipids, of which 170, 102 and 83 were different between ewe breeds, types of cycle and affected by their interaction, respectively (P < 0.05). Reduced levels of lipids involved in the resolution of inflammation (i.e. 14-HDoHE,17-HDoHE, 15-HETE) were identified in the low-fertility Suffolk breed compared to high-fertility ewe breeds. However, there was an up-regulation of the COX pathway accompanied by increased levels of prostaglandins in the Suffolk breed. These findings indicated a sub-optimal and pro-inflammatory environment that could have a negative effect on cervical sperm transport.

Viral infections in pregnancy and impact on offspring neurodevelopment: mechanisms and lessons learned.

Pregnant individuals with viral illness may experience significant morbidity and have higher rates of pregnancy and neonatal complications. With the growing number of viral infections and new viral pandemics, it is important to examine the effects of infection during pregnancy on both the gestational parent and the offspring. Febrile illness and inflammation during pregnancy are correlated with risk for autism, attention deficit/hyperactivity disorder, and developmental delay in the offspring in human and animal models. Historical viral epidemics had limited follow-up of the offspring of affected pregnancies. Infants exposed to seasonal influenza and the 2009 H1N1 influenza virus experienced increased risks of congenital malformations and neuropsychiatric conditions. Zika virus exposure in utero can lead to a spectrum of abnormalities, ranging from severe microcephaly to neurodevelopmental delays which may appear later in childhood and in the absence of Zika-related birth defects. Vertical infection with severe acute respiratory syndrome coronavirus-2 has occurred rarely, but there appears to be a risk for developmental delays in the infants with antenatal exposure. Determining how illness from infection during pregnancy and specific viral pathogens can affect pregnancy and neurodevelopmental outcomes of offspring can better prepare the community to care for these children as they grow. IMPACT: Viral infections have impacted pregnant people and their offspring throughout history. Antenatal exposure to maternal fever and inflammation may increase risk of developmental and neurobehavioral disorders in infants and children. The recent SARS-CoV-2 pandemic stresses the importance of longitudinal studies to follow pregnancies and offspring neurodevelopment.

Comparing pregnancy and pregnancy outcome rates between adolescents with and without pre-existing mental disorders.

There are limited population-based data on the role of mental disorders in adolescent pregnancy, despite the presence of mental disorders that may affect adolescents' desires and decisions to become pregnant. This study aimed to examine the relationship between specific types of mental disorders and pregnancy rates and outcome types among adolescents aged 13-19 years, using single-year age groups. We conducted a retrospective cohort study using data from the Merative™ MarketScan Research Databases. The study population consisted of females aged 13-19 years with continuous insurance enrollment for three consecutive calendar years between 2005 and 2015. Pregnancy incidence rates were calculated both overall and within the different categories of mental disorders. The presence of mental disorders, identified through diagnosis codes, was classified into 15 categories. Pregnancy and pregnancy outcome types were determined using diagnosis and procedure codes indicating the pregnancy status or outcome. To address potential over- or underestimations of mental disorder-specific pregnancy rates resulting from variations in age distribution across different mental disorder types, we applied age standardization using 2010 U.S. Census data. Finally, multivariable logistic regression models were used to examine the relationships between 15 specific types of mental disorders and pregnancy incidence rates, stratified by age. The age-standardized pregnancy rate among adolescents diagnosed with at least one mental disorder was 15.4 per 1,000 person-years, compared to 8.5 per 1,000 person-years among adolescents without a mental disorder diagnosis. Compared to pregnant adolescents without a mental disorder diagnosis, those with a mental disorder diagnosis had a slightly but significantly higher abortion rate (26.7% vs 23.8%, P-value < 0.001). Multivariable logistic regression models showed that substance use-related disorders had the highest odds ratios (ORs) for pregnancy incidence, ranging from 2.4 [95% confidence interval (CI): 2.1-2.7] to 4.5 [95% CI:2.1-9.5] across different age groups. Overall, bipolar disorders (OR range: 1.6 [95% CI:1.4-1.9]- 1.8 [95% CI: 1.7-2.0]), depressive disorders (OR range: 1.4 [95% CI: 1.3-1.5]- 2.7 [95% CI: 2.3-3.1]), alcohol-related disorders (OR range: 1.2 [95% CI: 1.1-1.4]- 14.5 [95% CI: 1.2-178.6]), and attention-deficit/conduct/disruptive behavior disorders (OR range: 1.1 [95% CI: 1.0-1.1]- 1.8 [95% CI: 1.1-3.0]) were also significantly associated with adolescent pregnancy, compared to adolescents without diagnosed mental disorders of the same age. This study emphasizes the elevated rates of pregnancy and pregnancy ending in abortion among adolescents diagnosed with mental disorders, and identifies the particular mental disorders associated with higher pregnancy rates.

Prevalence and Factors Associated with Teenage Pregnancy at Paynesville, Monrovia, Liberia: Facility Based Cross Section Study

Introduction: In Liberia, teenage pregnancy is a serious public health issue that causes social and economic hardship. Adolescent birth rates are among the highest in sub-Saharan Africa, according to statistics. There are significant differences in the prevalence of teenage pregnancy between and within nations. Most teenage pregnancies occur in places with poorer incomes and lower levels of education. The purpose of this research is to determine the prevalence of teenage pregnancy in Liberia and to investigate the risk factors related to it, particularly in the Paynesville city community of Duport Road cow field block "B.".&#x0D; Methods: The research that was done using the Duport Road Clinic as a resource center provided the data for this study. Fifty girls between the ages of 15 and 19 who visited the hospital and lived in the community throughout the study period were recruited as participants. Total population sampling was used to interview all 50 of the females. A population-based cross-sectional survey is used in this quantitative study to gather data, and IBM 20.0 SPSS was used for analysis.&#x0D; Results: According to the report, 50.2% of adolescent girls between the ages of 15 and 19 had started having children at the time of the survey. Teenage pregnancy in the community was significantly correlated with age (OR = 6.9; 95% CI: 4.647, 10.366, p – value 0.001), teenagers living with their parents (OR = 1.057; p &gt; 0.001), non-use of contraception (OR = 2.53; 95% CI: 1.739, 3.683), and teenage girls who were aware of contraceptive methods (OR = 2.86, 95% CI = 0.443, 18.463).&#x0D; Conclusion: In conclusion, a number of factors, including early sexual initiation, cohabitation, lack of education, and contraceptive non-use, contribute to the high rate of teenage pregnancy in Liberia. Interventions including encouraging the use of contraception, discouraging early sexual beginning, and setting up family planning clinics are advised in order to lessen its prevalence.

Cultural Ramifications on the Educability of Pregnant and Parenting Learners at Four South African High Schools

The study investigated how the socio-cultural and traditional practices of school-based education duty-bearers influenced the educational access and participation of pregnant and parenting learners (PPLs) who chose to continue with schooling after falling pregnant. Using a qualitative case study research design, four high schools with high rates of girl pregnancy from one South African education district were purposively selected. The participants included 8 school governing body (SGB), 8 school management team (SMT), 8 pregnant-monitoring teachers (PMT), 8 class teachers, 8 PPLs and 8 mainstream learners who schooled with PPLs. Data were collected through individual interviews for PPLs for their confidentiality, and focus group interviews for all the other participants. Study results indicated that due to cultural, traditional perceptions and practices, the South African national education policy measures on the prevention and management of learner pregnancy which allows schoolgirls to return to school after giving birth was loosely observed and implemented at the schools. The reasons for these are; a) Negative attitudes of teachers and mainstream to PPLs; b) Domestication of motherhood and childrearing by community; c) Mythological discernment of PPLs by mainstream learners; d) Character contamination; and e) Femininity as a negative label on PPLs in a formal school setting. Thus, from the findings, it is recommended that school-based duty bearers be trained on democratic education policy frameworks and their implementation strategies, to benefit the vulnerable children such as PPLs, among others.

Sperm binding to oviduct epithelial spheroids varies among males and ejaculates but not among females in pigs

The elimination of ejaculates and males with low fertility despite good sperm motility and morphology is crucial to maintain high pregnancy rates after artificial insemination (AI) in farm animals. The ability of sperm to survive in the female tract is particularly crucial in pigs due to the large variation in the timing between AI and ovulation and the high number of oocytes to fertilise. The objective of this study was to characterise a new in vitro model of oviduct sperm reservoir using porcine oviduct epithelial spheroids (OES) and to assess the variability in sperm binding to OES among gilts, boars and their ejaculates. Isthmic mucosa fragments were collected from gilt oviducts at a slaughterhouse, and after 48 h of culture, the OES that had spontaneously formed were sorted according to their vesicle shape and size (150–200 μm in diameter) for characterisation and sperm binding assays. The OES contained viable, cytokeratin-positive and vimentin-negative cells, of which 36.4 ± 2.0% were multiciliated. The average proportion of multiciliated cells per OES did not change among culture replicates. After co-incubation with boar fresh semen, only sperm of normal morphology were found to bind, by their head, to cilia of OES. The density of sperm bound to the OES surface increased linearly with sperm concentration. The bound sperm density on OES was used to assess the binding capacity of fresh ejaculates collected from Pietrain boars. For a given ejaculate, the bound sperm density did not vary among pools of OES female donors. The analysis of five successive ejaculates from nine boars indicated significant differences in bound sperm densities on the OES among individual boars and their ejaculates (P < 0.01). There was no correlation between the sperm bound density and sperm parameters measured by computer-assisted sperm analysis or the initial dilution of the ejaculate. In conclusion, the OES characterised in this study offered physiological conditions to study sperm binding to the isthmic reservoir and evidenced that sperm from different ejaculates and different boars vary in their ability to bind to these oviduct spheroids despite homogeneous motility and morphology.

Fluoroscopic-guided hysteroscopic tubal cannulation results in high technical success and pregnancy rates comparable with the more traditional laparoscopically guided hysteroscopic tubal cannulation

To compare women with proximal tubal obstruction (PTO) undergoing hysteroscopic tubal cannulation with fluoroscopic guidance vs. laparoscopic guidance. Retrospective cohort study. All fluoroscopically-guided hysteroscopic tubal cannulations were performed in an ambulatory suite. All laparoscopically-guided hysteroscopic tubal cannulations were performed in a hospital operating room. Infertile women with unilateral or bilateral PTO on hysterosalpingography who failed selective salpingography in the radiology suite and had a planned laparoscopy or hysteroscopy in the operating room for defects seen on sonohysterography were studied. All women had a Novy catheter system positioned hysteroscopically to cannulate the occluded fallopian tube(s). Women undergoing fluoroscopically guided hysteroscopic tubal cannulation (FHTC), which used contrast and C-arm pelvic imaging at an ambulatory center, were compared with those undergoing hospital-based laparoscopically guided hysteroscopic tubal cannulation (LHTC) with laparoscopic visualization. Tubal cannulation success; bilateral cannulation success; tubal perforations; post-FHTC non-in vitro fertilization (non-IVF) intrauterine pregnancies; days from procedure to pregnancy for non-IVF intrauterine pregnancies; and time to non-IVF pregnancy hazards ratio. A total of 76 infertile women undergoing either FHTC (34 women) or LHTC (42 women) between 2015 and 2019 were included. Demographic variables were similar among the 2 groups. A total of 31 (92%) of 34 of patients undergoing FHTC and 36 (86%) of 42 of patients undergoing LHTC had at least one tube successfully cannulated. In total, 30 (78%) of 34 of patients undergoing FHTC and 32 (79%) of 42 patients undergoing LHTC had all occluded tubes successfully cannulated. Tubal perforation occurred in 1 (3%) of 34 FHTC cases and 3 (7%) of 42 LHTC cases. A similar percentage of non-IVF treatment-induced intrauterine pregnancies were achieved in the FHTC and LHTC groups (10/34 [29%] vs. 12/42 [29%]). Among patients who conceived without IVF, time from procedure to pregnancy was lower in the FHTC group (101 ± 124.6 days) compared with the LHTC group (228 ± 216 days). There was a significant difference in time to pregnancy when only those who conceived were considered (hazard ratio, 9.39; 95% confidence interval, 2.42-36.51); however, there was no significant difference when all subjects regardless of pregnancy outcome were analyzed (hazard ratio, 1.48; 95% confidence interval, 0.64-3.446). Fluoroscopically guided hysteroscopic tubal cannulation is a safe, effective, incision free procedure that results in comparable rates of tubal patency and intrauterine pregnancies as LHTC. This technique should be considered in women undergoing treatment of PTO when operative laparoscopy is not otherwise indicated.

Challenges and opportunities for improving access to adolescent and youth sexual and reproductive health services and information in the coastal counties of Kenya: a qualitative study

BackgroundGlobally, adolescents and youth experience high unmet need for sexual and reproductive health (SRH) information and services. In Kenya, evidence shows that more than half of teenage pregnancies are unintended and that half of all new HIV infections occur in people ages 15-24-year-olds, with the majority of those being female. The coastal counties in Kenya record a relatively high adolescent pregnancy rate and higher rates of unmet need for contraception for all women of reproductive age compared to the national average. This study focused on gaining a deeper understanding of the existing challenges to and opportunities for accessing SRH information and services among adolescents and youth (AY) at the Kenyan coast.MethodsUsing qualitative methods, this study conducted thirty-six focus group discussions with adolescents, youth, and community health volunteers across all the six coastal counties in Kenya. The sample included adolescents aged 10–14 years in school (male and female), adolescents aged 15–19 years not in education (male and female), youths aged 20–24 years (mix of both male and female), and community health volunteers who were conveniently sampled. Thematic analysis was used to examine the data and report the study results.ResultsThe barriers to accessing AYSRH identified in the study are individual factors (feelings of shame, lack of information, and fear of being judged) parental factors, healthcare worker and health institution factors, teacher/educators factors, and broader contextual factors such as culture, religion, poverty, and illiteracy. Factors that facilitate access to AYSRH information and services included, supportive parenting and culture, AYSRH sessions in schools, peer support, supportive health institutions, gender inclusivity, and digital technology.ConclusionsAYSRH information and services at the Kenyan coast is strongly influenced by a range of individual, social, cultural, and economic factors. Improving access to AYSHR necessitates meaningful AY engagement, provision of youth-friendly services, use of digital technology as alternative pathways for sharing SRH information, strengthening parent-AY relationships, embracing peer-to-peer support, and the adoption of gender-inclusive approaches in AYSRH programming.

Healthcare provisions associated with multiple HIV-related outcomes among adolescent girls and young women living with HIV in South Africa: a cross-sectional study.

Adolescent girls and young women (AGYW) living with HIV experience poor HIV outcomes and high rates of unintended pregnancy. Little is known about which healthcare provisions can optimize their HIV-related outcomes, particularly among AGYW mothers. Eligible 12- to 24-year-old AGYW living with HIV from 61 health facilities in a South African district completed a survey in 2018-2019 (90% recruited). Analysing surveys and medical records from n = 774 participants, we investigated associations of multiple HIV-related outcomes (past-week adherence, consistent clinic attendance, uninterrupted treatment, no tuberculosis [TB] and viral suppression) with seven healthcare provisions: no antiretroviral therapy (ART) stockouts, kind and respectful providers, support groups, short travel time, short waiting time, confidentiality, and safe and affordable facilities. Further, we compared HIV-related outcomes and healthcare provisions between mothers (n = 336) and nulliparous participants (n = 438). Analyses used multivariable regression models, accounting for multiple outcomes. HIV-related outcomes were poor, especially among mothers. In multivariable analyses, two healthcare provisions were "accelerators," associated with multiple improved outcomes, with similar results among mothers. Safe and affordable facilities, and kind and respectful staff were associated with higher predicted probabilities of HIV-related outcomes (p<0.001): past-week adherence (62% when neither accelerator was reported to 87% with both accelerators reported), clinic attendance (71%-89%), uninterrupted ART treatment (57%-85%), no TB symptoms (49%-70%) and viral suppression (60%-77%). Accessible and adolescent-responsive healthcare is critical to improving HIV-related outcomes, reducing morbidity, mortality and onward HIV transmission among AGYW. Combining these provisions can maximize benefits, especially for AGYW mothers.

TWO SEXUALLY ACTIVE BUCKS HOUSED WITH FOUR SUCCESSIVE GROUPS OF ANOVULATORY DOES INDUCED HIGH PREGNANCY RATES DURING SEVEN-DAY MATING PERIODS

&lt;p&gt;&lt;strong&gt;Background.&lt;/strong&gt; In seasonally anovulatory goats, sexually active bucks led a high pregnancy rate during a mating period of 36 days. Progesterone priming of does can reduce the length of the mating period while maintaining high fertility by allowing oestrous behaviour at the first male-induced ovulation. &lt;strong&gt;Objective.&lt;/strong&gt; To determine whether high fertilization rates could be achieved by using two sexually active bucks, alternated daily for a period of seven days in four successive groups of does. &lt;strong&gt;Methodology.&lt;/strong&gt; Two control bucks were used only with one group of does (&lt;em&gt;n&lt;/em&gt; = 19), whereas two experimental bucks were successively housed with four groups of does (&lt;em&gt;n&lt;/em&gt; = 18 or 19 each). One of the control and experimental bucks was introduced to their respective groups in the morning and removed 24 h later to rest for 24 h. Immediately after the removal of the first buck, the second buck was placed with the group of does. Each doe was treated with 25 mg of progesterone im 48 h prior to the first introduction of bucks to reduce short ovulatory cycles. &lt;strong&gt;Results.&lt;/strong&gt; In each group, the proportion of does that ovulated was higher than 93%. These proportions did not differ among groups exposed to the control or experimental bucks (&lt;em&gt;P&lt;/em&gt; &amp;gt; 0.05). In each group, the proportion of pregnant does was higher than 78%; proportions did not differ among groups (&lt;em&gt;P&lt;/em&gt; &amp;gt; 0.05). &lt;strong&gt;Implications. &lt;/strong&gt;At farms with few bucks, efficient management of sexually active bucks can yield a high percentage of pregnant females. &lt;strong&gt;Conclusion.&lt;/strong&gt; These results indicate that two sexually active bucks housed with four successive groups of progesterone-treated anovulatory does during a mating period of seven days were able to achieve high pregnancy rates.&lt;/p&gt;&lt;div id="gtx-trans" style="position: absolute; left: -60px; top: -20px;"&gt; &lt;/div&gt;

Effects of different treatment methods on clinical efficacy and fertility outcomes of patients with adenomyosis

ObjectiveThis trial was to investigate the effect of different treatment methods on the clinical efficacy and fertility outcome of patients with adenomyosis.MethodsIn total, 140 patients with adenomyosis were evenly and randomly allocated into group A (laparoscopic surgery), group B (laparoscopic surgery combined with gonadotropin-releasing hormone analogs [GnRH-a]), group C (ultrasound-guided percutaneous radiofrequency ablation), and group D (ultrasound-guided percutaneous radiofrequency ablation combined with GnRH-a). On the 3rd day after surgery, patients in group B and group D were subcutaneously injected with GnRH-a (Leuprorelin Acetate SR for Injection) at 3.75 mg/time, once every 4 weeks, for a total of 3 months. The therapeutic effects of the 4 groups were compared, including menstrual volume, dysmenorrhea score, uterine volume, clinical efficacy, luteinizing hormone (LH), estradiol (E2), and follicle-stimulating hormone (FSH) levels, CA125 levels, recurrence, pregnancy status, and pregnancy outcomes.ResultsAfter treatment, the menstrual volume of 4 groups was lowered, dysmenorrhea, Visual Analog Scale (VAS) score, LH, FSH, E2, and CA125 levels were reduced, and uterine volume was decreased. The menstrual volume, VAS score, levels of LH, FSH, E2, and CA125, and uterine volume were reduced in groups B, C, and D compared with group A, and the decrease was more significant in group D. The total effective rate of group D was 100.00%, which was higher than that of group A (71.43%), group B (80.00%), and group C (82.86%). After one year of drug withdrawal, the recurrence of hypermenorrhea, dysmenorrhea, uterine enlargement, and excessive CA125 in group D was significantly lower than that in groups A, B and C, and the recurrence in groups B and C was significantly lower than that in group A (P < 0.05). Compared with groups A, B, and C, group D had a higher pregnancy rate, natural pregnancy rate, and lower in vitro fertilization-embryo transfer rate (P < 0.05), but showed no significant difference in pregnancy outcomes.ConclusionUltrasound-guided percutaneous radiofrequency ablation combined with Leuprorelin Acetate is effective in the treatment of adenomyosis, which can effectively relieve clinical symptoms, protect postoperative ovarian function, reduce recurrence rate, alleviate pain, and improve quality of life.