Likelihood Of Pregnancy Research Articles

Prevalence and factors associated with teenage pregnancy among parturients in Mbale Regional Referral Hospital: a cross sectional study.

In Uganda, 12% of the audited maternal deaths occur among teenagers. The prevalence and factors associated with teenage pregnancy in health facilities is not well documented. We determined the prevalence and factors associated with teenage pregnancy in Mbale Regional Referral Hospital. We conducted a cross sectional study between July and September 2019.We consecutively enrolled and collected information from 427 respondents. Associated factors were determined using logistic regression, a P-value < 0.05. The prevalence of teenage pregnancy was 20.6% [95% CI : (17.0% - 24.7%)]. Rural residence [(AOR: 2.8 (1.08 - 7.09)], primary level of education [(AOR: 9.57 (3.48 - 26.3)], unhappy feelings about the current pregnancy [(AOR: 3.57(1.05 - 12.15)], primiparity [(AOR: 21.05 (7.36 - 60.15)] increased the likelihood of teenage pregnancy. While, history of ever use of contraceptives [(AOR: 0.32 (0.12 - 0.84)], age at coitarche [(AOR: 0.68 (0.54 - 0.85)], grand multiparity [(AOR: 0.06 (0.01 - 0.51)], and exposure to sex education at home [(AOR: 0.37 (0.15 - 0.89)] decreased its likelihood. The prevalence of teenage pregnancy was high. It was associated with being resident in rural area, low level of education and ever use of contraception. Promotion of reproductive health education may prevent teenage pregnancy.

Does an Ileoanal Anastomosis Decrease the Rate of Successful Pregnancy Compared With an Ileorectal Anastomosis? A National Study of 1491 Patients.

Report the rate of successful pregnancy in a national cohort of women with either an ileal pouch anal (IPAA) or ileorectal (IRA) anastomosis constructed after colectomy for inflammatory bowel disease (IBD) or polyposis. Fertility after IPAA is probably impaired. All available data are corroborated by only small sample size studies. It is not known whether construction of IPAA versus IRA influences the odds of subsequently achieving a successful pregnancy, especially with increased utilization of the laparoscopic approach. All women (age: 12-45y) undergoing IRA or IPAA in France for polyposis or IBD, between 2010-2020, were included. A control population was defined as women aged from 12 to 45 years undergoing laparoscopic appendicectomy during the same period. The odds of successful pregnancy were studied using an adjusted survival analysis. A total of 1491 women (IPAA=872, 58%; IRA=619, 42%) were included. A total of 220 deliveries (15%) occurred during the follow-up period of 71 months (39-100). After adjustment, the odds of successful pregnancy was not significantly associated with type of anastomosis (after IPAA: Hazard Ratio [HR]=0.79, 95% confidence interval=0.56-1.11, P =0.17). The laparoscopic approach increased the odds of achieving successful pregnancy (HR=1.79, 95% confidence interval=1.20-2.63, P =0.004). IRA and IPAA significantly impacted fertility when compared with the control population ( P <0.001). In this large cohort study, total colectomy for polyposis or IBD was associated with reduced fertility compared with the general population. No difference in odds of achieving successful pregnancy was found between IRA and IPAA after adjustment. This analysis suggests laparoscopic surgery may be associated with greater likelihood of pregnancy.

O-263 Sperm parameters in cancer patients: the role of cancer and cancer diagnoses

Abstract Study question How do sperm parameters compare in various oncologic conditions when compared with controls? Is there an association between severity of the disease and sperm parameters? Summary answer Most cancer types appear to affect sperm parameters. Motility is reduced in all cancers, while sperm concentration is strongly diminished in testicular cancer. What is known already There is no actual consensus whether cancer is negatively associated with semen quality. Some studies have reported poorer sperm parameters in men with cancer, especially testicular cancer. Others have reported no differences in semen parameters of cancer patients when compared with patients with benign diseases. Furthermore, small studies have shown conflicting differences in sperm parameters when comparing across different cancer types. Study design, size, duration Academic single-centered, retrospective cohort study with men banking sperm for fertility preservation prior to undergoing chemotherapy. A total 965 patients with various cancer types, recently diagnosed, produced at least one sample for sperm cryopreservation between 2004 and 2020. Concentration and progressive motility were analyzed for each sample at the time of cryopreservation, before beginning the chemotherapy treatments. Participants/materials, setting, methods The first sample of each patient was kept for data analysis (n = 965). The control group were unselected homosexual male couples planning parenthood, without any known fertility impairment (n = 39). Cancers were grouped as: testis (n = 297), lymphoma (n = 285), leukemia (n = 79), sarcoma (n = 85), brain (n = 61), gastro-intestinal (GI) (n = 73), ear-nose-throat (ENT) (n = 24), and other (n = 52). The last group included cancers of such as kidney, prostate, melanoma, or lung cancer. T-test and Fisher-test were used for statistical analyses. Main results and the role of chance Patients with testicular cancer had significantly lower mean sperm concentration when compared to controls (30.5 vs 69.9 M/ml; p &amp;lt; 0.01). Other groups showed similar concentration values when compared to controls. Furthermore 47% testicular cancer patients had oligospermia (as determined by WHO criteria) compared with 10% unselected controls (p &amp;lt; 0.001) However, sperm from patients with almost all types of cancer showed lower motility rates when compared to controls (31.5 to 35.0% vs 49.0%; p &amp;lt; 0.001). The only group showing similar motility with controls was ENT cancers (41.1% vs 49%, p = 0.2). Similarly, sperm samples from all cancer groups showed higher proportions with asthenospermia (as determined by WHO criteria) when compared with controls (39.1%-54.7% vs 18%, p &amp;lt; 0.01) For individual cancer groups, comparing sperm parameters between patients who survived and those who died, there were no significant differences, suggesting the severity or stage does not modulate the effect of the cancer itself on the sperm. Patients in the testis, lymphoma, leukemia, sarcoma and brain cancer groups were significantly younger than controls (25.3-29.1 vs 37.3 years old), while GI and ENT groups were similar to controls (37.4 and 36.5 vs 37.3). In the “other cancers” group, patients were significantly older than controls (44.4 vs 37.3). Limitations, reasons for caution The interpretation of the findings of this study is limited by the retrospective nature of the analysis and the potential for unmeasured confounding variables. Wider implications of the findings There is an association between abnormal sperm parameters in samples for pre-chemotherapy cryopreservation and all cancer types. This may affect the future likelihood of pregnancy. Young men with cancer need to be counselled that ICSI may be recommended should they need or choose to use their cryopreserved sperm. Trial registration number Not applicable

P-234 AI study shows the effect of patient age on embryo quality is inherent in the morphology of an embryo

Abstract Study question Does patient age need to be explicitly factored into AI-based embryo quality assessment, or does embryo morphology alone capture the age-related decline in embryo quality? Summary answer Age-related effects on embryo quality are inherently captured in embryo morphology. AI algorithms that assess morphology correlate with expected decline in embryo quality with age. What is known already Patient age strongly correlates with genetic aneuploidy in oocytes, which results in a dramatic reduction in genetic integrity and viability of embryos with patient age1. This negative correlation ultimately leads to poorer implantation and clinical pregnancy outcomes. AI imaging tools assess the quality of embryos generally, using morphology alone2. However, it is unknown whether these morphological assessments inherently consider age-related quality factors like cytoplasmic and/or genetic competence, or whether age should be incorporated as a separate variable. The current study aimed to assess the correlation of AI-based scores with the age-related decline in embryo quality. Study design, size, duration The study used a retrospective dataset of static Day 5 blastocyst images taken using an optical light microscope with associated PGT-A or pregnancy outcomes. The dataset comprised images of 4,000 embryos sourced from 1,199 consecutive patients treated between 2011 and 2020 at five IVF clinics (USA). The study evaluated correlation of algorithms Life Whisperer Genetics and Life Whisperer Viability with patient or donor age. Data were excluded in donor cases where age was not known. Participants/materials, setting, methods 4,000 embryo images were used to report a linear correlation between proportion of euploids(%) and pregnancies(%) across six age-brackets, between 20 to 50 years old. Life Whisperer Genetics AI was applied to a blind dataset of 809 images to assess likelihood of euploidy, and Life Whisperer Viability AI applied to a dataset of 556 images to assess likelihood of pregnancy. Scores within each age-bracket were averaged and chi-squared analyses was used to assess significance. Main results and the role of chance As expected, there was a significant negative correlation between the number of euploid embryos(%) and patient/donor age on a dataset of 4,000 images (slope of -13.2±0.2), and on a blind test set of 809 embryos (slope of -11.2±0.2). The Life Whisperer Genetics AI score was then reported on the blind test set, showing a significant negative correlation with age (-0.45±0.16 with a χ2/dof value of 0.41). The significant downward trend indicates that the AI, using morphology alone, can account for the age-related impact in the genetic competence without a corresponding reduction in accuracy, and without needing additional age-related variables in its calculation. The AI was able to generalize correctly, identifying morphological signs of ploidy well, regardless of age. Regarding cytoplasmic or metabolic competence, we report on a blind dataset of 556 images that the proportion of viable embryos(%) reduces with increasing patient age, although exhibiting a peak in proportion of viable embryos in the 25-29 year bracket. Similarly, we show that Life Whisperer Viability AI scores within each age-bracket reduce with age. Our results suggest that both AI algorithms for genetic competence and metabolic competence in terms of viability take into account patient age based on morphology. Limitations, reasons for caution Although age was shown to be represented in embryo morphology, adding a separate age-related variable could be considered in future studies. However, for embryo ranking and selection for a given patient, this is likely to be of value only when comparing embryos corresponding to different donor oocytes. Wider implications of the findings As the age of the patient increases, the morphology of their embryos also changes, corresponding to a decrease in embryo quality. This justifies morphology-based embryo quality assessment, giving credence to generalizable AI that perform robust assessment of embryo quality for patients of all ages, and do not require calibration. Trial registration number Not Applicable

Does Dysmenorrhea Affect Clinical Features and Long-Term Surgical Outcomes of Patients With Ovarian Endometriosis? A 12-Year Retrospective Observational Cohort Study.

BackgroundTo examine and compare the differences in clinical characteristics and long-term postoperative outcomes of ovarian endometriomas (OMA) patients with and without dysmenorrhea, including data from at least 8 years of postoperative follow-up examinations.MethodsRetrospective analysis of 334 OMA patients, including their demographic and clinical data. Long-term follow-up record was also collected. All laparoscopic cystectomy procedures were performed by the same surgeon at Peking Union Medical College Hospital between January 2009 and April 2013. Patients were divided into the dysmenorrhea and non-dysmenorrhea groups to perform the analysis of their preoperative characteristics, relevant surgical findings, and postoperative outcomes at the follow-up.ResultsOut of 334 OMA patients, 257 (76.9%) patients were allocated to the dysmenorrhea group, while the rest 77 (23.1%) patients were included in the non-dysmenorrhea group. Compared with the dysmenorrhea group, the non-dysmenorrhea group exhibited a reduced proportion of chronic pelvic pain (CPP) (P = 0.003), dyspareunia (P < 0.001), tenesmus (P < 0.001), concurrency of deep infiltrating endometriosis (DIE) (P < 0.001), and adenomyosis (P = 0.032). Preoperative infertility was significantly higher in the dysmenorrhea group (P = 0.001). The mean operating time in the dysmenorrhea vs. the non-dysmenorrhea group was 68.0 vs. 56.0 min (P < 0.001). According to the revised American Fertility Society (rAFS) scoring system, the mean scores of the two groups were 52.1 vs. 44.6 (P = 0.033). During follow-up, the dysmenorrhea group showed a higher rate of disease relapse (P < 0.001). A minimum postoperative follow-up period of 8 years was required to evaluate the pregnancy outcomes. Successful pregnancies were identified in 97/257 (37.7%) cases in the dysmenorrhea group and 36/77(46.8%) cases in the non-dysmenorrhea group (P = 0.157), respectively. Though the dysmenorrhea group had a higher rate of postoperative infertility, differences were not significant between the two groups.ConclusionsCompared with the dysmenorrhea group, OMA patients without dysmenorrhea exhibited lower proportions of CPP, dyspareunia, tenesmus, lower concurrency of DIE and adenomyosis, shorter mean operating time, lower mean rAFS scores, and lower infertility rates. During the long-term follow-up, a lower recurrence rate was observed in the non-dysmenorrhea group. Regarding fertility outcomes, non-dysmenorrhea patients had a higher likelihood of successful pregnancy after surgery. Postoperative management needs to be evaluated separately according to dysmenorrhea pathology.

Factor Structure of the Sexual Risk Survey Among U.S. College Students with and without ADHD: Assessing Clinical Utility with a High-Risk Population.

Young adults, particularly college students, report a higher prevalence of risky sexual behavior than the general population, increasing their likelihood for unplanned pregnancy, sexually transmitted infections (STIs), and negative psychological outcomes. Although sexual risk behavior and its consequences are a major public health concern, current prevention literature is insufficient and relies on sexual risk measures with limited psychometric support. The present study, therefore, examined the psychometric properties of a sexual risk survey (SRS; Turchik, Garske, in Arch Sex Behav 38:936-948, 2009), using data from the first year of a longitudinal study following the outcomes of college students with and without attention-deficit/hyperactivity disorder (ADHD; N = 410). Principal components analyses were conducted to assess the factorial structure of the SRS comparing results from a general college population and a college population considered to be high-risk (ADHD). Results revealed four components across both samples. Internal consistency estimates for component scores and total scores ranged from .627 to 918. Implications of the findings are discussed and suggestions for future studies are advanced.

Preconception Substance Use and Risk of Unintended Pregnancy: Pregnancy Risk Assessment Monitoring System 2016-17.

This study examined the association between preconception substance use and unintended pregnancy in a large, nationally representative sample of women. In this cross-sectional study, we used data from the Pregnancy Risk Assessment Monitoring System (PRAMS) comprising, 74,543women who had birth during 2016-17. Logistic regression was used to assess the independent association of unintended pregnancy overall and by subtypes to preconception substance use (smoking and other nicotine/tobacco use, alcohol consumption, and use of cannabis, illicit/recreational drugs) and specific medication including prescription opioids, antidepressants and over the counter pain relief. Overall, 41% of pregnancies were unintended. Nearly 57% of participants reported alcohol consumption during the preconception period, with 32% indicating binge drinking, 17% reported preconception smoking, and 10% cannabis use. Unintended pregnancy was significantly associated with substance use, including smoking (adjusted odds ratio [AOR]:1.5, 95% confidence interval [CI]: 1.4-1.6); as well as the use of other nicotine/tobacco (AOR:1.4, 95% CI: 1.3-1.5); cannabis (AOR: 1.9, 95% CI: 1.5-2.3); illicit/recreational drugs (AOR:1.7, 95% CI: 1.2-2.4), prescription opioids (AOR:1.4, 95% CI: 1.02-1.9), and prescription antidepressants (AOR 1.8, 95% CI: 1.1-3.0). The likelihood of unintended pregnancy was significantly elevated with heavy smoking, heavy alcohol consumption, and binge drinking. Analyses by unintended pregnancy subtype yielded similar results. Preconception substance use was significantly and positively associated with unintended pregnancy. Evidence-based interventions are needed addressing substance use behavior and effective contraceptive use to prevent unintended pregnancy and related adverse effects on maternal and child health.

Pregnancy and Neonatal Outcomes After Exposure to Alprazolam in Pregnancy.

Alprazolam is a commonly prescribed benzodiazepine for anxiety or panic disorder, even in pregnant women. Information on the safety of alprazolam during pregnancy is insufficient. We aimed to evaluate pregnancy and neonatal outcomes after exposure to alprazolam during pregnancy. A prospective study was conducted on 725 pregnancies from January 2000 to December 2019. Participants were recruited through the Korean Mother-Safe Program, a service providing information on drug-induced teratogenic risk during pregnancy and breastfeeding. Exposed (N = 96) and non-exposed (N = 629) women to alprazolam during pregnancy were selected and followed-up until delivery. Pregnancy outcomes, including spontaneous abortion, still birth, low birth weight (LBW), preterm birth, Apgar score (at 1 and 5 min), and malformations were measured and compared. Multivariable logistic regression was performed to examine the association between alprazolam exposure and outcomes. The mean age was 32.9 (SD 4.0) years in the alprazolam-exposed group and 31.8 (SD 3.8) years in the unexposed group (p = 0.008). The alprazolam exposure group demonstrated a significantly higher likelihood of pregnancy and neonatal outcomes: spontaneous abortion (OR = 2.38; 95% CI 1.20–4.69), LBW (OR = 3.65; 95% CI 1.22–11.00), and Apgar score at 1 min ≤ 7 (OR = 2.19; 95% CI 1.02–4.67). There was no significant difference in congenital abnormalities between the exposure and non-exposure groups. Our findings confirmed that alprazolam exposure during pregnancy was significantly associated with adverse pregnancy and neonatal outcomes, including spontaneous abortion, low birth weight, and Apgar score at 1 min ≤ 7. Alprazolam during pregnancy should be appropriately regulated and monitored.

Success rate in a clinical equine in vitro embryo production program

In vitro embryo production (IVEP) via Ovum Pick-Up (OPU) and Intracytoplasmic Sperm Injection (ICSI) has become a popular breeding technique in Warmblood mares because of the high success rate and several practical advantages. IVEP offers a solution for a variety of reproductive issues including, but not limited to, sub-fertility in stallions or mares, poor quality or scarce frozen semen, difficulty in synchronizing donor and recipient mares, and inefficient use of recipient mares. In 515 OPU-ICSI sessions performed in our facility in 2021, a mean of 25.9 antral follicles were aspirated yielding an average 13.8 immature oocytes, which were shipped overnight to a specialized ICSI laboratory (Avantea). One or more blastocysts (range: 0–13 blastocysts) were produced from 78% of procedures with a mean of 2.12 blastocysts per session; the likelihood of pregnancy after transfer of a cryopreserved thawed IVP blastocysts in 2021 (n = 781) was 77.7%. Several donor mare, recipient mare, stallion and embryonic factors influence the likelihood of producing an in vitro blastocyst or achieving pregnancy. Approximately 60% of the transferred IVP blastocysts yield a foal; moreover, neither gestation length nor the health of foals is noticeably influenced by IVEP. On the other hand, a skewed sex ratio towards colts is apparent among IVEP foals resulting from day 7 but not day 8 embryos, suggesting that male embryos develop more rapidly in vitro. Although serious complications after OPU are uncommon, owners should be aware of their existence, because some complications can be life-threating.

Environmental variation effects fertility in tropical beef cattle.

The northern Australia beef cattle industry operates in harsh environmental conditions which consistently suppress female fertility. To better understand the environmental effect on cattle raised extensively in northern Australia, new environmental descriptors were defined for 54 commercial herds located across the region. Three fertility traits, based on the presence of a corpus luteum at 600 d of age, indicating puberty, (CL Presence, n = 25,176), heifer pregnancy (n = 20,989) and first lactation pregnancy (n = 10,072) were recorded. Temperature, humidity, and rainfall were obtained from publicly available data based on herd location. Being pubertal at 600 d (i.e. CL Presence) increased the likelihood of success at heifer pregnancy and first lactation pregnancy (P < 0.05), underscoring the importance of early puberty in reproductive success. A temperature humidity index (THI) of 65–70 had a significant (P < 0.05) negative effect on first lactation pregnancy rate, heifer pregnancy and puberty at 600 d of age. Area under the curve of daily THI was significant (P < 0.05) and reduced the likelihood of pregnancy at first lactation and puberty at 600 days. Deviation from long-term average rainfall was not significant (P < 0.05) for any trait. Average daily weight gain had a significant and positive relationship (P < 0.05) for heifer and first lactation pregnancy. The results indicate that chronic or cumulative heat load is more determinantal to reproductive performance than acute heat stress. The reason for the lack of a clear relationship between acute heat stress and reproductive performance is unclear but may be partially explained by peak THI and peak nutrition coinciding at the same time. Sufficient evidence was found to justify the use of average daily weight gain and chronic heat load as descriptors to define an environmental gradient.

Shedding light on attitudes towards pregnancy among Inuit adolescents from Nunavik

ABSTRACT Better understanding attitudes toward pregnancy – a potent predictor of adolescent pregnancy – could help explain the high adolescent pregnancy rate in Nunavik, Canada. The objective of this study was to assess the distribution of different attitudes toward pregnancy and the factors associated with high pregnancy likelihood attitudes (HPLA; favourable, indifferent, and ambivalent), focusing on the perceived benefits of childbearing (BOC). T-tests, chi-square tests, and logistics regressions were performed based the answers of 159 Inuit women aged 16 to 20 years from the Qanuilirpitaa? survey. About 43% were ambivalent, 16% favourable, 5% indifferent, and 35% unfavourable toward pregnancy. Bivariate analysis indicate that the HPLA group was more likely to work, to report less frequent positive interactions, and to show a higher BOC score compared to others. Multivariate analysis show that an increased BOC score was associated with HPLA (OR = 1.09, 95% CI = 1.01 − 1.18). Perceiving that a baby would strengthen the relationship with the other parent (OR = 1.65, 95% CI = 1.15 − 2.37) and that it would help to access housing were individually associated with HPLA (OR = 1.45, 95% CI = 1.02 − 2.10). Findings provide evidence to support Inuit adolescents’ reproductive choices.

Low Rates of Contraception Use in Women With Human Immunodeficiency Virus.

BackgroundWomen with human immunodeficiency virus (WWH) have low rates of hormonal or long-acting contraceptive use. Few studies have described contraception use among WWH over time.MethodsWe examined contraception (including all forms of hormonal contraception, intrauterine devices, and bilateral tubal ligations) use among cisgender women aged 18–45 years in care at Vanderbilt’s human immunodeficiency virus (HIV) clinic in Nashville, Tennessee, from 1998 through 2018. Weighted annual prevalence estimates of contraception use were described. Cox proportional hazards models examined factors associated with incident contraception use and pregnancy.ResultsOf the 737 women included, median age at clinic entry was 31 years; average follow-up was 4.1 years. At clinic entry, 47 (6%) women were on contraception and 164 (22%) were pregnant. The median annual percentage of time on any contraception use among nonpregnant women was 31.7% and remained stable throughout the study period. Younger age was associated with increased risk of pregnancy and contraceptive use. Psychiatric comorbidity decreased likelihood of contraception (adjusted hazard ratio [aHR], 0.52 [95% CI {confidence interval}, .29–.93]) and increased likelihood of pregnancy (aHR, 1.77 [95% CI, .97–3.25]). While not associated with contraceptive use, more recent year of clinic entry was associated with higher pregnancy risk. Race, substance use, CD4 cell count, HIV RNA, smoking, and antiretroviral therapy were not associated with contraception use nor pregnancy.ConclusionsMost WWH did not use contraception at baseline nor during follow-up. Likelihood of pregnancy increased with recent clinic entry while contraception use remained stable over time. Continued efforts to ensure access to effective contraception options are needed in HIV clinics.

Effect of growth and carcass traits on likelihood of early pregnancy in Nellore heifers raised at intensive nutritional plan

This study evaluated the influence of the quantitative traits measured by real-time ultrasound (adjusted longissimus muscle area [AdjLMA], adjusted rump fat thickness [AdjRFT], and adjusted marbling [AdjMAR]) as well as age at first breeding [AFB] and adjusted weight [AdjWeight], on the probability of occurrence of early pregnancy (EP) in 55 Nellore heifers, and also performed an economic analysis. All calves received supplementation in creep-feeding (ad libitum), and at weaning (average age= 210 ± 30 days; average weight= 241 ± 33 kg) until first breeding by artificial insemination (May to November) all heifers were managed in the same group (two paddocks of 25 ha each evenly covered with Urochloa Marandu Grass) and received protein-energy supplementation (1% of average BW per animal/day). The quantitative variables were collected immediately after timed artificial insemination (average age= 392 ± 27 days; average weight= 431.90 kg), and the pregnancy diagnosis was completed at 30 days following insemination. For economic analysis, two systems were compared (age at first breeding at 13 and 24 months). The greater adjusted weight on the first breeding increased the probability of occurrence of early pregnancy, while the greater adjusted longissimus muscle area reduced. In addition, intensive meat production systems provide greater economic return throughout cow-calf operation.

Long-term Outcomes Following Surgical Management of Rectal Endometriosis: Seven-year Follow-up of Patients Enrolled in a Randomized Trial

To compare functional outcomes, recurrence rate, and pregnancy likelihood in patients undergoing conservative or radical surgery for deep rectal endometriosis followed up for 7 years. Prospective study in a cohort of patients enrolled in a 2-arm randomized trial from March 2011 to August 2013. A tertiary referral center. Fifty-five patients with deep endometriosis infiltrating the rectum. Patients underwent either segmental resection or nodule excision via shaving or disk excision, depending on randomization that was performed preoperatively using sequentially numbered, opaque sealed envelopes. The primary end point was the number of patients experiencing one of the following symptoms: constipation, frequent bowel movements, anal incontinence, or bladder dysfunction 24 months after surgery. The secondary end points were values of gastrointestinal and overall quality of life scores. The 7-year recurrence rates (new deep endometriosis nodules infiltrating the rectum) in the excision vs segmental resection arms were 7.4 % vs 0% (p=.24). One of the symptoms included in the definition of the primary outcomes was recorded in 55.6% vs 60.7% of patients (p=.79). However, 51.9% vs 53.6% of patients considered their bowel movements as normal (p=.99). An intention-to-treat comparison of overall quality of life scores did not find a difference between the 2 groups 7 years after surgery. At the end of the 7-year study period, 31 of 37 patients who tried to conceive were successful (83.8%), including 27 pregnancies (57.4%) resulting from natural conception and 20 pregnancies (42.6%) resulting from assisted reproductive technology procedures. The pregnancy rate was 82.4% vs 85% in the 2 arms (p=.99). A 75.7% live birth rate was recorded. At the end of the follow-up, there were 15 women with 1 child (40.5%) and 13 women with 2 children (35.1%). During the 7-year follow-up, the reoperation rates were 37% and 35.7%, respectively, in each arm (p=.84). Among the 27 reoperation procedures during the follow-up period, 11 (40.7%) were for postoperative complications, 7 (25.9%) were necessary before assisted reproductive technology management, 8 (29.6%) were for recurrent abdominal or pelvic pain, and 1 (3.7%) was for midline ventral hernia after pregnancy. Our study did not reveal a considerable difference in terms of digestive functional outcomes, recurrence rate, reoperation risk, and pregnancy likelihood when conservative and radical rectal surgeries for deep endometriosis were compared 7 years after surgery. The postoperative pregnancy rate observed in our series was high.

Contraception after in vitro fertilisation (IVF): a qualitative study of the views of women who have had spontaneous pregnancies after successful IVF

BackgroundThe use of in vitro fertilisation (IVF) has increased rapidly since its inception in 1978. Women seeking IVF have a wide range of subfertility causes including unexplained subfertility. A growing subgroup of women seek treatment for other reasons than fertility problems, for example, women in same sex relationships and single women. This study aims to better understand the contraceptive needs of women after successful IVF pregnancy in order to improve service delivery and prevent unplanned and rapid-repeat pregnancies.MethodsA qualitative study of views of women who have had spontaneous pregnancies after successful IVF. Participants were recruited using purposive and snowballing sampling methods from social media and peer networks. The framework method was used for analysis using NVivo12.ResultsThe sample comprised 21 interviewees from the United Kingdom (UK), having a range of spontaneous pregnancy outcomes, including single and multiple livebirths, miscarriage, ectopic pregnancy and termination of pregnancy. Contraceptive choices were subject to a complex and dynamic interaction of influencing factors including beliefs regarding subfertility, desire for children and views on contraception. None of the women recalled receiving any information or useful counselling about contraception during fertility or maternity care. After IVF pregnancy, most women (n = 16) used no or ineffective contraception. Spontaneous pregnancy was not universally welcomed in this group and inter-pregnancy intervals were often short (n = 16, less than 18 months). Even after subsequent spontaneous pregnancy, use of contraception and the most effective methods remained low. Women held persistent beliefs regarding their subfertility despite subsequent spontaneous pregnancy. They associated aspects of the IVF process with a sense of personal failure, despite an ultimately “successful” outcome of livebirth. These aspects may reinforce their self-belief in subfertility. Other barriers to contraception use in women having IVF included: lack of knowledge of likelihood of spontaneous pregnancy, lack of contraceptive experience and inherent incentives towards shorter inter-pregnancy intervals.ConclusionsThe contraceptive needs of women having IVF pregnancies are real and are being overlooked. Fertility services should take responsibility for providing information on the risks of subsequent spontaneous pregnancy. Maternity and community healthcare professionals must address women’s perceptions of their fertility in order to engage them in contraception counselling.

Natural cycles achieve better pregnancy outcomes than artificial cycles in non-PCOS women undergoing vitrified single-blastocyst transfer: a retrospective cohort study of 6840 cycles.

To identify the optimal method for endometrial preparation in vitrified single-blastocyst transfer (VSBT) cycles. This was a retrospective cohort study for non-PCOS patients who underwent VSBT cycles from March 2015 to November 2019 in an academic reproductive medical center. A total of 6840 VSBT cycles were enrolled and classified into two groups according to different endometrial preparation methods. The non-PCOS patients who underwent VSBT showed a significantly higher clinical pregnancy rate (61.96% vs 56.85%, p < 0.001) and live birth rate (49.09% vs 39.86%, p < 0.001), as well as a statistically lower early miscarriage rate (12.02% vs 18.08%, p < 0.001) in the natural cycle (NC) group compared with the artificial cycle (AC) group. Multivariable analysis further confirmed that NC was associated with an increased likelihood of clinical pregnancy (adjusted odds ratio(aOR) 0.852, 95% confidence interval (CI) 0.765-0.949, p = 0.004) and live birth (aOR0.746, 95% CI 0.669-0.832, p < 0 .001), but decreased early miscarriage occurrence (aOR 1.447, 95% CI 1.215-1.724, p < 0.001) compared to AC. Our study demonstrated that non-PCOS patients could benefit from NC in vitrified blastocyst transfer. Increased clinical pregnancy rate and decreased early miscarriage rate led to a significantly higher live birth rate in NC patients compared with AC with our present protocol.

Predicting Embryo Viability Based on Self-Supervised Alignment of Time-Lapse Videos.

With self-supervised learning, both labeled and unlabeled data can be used for representation learning and model pretraining. This is particularly relevant when automating the selection of a patient's fertilized eggs (embryos) during a fertility treatment, in which only the embryos that were transferred to the female uterus may have labels of pregnancy. In this paper, we apply a self-supervised video alignment method known as temporal cycle-consistency (TCC) on 38176 time-lapse videos of developing embryos, of which 14550 were labeled. We show how TCC can be used to extract temporal similarities between embryo videos and use these for predicting pregnancy likelihood. Our temporal similarity method outperforms the time alignment measurement (TAM) with an area under the receiver operating characteristic (AUC) of 0.64 vs. 0.56. Compared to existing embryo evaluation models, it places in between a pure temporal and a spatio-temporal model that both require manual annotations. Furthermore, we use TCC for transfer learning in a semi-supervised fashion and show significant performance improvements compared to standard supervised learning, when only a small subset of the dataset is labeled. Specifically, two variants of transfer learning both achieve an AUC of 0.66 compared to 0.63 for supervised learning when 16% of the dataset is labeled.

Spatial distribution and factors associated with adolescent pregnancy in Nigeria: a multi-level analysis

BackgroundAdolescent pregnancy is a global public health and social phenomenon. However, the prevalence of adolescent pregnancy varies between and within countries. This study, therefore, sought to investigate the spatial distribution and factors associated with adolescent pregnancy in Nigeria.MethodsUsing data from the women’s recode file, a sample of 9448 adolescents aged 15-19 were considered as the sample size for this study. We employed a multilevel and spatial analyses to ascertain the factors associated with adolescent pregnancy and its spatial clustering.ResultsThe spatial distribution of adolescent pregnancy in Nigeria ranges from 0 to 66.67%. A high proportion of adolescent pregnancy was located in the Northern parts of Nigeria. The likelihood of adolescent pregnancy in Nigeria was high among those who had sexual debut between 15 to 19 years [aOR = 1.49; 95%(CI = 1.16-1.92)], those who were currently married [aOR = 67.00; 95%(CI = 41.27-108.76)], and adolescents whose ethnicity were Igbo [aOR = 3.73; 95%(CI = 1.04-13.30)], while adolescents who were currently working [aOR = 0.69; 95%(CI = 0.55-0.88)] were less likely to have adolescent pregnancy.ConclusionA high proportion of adolescent pregnancy was located in the Northern parts of Nigeria. In addition, age at sexual debut, educational level, marital status, ethnicity, and working status were associated with adolescent pregnancy. Therefore, it is vital to take cognizant of these factors in designing adolescent pregnancy prevention programs or strengthening existing efforts in Nigeria.

Phenotypic Heterogeneity and Fertility Potential of Patients With 17-Hydroxylase/17,20-lyase Deficiency.

17α-Hydroxylase/17,20-lyase deficiency (17OHD) is caused by a human CYP17A1 gene mutation and has the classical phenotype of hypertension, hypokalemia, sexual infantilism, and primary amenorrhea in females (46,XX) and disorders of sexual development in males (46,XY). To date, few cases of 17OHD have been reported, and the likelihood of pregnancy has rarely been explored. To study the clinical characteristics, phenotype heterogeneity, genotyping, and the likelihood of pregnancy of patients with 17OHD. Genotype analysis was performed by direct sequencing of the CYP17A1 gene and next-generation sequencing in nonclassical patients. In vitro enzyme activity assays and 3-dimensional structure observations were used to assess the function of 3 missense mutations of the CYP17A1 gene. Progestin-primed ovarian stimulation (PPOS) was chosen for ovulation induction in 2 patients. Eight mutations were identified from 13 patients, including the homozygous mutations p. N395D and p. R496C and compound heterozygous mutations p. Y329fs/p. A421A and p. I332T/p. D487_F489del in 4 nonclassical patients. For the 3 missense mutations, an in vitro functional study showed mild impairment of 17α-hydroxylase activities 15.3-25.0% but residual 17,20-lyase activities 6.6%-9.4%. Two 46,XX females succeeded in pregnancy and delivery by combined PPOS, in vitro fertilization embryo transfer (IVF-ET), and the use of low-dose glucocorticoids. Partial 17OHD present nonclassical clinical features, without hypertension and hypokalemia. Successful pregnancy in such 46,XX patients could be attained by the appropriate choice of ovulation induction regimen, precise dose of glucocorticoid to reduce progesterone levels, and the use of IVF-ET.

Obstetrical and Perinatal Outcomes in Female Survivors of Childhood and Adolescent Cancer: A Population-Based Cohort Study.

The likelihood of pregnancy and risk of obstetrical or perinatal complications is inadequately documented in female survivors of pediatric cancer. We assembled a population-based cohort of female survivors of cancer diagnosed at age 21 years and younger in Ontario, Canada, between 1985 and 2012. Survivors were matched 1:5 to women without prior cancer. Multivariable Cox proportional hazards and modified Poisson models assessed the likelihood of a recognized pregnancy and perinatal and maternal complications. A total of 4062 survivors were matched to 20 308 comparisons. Median (interquartile range) age was 11 (4-15) years at cancer diagnosis and 25 (19-31) years at follow-up. By age 30 years, the cumulative incidence of achieving a recognized pregnancy was 22.3% (95% confidence interval [CI] = 20.7% to 23.9%) among survivors vs 26.6% (95% CI = 25.6% to 27.3%) among comparisons (hazard ratio = 0.80, 95% CI = 0.75 to 0.86). A lower likelihood of pregnancy was associated with a brain tumor, alkylator chemotherapy, cranial radiation, and hematopoietic stem cell transplantation. Pregnant survivors were as likely as cancer-free women to carry a pregnancy >20 weeks (relative risk [RR] = 1.01, 95% CI = 0.98 to 1.04). Survivors had a higher relative risk of severe maternal morbidity (RR = 2.31, 95% CI = 1.59 to 3.37), cardiac morbidity (RR = 4.18, 95% CI = 1.89 to 9.24), and preterm birth (RR = 1.57, 95% CI = 1.29 to 1.92). Preterm birth was more likely in survivors treated with hematopoietic stem cell transplantation (allogenic: RR = 8.37, 95% CI = 4.83 to 14.48; autologous: RR = 3.72, 95% CI = 1.66 to 8.35). Survivors of childhood or adolescent cancer are less likely to achieve a pregnancy and, once pregnant, are at higher risk for severe maternal morbidity and preterm birth.