Likelihood Of Pregnancy Research Articles

Peroxiredoxin 4, a new oxidative stress marker in follicular fluid, may predict in vitro fertilization and embryo transfer outcomes

BackgroundPeroxiredoxin 4 (Prdx4), a member of the Prdx family, can catalyze the reduction of reactive oxygen species. This study aims to explore whether Prdx4 can serve as an effective marker in follicular fluid (FF) for predicting in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycle outcomes.MethodsIn this prospective study, all participants were recruited from the center of clinical reproductive medicine from 2017 September to 2018 December. Women with tubal or male factor infertility undergoing their first IVF/ICSI cycle were recruited (n=138). FF samples from each patient were collected on the day of oocyte retrieval. Prdx4 concentrations were measured, and the correlation between Prdx4 levels and IVF outcomes was analyzed.ResultsThe results showed that pregnant women had higher levels of Prdx4 than nonpregnant women. Prdx4 was positively correlated with the oocyte fertilization rate (r =0.334; P=0.011) and good quality embryo rate (r =0.326; P=0.013). Furthermore, we found that the clinical pregnancy rate was positively correlated with Prdx4 levels in a concentration-dependent manner in the Prdx4 quartiles (<13.38, 13.83–16.93, 16.93–22.93, >22.93 ng/mL). The fertilization rates, clinical pregnancy rates and live pregnancy rates were all significantly higher in the highest Prdx4 quartile group than in the lowest quartile. Moreover, the results indicated that Prdx4 had an area under the receiver operating characteristic curve (AUC) of 0.754, corresponding to an optimal cutoff point of 22.30 ng/mL.ConclusionsOur results provide evidence that higher expression of antioxidants, such as Prdx4, in the FF of IVF patients tends to indicate a higher likelihood of pregnancy through an oocyte quality mechanism.

DEVELOPING A DECISION SUPPORT TOOL TO DETERMINE OPTIMAL NUMBER OF EUPLOID EMBRYOS BANKED TO ACHIEVE A DESIRED FAMILY SIZE

As women get older, the likelihood for pregnancy decreases: the chance of live birth (LB) after one IVF cycle at the age of 40 is 23%, but it declines to 4% at the age of 43, an 83% decrease.1 This poses a challenge in particular for women above 35 who desire more than one child. After delivery of the first baby, the chance for pregnancy through a new IVF cycle will most likely be decreased. Ideally, women would bank the total number of euploid embryos needed to complete their family at a younger age.

Underestimation of pregnancy risk among women in Vietnam

BackgroundAddressing women’s inaccurate perceptions of their risk of pregnancy is crucial to improve contraceptive uptake and adherence. Few studies, though, have evaluated the factors associated with underestimation of pregnancy risk among women at risk of unintended pregnancy.MethodsWe assessed the association between demographic and behavioral characteristics and underestimating pregnancy risk among reproductive-age, sexually-active women in Hanoi, Vietnam who did not desire pregnancy and yet were not using highly-effective contraception (N = 237). We dichotomized women into those who underestimated pregnancy likelihood (i.e., ‘very unlikely’ they would become pregnant in the next year), and those who did not underestimate pregnancy likelihood (i.e., ‘somewhat unlikely,’ ‘somewhat likely’ or ‘very likely’). We used bivariable and multivariable logistic regression models to identify correlates of underestimating pregnancy risk.ResultsOverall, 67.9% (n = 166) of women underestimated their pregnancy risk. In bivariable analysis, underestimation of pregnancy risk was greater among women who were older (> 30 years), who lived in a town or rural area, and who reported that it was “very important” or “important” to them to not become pregnant in the next year. In multivariable analysis, importance of avoiding pregnancy was the sole factor that remained statistically significantly associated with underestimating pregnancy risk (odds ratio [OR]: 0.11; 95% confidence interval [CI], 0.05–0.25). In contrast, pregnancy risk underestimation did appear to vary by marital status, ethnicity, education or other behaviors and beliefs relating to contraceptive use.ConclusionsFindings reinforce the need to address inaccurate perceptions of pregnancy risk among women at risk of experiencing an unintended pregnancy.

Corpus Luteum Color Doppler Ultrasound and Pregnancy Outcome in Buffalo during the Transitional Period.

Simple SummaryThe advent of color Doppler ultrasonography promoted tremendous advances in research and clinical practice in animal reproduction, because it allowed noninvasive visualization of the vascularization in reproductive organs. In particular, the corpus luteum blood flow reflects luteal function better than luteal size in ruminants. Since buffaloes are a seasonal species, it is important to evaluate corpus luteum functionality also during the nonbreeding season, through blood flow examination and early pregnancy diagnosis. For this reason, we selected 29 Mediterranean buffaloes that had undergone synchronization and artificial insemination and were examined daily, from 5 to 10 days post-artificial insemination. Then, we retrospectively classified the buffaloes as pregnant or nonpregnant. Statistical analysis showed that pregnant animals had higher mean progesterone concentration and higher mean time average medium velocity values from Day 5 to Day 10 compared to nonpregnant buffaloes. Moreover, these two parameters could be used to predict the likelihood of pregnancy, starting on Day 6, although more reliable results could be obtained at Day 10 post-artificial insemination. In conclusion, a proper CL growth and development from Day 5 to Day 10 post-timed artificial insemination (TAI) is crucial for pregnancy maintenance during the transitional period.This study evaluated corpus luteum (CL) development in buffaloes out of breeding season and assessed an early pregnancy diagnosis. Mediterranean buffaloes (n = 29) were synchronized and artificially inseminated. CL B-mode/color Doppler ultrasonography examinations were performed daily from Days 5 to 10 post-synchronization, recording CL dimensions and blood flow parameters. Blood samples were collected on the same days for the progesterone (P4) assay. Data were grouped into pregnant or nonpregnant and retrospectively analyzed. The total pregnancy rate was 50.0% (13/26) on Day 45. A significant difference between CL average area in pregnant and nonpregnant buffaloes was recorded only on Day 10. Pregnant buffaloes showed a significantly higher mean P4 concentration and higher mean time average medium velocity (TAMV) values from Day 5 to Day 10 compared to nonpregnant buffaloes. Linear regression analysis showed a significant relationship between P4 levels and TAMV. Multiple logistic regression highlighted a significant influence of TAMV on pregnancy outcome, particularly on Day 8. This is probably due to the strong relationship between TAMV and P4 production. Both TAMV and P4 could be used to predict pregnancy starting on Day 6, although a more reliable result was obtained at Day 10. Thus, the period between Days 5 and 10 is critical for CL development during the transitional period in buffalo.

Post-Caesarean section niche-related impaired fertility: hypothetical mechanisms.

Caesarean section can result in an indentation of the myometrium at the site of the Caesarean scar, called a niche. Niches can cause symptoms of abnormal uterine blood loss, dysmenorrhoea, chronic pelvic pain and dyspareunia and are possibly related to subfertility. Various other explanations for the cause of subfertility after Caesarean section have been proposed in the literature, such as uterine pathology, intra-abdominal adhesions and women’s reproductive choices. Not all niches cause symptoms and the relation with subfertility and a niche in the uterine scar still needs further study since direct evidence is lacking so far. Based on the limited available evidence, and in combination with observations made during sonographic hysteroscopic evaluations and laparoscopic niche repair, we propose and discuss three hypothetical mechanisms: (i) the environment for sperm penetration and implantation may be detrimental; (ii) there could be a physical barrier to embryo transfer and implantation; and (iii) psychogenic factors may reduce the likelihood of pregnancy. Several innovative surgical treatments have been developed and are being implemented for niche-related problems. Promising results are reported, but more evidence is needed before further implementation in daily practice. The additional value of niche resections should be compared to expectant management or fertility therapies, such as ART, in randomized controlled trials. Therefore, our suggested hypotheses should, for the time being, not be used for justification of any specific procedures outside clinical trials.

Reproductive performance following a modified Presynch-Ovsynch, Double-Ovsynch, or conventional reproductive management program in Korean dairy herds

We aimed to compare the reproductive performance of dairy cattle following a modified Presynch-Ovsynch, Double-Ovsynch, or conventional reproductive management program (CRMP). On Day 30 (±5) after calving (calving = Day 0), 960 lactating cows were assigned randomly to one of two presynchronization treatments, before the synchronization of ovulation (Ovsynch) or CRMP without presynchronization. Cows were administered prostaglandin F2α (PGF2α) on Days 38 (±5) and 52, and gonadotropin-releasing hormone (GnRH) on Day 55 (Presynch-G-Ovsynch group, n = 333); or GnRH on Day 45 (±5), PGF2α on Day 52, and GnRH again on Day 55 (Double-Ovsynch group, n = 307). Thereafter, each cow underwent Ovsynch 7 days later: GnRH on Day 62, PGF2α on Day 69, and GnRH again 56 h later, followed by timed artificial insemination (AI) 16 h later. The remaining cows underwent AI when estrus was detected or Ovsynch (CRMP group, n = 320). In a subset of cows (each n = 40) in the two presynchronization groups, blood collections and ovarian ultrasonography were performed on Days 30 (±4), 52, 62, and 69, and uterine cytology on Days 30 (±4) and 52. The probabilities of pregnancy per AI 32 and 60 days after the first AI were higher in the Presynch-G-Ovsynch (odds ratio [OR]: 1.89 and 1.81, P < 0.01) and Double-Ovsynch (OR: 1.63 and 1.60, P < 0.05) groups than in the CRMP group. The likelihood of pregnancy by 210 days postpartum was higher (P < 0.05) in Presynch-G-Ovsynch (hazard ratio [HR]: 1.29) and Double-Ovsynch (HR: 1.31) groups than in the CRMP group, whereas the least square mean number of inseminations per conception was lower (P < 0.05) in Presynch-G-Ovsynch (1.8) and Double-Ovsynch (1.8) groups than in the CRMP group (2.1). The percentages of cows with serum progesterone concentrations ≥1.0 ng/mL or with a corpus luteum (CL) did not differ between the groups (P > 0.1) on Days 30, 62, and 69, but were lower (P < 0.05) on Day 52 in the Presynch-G-Ovsynch than in the Double-Ovsynch groups. However, the diameter of the dominant follicles, the proportion of neutrophils in uterine cytological samples, and the prevalence of an accessory CL on Day 69 did not differ (P > 0.1) between the two groups. In conclusion, both the Presynch-G-Ovsynch and Double-Ovsynch programs improved reproductive performance vs. CRMP in smallholder Korean dairy herds, and there were no differences in the ovarian endocrine and structural dynamics, or uterine health, between the two programs involving presynchronization.

Treatment with an elevated dose of the GnRH analogue dephereline in the early luteal phase improves pregnancy rates in repeat-breeder dairy cows

This study sought to establish whether treatment with the GnRH analog dephereline in the early luteal phase could be useful to improve fertility in repeat-breeder cows (>3 inseminations). Dephereline was given 5–7 days after insemination, and effects of both a single and elevated (2.5 times) dephereline dose on pregnancy and subsequent embryo survival determined in repeat-breeder lactating dairy cows. The study population comprised 810 cows: 399 repeat-breeder cows and 411 non repeat breeders. To determine the effects of treatment on the pregnancy rate, three study groups were established: Control, no treatment (n = 269), DEPH, single dephereline dose (100 μg) (n = 270), or 2.5DEPH, 2.5 dephereline doses (250 μg) (n = 271). Recorded pregnancy rates in these groups were 28.6% (77/269), 31.9% (86/270) and 39.1% (106/271), respectively. Binary logistic regression analysis revealed a significant effect of the interaction treatment x repeat breeder on the pregnancy rate. This meant that the single dose and control treatments led to a pregnancy likelihood of repeat-breeder cows reduced by factors of 0.47 and 0.34, respectively, when compared to the 2.5 dose treatment as reference. Treatment had no effects on non repeat breeders. Based on odds ratios, treatment given either as a single or 2.5 dose increased the probability of an additional corpus luteum (more corpora lutea than embryos) in pregnant cows by factors of 5 or 5.4, respectively. Treatment had no effect on embryo survival. Our findings support the hypothesis that dephereline treatment in the early luteal phase after AI improves fertility in repeat-breeder cows. A dephereline dose 2.5 times higher than normal led to improved pregnancy rates, thus overcoming the impacts of repeat-breeder syndrome. Importantly, both the single and 2.5 dephereline doses increased the chances of pregnant cows having an additional corpus luteum, likely favoring embryo survival.

Effects of timing of artificial insemination and treatment of semen with a Slo3 potassium channel blocker on fertility of dairy heifers subjected to the 5-day CIDR-Synch protocol

Two experiments were conducted to evaluate the effects of the timing of artificial insemination (AI) and incorporation of the Slo3 K+ channel blocker 4-(4-chlorophenyl)butyl-diethyl-heptylammonium to semen extender (CSE) on pregnancy per AI (P/AI) and pregnancy loss in dairy heifers. In experiment 1, Holstein heifers were subjected to the 5-d CIDR-Synch protocol: d -8 GnRH and controlled internal drug-release device (CIDR); d -3 PGF2α and CIDR removal; d -2 PGF2α; d 0 GnRH) and assigned randomly to receive timed AI with control semen on d 0 (72-CON; n = 104), control semen on d -1 (48-CON; n = 100), or CSE-treated semen on d -1 (48-CSE; n = 98). Heifers were fitted with collar-mounted automated estrus detection devices to monitor physical activity and rumination. In experiment 2, Holstein heifers were subjected to the 5-d CIDR-Synch protocol and received a mount detection patch at the first PGF2α injection. Heifers detected in estrus before d 0 were inseminated on the same day, whereas those not detected in estrus received the second GnRH injection and timed AI on d 0. Heifers were assigned randomly to receive AI with control (AI-CON; n = 148) or CSE-treated semen (AI-CSE; n = 110). Four bulls with proven fertility were used in both experiments, and ejaculates from each sire were divided and processed as CON or CSE. Pregnancy was diagnosed by transrectal ultrasonography at 29 and 54 d after AI. Data were analyzed by logistic regression, and statistical models included the fixed effects of treatment and enrollment week. In experiment 1, orthogonal contrasts were built to assess the effects of day of AI (72-CON vs. 48-CON + 48-CSE) and treatment of semen with CSE (48-CON vs. 48-CSE). Pregnancy per AI on d 29 (72-CON = 60.8, 48-CON = 35.2, 48-CSE = 39.8%) and d 54 (72-CON = 58.2, 48-CON = 31.6, 48-CSE = 36.2%) was greater for heifers inseminated on d 0 compared with d -1. However, no effect of semen extender on P/AI was observed in heifers inseminated on d -1. In experiment 2, P/AI tended to be greater for AI-CSE than for AI-CON on d 29 (58.6 vs. 47.3%) and d 54 after AI (55.6 vs. 43.7%). Advancing AI by 24 h decreased the likelihood of pregnancy, and use of CSE was unable to overcome the expected asynchrony between insemination and ovulation. Nevertheless, incorporation of CSE in semen processing tended to improve P/AI when heifers received AI upon detected estrus or timed AI concurrently with the final GnRH of the 5-d CIDR-Synch protocol.

Likelihood of pregnancy is reduced in lactating recipient mares with a short post-partum period preceding embryo transfer

Likelihood of pregnancy is reduced in lactating recipient mares with a short post-partum period preceding embryo transfer

Expression of MSX1, HOXA11 and TP53I3 in the endometrium associated with the onset of pregnancy after repeated failed IVF attempts in patients with tubo-peritoneal factor infertility

Relevance. The success of the in vitro fertilisation (IVF) program, among other factors, depends on the readiness of the endometrium to accept the embryo. It is believed that this is possible during the so-called implantation window, the timing of which can be shifted under the influence of various factors. Evaluation of endometrial receptivity and the implantation window based on analysis of endometrial gene expression before embryo transfer is a promising approach for predicting the likelihood of pregnancy in IVF programs.&#x0D; Aim. To construct a classifier based on the expression of endometrial genes for predicting the outcome of an IVF program in patients with tubal-peritoneal infertility factor and repeated failed IVF attempts in history.&#x0D; Materials and methods. Before the IVF program, a genome-wide transcriptome profiling of endometrial samples of 15 women with tubal-perioneal infertility factor and repeated unsuccessful IVF attempts in history was carried out using Affymetrix arrays. Potential genes capable of classifying IVF program outcomes were selected, after which the expression of these genes was analyzed by qPCR-RT in the endometrium of 47 women to construct IVF outcome classifiers based on the expression of pairs or triples of genes.&#x0D; Results. A classifier based on the expression of the triple of genes MSX1 (HOX7), HOXA11, and TP53I3 made it possible to determine the onset of pregnancy in an IVF program with a sensitivity of 73% and a specificity of 71% with an area under the ROC-curve (AUC) of 0.738 (95% confidence interval 0.5770.898). Earlier, a relationship was found between the expression of these genes and receptivity of the endometrium, which suggests that these genes play a role in the onset of the implantation window.&#x0D; Conclusions. The use of a classifier based on the genes MSX1 (HOX7), HOXA11, and TP53I3 can determine the readiness of the endometrium to accept an embryo and create an individual prognosis of the outcome of an IVF program in women with tubal-peritoneal infertility factor and repeated failed IVF attempts in history.

Measuring serum estradiol and progesterone one day prior to frozen embryo transfer improves live birth rates

BackgroundGiven no consensus in the literature, this study sought to determine if a protocol of measuring serum estradiol and progesterone the day prior to frozen embryo transfer (FET) improves likelihood of pregnancy and livebirth.MethodsThis was a retrospective time-series study of women undergoing autologous vitrified-warmed blastocyst programmed FETs at an academic institution. Live birth rates were compared between a surveillance protocol, where serum estrogen and progesterone surveillance are performed the day prior to a programmed FET, and a standard protocol, whereby no hormonal lab evaluation is performed the day prior.ResultsThree hundred seventy-nine standard FET and 524 surveillance FET cycles were performed. Patients in the surveillance protocol were significantly more likely to achieve live birth (51% vs. 39%; aOR 1.6, 95%CI [1.2, 2.2]). Obese women were noted to be more likely to have lower progesterone hormone levels on surveillance labs (OR 3.2, 95%CI [2.0, 5.3]). However those whose hormonal medication dose was modified because of pre-transfer labs were as likely to achieve live birth as those whose dose was not modified (47% vs. 53%; aOR 0.8, 95%CI [0.6, 1.2]).ConclusionsCycles with the surveillance protocol were more likely to result in live birth. Patients with low levels of pre-transfer hormones, such as obese patients, likely have lower pregnancy rates. It is possible that when these levels were corrected after measurement, pregnancy rates improved to match those whose levels were not low enough to warrant intervention.

External validation of a simple scoring system to predict pregnancy viability in women presenting to an early pregnancy assessment clinic.

A scoring system combining clinical history and simple ultrasound parameters was developed to predict early pregnancy viability beyond the first trimester. The scoring system has not yet been externally validated. This study aimed to externally validate this scoring system to predict ongoing pregnancy viability beyond the first trimester. This prospective observational cohort study enrolled women with singleton intrauterine pregnancies before 12 weeks of gestation. Women underwent examination and ultrasound scan to assess gestational sac size, yolk sac size, and fetal pulsation status. A pregnancy-specific viability score was derived in accordance with the Bottomley score. Pregnancy outcomes at 13 to 16 weeks were documented. Receiver-operating characteristic curve analysis was used to assess the discriminatory performance of the scoring system. In total, 1508 women were enrolled; 1271 were eligible for analysis. After adjustment for covariates, miscarriage (13%) was significantly associated with age ≥35 years (odds ratio [OR]=1.99, 95% confidence interval [CI]: 1.19-3.34), higher bleeding score (OR=2.34, 95% CI: 1.25-4.38), gestational age (OR=1.17, 95% CI: 1.13-1.22), absence of yolk sac (OR=4.73, 95% CI: 2.11-10.62), absence of fetal heart pulsation (OR=3.57, 95% CI: 1.87-6.84), mean yolk sac size (OR=1.25, 95% CI: 1.06-1.47), and fetal size (OR=0.82, 95% CI: 0.77-0.88). The area under the receiver operating characteristic curve was 0.91 (95% CI: 0.89-0.93). Viability score of ≥1 corresponded to a >90% probability of viable pregnancy. The scoring system was easy to use. A score of ≥1 could be used to counsel women who have a high likelihood of viable pregnancy beyond the first trimester.

Fertility trends of women with serious mental illness in the United Kingdom 1992–2017: A primary care cohort study using the clinical practice research datalink

BackgroundChanges in care may mean women with serious mental illness (SMI) are more fertile. We investigated 1) the live-birth and pregnancy rate of women with and without SMI over time, 2) the likelihood of pregnancy when using second or first-generation antipsychotics. MethodRetrospective cohort study of women (15–45 years) registered in Clinical Practice Research Datalink (CPRD) general practices between 1992 and 2017. Each analysis year, women with SMI (affective and non-affective psychotic disorder) were matched with up to four women with no record of SMI on age, calendar year and general practice. Pregnancy and live-birth rates and the rate ratio (RR) comparing women with and without SMI were estimated. The stability of the RR between years was tested. For women with SMI, the pregnancy rates when on or off first or second-generation antipsychotics were calculated and compared using Poisson regression models. ResultsIn total, 12,524 women with SMI were matched to 50,074 women without SMI, median age 34 [IQR 28–39] years. Between 1992 and 2017 women with SMI had 50% fewer live-births than women without SMI (RR 0..50, 95%CI 0.45–0.55). The pregnancy rate ratio increased from 0.64 (95%CI 0.48–0.86) (1992–1994) to 1.00 (95%CI 0.81–1.22) (2016–2017), (p < 0.0001), but this change was only seen in women with affective disorders. Women are most likely to become pregnant after discontinuing either a second-generation or first-generation antipsychotic (RR 1.74, 95%CI 1.42–2.13). ConclusionsWomen with SMI are increasingly experiencing pregnancy but not live-birth, which suggests the reproductive health needs of these women are unmet.

The impact of disturbancesin natural conception cycles.

Many physiciansand other healthcare professionals are often asked questions on interfering factors for conception by couples with a desire for children. Such possible disturbances include, for example, the very common minor diseases, stress and also sexual intercourse during the suspected implantation period. Non-scientifically based statements about disturbances in conception cycles, as found in many layman publications and on the internet, can strongly unsettle couples with a desire for children and force them into corset of rules of conduct. Therefore, a systematic scientific evaluation of the impact of disturbances on conception is urgently needed. A search for possible disturbancesin natural conception cycles together with up to three of the respective pre-cycles in a large cycle database from users of the symptothermal method of natural family planning in Germany was performed. Disturbances were qualified by scientific panel decision and analysed statistically with their effects on the chances of spontaneous conception. Mixed logistical regression models and survival time analyses were used. A total of 237 women with a total of 747 cycles could be included in the analysis. In 61% of all 237 conception cycles, disturbances occurred. The statistical analysis shows that disturbances in natural conception cycles unexpectedly increase the likelihood of pregnancy by an overall factor of 1.32 (95% CI 1.04-1.70). Sexual intercourse in the window of implantation does not decrease the chances of conception. Relaxation states at the time of ovulation and/or during the implantation period have no representable effect and do not increase the chance of pregnancy. Couples trying to conceive should at least be informed that disturbances in conception cycles, such as minor diseases, stress or sexual intercourse during the implantation period do not interfere with conception. Relaxation has no effect in favour of success. This takes away the guilty feeling of couples, fearing that they possibly did something wrong in cycles without the desired pregnancy.

Patterns of Risky Sexual Behaviors and Associated Factors among Youths and Adolescents in Vietnam.

Youths and adolescents are vulnerable to HIV/STIs from unprotected sex. Promotion of young population’s awareness about risky sexual behaviors is essential to develop contextualized interventions. A cross-sectional study was conducted in five Vietnamese provinces to document current attitudes and practices regarding sexual behaviors among youths. The information on sociodemographic characteristics, substance use, and sexual behaviors was collected via self-reported questionnaires. The factors associated with risky sexual behaviors were identified by the multivariate logistic regression. Among the 1200 participants, 73.5% reported having sex in their lifetime, and 48.1% used condoms at their latest sexual intercourse. Participants in urban areas were more likely not to intend to use condoms and had a higher unintended pregnancy rate than in rural areas. Older age was positively associated with not wanting to use and not using condoms. Substance-using participants were more likely to not use condoms. The participants taking alcohol or other stimulants before sex had a higher likelihood of unintended pregnancy. Respondents’ attitudes and practices regarding sexual behaviors were associated with gender and employment. This study indicated that young population’s awareness in Vietnam is high, however, risky sexual behaviors also remain common. Sex-related educational programs about the consequences of substance use, multiple sex partners, and unprotected sex should be developed.

Management of endometriosis-related infertility: Considerations and treatment options.

Endometriosis is a common inflammatory disease in women of reproductive age and is one of the major causes of infertility. Endometriosis causes a sustained reduction of ovarian reserve through both physical mechanisms and inflammatory reactions, which result in the production of reactive oxygen species and tissue fibrosis. The severity of endometriosis is related to ovarian reserve. With regard to infertility treatment, medical therapy as a neoadjuvant or adjuvant to surgical therapy has no definite beneficial effect. Surgical treatment of endometriosis can lead to ovarian injury during the resection of endometriotic tissue, which leads to the deterioration of ovarian reserve. To overcome this disadvantage, a multistep technique has been proposed to minimize the reduction of ovarian reserve. When considering surgical treatment of endometriosis in patients experiencing infertility, it should be kept in mind that ovarian reserve can be reduced both due to endometriosis itself and by the process of removing endometriosis. In cases of mild- to moderate-stage endometriosis, intrauterine insemination with ovarian stimulation after surgical treatment may increase the likelihood of pregnancy. In cases of severe endometriosis, the characteristics of the patient should be considered in a multidisciplinary manner to determine the prioritization of treatment modalities, including surgical treatment and assisted reproduction methods such as in vitro fertilization. The risk of cancer, complications after pregnancy, and infection during oocyte retrieval should also be considered when making treatment decisions.

Documentation of pregnancy status before surgery in Kenya

Background: Performing surgical procedure on a pregnant woman may have major consequences for the fetus, patient, healthcare worker and institution. Assessment of pregnancy status in women of reproductive age when admitted to hospital is therefore an important safety practice. Documentation of likelihood of pregnancy among women admitted in the surgical units of Kenyatta National Hospital (KNH) is not known. Objective: To assess documentation of pregnancy status and possibility of pregnancy before surgery at KNH. Methods: This was a retrospective study involving all surgical units of female patients of reproductive age with various diagnoses and scheduled to undergo surgery between January 2011 and December 2016. Data collected included documentation of age, parity, last menstrual period, level of education, use of family planning, and pregnancy status confirmation using urine or serum beta human chorionic gonadotrophin (HCG) and ultrasound. Results: We analysed data from 331 patient records. All (100%) of the sampled records had age of the patient recorded, 43% had information on parity documented, 35% had last normal menstrual period recorded, and only 26% of the records showed information on use of family planning. 19 (5.7%) patients were confirmed to be pregnant using ultrasound and urine β-HCG. Conclusion: Although only a small proportion of women admitted in surgical units were pregnant, data on likelihood of pregnancy as deduced from information on age, last menstrual period and use of family planning were missing. Keywords: Pregnant, Fetus, Safety, Surgery, Anaesthesia

Lipid droplets in granulosa cells are correlated with reduced pregnancy rates

BackgroundLipids are an important source for energy production during oocyte maturation. The accumulation of intracellular lipids binds to proteins to form lipid droplets. This may lead to cellular lipotoxicity. The impact of lipotoxicity on cumulus and granulosa cells has been reported. This pilot study evaluated their correlation to oocyte and embryo quality.DesignProspective case-control study.Setting: Referral IVF unit.Patients: Women younger than age 40, undergoing IVF with intracytoplasmic sperm injection.Interventions: 15 women with BMI > 30 (high BMI) and 26 women with BMI < 25 (low BMI) were enrolled. IVF outcomes were compared between groups based on BMI. Lipid content in cumulus and granulosa cells was evaluated using quantitative and descriptive methods. Lipid profile, hormonal profile and C-reactive protein were evaluated in blood and follicular fluid samples. Demographic and treatment data, as well as pregnancy rates were collected from electronic medical records.ResultsHigher levels of LDL and CRP, slower cell division rate and lower embryo quality were found in the group with high BMI. There was no difference in pregnancy rates between groups. In light of these findings, treatment outcomes were reanalyzed according to patients who became pregnant and those who did not. We found that patients who conceived had significantly lower fat content in the granulosa cells, reflected by mean fluorescence intensity recorded by flow cytometry analysis (23,404 vs. 9370, P = 0.03).ConclusionsBMI has no effect on lipid content in cumulus and granulosa cells, and does not affect likelihood of pregnancy. However, women who achieved pregnancy, regardless of their BMI, had lower lipid levels in their granulosa cells. This finding is important and further study is needed to evaluate lipid content in granulosa cells as a potential predictor of IVF treatment success.

Addressing optimal maternal weight and exercise during the preconception period and pregnancy

Pregnancy is an opportunity for women to access the healthcare system and address their health needs. Before and during pregnancy, providers should emphasize assisting women in interventions aimed at establishing a healthy weight and exercise regimen and should tailor their guidance based on a woman’s baseline level of fitness. Doing so will improve a woman’s likelihood of pregnancy and improve outcomes if she does become pregnant. Our goal is to propose actions providers should take to improve a woman’s understanding of and ability to manage her weight and exercise goals during the preconception and pregnancy periods.

Multiphase abdomen-pelvis CT in women of childbearing potential (WOCBP): Justification and radiation dose.

To assess justification and radiation doses of abdomen-pelvis CT in women of childbearing potential (WOCBP) scanned in 2 tertiary hospitals in Qatar.The local ethical committee approved retrospective study of 451 WOCBP (14–55 years) who underwent abdomen-pelvis CT examinations. Patients’ age, clinical indications for ordered CT, scanner types and vendors, number and type of scan phases (non-contrast, arterial, portal venous, and/or delayed phases), and radiation dose descriptors (CT dose index volume - CTDIvol and dose length product- DLP) were recorded. Patients undergoing simultaneous chest-abdomen-pelvis CT were excluded. We classified the clinical indications for all 451 CT into indicated and unindicated based on the ACR Appropriateness Criteria. Information regarding the date of last menstrual period, likelihood of pregnancy, and if available, results of the pregnancy test were recorded. Data were analyzed with descriptive statistics (median and inter-quartile range) and analysis of variance (ANOVA).None of the patients were pregnant at the time of their scanning. Amongst the 673 phases acquired for multiphase abdomen-pelvis CT in 451 patients, the 47% unindicated phases (315/673) included non-contrast (122/673, 18%), arterial (33/673, 5%), portal venous (125/673, 19%) and delayed (35/673, 5%) phases. The respective median DLP for indicated and unindicated phases were 266 and 758 mGy.cm (P < .0001).Multiphase abdomen-pelvis CT exams are frequent but seldom justified in WOCBP. They lead to a substantial increase in unindicated radiation dose compared to a single-phase CT.