Incidence Of Live Births Research Articles

Clinical efficacy and adverse effects of LMWH combined with ASA in the treatment of RSA: A meta-analysis and systematic review.

The incidence of recurrent spontaneous abortion (RSA) in the clinic shows an increasing trend year by year, and the coagulation status of this group of patients is mostly relatively abnormal. Currently, commonly used drugs in clinical practice include Aspirin (ASA) and low molecular weight heparin (LMWH), but their optimal treatment remains controversial. We aimed to evaluate the clinical efficacy and adverse effects of LMWH combined with ASA in the treatment of RSA. Randomized controlled trials of LMWH combined with ASA for RSA were searched in the databases of PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure, Wanfang, VIP, and Chinese Biomedical Literature Service System from the construction of the database to June 2024. Data were analyzed using Review Manager 5.3 and Stata software. Dichotomous variables were analyzed using relative risk (RR) and 95% confidence interval (CI) as their statistics. The included literature was assessed for bias and risk of bias of eligible studies using Cochrane risk of bias tool. The risk of bias was evaluated based on the evaluation criteria recommended by the Cochrane Guidance Manual for Systematic Evaluation. A total of 32 papers with a total of 3397 patients with RSA were finally included. LMWH combined with ASA treatment significantly improved the live birth rate (RR = 1.31, 95% CI: [1.19, 1.45], P < .00001), the rate of preterm stillbirths (RR = 0.23, 95% CI: [0.13, 0.40], P < .00001), rate of term delivery (RR = 1.55, 95% CI: [1.43, 1.67], P < .00001), rate of miscarriage (RR = 0.42, 95% CI: [0.36, 0.48], P < .00001), incidence of petechiae (RR = 0.44, 95% CI: [0.26, 0.72], P = .001), and incidence of thrombocytopenia (RR = 0.61, 95% CI: [0.39, 0.96], P = .03). In contrast, the incidence of preterm live births (RR = 1.07, 95% CI: [0.90, 1.28], P = .44), adverse reactions (RR = 0.77, 95% CI: [0.59, 1.00], P = .05), gingival bleeding (RR = 1.12, 95% CI: [0.65, 1.93], P = .69), and gastrointestinal reactions (RR = 0.87, 95% CI: [0.64, 1.17], P = .35) were not significant. LMWH combined with ASA treatment might improve pregnancy outcomes and reduces the incidence of adverse events in patients with RSA.

New Insight of Lipiodol Flush on Pregnancy Outcomes in Women with Recurrent Implantation Failure Undergoing IVF/ICSI: a Prospective Study Based on Propensity Score Matching.

Pregnancy outcomes in women with recurrent implantation failure (RIF) undergoing in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI): does treatment with lipiodol flush matter? In this propensity score-matched study, we recruited 966 RIF patients who underwent IVF/ICSI from two tertiary hospitals. These patients were divided into groups based on whether they received lipiodol flush or not. Further stratification was applied to investigate the effect of lipiodol flush on pregnancy outcomes in RIF patients with different cycle type of embryo transferred. Then, patients subjected to lipiodol flush were categorized into three groups based on the duration of the interval: short interval (≤ 3months), moderate interval (3-6months), and long interval (≥ 6months). The groups were well-matched at baseline. The lipiodol flush group exhibited a significantly lower incidence of biochemical pregnancy (46.27% vs. 56.22%, p = 0.046) and live birth (25.87% vs. 37.31%, p = 0.014). Subgroup analysis for fresh embryo transfer cycles revealed no significant differences in pregnancy outcomes. Among RIF patients underwent frozen-thawed embryo transfer cycle, a statistically significant difference in the live birth rate was observed in the lipiodol flush group when compared to the control group (26.40% vs. 37.21%, p = 0.030). Analysis of different lipiodol flush intervals demonstrated a significantly lower live birth rate in the lipiodol flush group. Our results challenge the value of lipiodol use in clinical practice for the treatment of RIF.Trial registration: Chinese Clinical Trial Registry, ChiCTR1900024273. Registered 4 July 2019.

Live-Birth Incidence of Isolated D-Transposition of Great Arteries-The Shift in Trends Due to Early Diagnosis.

This is a single tertiary population-based study conducted at a center in southwest Romania. We retrospectively compared data obtained in two periods: January 2008-December 2013 and January 2018-December 2023. The global incidence of the transposition of great arteries in terminated cases, in addition to those resulting in live-born pregnancies, remained almost constant. The live-birth incidence decreased. The median gestational age at diagnosis decreased from 29.3 gestational weeks (mean 25.4) to 13.4 weeks (mean 17.2). The second trimester and the overall detection rate in the prenatal period did not significantly change, but the increase was statistically significant in the first trimester. The proportion of terminated pregnancies in fetuses diagnosed with the transposition of great arteries significantly increased (14.28% to 75%, p = 0.019).

Racialized inequities in live birth after cancer: A population-based study of 63,000 female adolescents and young adults with cancer.

Fertility after cancer is a top concern for adolescents and young adults with cancer (AYAs) (15-39 years old at diagnosis). The authors characterized live births after cancer by race and ethnicity ("race/ethnicity") in a population-based sample of female AYAs. This study used Texas Cancer Registry data linked to birth certificates (1995-2016) to estimate cumulative incidence of live birth, based on first live birth after cancer, and compared differences by race/ethnicity. Proportional subdistribution hazards models were used to estimate associations between race/ethnicity and live birth, adjusted for diagnosis age, cancer type, stage, year, and prior live birth, overall and for each cancer type. Among 65,804 AYAs, 10-year cumulative incidence of live birth was lower among non-Hispanic Black AYAs than other racial/ethnic groups: 10.2% (95% confidence interval [CI], 9.4-10.9) compared to 15.9% (95% CI, 14.1-17.9) among Asian or Pacific Islander, 14.7% (95% CI, 14.2-15.3) among Hispanic, and 15.2% (95% CI, 14.8-15.6) among non-Hispanic White AYAs (p<.01). In the adjusted overall model, Black AYAs were less likely to have a live birth after cancer than all other groups. In adjusted models for each cancer type, live birth was significantly less likely for Black AYAs with gynecologic cancers or lymphomas (compared to White AYAs) or thyroid cancers (compared to Hispanic AYAs). Black AYAs are less likely than AYAs of other races/ethnicities to have a live birth after cancer, in contrast to patterns of live birth in the general population. Research and action to promote childbearing equity after cancer are imperative.

A rapid improvement event: progesterone prescribing in prevention of miscarriage

A rapid improvement event (RIE) is a standard operational excellence technique that uses team-based problem solving to improve processes. In this study, a RIE was undertaken to improve progesterone prescribing...

Association of platinum-based chemotherapy with live birth and infertility in female survivors of adolescent and young adult cancer

ObjectiveLack of treatment-specific fertility risks for female survivors of adolescent and young adult cancer limits counseling on fertility preservation decisions. The objective was to estimate the effect of platinum-based chemotherapy on live birth and infertility after cancer. DesignRetrospective cohort study using U.S. administrative data ParticipantsWe identified incident breast, colorectal and ovarian cancer cases in females ages 15-39 who received platinum-based chemotherapy or no chemotherapy and matched them to females without cancer. ExposurePlatinum-based chemotherapy OutcomesWe estimated the effect of chemotherapy on incidence of live birth and infertility after cancer, overall and after accounting for competing events (recurrence, death, sterilizing surgeries). ResultsThere were 1,287 survivors in the chemotherapy group, 3,192 survivors in the no chemotherapy group, and 34,147 women without cancer, mean age 33. Accounting for competing events, overall five-year live birth incidence was lower in the chemotherapy group (3.9%) versus the no chemotherapy (6.4%) group. Adjusted relative risks versus no chemotherapy and no cancer were 0.61 (95%CI 0.42-0.82) and 0.70 (95%CI 0.51-0.93), respectively. Overall five-year infertility incidence was similar in the chemotherapy group (21.8%) compared to no chemotherapy group (20.7%). The adjusted relative risks versus no chemotherapy and no cancer were 1.05 (95%CI 0.97-1.15) and 1.42 (95%CI 1.31-1.53), respectively. Conclusions and relevanceCancer survivors treated with platinum-based chemotherapy experienced modestly increased adverse fertility outcomes. Estimated effects of platinum-based chemotherapy were affected by competing events, suggesting the importance of this analytic approach for interpretations that ultimately inform clinical fertility preservation decisions.

ANALYSIS OF DISTRIBUTION AND CHANGES IN SEX-STRUCTURE OF RANCHI DISTRICT (JHARKHAND)

In population geography, Sex-Structrue is one of the most important factors of population composition and this is studied as Biological composition of any population. Sex is an easily identifiable characteristic. The numerical measurement of sex composition of a population is known as sex ratio. Sex ratio is considered as an important index of economy prevailing in an area and is useful tool for regional analysis. For the study of the Sex-Structure of any population the two important measures are generally adopted as the percentage of males in the population and second, the sex-ratio. The latter is more frequently used in the study of population. Fertility signifies the actual incidence of live births in a population. It is an important demoraphic determinant of Sex-Structure of a population. The age and sex specific incidence of death has a direct effect on the overall sex structure of a population. Migration is the third important process which may change the sex composition of a population. The meaning of sexcomposition or Sex-Structure is to know about the ratio of males and females in any population. It is very necessary for population geographers to know about the sex ratio of any population because balance of any society may be depends upon it's balanced sex ratio. But, there are different reason which are responsible for unbalanced sex ratio such as nature of males and females. Because this nature of males and females are acts sometimes as complementary with each other and sometimes acts opposite against each other. Economy of any region can be understand through the sex ratio of that region. Sex-ratio is one of the most important tool for analysis of regional differences. The sex ratio of the total population at a point of time is known as "The overall sex ratio." The sex-ratio is also shown the socio-economic conditions of any region. It also affects the demographic structure of any region. Sex-ratio is calculated differently in different countries. In India, the sexratio is calculated in terms of number of Females per thousand males. Sex-ratio can be measured from the time of conception to the time of death. This study gives us description and analysis about Sex-Structure and it's distribution and changes in Ranchi district. The distribution and changes of Sex-Structure of Ranchi district affects total population of the district particularly in Rural and Urban areas. The Sex-Structure also influenced the Socio-Economic conditions of the Ranchi district gradually. The purpose of this study is to analyze the distribution and changes in Sex-Structure. The present study is an empirical research conducted in Ranchi district (Jharkhand) which is based on secondary data. In this paper an attempt has been made to throw light on the very important issues of analysing distribution and changes in Sex-Structure.

Abstract B094: Geographic accessibility to obstetricians and gynecologists is associated with incidence of live birth among Black adolescent and young adult female cancer survivors in Texas

Abstract Objective: To assess incidence of live birth after cancer diagnosis among Black adolescent and young adult women (AYA) age 15-39 years at diagnosis, and evaluate whether incidence varies by exposure to racial residential segregation, neighborhood poverty, or geographic accessibility to obstetricians/gynecologists. Methods: Black AYA women diagnosed with cancer between January 1, 1995 and December 31, 2015 were identified using population-based data from the Texas Cancer Registry. These data were linked with live birth certificates through December 31, 2016 to identify the first live birth after diagnosis. We measured three neighborhood characteristics using the 2010 U.S. Census: 1) Black racial residential segregation, using the Index at the Concentration of Extremes; 2) percent of the population living in poverty; and 3) geographic accessibility to obstetricians/gynecologists, calculated using National Provider Identifier data as the supply of healthcare and U.S. Census data as the demand for healthcare. We estimated cumulative incidence of live birth accounting for the competing risk of death, overall and by low vs. high (≥ 20%) poverty and sample-based quartiles of racial residential segregation and geographic accessibility. Results: We identified 689 first live births to 7,921 Black AYA women after cancer diagnosis. Two-thirds of the sample were age 30 years or older at diagnosis: 27.3% were aged 30-34 and 45.6% were aged 35-39. The most common cancer types were breast (34.3%), gynecologic (16.4%), lymphoma (9.8%), thyroid (8.5%), and gastrointestinal (7.5%). Stage at diagnosis was as follows: local (39.6%), regional (27.8%), distant (19.3%), and missing (13.4%). Five- and ten- year cumulative incidence of live birth after cancer diagnosis was 6.3 (95% confidence interval [CI]: 5.8-6.9) and 9.1 (95% CI: 8.4-9.8), respectively. Incidence of live birth was not associated with racial residential segregation or neighborhood poverty. Cumulative incidence of live birth varied by geographic accessibility to obstetricians/gynecologists (p=.046); however, nonlinear patterns were observed starting around five years after diagnosis, such that those residing in quartiles 1 (lowest accessibility) and 3 had lower incidence of live birth compared to those in quartiles 2 and 4 (highest accessibility). Discussion: To our knowledge, this is the first study examining the association of neighborhood characteristics and incidence of live birth in a population-based sample of Black AYA women after cancer diagnosis. We did not observe associations for racial residential segregation or neighborhood poverty. This may indicate that characteristics such as current health status, types of treatment received, or treatment side effects are more relevant for live birth after diagnosis. Geographic accessibility to obstetricians/gynecologists was associated with live birth, but in a nonlinear fashion. Future analyses will assess spatial patterns and potential confounders, such as urban or rural residence, which may account for non-linearity in this association. Citation Format: Sandi L. Pruitt, Jennifer S. Wang, Kevin A. Henry, Lynn N. Ibekwe, Caitlin C. Murphy. Geographic accessibility to obstetricians and gynecologists is associated with incidence of live birth among Black adolescent and young adult female cancer survivors in Texas [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B094.

Neighborhood deprivation and racial differences in in vitro fertilization outcomes

BACKGROUNDThere are significant racial disparities in in vitro fertilization outcomes, which are poorly explained by individual-level characteristics. Environmental factors such as neighborhood-level socioeconomic factors may contribute to disparities in in vitro fertilization outcomes; however, few studies have directly addressed this research question in a large, racially diverse cohort. OBJECTIVETo investigate whether neighborhood deprivation is associated with differences in in vitro fertilization outcomes. STUDY DESIGNOur retrospective cohort study included 1110 patients who underwent 2254 autologous in vitro fertilization cycles between 2014 and 2019 at an academic fertility center in the Southeastern United States. Neighborhood deprivation was estimated using the neighborhood deprivation index, a composite variable measuring community levels of material capital based off poverty, occupation, housing, and education domains. Using multivariable log-binomial generalized estimating equations with cluster weighting, risk ratios (RR) and 95% confidence intervals (CI) were estimated for cycle cancellation, miscarriage (defined as spontaneous pregnancy loss before twenty weeks after a confirmed intrauterine gestation), and live birth according to patient neighborhood deprivation index. RESULTSThere were positive associations between increasing neighborhood deprivation index (indicating worsening neighborhood deprivation) and body mass index, as well as increasing prevalence of tubal and uterine factor infertility diagnoses. The crude probability of live birth per cycle was lower in Black (24%) versus White patients (32%) and the crude probability of miscarriage per clinical pregnancy was elevated in Black (22%) as compared to White patients (12%). After adjustment, neighborhood deprivation index was not significantly associated with risk of cycle cancellation or live birth. Results were consistent when analyses were stratified by race. CONCLUSIONOur research demonstrates racial disparities between Black and White women in the incidence of miscarriage and live birth following in vitro fertilization. While level of neighborhood deprivation was closely related to race, it did not have strong associations with in vitro fertilization outcomes in our population as a whole or within strata of race.

LH on GnRH-ant day to basal LH affects the IVF/ICSI outcome of PCOS women undergoing GnRH-antagonist protocol.

The aim of this study was to investigate the influence of ratio of serum luteinizing hormone (LH) on gonadotropin-releasing hormone antagonist (GnRH-ant) day to basal LH (hLH/bLH) on in-vitro fertilization or intracytoplasmic sperm injection (IVF/ICSI) outcome in polycystic ovary syndrome (PCOS) women who received GnRH-ant protocol for controlled ovarian hyperstimulation (COH). This retrospective study was conducted in women with PCOS (n = 1116) who underwent the GnRH-ant protocol for COH between 2015 and 2022 and were stratified as group A (hLH/bLH < 1, n = 489) and group B (hLH/bLH ≥ 1, n = 627) according to the variation of serum LH. The outcomes of COH and the first frozen embryo transfer (FET) cycle were compared between group A, B and the linear relationship between hLH/bLH ratio and IVF/ICSI outcomes were studied by multivariate linear regression analysis and restricted cubic spline (RCS) models. There were significant differences in baseline characteristics and outcomes between group A and B. Group A had higher levels of bLH, AMH, estradiol (E2) on GnRH-ant start day and lower levels of LH on GnRH-ant start day. Group B has better ovulation induction outcomes: more retrieved oocytes, normally fertilized oocytes (2PN), cleavage embryos, available embryos and high-quality blastocysts. Multivariate linear regression analysis found no statistically significant connection between hLH/bLH and clinical outcomes. RCS models showed hLH/bLH had nonlinear association with outcomes, including number of oocytes retrieved, 2PN, available embryos, incidence of OHSS, chemical pregnancy, clinical pregnancy, abortion and live birth. hLH/bLH ratio could be a more forward-looking indicator of clinical outcome in women with PCOS undergoing GnRH-ant protocols than LH on trigger day and the ratio of LH level on trigger day to basal LH. hLH/bLH = 1 may be the best condition for higher live birth rate and lower OHSS rate.

Increased incidence of live births in implanted day 5 versus day 6 blastocysts following single embryo transfers with PGT-A

Elective single-embryo transfers of euploid or low-level mosaic blastocysts were analyzed in this retrospective study to determine the correlations of live birth (LB) probability with embryonic developmental features of implanted day 5 (D5, n = 245) or day 6 (D6, n = 73) blastocysts using time-lapse (TL) monitoring. According to the logistic regression analyses (adjusted odds ratio [OR] = 0.341, 95% confidence interval [CI] = 0.169–0.685, P < 0.05), the LB probability was negatively associated with the D6 group. The LB rate of the D5 group was higher than the D6 group (88.2% vs. 75.3%; P < 0.05). Compared with the D5 blastocysts, the D6 blastocysts exhibited comparable dysmorphisms except for the multinucleation at the 4-cell stage (10.9% vs. 2.9%, P < 0.05). Moreover, D6 blastocysts had considerably slower developmental kinetics and poorer blastocyst morphologies. Further analysis confirmed that the LB rate was not associated with developmental kinetics or dysmorphisms but rather with blastocyst morphology (inner cell mass [ICM] grade ≤ C vs. ICM grade A, adjusted OR = 0.155, 95% CI = 0.04–0.596, P < 0.05; trophectoderm [TE] grade ≤ C vs. TE grade A, adjusted OR = 0.157, 95% CI = 0.032–0.760, P < 0.05). In conclusion, D6 implanted blastocysts have a considerably lower LB rate than D5 implanted blastocysts. As determined by TL monitoring, the diminished blastocyst morphology can be one of the primary reasons underlying the decreased likelihood of LB.

Abortion Bans and Resource Utilization for Congenital Heart Disease: A Decision Analysis.

To investigate the implications of potential national abortion ban scenarios on the incidence of neonatal single-ventricle cardiac defects. A decision tree model was developed to predict the incidence of neonatal single-ventricle cardiac defects and related outcomes in the United States under four theoretical national abortion bans: 1) abortion restrictions in existence immediately before the June 2022 Dobbs v Jackson Women's Health Organization Supreme Court decision, 2) 20 weeks of gestation, 3) 13 weeks of gestation, and 4) a complete abortion ban. The model included incidence of live births of neonates with single-ventricle cardiac defects, neonatal heart surgery (including heart transplant and extracorporeal membrane oxygenation [ECMO]), and neonatal death. Cohort size was based on national pregnancy incidence and different algorithm decision point probabilities were aggregated from the existing literature. Monte Carlo simulations were conducted with 10,000 iterations per model. In the scenario before the Dobbs decision, an estimated 6,369,000 annual pregnancies in the United States resulted in 1,006 annual cases of single-ventricle cardiac defects. Under a complete abortion ban, the model predicted a 53.7% increase in single-ventricle cardiac defects, or an additional 9 cases per 100,000 live births. This increase would result in an additional 531 neonatal heart surgeries, 16 heart transplants, 77 ECMO utilizations, and 102 neonatal deaths annually. More restrictive gestational age-based bans are predicted to confer increases in cases of neonatal single-ventricle cardiac defects and related adverse outcomes as well. Universal abortion bans are estimated to increase the incidence of neonatal single-ventricle cardiac defects, associated morbidity, and resource utilization. States considering limiting abortion should consider the implications on the resources required to care for increasing number of children that will be born with significant and complex medical needs, including those with congenital heart disease.

Surgical correction of Tessier cleft no. 7: A single center 18-year experience

Tessier cleft 7 are rare craniofacial clefts. Live-birth incidence varies from 1/80,000 to 1/300,000, with the incidence of 1 in 120 craniofacial clefts among Asians. Its clinical presentation varies widely in severity, thus, complicating diagnosis and contributing to the lack of consensus regarding its surgical management. The aim of this study is to describe clinical findings, types of Tessier cleft 7 soft tissue repair, and its outcomes in Kuala Lumpur Hospital. This retrospective study reviewed records of children operated from January 2001 to July 2019. Data regarding concurrent congenital anomalies, complications, type of surgery, etc., were collected from outpatient records, operative notes, and clinical photographs. Twenty-eight children were treated, and 33 clefts (5 bilateral) were repaired. The male-to-female ratio was 1.3:1 (16 males and 12 females). Twenty-three patients had unilateral clefts (82.14%), with 14 right (60.86%) and 8 left (34.78%). Bilateral clefts were less common (17.86%). Twenty-three patients (82.14%) were Malay, 3 (10.71%) Chinese, 1 (3.57%) Indian, and 1 (3.57%) Cambodian. Eleven medical records were untraceable (discontinued due to duration of inactivity). There were 10 straight-line repairs, 5 Z-plasties, and 1W-plasty performed; 3 cases did not detail the type of repair. One child required scar revision, and 1 had hypertrophic scarring requiring corticosteroid injection-no disturbances in speech or oral incompetency while eating were reported. Duration of follow-up ranged from 3 to 14 years. Our center has a higher rate of Tessier cleft 7 attendance. Straight-line cutaneous repairs combined with inferior vermilion mucosal flap can be used with low rates of complication and revision surgery.

First live birth before surgical verification of endometriosis-a nationwide register study of 18324 women.

First live birth before surgical verification of endometriosis-a nationwide register study of 18324 women.

P-257 Transcriptomic signature of live birth revealed in cumulus cells of women undergoing an ICSI cycle for infertility treatment

Abstract Study question Is the transcriptome of cumulus cells surrounding an oocyte that was fertilised and transferred predictive of live birth? Summary answer Live birth is associated with a distinct transcriptomic signature in cumulus cells isolated from an oocyte that was fertilised and transferred. What is known already The selection of the best embryo for transfer is currently based on standard morphological assessment, which is intrinsically subjective, and time-lapse monitoring, which fails to show benefit in predicting pregnancy. Alternative non-invasive selection methods are in development including analysis of cumulus cells (CCs) isolated from oocytes that resulted in an eligible embryo for transfer. However the majority of the existing studies were conducted using outdated methodologies such as transcriptomic analysis with PCR and microarrays. Moreover, the studies associating CCs’ transcriptome with clinical and embryological outcomes lack consensus due to non-homogenous cohorts while the outcome of live birth is inadequately explored. Study design, size, duration CC samples (n = 17), collected between 2018 and 2021 and biobanked, were retrospectively selected for RNA sequencing on the basis of their embryo transfer outcome. Thus, we analysed CCs associated with an oocyte that resulted in pregnancy (n = 6), no pregnancy (n = 7), live birth (n = 5) and pregnancy without live birth (n = 5). Differential gene expression analysis identified the differentially expressed genes (DEGs) between the groups in relation to pregnancy and live birth. Participants/materials, setting, methods The samples were retrieved from subfertile couples undergoing controlled ovarian stimulation and intracytoplasmic sperm injection with subsequent unbiopsied fresh or frozen embryo transfer at the IVF centre of University Hospital Zurich. Maternal age was below 43 years. Libraries from CCs were prepared using the Smart-seq2 pipeline and the RNA sequencing was performed on the NovaSeq 6000 system. The DESeq2 workflow was conducted and the threshold for the adjusted p-values (FDR) was set to 0.05. Main results and the role of chance No DEGs emerged when comparing the transcriptomic profiles of cumulus cells between the “no pregnancy” and “pregnancy” groups. However, 139 DEGs were identified in the comparison between the “pregnancy without live birth” and “live birth” groups. 28 DEGs were familiar and relevant to competent cumulus-oocyte-complexes: CTGF (fold change: 4.38, FDR: 0.005), SERPINE2 (fc: 3.08, FDR: 0.0002), PCK1 (fc:3.04, FDR: 0.0001), HHIP (fc:2.69, FDR: 0.006), HS3ST (fc:2.45, FDR: 0.009) and BIRC5 (fc: -2.69, FDR 0.0001) among others. Functional enrichment analysis of DEGs revealed that the incidence of live birth is associated with promotion of pathways such as runt-related transcription factor 1 (RUNX1/2) signalling, glycosaminoglycan biosynthesis and sonic hedgehog signalling (SHH), and reduction in pathways such as glycosphingolipid biosynthesis and pyrimidine metabolism in cumulus cells. Limitations, reasons for caution We reveal the transcriptome associated with live birth in CCs analysed with RNAseq on a limited number of samples. Consolidation of these findings via utilisation of a validation prospective cohort is pending. Wider implications of the findings CCs’ transcriptome could inform the development of non-invasive biomarkers to predict the chance of live birth across a group of embryos eligible for transfer. The transcriptomic findings inspire further explorations in the field of cumulus-oocyte bidirectional communication and establishment of oocyte competence. Trial registration number N/A

Comparison of tadalafil and sildenafil in controlling neonatal persistent pulmonary hypertension

Background Persistent pulmonary hypertension of the newborn (PPHN) is a multifactorial syndrome, with 0.43–6.8/1000 live birth incidence and 10–20% mortality rate. Aim To compare the efficacy of tadalafil and sildenafil in controlling PPHN. Patients and methods This prospective study was carried out on 40 neonates with PPHN. Patients were equally divided into two groups: group 1 received tadalafil (Cialis 10 mg), 1 mg/kg as a single dose for 48 h, and group 2 received sildenafil (Silden 25 mg), 1 mg/kg/8 h for 48 h. Echocardiography was done at the time of enrollment and 48 h after starting treatment measuring the change in estimated systolic pulmonary artery pressure (ESPAP), patent ductus arteriosus assessment, assessment of left ventricle functions, changes in oxygen saturation, and oxygen requirements. Results Both drugs were successful in improving oxygen saturation, decreasing oxygen requirements, and decreasing ESPAP. There was a significant difference before and after treatment in both groups, whereas the difference between the two groups was statistically insignificant (P&gt;0.05). Conclusion Tadalafil and sildenafil can similarly reduce ESPAP in neonates with PPHN. No serious short-term adverse effects of tadalafil and sildenafil were observed.

Assisted human reproduction and pregnancy outcomes in Alberta, 2009-2018: a population-based study.

Assisted human reproduction (AHR) can be used to help individuals and couples overcome infertility issues. We sought to describe trends in pregnancies using AHR and to evaluate the impact of AHR on perinatal outcomes in a large population-based cohort in Alberta, Canada. We linked maternal and child administrative data for all live births occurring July 1, 2009, to Dec. 31, 2018, in Alberta, Canada, for this retrospective study. We identified AHR pregnancies from pharmaceutical claims or codes from the International Classification of Diseases and Related Health Problems (9th or 10th revision). Our main outcome measures were the incidence and temporal trends of live births in AHR pregnancies. We also compared maternal characteristics and perinatal outcomes of AHR and non-AHR pregnancies, and by maternal age group. Of 518 293 live births during the study period, 26 270 (5.1%) were conceived with AHR. The incidence of AHR pregnancies increased from 30.8 per 1000 pregnancies in 2009 to 54.7 per 1000 pregnancies in 2018. Females who used AHR were older (33.9 yr v. 30.1 yr, p < 0.001) and the number of females aged 30-35 years and older than 35 years who delivered following AHR increased over the study period (30-35 yr: 36.9 to 55.3 per 1000 pregnancies; > 35 yr: 79.1 to 95.2 per 1000 pregnancies). The proportion of live births with cesarean delivery (40.5% v. 23.3%, p < 0.001), low birth weight (26.9% v. 7.6%, p < 0.001), congenital malformation (0.5% v. 0.3%, p = 0.002) and admission to the neonatal intensive care unit (25.3% v. 9.7%, p < 0.001) was higher in the AHR group than the non-AHR group. The incidence of live births following AHR pregnancies in Alberta was 5.1% between 2009 and 2018, and increased by 0.26% per year; newborns in the AHR group appeared smaller and showed signs of poorer health. This study provides insights on potential perinatal complications following AHR that may be important when caring for the newborn child.

The impact of the embryo banking on the cumulative live birth rate in women with poor ovarian response according to the Bologna criteria.

To evaluate the impact of embryo banking on the cumulative live birth rate (CLBR) and the time to live birth (TTLB) in poor ovarian responders (POR) according to the Bologna criteria. A total of 276 infertile women undergoing IVF with POR were included in this retrospective study. They were divided into two groups with (n = 121) or without (n = 155) embryo banking at the discretion of the attending physicians. A total of 656 and 405 stimulation cycles were started in the two groups respectively during the 24 month follow-up. The biochemical pregnancy, clinical pregnancy, ongoing pregnancy, and live birth rate per transfer were comparable between two groups (p > 0.05). The CLBR was significantly lower in the banking group than in the non-banking group (31.4% (38/121) and 43.2% (67/151), p < 0.05). TTLB was significantly longer in the banking group (20.5 months vs. 16.0 months, p < 0.001). In the Kaplan-Meier analysis, the cumulative incidence of live birth was significantly lower in the banking group compared with the non-banking group (Log rank test, chi-square = 21.958, p < 0.001). Embryo banking in women undergoing IVF with POR based on the Bologna criteria reduces CLBR and lengthens TTLB when compared with no embryo banking.

The Effect of Age on IVF-ET Outcome in Infertile Patients with PCOS Based on Tiangui Theory in Chinese Medicine.

Objective Our aim was to investigate the effect of age on the outcome of IVF-ET and ICSI in infertile PCOS patients under the guidance of Tiangui theory in traditional Chinese medicine. Method This was a retrospective analysis of 532 infertile women with PCOS and 1,392 women with infertility due to tubal factors as the controls. All of the participants were divided into different age groups-aged 20–28 years, 29–35 years, and ≥36 years-according to the stages of female reproductive development in Tiangui theory as described in the Canon of Internal Medicine-Treatise of Ancient Natural Truth. We explored the effect of age on controlled ovarian hyperstimulation (including the initial dosage and duration of Gn and the estradiol level on the day of human chorionic gonadotropin administration); the numbers of retrieved oocytes, 2PN zygotes, and embryos; and the rates of fertilization, clinical pregnancy, abortion, live birth, and OHSS incidence. Results Compared to controls, the maximum follicular diameter and the numbers of follicles with d ≥ 20 mm, retrieved oocytes, and 2PN zygotes were greater in the PCOS group with age >28 years (p < 0.05). The abortion rate of PCOS patients with age ≤28 years was higher than that of the controls. All PCOS groups and the control group showed reduced numbers of retrieved oocytes and live births with age. The difference in age was not significant in the PCOS groups but was significant in the control group (p < 0.05), and the trend in the PCOS groups was more gradual. Conclusion The fertility of all subjects decreased with age, but PCOS patients decreased more slowly than in controls at the same age, which verified the applicability of the guiding principles of Tiangui theory in the clinic.

Serum progesterone concentration on the day of embryo transfer in stimulated cycles does not correlate with reproductive outcomes

Research questionIs the live birth rate (LBR) in fresh embryo transfer IVF cycles affected by serum progesterone concentration on the day of embryo transfer? DesignA single-centre retrospective analysis of prospectively collected data from women who underwent IVF or intracytoplasmic sperm injection between July 2019 and July 2020, and had a fresh day 5 single embryo transfer. Overall, 825 first and second stimulation cycles were included. Patients underwent a gonadotrophin-releasing hormone antagonist protocol with human chorionic gonadotrophin (HCG) trigger, and received vaginal-only luteal phase support. The study population was an everyday patient cohort, treated with the unit's usual stimulation protocols. The correlation between serum progesterone concentrations on the day of embryo transfer and the incidence of positive HCG, clinical pregnancy and live birth were examined. Patients were divided into four groups based on serum progesterone concentrations (<150, 150–250, 251–400 and >400 nmol/l). The data were further interrogated using additional progesterone cut-offs. ResultsThere was no concentration of progesterone below or above which the chance of pregnancy was reduced. The chance of live birth following a blastocyst transfer was no different across the four groups (29.8, 26.6, 32.7 and 31.5%, respectively, P = 0.55). There was no negative association between progesterone and chance of pregnancy when other progesterone thresholds were applied. Estimates were adjusted for confounding factors such as maternal age. ConclusionSerum progesterone concentration on the day of fresh embryo transfer does not correlate with the LBR.