Higher Incidence Of Miscarriages Research Articles

Presence of Adenomyosis Impairs Clinical Outcomes in Women Undergoing Frozen Embryo Transfer: A Retrospective Cohort Study.

(1) Background: The presence of adenomyosis among pregnant patients has been associated with a higher incidence of miscarriage and pregnancy complications. Although the role of adenomyosis in women undergoing in vitro fertilization (IVF) was investigated in several studies and demonstrated a potentially detrimental effect on live birth rates following IVF, most of them were small studies in which the adenomyosis diagnosis was not confirmed based on solid ultrasonographic criteria. (2) Methods: 3503 patients undergoing their first blastocyst frozen transfer through a hormonal replacement (HRT) FET cycle. Among them, 140 women had a confirmed diagnosis of adenomyosis based on the MUSA criteria. (3) Results: Adenomyosis patients were more likely to proceed with deferred FET compared with no-adenomyosis women (p = 0.002) and were significantly more likely to be treated with GnRH agonist pre-treatment (2 months) (p < 0.001). The presence of adenomyosis significantly decreased the clinical pregnancy rates (aOR 0.62, 95% CI: 0.39-0.98, p = 0.040) and live birth rates (aOR 0.46, 95% CI: 0.27-0.75, p = 0.003) and significantly increased the miscarriage rates (aOR 2.13, 95% CI: 0.98-4.37, p = 0.045). Multivariable logistic regression adjusting for age, autologous or donor oocytes, PGT-A, deferred FET, serum progesterone levels the day before FET, GnRH agonist pre-treatment, number of embryos transferred, and adenomyosis demonstrated that the use of the GnRH agonist protocol did not decrease or increase the miscarriage rate, clinical pregnancy rate, or live birth rate. (4) Conclusions: The presence of adenomyosis had a significant negative impact on the clinical outcomes of patients undergoing FET and was associated with higher miscarriage, lower clinical pregnancy, and live birth rates. GnRH agonist pre-treatment does not appear to improve clinical outcomes.

P-242 Genetic laboratories report significantly different aneuploidy rates for identical patient populations, a finding with important implications for clinics using PGT-A

Abstract Study question If a clinic changes the genetic laboratory it works with, should it expect its new PGT-A results to be equivalent to those it received previously? Summary answer Changing the genetic service provider can result in a significant difference in the proportion of embryos classified euploid, with important clinical implications. What is known already Preimplantation genetic testing for aneuploidy (PGT-A) aims to distinguish potentially viable euploid embryos from embryos harbouring lethal chromosome abnormalities. Typically, IVF clinics perform biopsy at the blastocyst stage and send the resulting trophectoderm specimens to specialist genetic laboratories for analysis. However, many commercially available genetic methods have not been subjected to rigorous validation, leading to uncertainty about their accuracy and predictive value. It would be concerning if the classification of embryos, derived from the same patient population, and from the same clinic, varied depending on the company that provides PGT-A services. Such differences would be unlikely to reflect biological reality. Study design, size, duration Our clinic recently began working with a new genetics company. Our previous PGT-A reference laboratory issued results for 1,136 blastocyst biopsy specimens over ∼15 months. Subsequently, the second company tested 784 biopsy samples in 7 months. Patient populations during the two periods were essentially identical (average maternal age 38.0 years). Participants/materials, setting, methods The first company used whole genome amplification followed by next generation sequencing (NGS) to evaluate the relative amount of DNA from each chromosome. The second company’s method was highly validated, involving targeted amplification of thousands of sites in the genome, again followed by NGS and analysis of relative DNA quantity from individual chromosomes. Additionally, they genotyped numerous polymorphisms, which assist in the detection of haploidy/triploidy, and also reveals problems that can compromise accuracy (e.g. contamination). Main results and the role of chance The first PGT-A company classified 44.4% of blastocysts euploid, 4.1% low-level mosaic, 51.5% aneuploid. In contrast, the second company reported significantly fewer embryos aneuploid (44.0%; P = 0.0019). Even if the mosaics reported by the first company are considered for transfer, the second company is still associated with more potentially transferable embryos (relative increase greater than one-sixth). If PGT-A results from the second company are correct, it implies that potentially viable embryos may have been misclassified by the first company, risking their exclusion and loss of the pregnancies they might have produced. Conversely, if the first company is correct, the second company may be failing to detect some aneuploidies, leading to inadvertent transfer of abnormal embryos, lower pregnancy rates and a higher incidence of miscarriage. 299 transfers following PGT-A using the first company produced 171 pregnancies (74.7%), while 64 single embryo transfers have taken place after PGT-A with the second company, resulting in 53 pregnancies (82.8% per transfer). Losses (biochemical or miscarriage) affected 21.6% and 16.9% of pregnancies after PGT-A conducted by the first and second companies, respectively (ongoing pregnancy rates of 58.5% and 68.8% per transfer, respectively) Thus, there is no evidence that aneuploidies are being missed by the second company. Limitations, reasons for caution Although there were no obvious differences between the patients with embryos tested by the two companies, this study was not prospective nor randomized, so a possibility of undetected differences remains. The study was not sufficiently powered to test the significance of apparent differences in implantation, miscarriage and ongoing pregnancy rates. Wider implications of the findings It is important that IVF clinics appreciate that individual PGT-A methods differ significantly, and that some have undergone much more rigorous validation than others. It is recommended that clinics ask PGT providers to share their validation data, especially clinical studies confirming that embryos classified ‘aneuploid’ or ‘abnormal’ are truly non-viable. Trial registration number Not applicable

O-268 Presence of adenomyosis impairs clinical outcomes in women undergoing frozen embryo transfer

Abstract Study question Does the presence of adenomyosis impact the clinical outcomes of patients undergoing frozen embryo transfer (FET)? Summary answer Presence of adenomyosis is associated with higher miscarriage and lower clinical pregnancy and live birth rates. GnRH agonist pre-treatment does not increase clinical outcomes. What is known already Presence of adenomyosis among pregnant patients has been associated with a higher incidence of miscarriage and pregnancy complications. Although the role of adenomyosis in women undergoing in vitro fertilization (IVF) has been investigated in several studies demonstrating a potential detrimental effect on live birth rates following IVF, most of them were small studies in which adenomyosis diagnosis was not confirmed based on solid ultrasonographic criteria. Considering the fragmented evidence up to date, we decided to perform a large retrospective study including women with adenomyosis undergoing FET which has been confirmed based on solid ultrasonographic criteria. Study design, size, duration Retrospective cohort study of 3503 patients undergoing their first cycle of blastocyst frozen transfer in a university-affiliated fertility center between January 2017 and December 2021. Participants/materials, setting, methods Overall, 3503 patients undergoing their first blastocyst frozen transfer through a hormonal replacement (HRT) FET cycle. Patients were categorized as adenomyosis when fulfilling to the Morphological Uterus Sonographic Assessment (MUSA) criteria and as non-adenomyosis when no-adenomyosis was identified. Among them 140 women had a confirmed diagnosis of adenomyosis based on MUSA criteria. Clinical information was retrospectively collected from medical records. Main results and the role of chance Comparisons between adenomyosis and non-adenomyosis groups revealed similar baseline characteristics in terms of patients’ weight, parity, smoking status, and age. Similarly, endometrial thickness and mean serum progesterone levels the day before FET as well as the number of embryos transferred were comparable between groups. Adenomyosis patients were more likely to proceed with a deferred FET (freeze-all protocol) as compared with no-adenomyosis women (p = 0.002) and were significantly more likely to be treated with GnRH agonist pre-treatment (2 injections) (P &amp;lt; 0.001). Multivariable logistic regression, adjusting for age, autologous or donor oocytes, PGT-A, deferred FET, serum progesterone levels the day before FET, GnRH agonist pre-treatment, number of embryos transferred, and adenomyosis, demonstrated that the use of GnRH agonist protocol did not affect miscarriage, clinical pregnancy rate or live birth rate. However, the presence of adenomyosis significantly decreased clinical pregnancy rates (OR 0.62, 95% CI: 0.39-0.98, P = 0.040) and live birth rates (OR 0.46, 95% CI: 0.27-0.75, P = 0.003) and significantly increased miscarriage rates (OR 2.13, 95% CI 0.98-4.37, p = 0.045). PGT-A was the only factor associated with a significative reduction in miscarriage rate. Limitations, reasons for caution The main limitation of this study is the single-center retrospective approach. Furthermore, due to the limited number of cases with adenomyosis focal and diffuse adenomyosis were analyzed together although this may be clinically distinct entities. Wider implications of the findings The results of this study demonstrate that presence of adenomyosis has significant negative impact on the clinical outcomes of patients undergoing FET. Future prospective studies are needed to create a consensus on the optimal ET technique for these patients. Trial registration number Not Applicable

Эффективность прогестагенов в лечении угрозы прерывания многоплодной беременности, наступившей в результате вспомогательных репродуктивных технологий

Women with multiple pregnancies resulting from assisted reproductive technologies (ART) demonstrate higher incidence of miscarriage and obstetric complications than women in the general population. Gestagens are the mandatory therapy to prevent miscarriage in women with single pregnancies (level B evidence). Objective. To evaluate the efficacy of different progestogens (dydrogesterone and micronized progesterone) for the treatment of threatened miscarriage in women with multiple pregnancies resulting from ART. Patients and methods. This prospective cohort study included 75 women with multiple pregnancies resulting from ART and threatened miscarriage in the first trimester. Group 1 comprised 46 patients who received oral dydrogesterone at a dose of 40 mg/day. Group 2 comprised 29 patients who received oral micronized progesterone at a dose of 600 mg/day. In both groups, the symptoms of threatened miscarriage were eliminated within 2 weeks. All patients gave their informed consent for long-term supportive therapy with progesterone agents (dydrogesterone at a dose of 20 mg/day and micronized progesterone at a dose of 200 mg/day) up to 26 weeks of gestation without interruptions. Results. Treatment of threatened miscarriage in the first trimester using progestogens was effective in 93.6% of patients from both groups. Patients receiving progesterone developed cervical shortening twice as often as patients receiving dydrogesterone (55.2% vs 26.1%). Patients receiving vaginal progesterone were 4 times more likely to have bacterial vaginosis. Conclusion. Administration of dydrogesterone and micronized progesterone as a part of comprehensive treatment to prevent miscarriage in the first trimester with subsequent progestogen support up to 26 weeks of gestation was highly effective. Dydrogesterone was significantly more effective in prevention of obstetric complications. Key words: multiple pregnancy, assisted reproductive technologies, pregnancy after ART, posttransfer support, threatened early miscarriage, cervical weakness, dydrogesterone, micronized progesterone

Pregnancy outcomes in women with mechanical heart valves

Abstract Background Mechanical heart valves (MHV) and their absolute need for adequate anticoagulation poses a challenge for pregnancy, either due to warfarin fetotoxicity or an increased risk of maternal thromboembolism. This represents a unique patient (P) group where data is scarce and maternal and fetal risks and benefits must be carefully weighed. Purpose To assess maternal and perinatal outcomes in women with MHV on different anticoagulant regimens and compare them with patients with other types of valvular heart disease (VHD). Methods A retrospective analysis of 131 pregnancies in 83 women with VHD (mean age 26.5±5.6 years) was carried out in a tertiary referral centre from 2000 to 2019. 92 pregnancies with VHD, including 11 with biological prosthetic valves, and 39 pregnancies in 22 P with MHV were identified. The main outcome measures were major maternal complications and perinatal outcome. Results MHV implanted were in mitral position (89.7%), aortic (2.6%), or both (7.7%). History of rheumatic heart disease was identified in 16 P (72.7%) and a congenital etiology was present in 2 P (9.1%). 9 P (40.9%) were on warfarine and 13 P (59.1%) on acenocumarol. Regarding anticoagulation strategy, 21 P (65.6%) remained on oral anticoagulation and 10 P (31.3%) had been switched to some form of heparin during part or the entire pregnancy. Mechanical valve thrombosis complicated pregnancy in 4 patients (10.2%), all cases on heparin, and resulted in maternal death in 1 P. MHV P had more hemorrhagic complications (15.4 vs 2.2%, p=0.004) requiring transfusion or surgical revision. MHV P tended to experience more NHYA class worsening demanding initiation or intensification of cardiac medication (17.9 vs 5.4%, p=0.023). Also in the MHV group there was a higher incidence of miscarriage (46.2 vs 12.0%, p≤0.0005), comprising spontaneous abortion (31.6 vs 7.6%, p&amp;lt;0.0005) and fetal malformations (18.4 vs 5.4%, p=0.028), including warfarin embryopathy (10.3 vs 1.1%, p=0.012). The live birth rate was higher in women on heparin compared with those on warfarin (85.9 vs 79.2%, p=0.002). The presence of multivalve disease (p=0.04), mechanical protheses (p&amp;lt;0.001), ACO (p&amp;lt;0.001) and previous impaired LVEF (p=0.02) were related to miscarriage. In multivariate analysis, ACO was the unique independent predictor of unsuccessful pregnancy (p=0.01). Only 29% of the patients with an MHV had a pregnancy free of serious adverse events compared with other types of VHD (81.5%, p&amp;lt;0.0005). Conclusions MHV remains a challenging condition for pregnancy with only 29% chance of experiencing an uncomplicated pregnancy with a live birth. The increased morbimortality warrant extensive prepregnancy counseling with prosthesis type discussion,centralization of care and further larger studies to come up with evidence-based recommendations. Funding Acknowledgement Type of funding source: None

Miscarriage Rate Is High With Frozen-Thawed Blastocysts Arising From Poor-Quality Cleavage Stage Embryos.

Embryos with low morphological scores can still develop to the blastocyst stage and result in good clinical outcomes. However, no studies have reported the possible effects of transferring cryopreserved blastocysts developed from poor-quality cleavage stage embryos on pregnancy and perinatal outcomes. In this retrospective study, the clinical value of transferring blastocysts derived from day 3 poor-quality cleavage stage embryos during in vitro fertilization and embryo transfer procedures was evaluated. According to the quality of embryos on day 3 from which the transferred blastocyst originated, patients were divided into three groups: poor-quality (111 cycles, group A), good-quality (235 cycles, group B), and top-quality (119 cycles, group C). Group A experienced the highest miscarriage rate (30.2%) which was increased when compared to group C (12.5%) (P = 0.03). The clinical pregnancy rates and live birth rates were not significantly different among the three groups. However, good blastocyst originating from top day 3 embryos resulted in higher live birth rate. Of the 218 live births, no differences in obstetric and perinatal outcomes were noted among the three groups. The results showed that extended culture of poor-quality cleavage stage embryos could resulted in favorable clinical pregnancy rates but at a higher incidence of miscarriages. Meanwhile, the risk of adverse perinatal outcomes was not increased.

730: Should Women wait for the first menstrual period following spontaneous miscarriage before becoming pregnant again?

To determine whether conception prior to the first menstrual period after a first trimester pregnancy loss is associated with a risk of repeat miscarriage or adverse fetal outcomes. A retrospective cohort study (n= 107 women) who had a spontaneous first-trimester miscarriage followed by a subsequent pregnancy with an IPI (interpregnancy interval) < 12 weeks. All pregnancies ended either in spontaneous, medical or surgical abortion. Pregnancy outcome was compared between women who conceived after their next menstrual period (n=57) to women who conceived prior to their next menstrual period (n=50). The primary outcome was miscarriage, and secondary outcomes were gestational age at delivery and birth weight. 1. The rate of recurrent first trimester pregnancy loss among women who conceived prior to their next menstruation was 10.4% in comparison 15.8% for women conceived after their next menstruation (p=0.604). 2. There was no difference in gestational age at delivery and birth weight between the study groups (Table). Other outcomes were also similar for both groups (Table 1). 3. Multiple logistic regression analysis confirmed that conception prior to the next menstrual period was not associated with a higher incidence of miscarriage (OR 1.74, 95% CI: 0.7-4.0, p=0.46) (Table 2). Conception shortly after a spontaneous miscarriage without waiting for the next menstrual period is not associated with adverse maternal or perinatal outcomesView Large Image Figure ViewerDownload Hi-res image Download (PPT)

Pregnancy outcome in a cohort of Egyptian women with rheumatoid arthritis

BackgroundFemale patients with rheumatoid arthritis (RA) can have successful pregnancies. However, those who experience a higher disease activity during pregnancy and require continued treatment have a potential risk of maternal and neonatal complications. Aim of the workTo assess pregnancy outcome (adverse maternal and neonatal outcomes) in an Egyptian cohort of female RA patients. Patients and methodsThiscross-sectional study involved 200 female RA patients and 100 healthy age-matched controls. All were subjected to detailed gynecological history including: number of pregnancies, miscarriage, mode of delivery, maternal complication (gestational diabetes and preeclampsia), fetal complication (prematurity, low birth weight ‘LBW’ and congenital anomalies) and medicationsused during pregnancy. The disease activity score (DAS28) was assessed pre-conception and in each trimester. ResultsPatients had significantly lower number of pregnancies (p = 0.002) and deliveries (p = 0.001) and higher incidence of miscarriages (p = 0.022) compared to controls. Delivery by Cesarean section (CS) was higher inpatients (p = 0.001) with an increased risk of preeclampsia (p = 0.042). Both the antenatal and natal DAS28 significantly correlatedwith abortions, deliveries by CS and LBW (p = 0.005, p = 0.004 and p < 0.001, respectively). Pre-conceptional methotrexate use significantly correlated with the number of abortions (p = 0.02). Corticosteroid use during pregnancy was related to LBW of newborns (p = 0.03). ConclusionPregnant RA patients have higher frequency of abortion, delivery by CS, preeclampsia and LBW of newborns; especially those having higher disease activity and/ortreated with potentially harmful medications. It is crucial to educate female RA patients about these risks and they should be considered as high-risk pregnancy and followed accordingly.

Possible Changes in Maternal Plasma Cortisol, AdrenocorticotropicHormones, Pregnancy Associated Plasma Protein-A and Alpha-fetoproteinin HIV Pregnant Women at NAUTH Nnewi, Nigeria

Background: There is limited information on if HIV infection induces stress in pregnancy. HIV can possibly contribute to the alterations in some fetal viability hormones thereby lead to adverse pregnancy outcome. The present study aimed to assess the possible changes in maternal cortisol, Adrenocorticotropic (ACTH), Pregnancy associated plasma protein-A (PAPP-A) and alpha-fetoprotein (AFP) hormone concentrations in HIV-infected pregnant women and their pregnancy outcomes. Methods: A cross sectional study of 80 (Eighty) volunteer pregnant women aged (18-49) years recruited during routine antenatal clinics in Nnamdi Azikiwe Teaching Hospital, Nnewi, Anambra State, Nigeria was conducted. The participants were divided into groups: 40 (forty) apparently healthy pregnant and 40 (forty) HIV-infected pregnant women. 5 ml of morning blood samples were collected from each subject in their 1st and 2nd trimesters for estimation of Cortisol, ACTH, AFP and PAPP-A using ELISA method. Results: The result showed that the mean systolic and diastolic blood pressures (mmHg) of HIV pregnant women were significantly higher than control (p<0.05 respectively). The mean value of cortisol (ng/ml) in HIV pregnant women was significantly higher when compared with control subjects (p<0.05). Cortisol showed inverse significant correlation with AFP in HIV-infected pregnant women. Maternal outcomes showed thatt HIV-infected pregnant women had significantly higher incidence of miscarriages and preeclampsia with higher incidence of perinatal outcomes such as low birth weight babies (LBW), preterm delivery, spontaneous abortion, still birth and low Apgar scores when compared with apparently normal pregnant women (P<0.05 respectively). Conclusion: the significantly higher cortisol level and BP in HIV pregnant women is indicative of oxidative stress due to perceived stress by HIV infection which might predispose the affected women to hypertension and preeclampsia. The highest adverse reactions observed in HIV pregnant women might be related to the damaged immune system by HIV infection however, the placental defect associated with increased placental permeability to AFP and the activity of the insulin-like growth factor (IGF) system is not related to the activity of stress thereby do not influence their birth outcomes.

A Review of Inadequate and Excessive Weight Gain in Pregnancy

Women with a normal prepregnancy body mass index (BMI) and those who meet the recommended weight gains are healthiest and have healthier children. Adequate gestational weight gain contributes to better perinatal short- and long-term health outcomes in both mothers and infants. However, many key aspects of the health of women of childbearing age have changed, including a high prepregnancy BMI and advanced age, along with a high proportion of women from diverse ethnicities. Overweight and obesity have become major problems in the world. High prepregnancy BMI, overweight and obesity, are risk factors for adverse pregnancy outcomes, such as gestational diabetes, preeclampsia, cesarean delivery, and having a macrosomic infant. On the other hand, underweight is associated with a higher incidence of miscarriage, and the delivery of small for gestational age (SGA) and low birth weight (LBW) infant. Prepregnancy BMI and gestational weight gain show strong association with pregnancy outcomes. Their combined effects on maternal and neonatal outcomes, including short- and long-term health risks, are strong. Therefore, it is important that health providers help women implement lifestyle changes to achieve normal BMI levels preconception, avoid excess weight gain during pregnancy and eliminate postpartum weight retention.

Epididymis seleno-independent glutathione peroxidase 5 maintains sperm DNA integrity in mice

The mammalian epididymis provides sperm with an environment that promotes their maturation and protects them from external stresses. For example, it harbors an array of antioxidants, including non-conventional glutathione peroxidase 5 (GPX5), to protect them from oxidative stress. To explore the role of GPX5 in the epididymis, we generated mice that lack epididymal expression of the enzyme. Histological analyses of Gpx5-/- epididymides and sperm cells revealed no obvious defects. Furthermore, there were no apparent differences in the fertilization rate of sexually mature Gpx5-/- male mice compared with WT male mice. However, a higher incidence of miscarriages and developmental defects were observed when WT female mice were mated with Gpx5-deficient males over 1 year old compared with WT males of the same age. Flow cytometric analysis of spermatozoa recovered from Gpx5-null and WT male mice revealed that sperm DNA compaction was substantially lower in the cauda epididymides of Gpx5-null animals and that they suffered from DNA oxidative attacks. Real-time PCR analysis of enzymatic scavengers expressed in the mouse epididymis indicated that the cauda epididymidis epithelium of Gpx5-null male mice mounted an antioxidant response to cope with an excess of ROS. These observations suggest that GPX5 is a potent antioxidant scavenger in the luminal compartment of the mouse cauda epididymidis that protects spermatozoa from oxidative injuries that could compromise their integrity and, consequently, embryo viability.

Maternal Immune Response to Fetal Platelet GPIbα Causes More Frequent Miscarriage in An Animal Model: A Potential Explanation for Low Reported Incidence of Fetal and Neonatal Immune Thrombocytopenia Mediated by Anti-GPIbα Antibodies.

Fetal and neonatal immune thrombocytopenia (FNIT) is a life-threatening bleeding disorder, resulting from fetal platelet opsonization and destruction by maternal antibodies developed during pregnancy. The frequency of FNIT has been estimated at 0.5–1.5/1,000 liveborn neonates. However, the incidence of fetal mortality is currently unknown, as the rate of miscarriage in affected pregnant women has not been well studied. Integrin αIIbβ3 and Glycoprotein (GP) Ibα are major glycoproteins expressed on the platelet surface and are the two major antigens targeted by anti-platelet antibodies in autoimmune thrombocytopenia (ITP). However, it is unclear why the incidence of FNIT caused by anti-GPIbα antibodies is far lower than that of FNIT mediated by anti-β3 integrin antibodies. This difference cannot be well explained by the frequency of genetic polymorphisms of the two antigens. We hypothesized that: 1) GPIbα is less immunogenic, leading to less maternal antibody production during pregnancy, or 2) anti-GPIbα antibodies cause a less severe pathology, and thus have a lower chance of being reported, or 3) anti-GPIbα antibodies cause higher incidence of miscarriage, resulting in reduced reported cases. To test these hypotheses, the maternal immune response against fetal platelet GPIbα versus β3 integrin were compared in FNIT models, using syngeneic background BALB/c GPIbα−/− and β3−/− mice. The FNIT models were established by transfusing female GPIbβ −/− or α3−/− mice with 108 gel-filtered platelets from wild-type (WT) BALB/c mice weekly. After two platelet immunizations, flow cytometry assays were used to detect the titers of anti-GPIbα and anti-β3 antibodies, and the immunized females were bred with WT BALB/c male mice. We found that there was no significant difference in mean antibody titer between the two groups (P>0.05). However, miscarriage occurred more frequently in anti-GPIbα-mediated FNIT (14/16 versus 8/16, P<0.05), particularly in pregnant mice with antibody titer less than 1:800 (11/13 versus 6/14, P<0.05). When antibody titers were higher than 1:800, miscarriage occurred in all mice and no difference was observed between the two groups (3/3 versus 2/2, P>0.05). Our data suggest that fewer reported FNIT cases mediated by anti-GPIbα antibodies cannot simply be explained by less immunogenicity of GPIbα, or less severe pathology caused by anti-GPIbα antibodies. Higher incidence of miscarriage caused by maternal immune response to fetal GPIbα likely masks the reported frequency and severity of this life-threatening disease. The mechanisms leading to miscarriage in FNIT, and the potential therapeutic effect of intravenous immunoglobulin (IVIG) in this disorder are currently being investigated. (Li C and Piran S contributed equally to this work).

Anti-Müllerian hormone as a predictor of IVF outcome

Serum anti-Müllerian hormone (AMH) concentration and antral follicle count (AFC) are two increasingly popular static measures used to predict ovarian reserve prior to IVF treatment. While they have been shown to be good predictors of oocyte yield during ovarian stimulation, their status as indicators of oocyte quality and pregnancy rates is currently uncertain. The present study measured baseline concentrations of serum AMH and FSH, and AFC from 126 women undergoing IVF treatment. These data were then related to IVF outcomes. As expected, patients with lower serum AMH and AFC produced a significantly (P < 0.001) lower number of oocytes compared with patients with higher serum AMH/AFC. Fertilization rates in patients with lower serum AMH were significantly inferior compared with patients with higher serum AMH, irrespective of whether IVF (P = 0.043) or intracytoplasmic sperm injection (P = 0.006) was used to achieve fertilization. These low AMH patients yielded fewer oocytes, had lower fertilization rates, generated fewer embryos, and had a higher incidence of miscarriage during fresh transfers, ultimately culminating in a halving of the pregnancy rate per IVF cycle compared with the high AMH group.

High frequency of chromosomal abnormalities in embryos obtained from oocyte donation cycles

High frequency of chromosomal abnormalities in embryos obtained from oocyte donation cycles

Sperm chromatin intergity is related to body mass index: men presenting with high BMI scores have a higher incidence of sperm DNA fragmentation

Objective: Body mass index (BMI) has been demonstrated to impact fertility. Females with a BMI >25 typically are insulin resistant, suffer from PCOS and have a poor fertility prognosis. Those undergoing ART therapy typically require larger gonadotropin dosages and produce fewer mature oocytes plus have a higher incidence of miscarriages. Men with high BMI values present with lower numbers of normal-motile sperm cells. However, the impact of BMI on sperm chromatin integrity is unknown. Therefore the study objective was to determine the relation between BMI and sperm chromatin integrity.

Men with high body mass index values present with lower numbers of normal-motile sperm cells

Objective: Body mass index (BMI) has been demonstrated to impact female fertility. Females with a BMI >25 typically are insulin resistant, suffer from PCOS and have a poor fertility prognosis. Those undergoing ART therapy typically require larger gonadotropin dosages and produce fewer mature oocytes plus have a higher incidence of miscarriages. There is little to no information (men with a BMI < 20 have an abnormal semen analysis and low testosterone levels) on the impact of BMI on male fertility and, or semen parameters. Therefore the study objective was to determine the relation between BMI and semen parameters.

The health effects of chemical waste in an urban community

This paper presents the results of a community health survey of people living near a hazardous chemical waste site in Kingston, Queensland. In comparison with a matched control group, people near the site were no more likely to report serious diseases, and reports of cancer and mortality rates did not differ in the two groups. Kingston residents reported higher rates of symptoms of general poor health, high levels of stress and anxiety and a higher incidence of miscarriages. The reports of poor physical health appear to be independent of proximity to the hazardous waste site and duration of residence in the area. Symptom prevalence and perceived recent decline in health correlate most strongly with the stress and anxiety measures. While long-term investigation is necessary, it appears at this stage that the chemical waste is not associated with an increase in major diseases as reported by those who were interviewed. When health in a broader sense is considered, however, it is clear that the situation has had a negative impact.

Developmental and sexual factors in women: a comparison between control, neurotic and psychotic groups.

Comparison of groups of controls, neurotics, and psychotics were made by means of a structured interview. Developmental symptoms (enuresis and somnambulism) were not noted to be harbingers of psychiatric disease. Menopausal symptoms, dysmenorrhea, dyspareunia, frequency of orgasms and enjoyment of coitus did not differentiate the groups. A higher incidence of miscarriages was noted in psychotic patients and a lower incidence of somnambulism was seen in the psychoses. A significantly higher percent of psychotics had intercourse infrequently, although in other sexual areas as noted above the psychotic group was like the others.