Pregnancy Loss Rate Research Articles

Chronic endometritis diagnosed using a cut-off of ≥5 CD138 plasma cells significantly affects the reproductive outcomes of frozen embryo transfer: a case-control study.

To investigate the clinical significance of a diagnosis of chronic endometritis (CE) made using a diagnostic cut-off of ≥1 or ≥5 CD138 plasma cells per high power field (HPF) in asymptomatic patients undergoing in vitro fertilization (IVF) with frozen embryo transfer (FET). In this retrospective case-control study, 1,865 patients underwent freeze-all-IVF treatment between January and December 2019, with 419 undergoing endometrial biopsies at oocyte retrieval. Of the 419 biopsy-patients, 301 have since undergone first FET. The processed endometrial biopsies of the 301 patients underwent immunohistochemical (IHC) examination with anti-CD138 to count CD138+ plasma cells per HPF. CE diagnosis was defined as 0 CD138 plasma cells (control-group), ≥1 CD138 plasma cells (CEcontrol-group) or ≥5 CD138 plasma cells (CEdisease-group) per HPF. Twenty-six (8.6%) patients were retrospectively diagnosed having ≥1 CD138 plasma cells, and five patients (1.7%) having ≥5 CD138 plasma cells (CEdisease-group) per HPF. The live birth and pregnancy loss rates of the three groups were 52.7% and 27.9%, 53.8% and 26.3% and 20.0% and 66.7%, respectively. The antral follicle count (AFC) of the three groups were 15.0 (9.0-22.0), 10.5 (7.75-15.25), and 6.0 (5.0-14.0), respectively. Asymptomatic patients diagnosed with CE with ≥5 CD138 plasma cells per HPF, had the lowest live birth and highest pregnancy loss rates, with these patients also having significantly reduced AFC.

Overweight and Obesity Affect The Efficacy of Vaginal vs. Intramuscular Progesterone for Luteal-Phase Support in Vitrified-Warmed Blastocyst Transfer

ABSTRACT The prevalence of obesity in reproductive age women continues to increase worldwide. Recent meta-analyses suggest that female obesity is negatively associated with live birth rate (LBR) after in vitro fertilization, as well as a higher risk of miscarriage after euploid embryo transfer. The interplay between adiposity and reproductive hormones such as progesterone may be partially responsible, and research shows that obese women may require higher progesterone supplementation in frozen-thawed embryo transfer (FET). Although the vaginal route of progesterone supplementation has predominated in most in vitro fertilization centers globally, the route of supplementation has been gaining interest. Studies comparing different routes have focused on the general infertility population, and it remains essential to investigate the interrelationship between the routes of progesterone supplementation, overweight/obesity, and treatment outcomes. This retrospective cohort study aimed to compare the difference in the LBR between vaginal progesterone and intramuscular progesterone in cryopreserved blastocyst transfer cycles and assess whether obesity may modify these associations. Patients who underwent a single, vitrified-warmed, blastocyst transfer between January 2018 and June 2021 and received exogenous hormone replacement for endometrial preparation were included. The route of progesterone supplementation was based on patient preference. The primary study outcome was live birth, and secondary outcomes included a positive b-hCG test result, clinical pregnancy, miscarriage, and total pregnancy loss. Normal weight was defined as 18.5–24.9 kg/m2, overweight was defined as a body mass index (BMI) of 25–29 kg/m2, and obese was defined as ≥30 kg/m2. Multivariate regression was used to assess the association between the route of progesterone supplementation and LBR while controlling for known potential covariates, and an interaction analysis was performed with overweight/obesity as the interaction term. A total of 6905 FET cycles from 6251 patients were included for this analysis, with 4616 cycles using vaginal progesterone and 2289 cycles using intramuscular progesterone. The proportions of overweight and obese women were comparable between the 2 groups. After adjusting for confounding variables, the LBR in the vaginal and intramuscular progesterone groups were 46.23% (2134/4616) and 48.62% (1113/2289), respectively (adjusted odds ratio [aOR], 0.89; 95% confidence interval [CI], 0.81–0.98). Although the rates of a positive serum hCG result and clinical pregnancy were similar between the 2 groups, miscarriage rate (15.34% vs 11.40%; aOR, 1.40; 95% CI, 1.20–1.63) and total pregnancy loss (22.22% vs 18.90%; aOR, 1.23; 95% CI, 1.08–1.40) per FET were significantly higher in the vaginal progesterone group than in the intramuscular progesterone group. Among normal-weight women, the LBR was lower in the vaginal progesterone group than the intramuscular progesterone group (aOR, 0.84; 95% CI, 0.75–0.95), and among women with overweight/obesity, the LBR was similar between the 2 groups. Analysis with BMI as a continuous variable on route of progesterone showed a nonlinear relationship between route and LBR after adjustment. Among overweight/obese women, BMI modified the association between route of progesterone and LBR (P interaction = 0.047); however, among women with normal weight, this was not significant (P interaction = 0.569). The result of this study demonstrates that the rate of pregnancy loss for vaginal progesterone was significantly increased and resulted in a lower LBR in patients receiving vitrified blastocysts, and suggested that overweight/obesity influenced the relationship between route of progesterone supplementation and LBR. Interestingly, an LBR advantage for the intramuscular route over the vaginal route was observed exclusively in women with normal weight.

CHALLENGES FOR CHROMOSOME ANALYSIS IN PREGNANCY LOSS: LESSONS LEARNED FROM 1208 SAMPLE EXPERIENCE

Objective: Previous studies have shown that half of the spontaneous abortions were associated with fetal chromosomal abnormalities, however it is not always possible to reveal the reasons of pregnancy loss. The aim of the current study was to investigate the frequency of chromosome abnormalities and culture failure rates of pregnancy loss and compare the results with similar studies in the literature.
 
 Material and Methods: The karyotype analysis results of 1208 abortion materials which were obtained from long-term cultures of chorionic villus samples of the patients who were admitted to the Haseki Training and Research Hospital Genetic Diagnosis Center between August 2016 and February 2021, were evaluated retrospectively.
 
 Results: No results were obtained due to culture failure in approximately half of the materials. Numerical anomalies were observed in 87% (116) of abnormal karyotypes that consist of trisomy, monosomy X and triploidy. Trisomies were the most common anomaly. While the frequency of trisomy was significantly higher in the older age group (≥35 years) (p=0.001), the frequency of monosomy X and triploidy were higher in the younger age group. Chromosomal changes whose frequencies were not affected by maternal age were structural chromosomal abnormalities and tetraploidies.
 
 Conclusion: Since the developing new Technologies are still not affordable enough and their widespread use is limited. As a result, current approaches have indicated that chromosome analysis is still a necessary and useful method. It is thought that detecting the chromosomal anomaly that led to abortion facilitates multidisciplinary patient management and enables to provide more accurate and comprehensive genetic counseling. In cases where the chromosome analysis test is not informative, the application of DNA-based tests such as Quantitative Fluorescence PCR (QF-PCR) and molecular karyotyping may help the diagnosis.

Finding of the optimal preparation and timing of endometrium in frozen-thawed embryo transfer: a literature review of clinical evidence.

Frozen-thawed embryo transfer (FET) has been a viable alternative to fresh embryo transfer in recent years because of the improvement in vitrification methods. Laboratory-based studies indicate that complex molecular and morphological changes in endometrium during the window of implantation after exogenous hormones with controlled ovarian stimulation may alter the interaction between the embryo and endometrium, leading to a decreased implantation potential. Based on the results obtained from randomized controlled studies, increased pregnancy rates and better perinatal outcomes have been reported following FET. Compared to fresh embryo transfer, fewer preterm deliveries, and reduced incidence of ovarian hyperstimulation syndrome were found after FETs, yet there is a trend of increased pregnancy-related hypertensive diseases in women receiving FET. Despite the increased application of FET, the search for the most optimal priming protocol for the endometrium is still undergoing. Three available FET protocols have been proposed to prepare the endometrium: i) natural cycle (true natural cycle and modified natural cycle) ii) artificial cycle (AC) or hormone replacement treatment cycle iii) mild ovarian stimulation (mild-OS) cycle. Emerging evidence suggests that the optimal timing for FET using warmed blastocyst transfer is the LH surge+6 day, hCG administration+7 day, and the progesterone administration+6 day in the true natural cycle, modified natural cycle, and AC protocol, respectively. Although still controversial, better clinical pregnancy rates and live birth rates have been reported using the natural cycle (true natural cycle/modified natural cycle) compared with the AC protocol. Additionally, a higher early pregnancy loss rate and an increased incidence of gestational hypertension have been found in FETs using the AC protocol because of the lack of a corpus luteum. Although the common clinical practice is to employ luteal phase support (LPS) in natural cycles and mild-OS cycles for FET, the requirement for LPS in these protocols remains equivocal. Recent findings obtained from RCTs do not support the routine application of endometrial receptivity testing to optimize the timing of FET. More RCTs with rigorous methodology are needed to compare different protocols to prime the endometrium for FET, focusing not only on live birth rate, but also on maternal, obstetrical, and neonatal outcomes.

Metabolomic evolution of the postpartum dairy cow uterus.

High rates of early pregnancy loss are a critical issue in dairy herds, particularly in seasonal, grazing systems. Components of the uterine luminal fluid (ULF), on which the early embryo depends for sustenance and growth, partly determine early pregnancy losses. Here, changes in ULF from early to mid-postpartum in crossbred dairy cows were explored, linking them with divergent embryo development. For this, the uteri of 87 cows at Day 7 of pregnancy at first and third estrus postpartum were flushed to collect ULF. Eighteen metabolites (chiefly organic acids and sugars) significantly varied in abundance across postpartum, indicating a molecular signature of physiological recovery consistent of the upregulation of pyrimidine metabolism and glycerophospholipid metabolism, and downregulation of pentose phosphate and taurine metabolism pathways. Joint pathway analysis of metabolomics data and a previously generated proteomics data set on the same ULF samples suggests key links between postpartum recovery and subsequent successful embryo development. These include upregulation of VEGFA and downregulation of metabolism, NRF2, T-cell receptor, which appear to improve the ULF's capacity of sustaining normal embryo development, and a putative osmo-protectant role of beta-alanine. These relationships should be further investigated to develop tools to detect and reduce early pregnancy loss in dairy cows.

Effects of reduced follicle-stimulating hormone dosage before human chorionic gonadotropin trigger on in vitro fertilization outcomes

ObjectiveTo determine whether a reduced dose of follicle-stimulating hormone (FSH) before human chorionic gonadotropin (hCG) trigger during ovarian stimulation can affect in vitro fertilization (IVF) outcomes.MethodsThis study included 347 patients with a normal ovarian response who received a reduced dose of FSH before hCG trigger for 2–3 days (Group A) and 671 patients who did not receive a reduced dose (Group B) from a university-affiliated IVF center between January 2021 and December 2022. The primary endpoint was estrogen (E2) and progesterone (P) levels on the day of hCG trigger, fresh embryo transfer cycles, laboratory outcomes, and clinical outcomes between the two groups.ResultsOn the day of hCG trigger, Group A had significantly lower E2 and P levels than those in Group B (3454.95 ± 1708.14 pg/mL versus 3798.70 ± 1774.26 pg/mL, p = 0.003; and 1.23 ± 0.53 ng/mL versus 1.37 ± 0.59 ng/mL, p < 0.001, respectively). The proportion of patients with P levels ≥ 1.5 ng/mL was 22.48% in Group A compared to 34.58% in Group B (p < 0.001), while the proportion of patients with E2 ≥ 5000 pg/mL was 15.27% in Group A compared to 25.93% in Group B (p < 0.001). The fresh embryo-transfer cycle rate in Group A was higher than that in group B (54.47% and 32.64%, respectively; p < 0.001). Despite the reduction in FSH dosage, there were no significant differences between groups regarding the number of oocytes retrieved, total number of mature oocytes, normal fertilization rate, cleavage rate, Day 3 top-quality rate, implantation rate, pregnancy rate per cycle, and early pregnancy loss rate.ConclusionWhile a reduced dose of FSH prior to hCG trigger during ovarian stimulation did not significantly affect IVF outcomes, it was associated with lower E2 and P levels, resulting in fewer cycles with E2 ≥ 5000 pg/mL and P ≥ 1.5 ng/mL on the day of the hCG trigger.

Frozen-Thawed Embryo Transfer Using Autologous Oocytes Retrieved from Women Aged ≥45 Years: A Retrospective Study

Objective: To assess the pregnancy outcomes, including live birth rate and pregnancy loss for women aged 45–49 years at the time of oocyte retrieval, who underwent frozen autologous transfer of embryos. Methods: Among frozen-thawed embryo transfers (ET) performed at our clinic from September 2013 to March 2021, 1,114 cycles of women aged 45–49 years at the time of oocyte retrieval were examined retrospectively. Positive pregnancy test, clinical pregnancy, pregnancy loss, and live birth rates per transfer among each age group were analyzed using one-way analysis of variance or the Fisher’s exact test. Results: The mean age at the time of oocyte retrieval and ET was 45.8 and 46.5 years, respectively. Positive pregnancy test rate was 7.6%, of which 72.9% resulted in pregnancy loss. The clinical pregnancy and live birth rates were 5.1% and 2.0%, respectively, with a live birth rate of 3.0% for women with oocytes retrieved at 45 years of age. Multivariate analysis revealed that younger oocyte retrieval age was associated with biochemical and clinical pregnancy; however, no such association was observed for cases with live birth. The oocyte retrieval age of patients with live births was 45 years in 16 cases, 46 years in six cases, and 47 years in one case. In one case of live birth (46 years old), 21 trisomy was observed in the child; however, congenital abnormalities were not observed in other cases. Chorionic tests were performed on the fetuses in 12 of the 33 clinical abortions, of which 11 showed chromosomal abnormalities. Conclusions: Fertility treatment with autologous oocytes in advanced-age women has a low success rate. Although prognosis is poor above 45 years of age, these results can help in providing information to aid patients in their decisions regarding whether or not to pursue treatment.

Comparing the Effect of Monofilament and Braided Suture on Pregnancy Loss Rates in Women Requiring Vaginal Cervical Cerclage

Comparing the Effect of Monofilament and Braided Suture on Pregnancy Loss Rates in Women Requiring Vaginal Cervical Cerclage

Reproductive history does not compromise subsequent live birth and perinatal outcome following in-vitro fertilization: analysis of 25 329 first frozen-thawed embryo transfer cycles without preimplantation genetic testing for aneuploidy.

To investigate the effect of women's reproductive history on live-birth rate and perinatal outcome after first frozen-thawed embryo transfer (FET) without preimplantation genetic testing for aneuploidy. This was a retrospective cohort study of women who had undergone their first FET cycle between January 2014 and December 2020 at a university-affiliated fertility center. No transferred embryo underwent preimplantation genetic testing for aneuploidy. The women were categorized into five groups based on their reproductive history: no previous pregnancy; previous termination of pregnancy (TOP); previous pregnancy loss; previous ectopic pregnancy (EP); and previous live birth. The women with no previous pregnancy were considered as the reference group. The primary outcome was the live-birth rate and secondary endpoints included rates of positive pregnancy test, clinical pregnancy, pregnancy loss and EP as well as perinatal outcomes such as birth weight and preterm birth. Multivariable logistic regression analyses were used to control for a number of potential confounders, including age, body mass index, education level, duration and cause of infertility, insemination method, type of endometrial preparation, number of embryos transferred, embryo developmental stage, quality of the embryos transferred, year of treatment and endometrial thickness. Additionally, propensity score matching (PSM) was used to check the robustness of the main findings. In total, 25 329 women were included in the final analysis. On univariate analysis, each reproductive-history type except for previous EP was significantly associated with worse pregnancy outcome following in-vitro fertilization (IVF), including rates of positive pregnancy test, clinical pregnancy, pregnancy loss and live birth, when compared with the group of women with no previous pregnancy. However, after correcting for several potential confounders, the differences in rates of live birth, pregnancy loss, positive pregnancy test and clinical pregnancy were no longer significant between the study and control groups on multivariable regression models, while the risk of EP after embryo transfer was elevated among women with a previous TOP or EP. There was no increased risk of adverse perinatal outcome associated with reproductive history compared with the control group. Notably, similar results were obtained from the PSM models, confirming the robustness of the main findings. Relative to women without a previous pregnancy, those with a prior TOP, pregnancy loss, EP or live birth did not have compromised live-birth rate or perinatal outcomes following FET without preimplantation genetic testing for aneuploidy, with the exception of an increased risk of EP in those with prior TOP or EP. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.

Conception rate and pregnancy loss in fixed-time cattle embryo transfer programs are related to the luteal blood perfusion but not to the corpus luteum size

This study aimed to evaluate the effect of luteal blood perfusion and corpus luteum (CL) area on the conception rate and occurrence of pregnancy loss of recipients in a large-scale fixed-time embryo transfer (FTET) program. Multiparous Brangus cows (n = 1700) at 45 days postpartum and body condition scores (BCS) between 2.5 and 4.0 (3.0 ± 0.3) were used in this study. On a random day of the estrous cycle (day −10), the females received progesterone and estradiol based on the FTET protocol. On day 7, 1465 recipients had at least one CL and were evaluated using B-mode ultrasound for the CL area (cm2) and color Doppler for the luteal blood perfusion score (I/low-vascularization area <40% of the CL; II/medium-vascularization >45% to < 50%; and III/high-vascularization >50%). Immediately after CL evaluation, each recipient received a single fresh embryo (blastocyst stage) ipsilateral to the CL, in vitro produced from a commercial laboratory. Pregnancy diagnosis was performed at 30 days and repeated 60 days later to evaluate pregnancy loss (30–90 days). Ultrasound evaluation and embryo transfer were performed by a single technician. For data analysis, in addition to luteal blood perfusion groups, recipients were retrospectively ranked according to CL area into small (<3 cm2; 2.63 ± 0.01), medium (>3 to < 4 cm2; 3.44 ± 0.01), and large (>4 cm2; 4.77 ± 0.03). Data were analyzed using a logistic regression model (P < 0.05). The overall conception rate was 44.2% (648/1465), influenced by the luteal blood perfusion score [P = 0.03; high 48.4%a (134/277), medium 44.6%a (427/958), and low 37.8%b (87/230)] but not by CL area ranking [P = 0.37; large 41.8% (225/538), medium 45.2% (276/610), and small 46.4% (147/317)]. There was no interaction between the luteal blood perfusion score and CL area ranking (P = 0.81), and the BCS did not affect the results of this study (P = 0.51). In terms of pregnancy loss up to 90 days, there was no effect on the CL area ranking (P = 0.77), but the flow score showed an effect [P = 0.03; high 3.6%b (5/139), medium 9.3%a (44/471), and low 10.3%a (10/97)]. The conception rate and occurrence of pregnancy loss in the FTET program in beef cattle are related to luteal blood perfusion but not CL size.

Dolutegravir and pregnancy outcomes including neural tube defects in the USA during 2008–20: a national cohort study

A study from Botswana identified an increased risk of neural tube defects (NTDs) in infants of mothers with HIV who were treated with dolutegravir around the time of conception. We aimed to examine associations of dolutegravir use with NTDs and pregnancy loss using large health-care claims databases from the USA, a country with folic acid fortification of food. In this cohort study, we analysed health-care claims data, recorded in the Merative MarketScan commercial database (MarketScan data) and Centers for Medicare & Medicaid Services Medicaid database (Medicaid data) from Jan 1, 2008, to Dec 31, 2020. We identified pregnancies with enrolment during their entire duration among women aged 15-49 years and we estimated time of conception. For each pregnancy, we determined HIV status and periconceptional exposure to dolutegravir or other antiretroviral agents. We estimated and compared the incidence rate of NTDs, stillbirths, and pregnancy loss (ie, spontaneous or induced abortions) by type of periconceptional antiretroviral exposure. We calculated adjusted risk ratios of the adverse outcomes using Poisson models adjusting for demographic and clinical factors. Of 4 489 315 pregnancies in MarketScan data and 14 405 861 pregnancies in Medicaid data that had full enrolment, we identified 69 pregnancies in MarketScan data and 993 pregnancies in Medicaid data that were associated with HIV and periconceptional dolutegravir exposure. For women without HIV, the NTD rate was 4·1 per 10 000 live births (95% CI 3·9-4·3) in MarketScan and 5·7 per 10 000 live births (5·6-5·8) in Medicaid. No NTD cases were found among those with dolutegravir or non- dolutegravir antiretroviral drug exposure in the MarketScan data; only one NTD case was identified among women with dolutegravir, and three among women with non-dolutegravir antiretroviral exposure in Medicaid. After adjusting for covariates, there were no significant differences in risk ratios of NTD between groups with periconceptional dolutegravir or non-dolutegravir antiretroviral exposure and the group without HIV. However, compared with women without HIV, the risk of pregnancy loss was higher among women exposed to antiretroviral therapy: for dolutegravir exposure the adjusted risk ratio was 1·73 (95% CI 1·20-2·49) in MarketScan data and 1·41 (1·30-1·54) in Medicaid data; for non-dolutegravir antiretroviral exposure the adjusted risk ratio was 1·23 (1·10-1·37) in MarketScan data and 1·11 (1·07-1·15) in Medicaid data. We studied the largest US cohort of women with periconceptional or early-pregnancy dolutegravir exposure. Our results do not show an increased risk of NTDs in exposed infants in the USA. Administrative databases can be used, with rigorous methodology, to study correlates of rare outcomes, such as NTDs, and to monitor for adverse pregnancy outcomes in women who receive antiretrovirals. US Centers for Disease Control and Prevention.

Prophylactic low-molecular-weight heparin in women with thrombophilia undergoing in vitro fertilization.

To verify whether low-molecular-weight heparin (LMWH) could increase pregnancy rates and/or decrease abortion rates in women with thrombophilia undergoing assisted reproduction cycles. Cross-sectional study with patients undergoing in vitro fertilization (IVF) (N = 104). Women without thrombophilia (control group, n = 20), women with thrombophilia who did not receive LMWH (untreated group, n = 30), and women with thrombophilia, treated with daily enoxaparin from the day of embryo transfer until week 36 of gestation (treated group, n = 54). All women underwent controlled ovarian hyperstimulation. IVF was performed by intracytoplasmic sperm injection, and embryos were transferred on day 3. Pregnancy was detected by β-human chorionic gonadotropin (biochemical pregnancy) and fetal heartbeat at week 5 to 6. Ongoing pregnancy was determined by ultrasound on week 12. Patients in the untreated thrombophilia group presented with significantly lower ongoing pregnancy rates and live birth rates and significantly higher early pregnancy loss and abortion rates when compared with the control and the treated thrombophilia groups. In women with diagnosed coagulation disorders, use of LMWH is important to avoid miscarriages.

Effects of NGS-based PGT-a for idiopathic recurrent pregnancy loss and implantation failure: a retrospective cohort study

To clarify the effect of next-generation sequencing (NGS)–based preimplantation genetic testing for aneuploidy (PGT-A) combined with trophectoderm (TE) biopsy on the pregnancy outcomes of idiopathic recurrent pregnancy loss (iRPL) and idiopathic recurrent implantation failure (iRIF), we conducted a retrospective cohort study of 212 iRPL couples and 66 iRIF couples who underwent PGT-A or conventional in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) treatment. The implantation rate (IR) per transfer (64.2%), clinical pregnancy rate (CPR) per transfer (57.5%), and live birth rate (LBR) per transfer (45%) of iRPL couples of the PGT-A treatment group were significantly higher (p < 0.05) than those of the conventional IVF/ICSI group (IR per transfer,38.2%; CPR per transfer,33.3%; LBR per transfer, 28.4%), whereas the pregnancy loss rate (PLR) per transfer was similar between the two groups. These effects were also significant (p < 0.05) in iRPL couples with advanced maternal age (AMA, ≥35 years), whereas no significant differences were found in clinical outcomes between the PGT-A and conventional IVF/ICSI groups in younger iRPL couples (<35 years). The cumulative clinical outcomes of iRPL couples were comparable between the PGT-A and conventional IVF/ICSI groups. No significant differences were found in any clinical outcomes between the PGT-A and conventional IVF/ICSI groups for young or AMA couples with iRIF. In conclusion, NGS-based PGT-A involving TE biopsy may be useful for iRPL women to shorten the time to pregnancy and reduce their physical and psychological burden, especially for iRPL women with AMA; however, couples with iRIF may not benefit from PGT-A treatment. Considering the small sample size of the iRIF group, further investigations with a larger sample size are needed to verify our findings.

A comparison of culture and cooling for the short term preservation of in vivo derived dromedary camel embryos of varying morphological quality

Despite recent advancements in the cryopreservation of dromedary camel embryos, widespread application of the technique is still limited by the need for specialised vitrification equipment and supplies. Temporary, liquid-phase embryo storage methods provide a useful tool for short-term preservation of camel embryos.In the current study, we compared the use of in vitro embryo culture with cold liquid storage in order to maintain both high- (Grade 1- Excellent and 2-Good) and low- (Grade 3- Moderate and 4-Poor) morphological grade Day-7 dromedary camel embryos in vitro for up to 3 days. Embryos were either cooled and placed in Hams-F10 medium supplemented with HEPES and 10% FBS and then kept at 4 °C; or placed in Hams-F10 supplemented with sodium bicarbonate and 10% FBS and then cultured in a humidified atmosphere of 6% CO2 at 37 °C before being assessed for viability at 24 h. In high-morphological grade embryos, both cold storage and culture supported 100% viability (maintenance of normal morphology) over this period (Cooled n = 22, Cultured n = 20). In low-morphological grade embryos, culture supported higher viability (16/18, 88.9%) than did cooling (4/18, 22.2%). We then evaluated the effect of up to 3 days of cold storage or culture on embryo morphological grade, diameter, and developmental competence following embryo transfer. High-grade embryos were divided between culture and cold storage; low-grade embryos were evaluated only after culture. Over 3 days of culture, both high- and low-grade embryos tended to either maintain or improve upon their initial morphological score (P < 0.05) and increased in diameter (P < 0.001). Embryos subjected to cooling tended to have reduced morphological scores by 48 h of storage and decreased in diameter by 72 h (P < 0.05). No significant influence of storage method (cooling vs. culture), duration (24–72 h), or embryo grade (high vs low) was observed on pregnancy establishment at Day-60 (22.2%–57.2% pregnancy rates for all treatments). Overall, rates of pregnancy establishment were similar for transferred cultured (n = 45) and cooled (n = 45) embryos (pregnancy rates at Day 18, 48% vs 51.1%; at Day 60, 37.7% vs 37.7%). Rates of embryonic loss also were similar (22.7% vs 26%).In conclusion, whilst similar rates of pregnancy and pregnancy loss were observed following the transfer of both cooled and cultured embryos held in vitro for up to 3 days, amongst the two methods, only embryo culture appears to provide a means of effectively preserving Day- 7 dromedary camel embryos with reduced morphological values in vitro. Considering these embryos appear to show poor tolerance to the cooling procedure and are unlikely candidates for vitrification, embryo culture may provide an effective method for deriving pregnancies from low-morphological grade embryos when immediate transfer is not possible on the day of flushing.

SARS-CoV-2 in early pregnancy-does it affect the aneuploidy screening markers and cause pregnancy loss?

It is known that vertical transmission of various infections poses a potential risk to the fetus, especially in early pregnancy. Potential effects of SARS-CoV-2 infection on early pregnancy and placental formation and functions still remain unknown. To determine the alterations of prenatal aneuploidy screening markers in a group of pregnant women who were SARS-CoV-2 positive during the first trimester. The secondary goal was to assess pregnancy loss rates. The study group consisted of pregnant women who were diagnosed with mild forms of SARS-CoV-2 infection before the screening test at any time in early pregnancy. The control group included pregnant women who were not diagnosed with SARS-CoV-2 infection during their pregnancy. SARS-CoV-2 infection was detected by RT-PCR in the nasopharyngeal swab samples. Multivariate linear regression analysis was performed due to evaluate effect of SARS-CoV-2 infection on NT and serum aneuploidy screening parameters taking maternal age and gestational age which the COVID-19 RT-PCR test result was positive into account. We did not find any significant difference between the COVID-19-positive and COVID-negative groups in gestational age at screening, sonographic measurements of CRL, NT, and serum levels of PAPP-A, free hCG, and triple test serum markers even after accounting for maternal age and gestational age which the COVID-19 RT-PCR test result was positive. There was no statistically significant difference in pregnancy loss. We did not find any evidence for unfavorable prenatal biochemical, ultrasound markers of fetal aneuploidy screening tests, and pregnancy loss rates in our study group.

Association between serum LH levels on hCG trigger day and live birth rate after fresh embryo transfer with GnRH antagonist regimen in different populations.

To investigate whether serum LH levels on hCG trigger day are associated with live birth rate (LBR) after fresh embryo transfer with GnRH antagonist regimen in different populations. This study was a retrospective study. A total of 3059 fresh embryo transfers were divided into three populations: predicted normal ovarian responders (NOR) (n=2049), patients with PCOS (n=533), and predicted poor ovarian responders (POR) (n=477). Each population was stratified into three groups based on LH levels: < 25th percentile, 25-75th percentile, and > 75th percentile. The primary outcome of the study was LBR, and secondary outcomes included implantation, clinical pregnancy, and early pregnancy loss rates. Univariable and multivariable regression analyses were performed to adjust for potential confounders. In NOR, compared to the reference group (>75th percentile), LBR was significantly lower in the < 25th percentile group (adjusted OR=0.662; 95%CI, 0.508-0.863) and 25-75th percentile group (adjusted OR=0.791; 95%CI, 0.633-0.988). In PCOS patients, LBR decreased significantly in the < 25th percentile group (41.4%) compared to the 25-75th percentile group (53.7%) and > 75th percentile group (56.1%). In addition, the LBR was lower in the < 25th percentile group (33.6%) compared with the 25-75th percentile group (43.4%) and the>75th percentile group (42.0%) in POR, but this was not statistically significant. High serum LH levels are associated with increased LBR after fresh embryo transfer in GnRH antagonist cycles, which may be attributable to higher implantation rate. LH may be a predictor of whether to schedule fresh embryo transfer in IVF cycles for better clinical outcomes.

Fetal Outcomes and Prognostic Factors After Radiofrequency Ablation for the Selective Reduction in Complicated Monochorionic Multiple Pregnancies

Monochorionic pregnancies are responsible for some severe complications, and selective reduction of a single fetus can improve pregnancy outcomes. This study evaluated the fetal outcomes and procedure-related prognostic factors after radiofrequency ablation (RFA) in complicated monochorionic multiple pregnancies. This prospective cross-sectional study was conducted in an academic center from June 2020 to January 2022. The participants were 70 women with monochorionic multiple pregnancies who were candidates for selective fetal reduction by RFA. All participants' demographic data, RFA-related information, and pregnancy outcomes were evaluated and reported. The RFA procedure was successful in all participants. The most frequent RFA indications were twin-to-twin transfusion syndrome following selective intrauterine growth restriction. The mean gestational age at birth was 33.60±5.62 weeks. Also, 11 (15.7%) of the cases had preterm delivery up to 30 days after RFA. The total pregnancy loss rate was 12 (17.14%), and the total fetal survival rate after RFA was 82.85%. The mean time of the RFA procedure was 130.8±83.3seconds.The procedure was conducted easily in 31 (44.2%) cases. Althoughthe meantime of RFA procedure was longer in the not-easy group, the difference in surgery time was not significant (P=.296). There was no significant relationship (P=.623) between RFA indications and the gestational age of the remained fetus at delivery. The RFA needle was passed through the placenta in 18 (25.7%) cases. The mean gestational age at the delivery time was significantly lower in this group compared to their counterparts' gestational ages without needle placental passage (P=.030). Also, there was no significant correlation between gestational age at pregnancy termination and RFA cycles (P=.219). RFA is a relatively safe and minimally invasive procedure for the selective reduction of complicated monochorionic fetuses. Althoughmortality, premature membrane rupture, and preterm delivery are the potential risk factors for the remaining co-twin. According to this study, gestational age at the time of the procedure and passing the needle through the placenta can affect the outcome. Other procedure-related factors like easy- or hard-access procedures, and the number of RFA cycles are not significantly associated with gestational age at birth.

Understanding the Mental Health Impact of Previous Pregnancy Loss Among Currently Pregnant Veterans.

Pregnancy loss, including miscarriage and stillbirth, is common and associated with an increased risk for prenatal and postnatal depression, as well as posttraumatic stress disorder (PTSD). Racial disparities have been observed in pregnancy loss, with Black women having higher rates of pregnancy loss and postnatal depression. However, no research to date has examined the mental health and demographic correlates of pregnancy loss within a veteran population. The current study examined associations between pregnancy loss and mental health and demographic correlates among 1,324 pregnant veterans, of which 368 had a history of at least one stillbirth and/or miscarriage. Veterans with a history of pregnancy loss, compared with those without, were more likely to have a diagnosis of anxiety (52.7% vs. 46.4%, p=.04), depression (62.5% vs. 50.8%, p=.0001), or PTSD (46.5% vs. 37.6%, p=.003); were more likely to report receiving mental health care during pregnancy (23.1% vs. 16.8%, p=.01); and were more likely to have experienced military sexual trauma (harassment: 56.5% vs. 49.9%, p=.04; rape: 38.9% vs. 29.3%, p=.0004). Results also indicated that Black veterans were more likely to report a history of pregnancy loss (32.1% vs. 25.3%, p=.01). Further, Black veterans were more likely to experience clinically meaningful prenatal depression symptoms (adjusted odds ratio: 1.90; 95% confidence interval: 1.42-2.54) after accounting for past loss and age in logistic regression models. Taken together, findings from the present investigation corroborate previous research highlighting the deleterious impact of pregnancy loss and extend prior work by examining these associations among a diverse sample of pregnant veterans.

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.

The risk factors and impact of subchorionic hematoma in the first trimester in IVF twin pregnancies: a prospective cohort study.

This study aimed to identify the risk factors for subchorionic hematoma (SCH) in the first trimester of in vitro fertilization (IVF) twin pregnancies and investigate the impact of SCH on pregnancy outcomes. A prospective cohort study was conducted at Chengdu Women and Children's Central Hospital. The study recruited patients who were identified with twin pregnancies in the first trimester, undergoing IVF treatment from January 2020 to May 2021. The demographic characteristics and pregnancy outcomes were compared between the SCH and the non-SCH groups. A logistic regression analysis was used to determine the risk factors for SCH and adverse pregnancy outcomes. In the first trimester, 38% of patients developed SCH. The independent risk factors for SCH included male factor, hydrosalpinx, polycystic ovary syndrome (PCOS), previous miscarriage, and adenomyosis. With respect to the pregnancy outcomes, only the rate of twin pregnancy loss before 20 gestational weeks was significantly higher in the SCH group than in the non-SCH group. After adjusting for the confounding factors, the presence of SCH diminished the ovarian reserve, and previous miscarriage was independently related to twin pregnancy loss before 20 gestational weeks. This may be the first study to evaluate the risk factors of SCH in twin pregnancies who underwent IVF-ET/FET treatment, which may provide some theoretical basis for clinical practice in the future. Furthermore, it was found that the occurrence of SCH was associated with the loss of both pregnancies before 20 gestational weeks. Therefore, these patients should be offered increased surveillance and timely treatment.