Cases Of Pregnancy Loss Research Articles

Cell-Free DNA Analysis of Fetal Aneuploidies in Early Pregnancy Loss.

Background: Products of conception samples are often collected and analyzed to try to determine the cause of an early pregnancy loss. However, sample collection may not always be possible, and maternal cell contamination and culture failure can affect the analysis. Cell-free DNA-based analysis of a blood sample could be used as an alternative method in early pregnancy loss cases to detect if aneuploidies were present in the fetus. Methods: In this prospective study, blood samples from early pregnancy loss patients were analyzed for the presence of fetal aneuploidies using a modified version of a noninvasive prenatal testing assay for cell-free DNA analysis. Results from cell-free DNA analysis were compared against the gold standard, microarray analysis of products of conception samples. This study was registered with ClinicalTrials.gov, identifier: NCT04935138. Results: Of the 76 patient samples included in the final study cohort, 11 were excluded from performance calculations. The 65 patient samples included in the final analysis included 49 with an abnormal microarray result and 16 with a normal microarray result. Based on results from these 65 samples, the study found that genome-wide cell-free DNA analysis had a sensitivity of 73.5% with a specificity of 100% for the detection of fetal aneuploidies in early pregnancy loss cases. Conclusions: This prospective study provides further support for the utility of cell-free DNA analysis in detecting fetal aneuploidies in early pregnancy loss cases. This approach could allow for a noninvasive method of investigating the etiology of miscarriages to be made available clinically.

Correlation between sperm DNA fragmentation and methylation in male partners of couples with idiopathic recurrent pregnancy loss

With ∼50% recurrent pregnancy loss cases being termed idiopathic (iRPL), understanding of contribution of male factors to iRPL is still lacking. Higher prevalence of sperm DNA fragmentation index (DFI) and lower sperm 5-methylcytosine (5-mC) levels have been previously reported in male partners of iRPL couples and shed light on importance of the male gamete in maintenance of a successful pregnancy. The present study aimed to determine the serum sex steroid hormone levels, sperm DFI and 5-mC and correlation between them in male partners of fertile and iRPL couples. Further, correlation between sperm DFI and 5-mC with semen parameters and paternal age in both groups were determined. 36 male partners of fertile couples and 45 male partners of women experiencing iRPL were enrolled for this study and semen and blood samples were collected. Serum testosterone and estradiol levels were measured by ELISA; sperm DFI and global 5-mC were determined by TUNEL assay and ELISA respectively. Significantly higher serum testosterone levels were noted in the iRPL group (p = 0.028). Incidence of sperm DNA fragmentation was found to be higher in the iRPL study group but with no significance difference. No significant differences in sperm 5-mC values were noted. Upon correlation analysis within both groups, strong significant negative correlation of sperm DFI % and 5-mC % was observed in the control group (p < 0.001) but not the iRPL group (p = 0.249). Hence, we infer that with lower 5-mC levels in sperm genome, there is a higher incidence of sperm DFI in fertile men. However, this trend is not noted in men of iRPL group which could possibly be due to other underlying epigenetic alterations in genomic regions probably unsusceptible to fragmentation. On the other hand, no significant correlations of semen parameters, testosterone, estradiol and paternal age with sperm DFI and 5-mC were noted in both groups.

Cervical Cerclage: Prolonging Gestational Period for Successful Pregnancy Outcome

Background: Cervical Cerclage may be an effective treatment option in true cervical insufficiency. Cervical function plays a crucial role to protect growing fetus in utero in maintaining successful pregnancy. As the gestational weeks progress, the cervix undergoes dynamic changes, including softening and shortening, to accommodate fetal growth. Objective: The objective of this study is to evaluate the effectiveness and outcome of cervical cerclage placement as a preventive measure against recurrent pregnancy loss and preterm delivery and its complications, to analyze pregnancy outcomes among participants who received cervical cerclage and to investigate the relationship between cervical cerclage and pregnancy outcome based on gestational age. Method and Materials: The study was conducted over three years at CMH, Jashore and Ibn Sina Hospital Jashore, utilizing a retrospective and longitudinal interventional approach. Ethical approval was obtained before commencing the study, which involved 92 cases undergoing mid-trimester cervical cerclage. Cervical length measurements, cervical cerclage using the McDonald technique, and subsequent medical management were performed with outcome analyzed using descriptive statistics and odds ratio. Data were analyzed retrospectively through SPSS data analysis tool. Result: 45.65% of patients experienced term deliveries, while 33.70% had preterm deliveries, with 20.65% facing abortions. Distinct inclusion criteria unveiled diverse outcomes, such as recurrent pregnancy loss cases showing 40.82% preterm and 38.78% term deliveries. Odds ratios highlighted cervical length's significance, with a 0.25 ratio indicating reduced preterm risk. Interestingly, 61.69% of preterm births occurred between 34 and 36 weeks. Maternal outcomes indicated low incidence rates of hemorrhage (4.8%), infections (1.1%) and cervix laceration (2.4%). Conclusion: The study underscores cervical cerclage's potential in enhancing full-term pregnancies, particularly for patients with cervical incompetence. While highlighting its success, the study also acknowledges associated risks and complications. J Bangladesh Coll Phys Surg 2024; 42: 57-62

Biochemical markers for prediction of the first half pregnancy losses: a review.

26% of all pregnancies end in miscarriage, and up to 10% of clinically diagnosed pregnancies, and recurrent pregnancy loss is 5% among couples of childbearing ages. Although there are several known causes of pregnancy loss in the first half, including recurrent pregnancy loss, including parental chromosomal abnormalities, uterine malformations, endocrinological disorders, and immunological abnormalities, about half of the cases of pregnancy loss in its first half remain unexplained. The review includes observational controlled studies (case-control or cohort, longitudinal studies, reviews, meta-analyses), which include the study of biochemical factors for predicting pregnancy losses in the first half, in singlet pregnancy. The Newcastle-Ottawa Scale (NOS) was used to assess the research quality. Finally, 27 studies were included in the review, which has 134904 examined patients. The results of the review include estimates of β-human chorionic gonadotropin, progesterone, pregnancy-associated protein - A, angiogenic vascular factors, estradiol, α-fetoprotein, homocysteine and CA-125 as a predictors or markers of the first half pregnancy losses. It may be concluded that to date, research data indicate the unavailability of any reliable biochemical marker for predicting pregnancy losses in its first half and require either a combination of them or comparison with clinical evidence. A fairly new model shall be considered for the assessment of α-fetoprotein in vaginal blood, which may have great prospects in predicting spontaneous miscarriages.

Expression of PD-L1 in human placenta and retained product of conception of early pregnancy loss

Abstract Introduction/Objective Immune surveillance evasion and impeding rejection by the maternal immune response system are elemental in sustaining foetal development. The exact mechanism behind this paradoxical immune response remains unclear. Since the trophoblast directly interacts with the maternal immune-environment, these cells must have some contribution to local immunosuppression. The programmed death-1 receptor and its ligands (PD- 1/PDL1)illustrates a novel regulatory-costulatory pathway that plays a major role in establishing peripheral tolerance. It was recently proved that PDL1 is expressed at the feto-maternal interface is necessary for maintaining feto-maternal tolerance. We undertook this study to determine the expression-pattern of PD-L1 in formalin-fixed paraffin embedded tissues of human placentas in third trimester and retained product in early spontaneous abortions. Methods/Case Report Clinical history were recorded. The H&amp;E sections of 40 placenta &amp; 20 RPOC cases were examined. After evaluation appropriate sections were selected for IHC examination using anti-PD-L1 antibodies of Lab-vision and Biogenic Results (if a Case Study enter NA) Main focus of study was to see expression of PD-L1 at feto-maternal interface. 30 out of 40 third-trimester placenta expressed PD-L1 immunohistochemistry (13, 11 and 6 cases showed intense, fair and weak positivity respectively on outer surface of syncytiotrophoblast). 2 out of 20 early pregnancy loss cases in 11 &amp; 9wk gestation expressed PD-L1 positivity. Conclusion Fetal cells in direct contact with maternal blood villous syncytiotrophoblast are major source of PD-L1 at the maternal-fetal interface and may utilize these immuno-suppressive mechanisms to ensure tolerance of conceptus. Failure to adapt this mechanism can lead to pregnancy loss.

Does microfluidic sperm selection improve clinical pregnancy and miscarriage outcomes in assisted reproductive treatments? A systematic review and meta-analysis.

The microfluidic sperm selection (MFSS) device has emerged as a promising adjunct in assisted reproduction treatments (ART). It employs mechanisms of biomimicry based on the microanatomy of the female reproductive tract through strategies like chemotaxis and rheotaxis. Numerous studies assert improvements in ART outcomes with the use of MFSS, often attributed to the theoretical reduction in sperm DNA damage compared to other techniques. However, these attributed benefits lack validation through large-scale clinical trials, and there is no significant evidence of enhanced assisted reproductive treatments (ART) outcomes. To evaluate whether the utilization of MFSS enhances clinical pregnancy results and abortion outcomes in couples undergoing ART compared to standard sperm selection techniques for Intracytoplasmic Sperm Injection (ICSI). We also assessed laboratory outcomes as a supplementary analysis. We conducted searches across databases including PubMed, NIH, LILACS, CENTRAL, Crossref, Scopus, and OpenAlex. A total of 1,255 records were identified. From these, 284 duplicate records were eliminated, and an additional 895 records were excluded due to their association with patent applications, diagnostic tests, forensic analyses, or irrelevance to the research focus. Among the initially eligible 76 studies, 63 were excluded, encompassing abstracts, studies lacking adequate control groups, and ongoing clinical trials. Ultimately, 13 studies were selected for inclusion in the ensuing meta-analysis. Regarding clinical pregnancy, we assessed a total of 868 instances of clinical pregnancies out of 1,646 embryo transfers. Regarding miscarriage, we examined 95 cases of pregnancy loss among the 598 confirmed clinical pregnancies in these studies. The utilization of MFSS demonstrates marginal positive outcomes compared to standard sperm selection techniques, without statistical significance in any of the analyses. This study conducted the first meta-analysis to evaluate clinical pregnancy rates, miscarriage rates, and laboratory results associated with the use of MFSS compared to standard sperm selection techniques. We have also listed potentially eligible studies for future inclusion. It's important to emphasize the need for multicenter studies with standardized parameters to attain a more robust clarification of this issue.

Pregnancy loss in major fetal congenital heart disease: incidence, risk factors and timing.

Fetuses with congenital heart disease (CHD) are at increased risk of pregnancy loss compared with the general population. We aimed to assess the incidence, timing and risk factors of pregnancy loss in cases with major fetal CHD, overall and according to cardiac diagnosis. This was a retrospective, population-level cohort study of fetuses and infants diagnosed with major CHD between 1997 and 2018 identified by the Utah Birth Defect Network (UBDN), excluding cases with termination of pregnancy and minor cardiovascular diagnoses (e.g. isolated aortic/pulmonary pathology and isolated septal defects). The incidence and timing of pregnancy loss were recorded, overall and according to CHD diagnosis, with further stratification based on presence of isolated CHD vs additional fetal diagnosis (genetic diagnosis and/or extracardiac malformation). Adjusted risk of pregnancy loss was calculated and risk factors were assessed using multivariable models for the overall cohort and prenatal diagnosis subgroup. Of 9351 UBDN cases with a cardiovascular code, 3251 cases with major CHD were identified, resulting in a study cohort of 3120 following exclusion of cases with pregnancy termination (n = 131). There were 2956 (94.7%) live births and 164 (5.3%) cases of pregnancy loss, which occurred at a median gestational age of 27.3 weeks. Of study cases, 1848 (59.2%) had isolated CHD and 1272 (40.8%) had an additional fetal diagnosis, including 736 (57.9%) with a genetic diagnosis and 536 (42.1%) with an extracardiac malformation. The observed incidence of pregnancy loss was highest in the presence of mitral stenosis (< 13.5%), hypoplastic left heart syndrome (HLHS) (10.7%), double-outlet right ventricle with normally related great vessels or not otherwise specified (10.5%) and Ebstein's anomaly (9.9%). The adjusted risk of pregnancy loss was 5.3% (95% CI, 3.7-7.6%) in the overall CHD population and 1.4% (95% CI, 0.9-2.3%) in cases with isolated CHD (adjusted risk ratio, 9.0 (95% CI, 6.0-13.0) and 2.0 (95% CI, 1.0-6.0), respectively, based on the general population risk of 0.6%). On multivariable analysis, variables associated with pregnancy loss in the overall CHD population included female fetal sex (adjusted odds ratio (aOR), 1.6 (95% CI, 1.1-2.3)), Hispanic ethnicity (aOR, 1.6 (95% CI, 1.0-2.5)), hydrops (aOR, 6.7 (95% CI, 4.3-10.5)) and additional fetal diagnosis (aOR, 6.3 (95% CI, 4.1-10)). On multivariable analysis of the prenatal diagnosis subgroup, years of maternal education (aOR, 1.2 (95% CI, 1.0-1.4)), presence of an additional fetal diagnosis (aOR, 2.7 (95% CI, 1.4-5.6)), atrioventricular valve regurgitation ≥ moderate (aOR, 3.6 (95% CI, 1.3-8.8)) and ventricular dysfunction (aOR, 3.8 (95% CI, 1.2-11.1)) were associated with pregnancy loss. Diagnostic groups associated with pregnancy loss were HLHS and variants (aOR, 3.0 (95% CI, 1.7-5.3)), other single ventricles (aOR, 2.4 (95% CI, 1.1-4.9)) and other (aOR, 0.1 (95% CI, 0-0.97)). Time-to-pregnancy-loss analysis demonstrated a steeper survival curve for cases with an additional fetal diagnosis, indicating a higher rate of pregnancy loss compared to cases with isolated CHD (P < 0.0001). The risk of pregnancy loss is higher in cases with major fetal CHD compared with the general population and varies according to CHD type and presence of additional fetal diagnoses. Improved understanding of the incidence, risk factors and timing of pregnancy loss in CHD cases should inform patient counseling, antenatal surveillance and delivery planning. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.

Immunohistochemical study of MMP-2, MMP-9, EGFR and IL-8 in decidual and trophoblastic specimens of recurrent pregnancy loss cases

Background and Aim: Unexplained recurrent pregnancy loss has been a a challenging research task to experts since there is no explicit pathophysiological mechanism and therefore, the treatment remains elusive. Immunological imbalance and morphological abnormalities are under investigation. This study aims to evaluate the implication of MMP-2, MMP-9, EGFR, and IL-8 in recurrent pregnancy loss cases. Materials & Methods: The study was carried out through comparison among two groups; the unexplained miscarriage group which consisted of 22 women, and the control group consisted of 18 women, who had electively terminated their pregnancies. Both groups were in the first trimester of gestation. The specimens included the trophoblast, decidua basalis, and decidua parietalis. The study was conducted via immunohistochemical methods. Antibodies were used against MMP-2, MMP-9, EGFR, and IL-8. The results were presented at a contingency table and were statistically analyzed with the Chi-Square Test (X2). Results: There were remarkable disparities in some cases in the comparison of the two groups. MMP-9 was detected significantly high in recurrent pregnancy loss (RPL) cases, both on trophoblastic and decidual specimens (p-value < .00001), MMP-2 displayed no difference among the two groups (mild to moderate detection on trophoblast and almost negative on decidual tissues). EGFR was highly detected in trophoblastic tissue (p-value = .014). IL-8 detection was particularly different in both trophoblast and decidua parietalis of the two groups (p-value < .01). Conclusion: The study revealed both morphological and immunological dysregulations that might participate in the RPL pathogenesis.

Etiologic, diagnostic, and management aspects of patients with isthmic-cervical insufficiency

Isthmic-cervical insufficiency (ICI) is one of the main causes of recurrent miscarriage, leading to an increase in perinatal mortality rates and a deterioration of womens reproductive health. There are currently several methods for diagnosing ICI during pregnancy. In the non-pregnant state, its diagnosis is mainly made retrospectively based on a history of preterm birth due to shortening of the cervix. The main treatment for ICI during pregnancy is cervical cerclage. Despite the well-established technique, this surgical intervention is not always effective for prolonging pregnancy and is associated certain pregnancy risks, including uterine contractions, bleeding, and infection. Cases of cervical rupture after suturing have also been reported, which can ultimately lead to miscarriage or preterm delivery. There have been repeated cases of pregnancy loss in women even after the timely detection of ICI and surgical treatment, suggesting that these women are at risk of miscarriage in the future. For such patients, it is necessary to develop an examination algorithm to identify the various aspects of their cervical insufficiency and treatment at the pregravid stage.

Emergency physician gender is associated with early pregnancy loss management: a multisite retrospective cohort study

BackgroundPatients experiencing early pregnancy loss often first present to the emergency department (ED) where they can be managed non-operatively through expectant or medical management, or surgically by the obstetrical team....

From bench to in silico and backwards: What have we done on genetics of recurrent pregnancy loss and implantation failure and where should we go next?

Human reproduction goes through many challenges to its success and in many cases it fails. Cases of pregnancy loss are common outcomes for pregnancies, and implantation failures (IF) are common in assisted reproduction attempts. Although several risk factors have already been linked to adverse outcomes in reproduction, many cases remain without a definitive cause. Genetics of female reproduction is a field that may bring some pieces of this puzzle; however, there are no well-defined genes that might be related to the risk for recurrent pregnancy loss (RPL) and IF. Here, we present a literature review of the studies of genetic association in RPL and IF carried out in the Brazilian population and complemented with a database search to explore genes previously related to RPL and IF, where a search for genes previously involved in these conditions was performed in OMIM, HuGE, and CTD databases. Finally, we present the next steps for reproductive genetics investigation, through genomic sequencing analyses and discuss future plans in the study of RPL genetics. The combined strategy of looking for literature and databases is useful to raise hypotheses and to identify underexplored genes related to RPL and IF.

The Genetic and Genomic Landscape of Human Reproductive Disorders: An Overview with Our Experience

Genetics and genomics play a role in the causation of various human diseases. A large number of human reproductive disorders also arise as a result of genetic and genomic abnormalities. Reproductive disorders associated with predominantly genetics and genomic abnormalities are infertility, early pregnancy loss, congenital malformations, difference or disorder of sex development and reproductive cancers. The genetic etiology of human reproductive disorders is increasing with improved molecular biology techniques such as DNA microarray and next-generation sequencing. Infertility is one of the significant areas of reproductive disorders where genetics/genomics plays a substantial role and may result from chromosomal, copy number variation, Yq &amp; pseudo autosomal region microdeletion/microduplication, gene mutation (monogenic, oligogenic, polygenic), multifactorial, epigenetic, mitochondrial, etc. abnormalities. All idiopathic infertile couples should be screened for genetic disorders before assisted reproduction to prevent transmission, if any, in offspring. Pregnancy wastage in early pregnancy is very high (about 70%) and is mainly related to chromosome number, copy number variation, and some monogenic or epigenetic abnormalities. Therefore, all early pregnancy loss cases should also be tested for genetic causes. Congenital malformations are structural defects in embryo, fetus, or newborns and affect about 3% (major malformations) of all births. The malformations could be due to the abnormalities of chromosomes, copy number variation, monogenic, oligogenic, multifactorial, or environmental. Array CGH &amp;/or NGS should be used as the first step to screen congenital malformations. Differences/disorder of sex development is a developmental defect in which the determination and/or differentiation of chromosomal, gonadal, or phenotypic/anatomic sex is abnormal. It is a common disorder and is primarily related to genetic abnormalities. Therefore, a precise diagnosis, mainly through an array CGH and/or NGS, is crucial for the proper management to prevent future psychosexual problems and another birth with the disorder. Cancer is a genomic disorder characterized by genomic instability (due to a defect in DNA repair mechanism), uncontrolled replication (due to lack of response to inhibitory factors/loss of contact inhibition), neo-angiogenesis, invasion and metastasis. All cancer cases should be investigated for genomic markers (both hereditary and somatic) for precise diagnosis, prognosis, and genetic counseling. In this review, we will try to evaluate the role of genetics and genomics in the above-mentioned reproductive disorders, along with genetic &amp; genomic techniques used and reproductive counseling in addition to our experiences.

Whole genome bisulfite sequencing of sperm reveals differentially methylated regions in male partners of idiopathic recurrent pregnancy loss cases

To study the genome wide alterations in sperm DNA methylation in male partners of idiopathic recurrent pregnancy loss cases and note regions as potential diagnostic markers DESIGN: Case-Control study and methylome analysis of human sperm SUBJECTS: Control group consists of apparently healthy fertile men having fathered a child within the last 2 years (n = 39); and Case group consists of male partners of idiopathic recurrent pregnancy loss cases having two or more consecutive 1st trimester pregnancy losses (n = 47). None MAIN OUTCOME MEASURES: Sperm DNA samples of controls and cases were selected for Whole Genome Bisulfite Sequencing analysis based on the previously set thresholds of global methylation levels and methylation levels of imprinted genes (KvDMR and ZAC). Whole Genome Bisulfite Sequencing of selected sperm genomic DNA was performed to identify differentially methylated CpG sites of idiopathic recurrent pregnancy loss cases compared to fertile controls. Pathway analysis of all the differentially methylated genes was done by DAVID functional annotation tool and Kyoto Encyclopedia of Genes and Genomes tool. Differentially methylated CpGs within genes relevant to embryo and placenta development were selected to further validate their methylation levels in study population by pyrosequencing. A total of 9497 differentially methylated CpGs with highest enrichment in intronic regions were obtained. 5352 differentially methylated regions and 2087 differentially methylated genes were noted. Signaling pathways involved in development were enriched upon pathway analysis. Select CpGs within genes PPARG, KCNQ1, SETD2 and MAP3K4 showed distinct hypomethylated sub-populations within idiopathic recurrent pregnancy loss study population. Our study highlights the altered methylation landscape of idiopathic recurrent pregnancy loss sperm and their possible implications in pathways of embryo and placental development. The CpG sites that are hypomethylated specifically in sperm of idiopathic recurrent pregnancy loss sub-population can be further assessed as predictive biomarkers.

Potential safety signal of pregnancy loss with vascular endothelial growth factor inhibitor intraocular injection: A disproportionality analysis using the Food and Drug Administration Adverse Event Reporting System.

Objectives: Intraocular administration of vascular endothelial growth factor (VEGF) inhibitors may be associated with pregnancy loss. However, little is known about intraocular anti-VEGF therapy during pregnancy. Here, we conducted a pharmacovigilance study using a spontaneous reporting database to evaluate the relationship between intraocular VEGF inhibitors and pregnancy loss. Methods: We used the JAPIC AERS database which is composed of the Food and Drug Administration Adverse Event Reporting System (FAERS) dataset preprocessed by the Japan Pharmaceutical Information Center (JAPIC) to investigate the VEGF inhibitors ranibizumab, aflibercept, and bevacizumab. Disproportionality analyses were conducted for VEGF inhibitors and pregnancy loss. The lower limit of the 95% confidence interval (CI) of the reporting odds ratio (ROR) > 1 and a minimum of three reported cases of pregnancy loss were the detection criteria used in the current study. Results: In the FAERS, 19 pregnancy loss cases were reported for ranibizumab with an ROR of 4.44 (95% CI: 2.42-8.16), 6 for intraocular bevacizumab with an ROR of 32.25 (95% CI: 3.88-267.9), and 4 for intraocular aflibercept with an ROR of 5.37 (95% CI: 1.34-21.49). All these drugs met the detection criteria. Conclusion: Potential safety signals of pregnancy loss were obtained from intraocular administration of VEGF inhibitors during pregnancy. These signals should be validated using a causal design study.

THE ASSOCIATION IN SERUM VITAMIN D3 LEVELS IN PATIENTS WITH EARLY PREGNANCY LOSS

AIM: To nd out the association between vitamin D levels in normal pregnancy and pregnancy loss in the rst trimester. METHODOLOGY: -The present study was a hospital based comparative study conducted in 40 pregnant (7-9 weeks) women having pregnancy loss (Group I) and 40 pregnant (7-9 weeks) women having normal pregnancy coming to department of Obstetrics and Gynaecology, SMS medical college and associated hospitals, Jaipur, Rajasthan. The mean Vitamin D3 level in pregnancy loss cases RESULTS: was 17.77±6.56 ng/ml and in normal pregnancy group was 24.85±7.55 ng/ml. So the results showed that the mean Vitamin D3 level was signicantly higher in normal pregnancy group compare to early pregnancy loss cases. Pre CONCLUSION: sent study concluded that vitamin D has a signicant role during pregnancy started from early implantation and decidulization phase till late pregnancy

Pregnancy loss after in vitro fertilization and related factors

ABSTRACT Introduction: After getting pregnant by in vitro fertilization (IVF), pregnancy loss is one factor that prevents the baby from being born. An estimated 80% of pregnancy loss occurs in the first trimester, which is higher than in the natural pregnancy. The reason is said to be that the age of women receiving fertility treatment is often higher, leading to ovarian reserve, and decreased oocyte quantity and quality. However, studies on the pregnancy loss rate in Vietnam are still hard, and global studies still do not provide a complete consensus on the factors affecting this rate. This study aims to evaluate the pregnancy loss rate 12 weeks after in vitro fertilization and find some related factors. Methods: A cross-sectional descriptive study in embryo transfer patients after IVF treatment at Department of Assisted Reproduction in Hue Central Hospital was done from January 2020 to May 2021. Criteria for selection are pregnancy after embryo transfer (βhCG ≥ 25 UI/L after 14 days of embryo transfer) and having ultrasound monitoring up to 12 weeks gestation. Exclusion criteria include donor eggs, multifetal pregnancy reduction and ectopic pregnancy or hydatidiform mole. Results: There are 42 cases of pregnancy loss up to 12 weeks gestation in 133 pregnancies (βhCG ≥ 25 UI/L), equivalent to 31.6%. Among them were 9 cases of biochemical pregnancy, and 33 cases of pregnancy loss when having clinical pregnancy. The rate of at least one developing fetus to 12 weeks gestation is 102/133, equivalent to 76.7%. The pregnancy loss rate was statistically significantly lower in the group with endometriosis ≥ 10 mm before the embryo transferring date. Conclusion: Pregnancy loss after IVF is an issue that needs to be studied with a larger sample size to deeply understand the influencing factors to optimize the outcome of embryo transfer.

Male factor testing in recurrent pregnancy loss cases: A narrative review.

Recurrent pregnancy loss is a distinct disorder defined as the loss of at least 2 pregnancies before the 20 wk of gestation. With half of the genome of the embryo belonging to the father, the integrity of the sperm genome is crucial for a successful pregnancy. Semen analysis is recommended for men in such cases to evaluate sperm concentration, morphology, vitality and motility. However, other important sperm parameters such as sperm epigenetics, aneuploidy, Y chromosome microdeletion and chromatin integrity also correlate with successful pregnancy and delivery rate. This article examines the use of different sperm tests and their importance in male partners of women suffering from recurrent pregnancy loss.

Preconceptional evaluation of women with recurrent pregnancy loss: the additional value of assessing vascular and metabolic status

BackgroundA majority of recurrent pregnancy loss cases (RPL) remains unexplained. We hypothesized that complications in vascular and metabolic status may guide towards underlying problems that also predispose to RPL and that the number of pregnancy losses is related.MethodsA retrospective study in 123 women with either a history of low-order RPL (2–3 pregnancy losses) or high-order RPL (≥ 4 pregnancy losses) and 20 women with a history of uncomplicated pregnancy (controls) was performed. Vascular status was assessed by measuring hemodynamic parameters, determining abnormal parameters and analyzing their contribution to the circulatory risk profile (CRP). In a similar way, metabolic status was assessed. Metabolic parameters were measured, used to determine abnormal parameters and analyzed for their contribution to the metabolic syndrome (MetS).ResultsNo major differences were observed in vascular or metabolic parameters between women with RPL and controls. There was no relation with the number of pregnancy losses. However, when analyzing the presence of abnormal constituents, more than 80% of women with RPL had at least one abnormal constituent of the CRP. While only 27% had one or more abnormal constituent of the MetS.ConclusionsThe presence of abnormal circulatory factors prior to pregnancy, and to lesser extent constituents of the metabolic syndrome, may predispose to RPL and offer new insights to its pathophysiology.

Are the body shape index, the body roundness index and waist-to-hip ratio better than BMI to predict recurrent pregnancy loss?

PurposeEtiology could not be determined in approximately 50% of recurrent pregnancy loss cases, and it was named unexpected recurrent pregnancy loss(URPL). A body shape index(ABSI), body roundness index(BRI), and waist‐to‐hip ratio(WtHR) are new indexes that are superior to BMI in showing body fat distribution. We aimed to investigate the potency of ABSI, BRI, and WtHR in URPL, their superiority to BMI, and their suitability for clinical use.MethodsOne hundred and thirty‐eight patients between the ages of 20‐40 who applied to our hospital for URPL between January 2016 and December 31, 2020 were included in our study. Weight, height, waist circumference, and hip circumference were measured, and indexes were calculated. Differences between the URPL and control groups were calculated using the IBM SPSS program.ResultsThere was a significant difference between the two groups for BRI, ABSI, and WtHR values, while there was no significant difference in BMI. BRI(4.4 ± 1.7vs3.9 ± 1.5), ABSI(0.08 ± 0.005 vs 0.078 ± 0.004), and WtHR(0.84 ± 0.06vs0.82 ± 0.05) values were higher in the URPL group. ROC analysis showed us that BRI, ABSI, and WtHR have a diagnostic value for URPL(P < .05). When indexes were above the cutoff values, RPL risk increased 3.59 times in ABSI, 2.26 times in BRI, and 2.9 times in WtHR(P < .05).ConclusionsThe relationship between obesity and URPL can be explained more clearly by using effective indexes that show body fat distribution rather than BMI. Ethics committee approval was obtained from Erzincan Binali Yildirim University in 14.01.2021. Clinical Research Ethics Committee no: 01/01.

Estimation of pregnancy losses attributable to exposure to ambient fine particles in south Asia: an epidemiological case-control study

Maternal exposure to ambient particulate matter (PM2·5) is associated with pregnancy loss (ie, stillbirth and miscarriage). South Asia has the highest burden of pregnancy loss globally and is one of the most PM2·5 polluted regions in the world. However, knowledge of the relevant exposure-response function for mothers is insufficient. In this epidemiological case-control study, we collected data from Demographic and Health Surveys from India, Pakistan, and Bangladesh for the period 1998-2016 for women who reported at least one pregnancy loss and one or more livebirths. We assessed ambient exposure during gestation with satellite-based PM2·5 measurements for the period. To derive the exposure-response function, we did a self-compared case-control study in which each case of pregnancy loss was compared with a successful livebirth control or controls by the same mother. Using the estimated exposure-response function, we quantified pregnancy losses attributable to PM2·5 in the region for the period 2000-16 using a standard risk assessment approach. We assessed data for 34 197 mothers, who had at least one pregnancy loss and one or more livebirth, of whom 26 282 (76·9%) were from India, 4228 (12·4%) were from Pakistan, and 3687 (10·8%) were from Bangladesh. The 34 197 cases of pregnancy loss were matched with 76 282 livebirth controls. The mean level of PM2·5 exposure was 56·00 μg/m3 (SD 30·82) for cases and 54·57 μg/m3 (31·73) for controls. After adjustment for maternal age, non-linear terms for temperature and humidity, seasonal variation, and long-term trends, each 10 μg/m3 increment in PM2·5 was associated with an odds ratio for pregnancy loss of 1·03 (95% CI 1·02-1·05). According to the estimated non-linear exposure-response function by age and urban residence versus rural residence, for the period 2000-16, an estimated 349 681 (95% CI 152 932-489 493) pregnancy losses per year were attributed to ambient air exposure of more than 40 μg/m3 (the annual PM2·5 standard of India), accounting for 7·1% (95% CI 3·3-31·2) of the total annual pregnancy loss burden in south Asia for this period. However, our estimates could be biased because of the limitations of the data (eg, misclassification of induced and spontaneous pregnancy losses). Our findings add to epidemiological evidence of the association between pregnancy loss and PM2·5. Suboptimal air quality contributes to a considerable fraction of total pregnancy loss in south Asia. Controlling PM2·5 pollution will promote maternal health in south Asia. Chinese Natural Science Foundation and Ministry of Science and Technology of China.