Higher Miscarriage Rate Research Articles

Comparing the outcomes of rheumatic heart disease in pregnancy complicated with and without atrial fibrillation: A propensity score matched analysis

Atrial fibrillation (AF) may increase the risk of adverse maternal and fetal outcomes among pregnant with rheumatic valvular lesions (RHD). We aimed to assess the rate of occurrence of AF in pregnant with RHD and its impact on cardiac and maternal-fetal outcomes compared to those without it. The study group consisted of pregnant women with RHD and AF (cases) and a matched comparison group of pregnant women with RHD but without AF (controls) was derived from the database of pregnant women with RHD receiving care at our center between 2011 and 2021. Incidence of composite adverse outcomes(maternal death, heart failure, or thrombo-embolic events) and pregnancy outcomes were compared between them. Seventy-one (5.1%; 95%CI 4.1%-6.4%) pregnant women with RHD had AF during pregnancy and childbirth, most occurring in the late second or early third trimester. New-onset AF was diagnosed in 34 (47.9%) of them. After matching, the incidence of composite outcome was higher in women with AF (77.5% (95%CI 66.3%-85.7%) compared to women without AF (17.3%(95%CI 13.3%-22.1%), P < .001), with seven (9.9%) maternal deaths among cases and two (0.7%) in controls. Heart failure was the most common adverse cardiac event (26.7% vs. 4.2%, P < .001, cases vs controls). Those with AF had higher odds (adjusted OR 56.6 (14.1-226.8)) of adverse cardiac outcomes after adjusting for other risk factors. The frequency of most non-cardiac pregnancy complications was similar in both groups. However, there was a trend towards a higher rate of miscarriage (16.9% vs. 9.9%), small-for-gestational-age babies(16.3 vs. 9.0%), and cesarean rates(31.9% vs. 18.3%) women with AF compared to those who did not experience AF. Atrial fibrillation in pregnancy among women with RHD was associated with an increased risk of maternal morbidity and mortality, with a trend towards an increase in some non-cardiac pregnancy complications compared to those pregnant women without AF. Our study results provide background data for developing and implementing a pregnancy-specific management strategy tailored to middle-income settings.

A study of Rural Women's Health

According to the World Health Organization, health is not merely the absence of disease but a state of complete physical, mental and social well-being. The real meaning of being healthy is focusing on yourself and adopting healthy ways of living. After independence in India, health has been one of the main goals facing the country. There have always been obstacles in bringing health facilities to the rural people of the country. The average life expectancy of people in India increased from 32 years in 1951 to 64.6 years for men and 67.6 years for women in 2011. If we look at the nutritional status of women and adolescents in India, 58% of pregnant women are anaemic. 33% of malnourished women, 30% of married women under the age of 18 and 42% of women with low weight during pregnancy. A study unit of 10 villages has been selected from each taluka of Bhavnagar district. A total of 300 women namely 30-30 rural women from each village have been purposefully selected through Yadachh demonstration method. In the present study, 62% of the respondents have common illnesses like cold, cough, fever, and headache, in modern times, very few people take home remedies during the treatment of the illness, while the maximum number of respondents take the treatment in the hospital. There is a government hospital facility in their village to a small extent, while there is a small amount of private hospital, the government health worker comes to their village to a very small extent, 68% of the respondents say that the doctor comes regularly to the health center of their village, 69% of the subjects under study. The respondent is getting satisfactory advice from the employee. In the present study, more than half of the respondents have to pay the expenses of the illness to their husbands, while less amount have to be paid by themselves. In the present study maximum respondents know about Ma Amritham Yojana but take little benefit of it. In the present study only 8% respondents deliver at home. While 28% of the respondents give birth in a hospital and 42% in a private hospital. In the present study, rural women suffered from many health related problems due to economic factors. In the present study also more health related problems have been observed in uneducated women as compared to educated women. Overhead delivery is very harmful to a woman's health. Rural women have a high rate of miscarriage due to lack of education and awareness or other family reasons that negatively affect their health. Even today, there is a tradition in the rural society that after all the men in the house have eaten, the women eat, due to which there is not enough food left. This leads to malnutrition among rural women and this condition of malnutrition over time creates serious diseases. These health issues arise in villages under study where facilities are lacking.

A REVIEW OF PARIPLUTA YONIVYAPAD W.S.R. PELVIC INFLAMMATORY DISEASE ( P.I.D)

Twenty types of Yonivyapad have been described in all the Ayurveda Texts. All Yonivyapad are the significant causes of hampering the normalcy of the female reproductive system. Paripluta Yonivyapad" is one of the twenty Yonivyapad, and in these, Vata &amp; Pitta Dosha is considered the primary cause. Paripluta Yonivyapad can be correlated with pelvic inflammatory disease. PID is a disease of the upper genital tract. Most of the women ignore their health-related problems due to unawareness and lack of knowledge of their reproductive and sexual health. PID is a public health issue. Delayed management of PID may result in higher rates of miscarriage, chronic pelvic pain, STD, progressive organ damage and long-term reproductive disability due to its recurrence. Evaluation of proper disease management not only to cure but to reduce recurrence rate through Ayurvedic management without any side effects.

Fetal Surveillance From 39 Weeks’ Gestation to Reduce Stillbirth in South Asian–Born Women

ABSTRACT Women of South Asian background are known to have higher rates of stillbirth than women in other high-income countries, such as Australia or the United Kingdom. To reduce the rate of stillbirth, leading societies recommend antenatal fetal monitoring or induction of labor (IOL) at 41 weeks of gestation regardless of race/ethnicity. However, at 41 weeks' gestation, the risk of stillbirth for South Asian–born women is already up to 5 times higher than for Australian-born women. Initially, the UK National Institution for Health and Care Excellence recommended that all South Asian women undergo IOL earlier, at 39 weeks of gestation. However, this recommendation was criticized as being racist, and perpetuating the myth that race plays a factor in poor outcomes, so it was amended to state that South Asian–born women might benefit from additional monitoring and support. Still, there is no evidence to support this guidance. In July 2017, the State of Victoria in Australia implemented a new clinical guideline to provide South Asian women with biweekly cardiotocography and amniotic fluid measurement at 39 weeks of gestation. The aim of this study was to assess the impact of the new clinical guideline on the rates of stillbirth and select pregnancy outcomes for South Asian women. This was a cohort study that included women with singleton pregnancies who gave birth at term or beyond at a university- affiliated teaching health service located in 3 metropolitan areas in Australia from January 1, 2016, to December 31, 2020. Women were classified as South Asian born if they self-identified as being from Afghanistan, Bangladesh, Bhutan, India, Iran, the Maldives, Nepal, Pakistan, or Sri Lanka. The timeframe between January 1, 2016, and June 30, 2017, represented the period before the change in practice for fetal monitoring for South Asian women; the timeframe between July 1, 2017, and December 31, 2020, represented the period after. Although the new practice was applied to South Asian–born women in the second timeframe, fetal monitoring at 41 weeks was applied to all other women. The primary outcome was stillbirth at the onset of or during labor at 37 weeks and 39 weeks of gestation. The secondary outcomes included neonatal death at &lt;7 days, admission to the special care nursery or neonatal intensive care, Apgar score &lt;7 at 5 minutes, infant birthweight, gestation of birth, IOL, and mode of birth. A total of 3506 South Asian women gave birth before the change in practice, whereas 8532 gave birth postimplementation. The rate of stillbirth at 37 weeks' gestation for South Asian–born women was 2.3 per 1000 births—a 2.6-fold higher rate than for other women (0.9 per 1000 births; P = 0.06). After the change in practice, the rate of stillbirth fell by 64% for South Asian–born women (95% confidence interval, 87%–2%; P = 0.047). The association was stronger when the results were restricted to births after 39 weeks of gestation. Also, after the change in practice, reduced rates for early neonatal death (3.1 per 1000 vs 1.3 per 1000; P = 0.03) and admission to the special care nursery (16.5% vs 11.1%; P &lt; 0.001) were observed. The median gestation of birth for South Asian–born women was 39+3 weeks preimplementation compared with 39+2 weeks postimplementation, a difference of 1 day. The rate of IOL for South Asian–born women was 4.9% higher than other women (95% confidence interval, 1.3%–8.5%; P = 0.008). However, no significant difference was observed between the 2 groups in the rate of IOL per month after the change in practice, nor across the other secondary outcomes. In conclusion, fetal monitoring starting at 39 weeks' gestation among South Asian–born women reduced the rate of stillbirth, neonatal death, and admission to the special care nursery compared with previous guidelines to begin monitoring at 41 weeks.

(200) The Fertility and Childbearing Experiences of US Male Physicians

Abstract Introduction Recent attention has been brought to physician fertility in the last decade, most notably amongst female physicians who suffer an increased risk of infertility compared to the general population. Various factors related to a career in medicine play a role, such as a delay in pursuit of childbearing, a demanding work schedule, shift work, and stress associated with the profession. However, risk of infertility in the male physician population has yet to be studied. Objective Therefore, we sought to evaluate the experiences and childbearing patterns of a sample of American male physicians with special attention to timing of conception and childbearing, reflections upon professional and personal decision-making, and general knowledge regarding fertility. The primary objective of this study was to determine the incidence of infertility among American male physicians. Methods Utilizing a third party to access the American Medical Association (AMA) database, licensed US physicians registered as male and between the ages of 18-65 were identified. Within this cohort, 690 men were randomly selected and contacted via paper mail (340) or email (350) and asked to participate in the survey study. Surveys were administered electronically via REDCap (obtained through a QR code) and included questions regarding the physicians’ demographics, medical specialty, and whether they have attempted to conceive. Those who have attempted to conceive were also surveyed on their work experience at the time of their first attempt at conception and their experience and partner’s experience with fertility and childbearing. Internal Review Board approval was obtained for this study (STUDY 20211036). Results Fifty-three men responded to the survey (7.7%). All respondents were cisgender males with cisgender female partners. The majority (94.3%) had attempted to conceive and occurred most during residency (46.0%). The average age when first attempting conception was 31.6 years, and this was most commonly during residency (46.0%) or after training (30.0%). During this time, many (72.0%) were responsible for night shifts, overnight call duties, or both. In addition, as many as 34 men (68.0%) had no access to paid parental leave during this time. Of 50 men who attempted conception, 14 (28.0%) of their partners experienced a miscarriage. Eight men (17.0%) underwent a fertility workup, and 6 underwent infertility treatment(s). Only 4 respondents had insurance partially covering their infertility treatments, while the other two had no insurance coverage. Conclusions Male physicians are often exposed to long work hours, nighttime duties, and sparse paid parental leave during the time of their first attempt at conception, most commonly in residency. Our cohort shows a high rate of miscarriage (28.0%) and infertility assessment (16.0%) among this population. Future studies are needed to continue characterizing fertility amongst physicians. Disclosure No.

Endometrial pattern predicts pregnancy outcome in single-blastocyst frozen-embryo transfer: An analysis of 1383 cycles.

Several studies investigated endometrial patterns, with respect to pregnancy rates following the transfer of embryos but did not distinguish between single- and multiple-blastocyst procedures. We clarified how the endometrial pattern imaged to transfer a frozen embryo is associated with pregnancy outcomes in single-blastocyst frozen-embryo transfer (sbFET). Patients ≤35 years who underwent sbFET on the hormone replacement protocol. We analyzed endometrial patterns' associations with pregnancy outcomes in relation to blastocyst grade and pregnancy-related factors. Of the 1383 cycles, 483 were Lf, 840 were partial-Lf, and 60 were non-Lf. Leaf pattern (Lf): central echogenic line present and continuous. Overall, decreasing distinctness of the central echogenic line was associated with significantly lower rates of clinical pregnancy (Lf: 70.4%; partial-Lf: 58.1%; non-Lf: 28.3%) and live birth (56.3%, 45.5%, and 15.0%) and a higher miscarriage rate (20.0%, 21.7%, and 47.1%). Logistic regressions showed pregnancy and live birth to be significantly more likely and miscarriage less likely in Lf than non-Lf: OR (95% CI): 6.07 (3.24-11.37), 7.43 (3.47-15.39), and 0.20 (0.07-0.57). Non-Lf presentation was associated with lower rates of pregnancy and live birth, suggesting it signals unsuitable conditions for embryo transfer. We provide information on the pregnancy outcomes of sbFET for endometrial patterns.

Healthy Live Births after the Transfer of Mosaic Embryos: Self-Correction or PGT-A Overestimation?

The implementation of next generation sequencing (NGS) in preimplantation genetic testing for aneuploidy (PGT-A) has led to a higher prevalence of mosaic diagnosis within the trophectoderm (TE) sample. Regardless, mosaicism could potentially increase the rate of live-born children with chromosomic syndromes, though available data from the transfer of embryos with putative PGT-A mosaicism are scarce but reassuring. Even with lower implantation and higher miscarriage rates, mosaic embryos can develop into healthy live births. Therefore, this urges an explanation for the disappearance of aneuploid cells throughout development, to provide guidance in the management of mosaicism in clinical practice. Technical overestimation of mosaicism, together with some sort of "self-correction" mechanisms during the early post-implantation stages, emerged as potential explanations. Unlike the animal model, in which the elimination of genetically abnormal cells from the future fetal lineage has been demonstrated, in human embryos this capability remains unverified even though the germ layer displays an aneuploidy-induced cell death lineage preference with higher rates of apoptosis in the inner cell mass (ICM) than in the TE cells. Moreover, the reported differential dynamics of cell proliferation and apoptosis between euploid, mosaic, and aneuploid embryos, together with pro-apoptosis gene products (cfDNA and mRNA) and extracellular vesicles identified in the blastocoel fluid, may support the hypothesis of apoptosis as a mechanism to purge the preimplantation embryo of aneuploid cells. Alternative hypotheses, like correction of aneuploidy by extrusion of a trisomy chromosome or by monosomic chromosome duplication, are even, though they represent an extremely rare phenomenon. On the other hand, the technical limitations of PGT-A analysis may lead to inaccuracy in embryo diagnoses, identifying as "mosaic" those embryos that are uniformly euploid or aneuploid. NGS assumption of "intermediate copy number profiles" as evidence of a mixture of euploid and aneuploid cells in a single biopsy has been reported to be poorly predictive in cases of mosaicism diagnosis. Additionally, the concordance found between the TE and the ICM in cases of TE biopsies displaying mosaicism is lower than expected, and it correlates differently depending on the type (whole chromosome versus segmental) and the level of mosaicism reported. Thus, in cases of low-/medium-level mosaicism (<50%), aneuploid cells would rarely involve the ICM and other regions. However, in high-level mosaics (≥50%), abnormal cells in the ICM should display higher prevalence, revealing more uniform aneuploidy in most embryos, representing a technical variation in the uniform aneuploidy range, and therefore might impair the live birth rate.

Effects of fasting hyperglycemia in men on pregnancy outcomes of singleton pregnant women with cryo-thawed embryo transfer

BackgroundThe relationship of metabolic issues to pregnancy outcomes during assisted reproductive technology (ART) is gaining much attention. Fasting Plasma Glucose (FPG) is one of the most common metabolic indicators. Abnormal FPG not only affects the quality of life of human body, but also has a bearing on reproductive health. However, most attentions are paid on women's physical health and reproductive assessment, the health status of the male partner on pregnancy outcomes during ART treatment is often neglected. This study investigated whether male fasting hyperglycemia (FH, FPG > 6.1 mmol/L) can affect live birth rates (LBR) in singleton intrauterine clinical pregnancy women with cryo-thawed embryo transfer (CET) cycles.Material and methodsA retrospective cohort study (370 CET cycles with first singleton clinical intrauterine pregnancy and grouped by male FPG) was conducted to analyze the relationship between male FH and clinical pregnancy outcomes using binary logistic regression; the odds ratios (ORs) and 95% confidence intervals (CIs) were calculated as a measure of relevancy. Live birth rate was the main outcome measure.ResultsThe live birth rate (LBR) was significantly lower [58.6% vs. 81.8%, P = 0.007, adjusted OR 0.635, 95% CI 0.456–0.884] and miscarriage rate (MR) was significantly higher [41.4% vs. 18.2%, P = 0.007, adjusted OR 1.575, 95% CI 1.131–2.195] in the FH group when compared with the Con group. There was no difference in healthy baby rate [88.2% vs. 89.6%, P = 0.058, adjusted OR 2.143, 95% CI 0.974–4.716] or abnormal birth weight rate (23.5% vs. 11.8%, P = 0.238, adjusted OR 2.859, 95% CI 0.777–10.460] between the FH and control group. No birth defects were observed in the present study.ConclusionMale FH is an independent risk factor for lower LBR and higher MR in singleton intrauterine pregnancy women with CET cycles.

IMPACT OF COVID-19 PANDEMIC ON STILLBIRTH RATES IN DEVELOPING COUNTRIES: A STUDY FROM LADY READING HOSPITAL, PAKISTAN

The COVID-19 pandemic has created challenges, particularly for underdeveloped countries with fragile healthcare systems. These nations are experiencing increased pressure due to the pandemic and ongoing illnesses. This research aims to evaluate how the pandemic has indirectly impacted mother and newborn health in Pakistan, resulting in higher stillbirth rates. The study will analyze data from pre-pandemic and pandemic years to determine how healthcare interruptions, fewer prenatal visits, and infection concerns have affected stillbirth occurrences in tertiary-care hospitals. It is a cross-sectional study conducted at the Department of Obstetrics and Gynecology at Lady Reading Hospital, Peshawar, Pakistan, from January 2019 to January 2020. The Department of Obstetrics and Gynaecology at Lady Reading Hospital in Peshawar, Pakistan, conducted this cross-sectional research. Approved by ethics was acquired. Using internet calculators, the sample size of 200 was determined with a 5% margin of error, a 95% confidence interval, and a stillbirth percentage of 16%. Consecutive non-probability sampling was used. Patients who were at term and gave birth to stillborn children were included in the study; instances involving twin pregnancies, fetal abnormalities, and early neonatal deaths were not. For 2019 (before COVID-19) and 2020 (the pandemic year), retrospective data on medical problems, reasons for stillbirth, demographic traits, and prenatal visits were gathered. The causes of stillbirths were compared between the two years using chi-square testing. A p-value of 0.05 was considered statistically significant. The research discovered notable differences in stillbirth rates and associated variables between 2019 (before COVID-19) and 2020 (the pandemic year). The proportion of multiparous women increased to 62% in 2020 from 57% in 2019. A decline in prenatal bookings from 64% in 2019 to 52% in 2020 suggests that antenatal visits were fewer throughout the epidemic. There were notable variations between the two years in several stillbirth-related factors, including abruption, placenta previa, type II diabetes, gestational diabetes mellitus (GDM), malpresentation, intrauterine growth restriction (IUGR), obstructed labor, eclampsia, postdates, and unknown causes. These results demonstrate how the pandemic affected maternity care and how stillbirth rates are related to it. In an environment with inadequate resources, the research shows a significant rise in stillbirth rates during the COVID-19 epidemic. This increase is attributed to fewer prenatal visits, interruptions in healthcare services, and the pandemic's collateral consequences. These results highlight the need for tailored treatments and program changes for maternal health during medical emergencies.

Fast and sensitive differential diagnosis of pseudorabies virus-infected versus pseudorabies virus-vaccinated swine using CRISPR-Cas12a.

Pseudorabies virus (PRV) causes high mortality and miscarriage rates in the infected swine, and the eradication policy coupled with large-scale vaccination of live attenuated vaccines has been adopted globally against PRV. Differential diagnosis of the vaccinated and infected swine is highly demanded. Our multienzyme isothermal rapid amplification (MIRA)-Cas12a detection method described in this study can diagnose PRV with a superior sensitivity comparable to the quantitative PCR (qPCR) and a competitive detection speed (only half the time as qPCR needs). The portable feature and the simple procedure of MIRA-Cas12a make it easier to deploy for clinical diagnosis, even in resource-limited settings. The MIRA-Cas12a method would provide immediate and accurate diagnostic information for policymakers to respond promptly.

Preconception sleep duration, non-daytime work schedules, and incidence of spontaneous abortion: a prospective cohort study.

To what extent do self-reported sleep duration and non-daytime work schedules in either partner affect the rate of spontaneous abortion (SAB)? Incidence of SAB had little association with female sleep duration and a modest positive association with male short sleep duration, female work at night, and discrepant work schedules among partners. Several studies have reported an association between short sleep duration in either partner and reproductive health outcomes, including fecundability. Moreover, certain types of female occupational exposures during pregnancy have been associated with an increased risk of SAB. No studies have evaluated SAB risk in relation to male sleep and work schedules, or joint exposures within a couple. This prospective cohort study included 9357 female participants and 2602 of their male partners residing in North America (June 2013 to April 2023). Participants enrolled when they were attempting pregnancy and completed self-administered baseline questionnaires about their average sleep duration and work schedules. Among those who conceived, we ascertained SAB and gestational age at loss via follow-up questionnaires. We used multivariable Cox proportional hazards models with gestational weeks as the time scale to estimate hazard ratios (HRs) and 95% CIs relating SAB with sleep duration and non-daytime work schedules for female and male participants, and the couple. We used inverse probability weighting to account for potential selection bias due to the possibility of differential participation of male partners with respect to the exposures. Compared to female participants with recommended sleep (7-8.9 h), those reporting short sleep duration (<6 h) did not have a higher rate of SAB (HR 0.88, 95% CI 0.69, 1.13). Short self-reported sleep duration among male participants was modestly associated with a higher rate of SAB (adjusted and weighted HR 1.30, 95% CI 0.96, 1.75). Female night work at night (adjusted HR 1.19, 95% CI 1.02, 1.38) and male non-daytime work (adjusted and weighted HR 1.26, 95% CI 1.00, 1.59) were associated with modestly higher rates of SAB, whereas female rotating shift work was not (adjusted HR 0.91, 0.78, 1.05) compared with daytime workers. Couples in which work schedules were discrepant had an elevated rate of SAB if the male partner worked a non-daytime shift (adjusted and weighted HR 1.46, 95% CI 1.13, 1.88) compared with couples in which both members worked during the day. The corresponding HR if only the female partner worked a non-daytime shift was 1.21 (95% CI 0.92, 1.58). Data on sleep duration and work schedules were based on self-report, which is vulnerable to misclassification, particularly since participants were asked to report their average sleep duration during the past month. Work exposures were heterogeneous, as many different types of employment may require night and shift work and may have different associations with SAB. Our findings are consistent with previous research indicating that some types of female employment schedules may be associated with SAB incidence. This is the first study to indicate a relationship between SAB and male employment schedules, indicating that discrepant work schedules within a couple might be relevant. This work was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development grants R01HD105863 (PIs: L.A.W. and M.L.E.), R01HD086742 (PIs: L.A.W. and E.E.H.), and R21HD072326 (PI: L.A.W.). PRESTO has received in-kind donations from Swiss Precision Diagnostics and Kindara.com for primary data collection. L.A.W. is a consultant for AbbVie, Inc. and the Gates Foundation. M.L.E. is an advisor for and holds stock in Ro, Hannah, Dadi, Underdog, Vseat, & Doveras. The other authors have no competing interests to declare. N/A.

#347 : Factors Related to Mosaicism of Human Embryo: Conventional Statistics and Machine Learning Analysis

Background and Aims: Mosaicism arises from errors in the cell division process and can lead to cells containing a combination of normal and mutated genes. Mosaic embryos can produce healthy babies. However, it may be associated with a lower implantation and a higher miscarriage rate. Despite extensive research, the scientific understanding of the underlying causes of embryonic mosaicism remains limited, and conclusions remain subject to ongoing debate. Machine learning (ML) can capture complex relationships and automatically learn the most informative features, while conventional statistics (CS) are simple to understand. We aimed to apply both ML and CS to determine the critical factors that may be associated with mosaicism. Method: A retrospective analysis was conducted at the Infertility Department of Hung Vuong Hospital between 2018 and 2022 using medical data from 51 IVF couples. The study utilized both machine learning and conventional statistical methods to identify possible factors associated with mosaicism in human embryos. Results: Out of the 246 embryos studied, 84 (32%) were found to be mosaic. The performance of the classifiers in the machine learning analysis was relatively poor when using all features, with F1-scores ranging from 0.08 to 0.26. While feature selection helped to improve performance, the F1-scores remained low. On the other hand, the conventional statistical analysis revealed that patients with cryptozoospermia showed a positive association with mosaicism (OR 2.68, 95% CI 1.08 to 6.66, p=0.033). Conclusion: According to the machine learning algorithms, the current set of clinical features has no relation to the incidence of mosaicism. However, the conventional statistical analysis suggests that patients with cryptozoospermia may contribute to a higher risk of mosaicism. Further research is needed to fully understand the mechanisms underlying mosaicism in human embryos.

Analysis of controlled ovarian hyperstimulation protocols in women over 35 years old with poor ovarian response: a real-world study

The objective of this study was to investigate the optimal controlled ovarian hyperstimulation (COH) protocol for patients aged 35 and above with poor ovarian response (POR), utilizing real-world data. This retrospective cohort study examined clinical information from a total of 4256 patients between January 2017 and November 2022. The patients were categorized into three groups: modified GnRH agonist protocol (2116 patients), GnRH antagonist protocol (1628 patients), and Mild stimulation protocol (512 patients). Comparative analysis was conducted on clinical variables and pregnancy outcomes across the three groups. The GnRH agonist protocol was associated with a higher number of oocyte number (4.02 ± 2.25 vs. 3.15 ± 1.52 vs. 2.40 ± 1.26, p < 0.001), higher number of transferable embryos (1.73 ± 1.02 vs. 1.35 ± 1.22 vs. 1.10 ± 0.86, p = 0.016), higher cumulative live birth rate 28.50(603/2116) vs. 24.94(406/1628) vs. 20.51(105/512), p < 0.001) than GnRH antagonist protocol and Mild stimulation protocol, the Mild stimulation protocol was associated with a higher miscarriage rates 16.27(62/381) vs. 16.61(48/289) vs. 32.22(29/90), p = 0.001) than the other two groups. Therefore, it can be concluded that all three protocols can be used in patients over 35 years old with poor ovarian response. However, if patients require more frozen-thawed embryo transfers to achieve better cumulative live birth rates, the modified GnRH agonist protocol may be the preferable option.

SARS-CoV-2 infection during pregnancy and perinatal outcomes in Estonia in 2020 and 2021: A register-based study.

Data from different countries show partly controversial impact of SARS-CoV-2 infection on pregnancy outcomes. A nationwide register-based study was conducted in Estonia to assess the impact of SARS-CoV-2 infection at any time during pregnancy on stillbirth, perinatal mortality, Apgar score at 5 minutes, cesarean section rates, rates of preterm birth and preeclampsia. Data on all newborns and their mothers were obtained from the Estonian Medical Birth Registry, and data on SARS-CoV-2 testing dates, test results and vaccination dates against SARS-CoV-2 from the Estonian Health Information System. Altogether, 26 211 births in 2020 and 2021 in Estonia were included. All analyses were performed per newborn. Odds ratios with 95% confidence intervals (CI) were analyzed for all outcomes, adjusted for mother's place of residence, body mass index, age of mother at delivery and hypertension and for all the aforementioned variables together with mother's vaccination status using data from 2021 when vaccinations against SARS-CoV-2 became available. For studying the effect of a positive SARS-CoV-2 test during pregnancy on preeclampsia, hypertension was omitted from the models to avoid overadjustment. SARS-CoV-2 infection during pregnancy was associated with an increased risk of stillbirth (adjusted odds ratio [aOR] 2.81; 95% CI 1.37-5.74) and perinatal mortality (aOR 2.34; 95% CI 1.20-4.56) but not with a lower Apgar score at 5 minutes, higher risk of cesarean section, preeclampsia or preterm birth. Vaccination slightly decreased the impact of SARS-CoV-2 infection during pregnancy on perinatal mortality. A positive SARS-CoV-2 test during pregnancy was associated with higher rates of stillbirth and perinatal mortality in Estonia but was not associated with change in preeclampsia, cesarean section or preterm birth rates.

Association of Vitamin-D insufficiency and infertility: A Literature Review

Vitamin D receptors are present in both male and female central neural system and reproductive system hence Vitamin D sufficiency or insufficiency affects fertility. The present review aims to determine a correlation between Vitamin D insufficiency and infertility. Regarding female infertility, it was found that Vitamin D insufficiency is associated with increased issues during conception and higher miscarriage rate. Furthermore, Vitamin D insufficiency is associated with lower FSH levels affecting follicle formation, maturation and ovulation. Regarding male infertility, Vitamin D and its Receptor have been identified in the prostate, seminal vesicles, epididymis, germ cells, spermatogonia, spermatocytes and Sertoli cells. The prevalence of Vitamin D insufficiency is higher among men with lower sperm count and lower motility. However, the relation between Vitamin D and testosterone levels remain unclear. The present review stresses the effects of Vitamin D insufficiency in both male and female infertility.

High-intensity Focused Ultrasound is a Better Choice for Women with Fertility Desire: A Systematic Review and Meta-analysis of the Comparison between High-intensity Focused Ultrasound and Laparoscopic Treatment of Uterine Fibroids.

High-intensity focused ultrasound (HIFU) is commonly used to treat uterine fibroids and adenomyosis, but there is no evidence using metadata to compare fertility outcomes between conventional laparoscopic procedures and HIFU. The purpose of this study analysis is that evidence-based fertility outcomes may provide better treatment options for clinicians and patients considering fertility. The literature on fertility data for HIFU surgery versus laparoscopic myomectomy was searched in seven English language databases from January 1, 2010, to November 23, 2022. A total of 1375 articles were received in the literature, 14 of which were selected. We found that women who underwent HIFU surgery had higher rates of spontaneous pregnancy, higher rates of spontaneous delivery, and higher rates of full-term delivery but may have higher rates of miscarriage or postpartum complications than women who underwent laparoscopic myomectomy. Looking forward to future studies, it is hoped that the literature will examine endometrial differences in women who undergo HIFU and laparoscopic myomectomy to demonstrate the ability of endometrial repair. The location of fibroids in the sample should also be counted to allow for attribution statistics on the cause of miscarriage.

The natural cycle protocol of endometrial preparation for frozen embryo transfer decreases the miscarriage rate in women with recurrent pregnancy loss

Objective To investigate whether different endometrial preparation methods lead to different results. Design Retrospective cohort study. Patients Women with recurrent pregnancy loss undergoing frozen embryo transfer (FET). Interventions Natural cycle (NC) protocol (n = 111) with no drug or human chorionic gonadotropin (HCG) used for endometrial preparation, vs. the hormone replacement therapy (HRT) protocol (n = 797) with estrogen or gonadotropin releasing hormone agonist (GnRH-a) plus estrogen used for endometrial preparation. Main outcome measures Miscarriage rate and live birth rate (LBR). Results Compared to women in the HRT protocol, women undergoing NCs had fewer previous FET cycles, lower antral follicle counts (AFCs), fewer oocytes retrieved and a thicker endometrium on the day of progesterone administration. Women in the HRT group had a higher miscarriage rate (29.4% vs. 17.2%) and a lower LBR (37% vs. 46.9%) than the rates of women in the NC group. Univariate analysis showed that female age also had a negative association with the miscarriage rate. Logistic regression indicated that endometrial preparation using the NC protocol was linked to a decreased likelihood of miscarriage. Conclusions The NC protocol decreased the miscarriage rate and increased the LBR for patients with recurrent pregnancy loss compared with the HRT protocol.

THU301 Natural History Of Pregnancy And Pregnancy Outcomes In Subjects With Lipodystrophy

Abstract Disclosure: T.J. Neal: None. M.S. Startzell: None. E. Cochran: None. M. Lightbourne: None. R.J. Brown: None. Lipodystrophy syndromes are a group of rare heterogenous disorders characterized by deficiency of adipose tissue in a regional distribution (Partial Lipodystrophy, PL) or all of the body (Generalized Lipodystrophy, GL), leading to severe insulin resistance, diabetes, hypertriglyceridemia, non-alcoholic steatohepatitis, and polycystic ovarian syndrome. During pregnancy in patients with lipodystrophy, insulin resistance worsens during late gestation, leading to pregnancy complications that may threaten the lives of the fetus and mother. Case reports have suggested increased risk of pregnancy complications such as pre-eclampsia in patients with lipodystrophy. We sought to systematically examine pregnancy complications and offspring outcomes in lipodystrophy through a prospective study involving structured interviews with patients with known lipodystrophy and past pregnancy. Data were collected in 7 patients with PL (2 LMNA, PPARG, 4 unknown genetic cause) and 1 with GL (AGPAT2). These 7 patients had 21 pregnancies (mean 2.6), including 19 singleton and 2 twin gestations. 14 pregnancies (67%) were spontaneous and 7 (33%) required fertility treatment. 10 pregnancies (48%) in 6 patients resulted in 12 live births (7 term, 3 preterm; 3 vaginal and 8 C-section delivery) and 11 (52%) resulted in miscarriage (9 first trimester, 2 second trimester in 1 patient due to cervical insufficiency). There were no episodes of acute pancreatitis during pregnancy. Among the 10 pregnancies resulting in live birth, 100% were complicated by diabetes. 5 (50%) had pre-gestational diabetes and 5 (50%) had gestational diabetes that resolved after delivery. 8 (80%) required insulin during pregnancy (of whom none required insulin pre-pregnancy). 5 (50%) of these pregnancies were complicated by pre-eclampsia. Among all 21 pregnancies, metformin was used in 8 (38%), insulin in 8 (38%), metreleptin in 4 (19%) pregnancies (all 4 of which were in 1 patient with GL), and fenofibrate in 2 (9.5%). Among 12 offspring, 1 (8%) was small for gestational age (GA), 8 (67%) were appropriate for GA and 3 (25%) were large for GA. 6 (50%) had neonatal hypoglycemia. In summary, pregnancies in women with lipodystrophy showed high complication rates, including very high rates of miscarriage, diabetes, and pre-eclampsia. Larger studies are needed to determine how management of these patients during pregnancy, including with newer treatments such as metreleptin for GL, affects pregnancy and offspring outcomes. Presentation: Thursday, June 15, 2023

Identifying, synthesising and appraising existing evidence relating to myalgic encephalomyelitis/chronic fatigue syndrome and pregnancy: a mixed-methods systematic review

ObjectivesTo identify, synthesise and appraise evidence relating to myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and pregnancy.DesignMixed-methods systematic review, using convergent segregated design.Data sourcesMEDLINE, EMBASE, Scopus, PsycINFO, CINAHL, MedRxiv, PROSPERO and grey...

Effects of duration of long-acting GnRH agonist downregulation on assisted reproductive technology outcomes in patients with adenomyosis: a retrospective cohort study.

To elucidate the relationship between long-acting GnRH agonist (GnRHa) downregulation and assisted reproductive technology (ART) outcomes and identify the optimal duration of downregulation in patients with adenomyosis. Retrospective cohort study. The study was designed to evaluate ART outcomes in adenomyosis patients with and without GnRHa downregulation between January 2016 and December 2020. A total of 374 patients with adenomyosis (621 cycles) were included with 281 cycles in downregulation group versus 340 cycles in non-downregulation group. After 1:1 propensity score matching (PSM), a sample size of 272 cycles in each group was matched. The matched downregulation group was further divided into 1-month (147 cycles), 2-months (72 cycles), and ≥3 months downregulation (53 cycles) subgroups. Stratification analysis was conducted on pregnancy outcomes in 239 fresh embryo transfer (ET) cycles and 305 frozen embryo transfer (FET) cycles. The downregulation group had larger mean diameter of initial uterus and higher proportion of severer dysmenorrhea compared to non-downregulation group. The pregnancy-related parameters in GnRHa downregulation group were similar to those in non-downregulation group, except for higher late miscarriage rate (MR) (13.4% vs. 3.1%, P = 0.003). The subgroup comparisons in fresh ET cycles indicated that implantation rate (75.0% vs. 39.2%, P = 0.002), biochemical pregnancy rate (91.7% vs. 56.0%, P = 0.036) and clinical pregnancy rate (83.3% vs. 47.0%, P = 0.016) could be improved by prolonged GnRHa downregulation (≥3 months), whereas late MR was difficult to be reversed (30.0% vs. 3.2%, P = 0.017). In FET cycles, higher MR (53.6% vs. 29.9%, P = 0.029; 58.8% vs. 29.9%, P = 0.026) and lower live birth rate (18.8% vs. 34.1%, P = 0.023; 17.1% vs. 34.1%, P = 0.037) were observed in the 1-month and ≥3 months downregulation group, while no differences were found in the 2-months downregulation group compared to the non-downregulation group. In patients with severer adenomyosis, long-acting GnRHa downregulation might be correlated with improved ART outcomes. In fresh ET cycles, prolonged downregulation (≥3 months) might be beneficial to improve live birth rate, which needed to be verified by further study with larger sample. In FET cycles, the optimal duration of downregulation was not certain and still needed further exploration.