Reproductive Goals Research Articles

Personal reflections 25 years after the International Conference on Population and Development in Cairo

Personal reflections 25 years after the International Conference on Population and Development in Cairo

Implementation of reproductive life planning (RLP) in primary health care supported by an evidence-based website

Objectives: The aims of the study were to evaluate how well the reproductive life plan (RLP) tool was implemented in practice and explore the utility of the website www.reproduktivlivsplan.se for patient counselling.Methods: A cross-sectional study was conducted in 2018, in which 73 midwives in primary health care were asked to use the RLP tool and the website in their daily practice. Three months later, participants answered a questionnaire, based on normalisation process theory (NPT), about their implementation experience.Results: The response rate was 73% (n = 53). The mean length of midwifery experience was 15 years. Almost all respondents (89%) reported a positive attitude towards the tool and the website and their ability to use them in practice. The majority agreed to all statements about implementation of the RLP, according to NPT. Use of the RLP also made it easier for midwives to support clients in forming reproductive goals (85%, n = 45), give family planning advice (81%, n = 43), give advice about how to improve health before pregnancy (85%, n = 45) and give advice about how to preserve fertility (89%, n = 47). Nine out of ten respondents said they would recommend the website to other midwives.Conclusion: The RLP was well implemented among the respondents and the majority considered the website to be a useful tool. Long-term studies are needed to further elucidate the effects of the RLP on changes in health behaviour and pregnancy outcomes.

A testing paradigm for quantifying ICC profilers

To reproduce colors in one system which differs from another system in terms of the color gamut, it is necessary to use a color gamut mapping process. This color gamut mapping is a method to translate a specific color from a medium (screen, digital camera, scanner, digital file, etc) into another system having a difference in gamut volume. There are different rendering intent options defined by the International Color Consortium [5] to use the different reproduction goals of the user [19]. Any rendering intent used to reproduce colors, includes profile engine decisions to do it, i.e. looking for color accuracy, vivid colors or pleasing reproduction of images. Using the same decisions on different profile engines, the final visual output can look different (more than one Just Noticeable Difference[16]) depending on the profile engine used and the color algorithms that they implement. Profile performance substantially depends on the profiler engine used to create them. Different profilers provide the user with varying levels of liberty to design a profile for their color management needs and preference. The motivation of this study is to rank the performance of various market leading profiler engines on the basis of different metrics designed specifically to report the performance of particular aspects of these profiles. The study helped us take valuable decisions regarding profile performance without any visual assessment to decide on the best profiler engine.

Integrating preexposure prophylaxis delivery in routine family planning clinics: A feasibility programmatic evaluation in Kenya.

BackgroundYoung women account for a disproportionate fraction of new HIV infections in Africa and are a priority population for HIV prevention, including implementation of preexposure prophylaxis (PrEP). The overarching goal of this project was to demonstrate the feasibility of integrating PrEP delivery within routine family planning (FP) clinics to serve as a platform to efficiently reach at-risk adolescent girls and young women (AGYW) for PrEP in HIV high-burden settings.Methods and findingsThe PrEP Implementation in Young Women and Adolescents (PrIYA) program is a real-world implementation program to demonstrate integration of PrEP delivery for at-risk AGYW in FP clinics in Kisumu, Kenya. Between November 2017 and June 2018, women aged 15 to 45 from the general population seeking FP services at 8 public health clinics were universally screened for HIV behavioral risk factors and offered PrEP following national PrEP guidelines. We evaluated PrEP uptake and continuation, and robust Poisson regression methods were used to identify correlates of uptake and early continuation of PrEP, with age included as a one-knot linear spline. Overall, 1,271 HIV-uninfected women accessing routine FP clinics were screened for PrEP; the median age was 25 years (interquartile range [IQR]: 22–29), 627 (49%) were <24 years old, 1,026 (82%) were married, more than one-third (34%) had partners of unknown HIV status, and the vast majority (n = 1,200 [94%]) reported recent condom-less sex. Of 1,271 women screened, 278 (22%) initiated PrEP, and 114 (41%) returned for at least one refill visit after initiation. PrEP uptake was independently associated with reported male-partner HIV status (HIV-positive 94%, unknown 35%, HIV-negative 8%; p < 0.001) and marital status (28% unmarried versus married 21%; p = 0.04), and a higher proportion of women ≥24 years (26%; 191/740) initiated PrEP compared to 16% (87/531) of young women <24 years (p < 0.001). There was a moderate and statistically non-significant unadjusted increase in PrEP uptake among women using oral contraception pills (OCPs) compared to women using injectable or long-acting reversible contraception methods (OCP 28% versus injectable/implants/intrauterine devices [IUDs] 18%; p = 0.06). Among women with at least one post-PrEP initiation follow-up visit (n = 278), no HIV infection was documented during the project period. Overall, continuation of PrEP use at 1, 3, and 6 months post initiation was 41%, 24%, and 15%, respectively. The likelihood for early continuation of PrEP use (i.e., return for at least one PrEP refill within 45 days post initiation) was strongly associated with reported male-partner HIV status (HIV-positive 67%, -negative 39%, unknown 31%; overall effect p = 0.001), and a higher proportion of women ≥24 years old continued PrEP at 1 month compared with young women <24 years old (47% versus 29%; p = 0.002). For women ≥24 years old, the likelihood to continue PrEP use at 1 month post initiation increased by 3% for each additional year of a woman’s age (adjusted prevalence ratio [PR]: 1.03; 95% confidence interval [CI]: 1.01–1.05; p = 0.01). In contrast, for women <24 years old, the likelihood of continuing PrEP for each additional year of a woman’s age was high in magnitude (approximately 6%) but statistically non-significant (adjusted PR: 1.06; 95% CI: 0.97–1.16; p = 0.18). Frequently reported reasons for discontinuing PrEP were low perceived risk of HIV (25%), knowledge that partner was HIV negative (24%), experiencing side effects (20%), and pill burden (17%). Study limitations include lack of qualitative work to provide insights into women’s decision-making on PrEP uptake and continuation, the small number of measured covariates imposed by the program data, and a nonrandomized design limiting definitive ascertainment of the robustness of a PrEP-dedicated nurse-led implementation strategy.ConclusionsIn this real-world PrEP implementation program in Kenya, integration of universal screening and counseling for PrEP in FP clinics was feasible, making this platform a potential “one-stop” location for FP and PrEP. There was a high drop-off in PrEP continuation, but a subset of women continued PrEP use at least through 1 month, possibly indicating further reflection or decision-making on PrEP use. Greater efforts to support PrEP normalization and persistence for African women are needed to help women navigate their decisions about HIV prevention preferences as their reproductive goals and HIV vulnerability evolve.

Oocyte disposition preferences: planning for the future

To characterize the frozen oocyte disposition preferences of patients undergoing medical and social fertility preservation Descriptive Study This descriptive study was performed using data collected between 2011 and 2018 in the Division of Reproductive Endocrinology and Infertility at Northwestern University. Demographic and cycle information was collected for each patient. Medical diagnosis was collected for each medical fertility preservation patient. Medical and social fertility preservation (FP) patients were distinguished based on documentation in their initial consult note in the electronic medical record. Disposition options included: disposal, donation to research, or donation to a specified third party which was decided at the time of initial consent and scanned into the patient chart. The demographic parameters were compared between the two groups using chi-squared analysis. 578 oocyte vitrification cycles were identified between 2011 and 2018. 15 cycles were noted to have no documented disposition preference and were excluded from the analysis. 143 cycles corresponded to medical FP patients and 435 to social FP. Medical FP patients were more likely to be under the age of 35, have a higher BMI, and have had a prior live birth. In both groups, the most commonly selected option was donation to research (48.3% social, 48.3% medical), followed by donation to a specified third party (27.4% social, 28.7% medical) and finally disposal of oocytes (22.8% social, 17.5% medical). Our data shows that oocyte disposition choices are similar in patients undergoing oocyte vitrification for medical and social indications. Both groups most commonly elect donation to research, followed by donation to a specified third party. Disposal of oocytes was the least common disposition choice for both groups. While oocyte vitrification is a relatively new technology, utilization of these frozen gametes is low. Disposition preferences will become increasingly important as this patient population ages and meets their reproductive goals. Formalized research protocols need to be established to accommodate this anticipated increase in oocytes available for research.

The family planning quotient and reproductive life index (FPQ/RepLI) tool: a solution for family planning, reproductive life planning and contraception counseling

ObjectiveAccess to comprehensive and culturally appropriate reproductive life planning is essential to women’s health. Although many strategies and tools exist, few are designed for longitudinal use or provide visual aids. Our objective is to present the Family Planning Quotient (FPQ) and Reproductive Life Index (RepLI) (FPQ/RepLI) tool we created to facilitate the discussion of family planning and reproductive life goals between patients and providers and to provide a summary our evaluation of the tool. This tool was developed as a response to the Centers for Disease Control and Prevention’s charge of developing a tool that could help facilitate reproductive life planning by giving the patient a better understanding of their reproductive goals and trajectory.Study designThis cross-sectional evaluation of our tool took place with patients and providers at an urban, public hospital in Chicago. Patients spoke with a health educator about their sexual, gynecological, and obstetric history to complete the FPQ/RepLI tool. Our primary objective was to measure the proportion of women who indicated the tool was helpful and that they would use it to track their reproductive goals.Main outcome measuresPatients and providers completed an evaluation survey rating their satisfaction with the tool. Survey responses were summarized using frequencies and percentages.ResultsDuring the study, 790 patients completed the evaluation.. Most patients (n = 725, 91.9%) agreed that the tool was helpful and that they would use it to track their reproductive goals. Fifty-five (83.5%) providers agreed that there is a need for reproductive health tools in clinical practice.ConclusionsMost agreed that the tool helped the patient communicate goals, aided in educating about contraception, and facilitated the discussion and decision-making process about available contraceptives. The tool gives patients a resource for family and reproductive goal planning. Broad dissemination amongst other medical specialties beyond obstetrics and gynecology may make reproductive life planning accessible to more women.

High Incidence of Intended Partner Pregnancy Among Men Living With HIV in Rural Uganda: Implications for Safer Conception Services.

Many men with HIV express fertility intentions and nearly half have HIV-uninfected sexual partners. We measured partner pregnancy among a cohort of men accessing antiretroviral therapy in Uganda. Self-reported partner pregnancy incidence and bloodwork (CD4, HIV-RNA) were collected quarterly. Interviewer-administered questionnaires assessed men's sexual and reproductive health annually and repeated at time of reported pregnancy (2011-2015). We measured partner pregnancy incidence overall, by pregnancy intention and by reported partner HIV serostatus. We assessed viral suppression (≤400 copies/mL) during the periconception period. Cox proportional hazard regression with repeated events identified predictors of partner pregnancy. Among 189 men, the baseline median age was 39.9 years (interquartile range: 34.7-47.0), years on antiretroviral therapy was 3.9 (interquartile range: 0.0-5.1), and 51% were virally suppressed. Over 530.2 person-years of follow-up, 63 men reported 85 partner pregnancies (incidence = 16.0/100 person-years); 45% with HIV-serodifferent partners. By 3 years of follow-up, 30% of men reported a partner pregnancy, with no difference by partner HIV serostatus (P = 0.75). Sixty-nine percent of pregnancies were intended, 18% wanted but mistimed, and 8% unwanted. Seventy-eight percent of men were virally suppressed before pregnancy report. Men who were younger [adjusted hazard ratio (aHR): 0.94/yr; 95% confidence interval (CI): 0.89 to 0.99], had incomplete primary education (aHR: 2.95; 95% CI: 1.36 to 6.40), and reported fertility desires (aHR: 2.25; 95% CI: 1.04 to 4.85) had higher probability of partner pregnancy. A high incidence of intended partner pregnancy highlights the need to address men's reproductive goals within HIV care. Nearly half of pregnancy partners were at-risk for HIV, and one-quarter of men were not virally suppressed during periconception. Safer conception care provides opportunity to support men's health and reproductive goals, while preventing HIV transmission to women and infants.

Pregnancy Intention, Ambivalence, and Contraceptive use in Community Health Center (CHC) Populations

Abstract Introduction: Understanding the complexity of pregnancy intentions and resulting behaviors is essential to ensuring high quality, patient-centered reproductive health services that meet the needs of women and their partners. Community Health Centers (CHCs) play an important role in providing family planning care for traditionally underserved women, who may be at increased risk of experiencing unintended pregnancy. This study presents emerging findings on pregnancy intentions, ambivalence, and contraceptive behaviors among patients in CHC settings. Methods: This study employed a national survey (n=1,557) of women of reproductive age (18-44 years), sampled from 19 different CHC sites. The survey gathered information on patient characteristics, experiences with care, decision-making criteria and utilization of contraceptive services. Pregnancy intention was measured using the One Key Question®. Results: Approximately 12% of women reported that they wanted to become pregnant in the next year, while 88% were not actively seeking to become pregnant. Nearly 30% of those who did not desire a pregnancy reported not using contraception at the time of the survey. 1-in-4 women were pregnancy ambivalent and used contraception at approximately the same rates as women seeking to become pregnant. Conclusions: Women who express pregnancy ambivalence use contraception at similar rates to those who intend to become pregnant in the next year, potentially increasing their risk for unintended pregnancy. Understanding the characteristics and behaviors of underserved patients across different pregnancy intentions may help ensure that women receive the information, services, and support they need to achieve their reproductive health goals. Keywords: pregnancy intentions, family planning, community health centers, CHC, One Key Question®

Fertility, Pregnancy, and Postpartum: A Survey of Practicing Georgia Obstetrician Gynecologists.

OBGYNs help patients plan families, conceive, and deliver children, however the personal reproductive history and goals, infertility experiences, and birth outcomes of OBGYNs are not well studied.We aim to characterize female OBGYN reproductive experiences with a particular focus on infertility, reproductive life planning (methods of pregnancy prevention, reasons why pregnancy is/was delayed), birth outcomes (mode of delivery, delivery timing), and the postpartum period (breastfeeding, maternity leave, postpartum depression). An anonymous email survey was distributed to female members of Georgia OBGYN Society and EmoryUniversity Department of Gynecology and Obstetrics. Descriptive statistics and bivariable analysis were performed using Microsoft Excel and OpenEpi. Of 352 surveys, 204 of 269 women who opened the survey agreed to participate (75.8% per opened email, 58.0% per sent email). Mean age of first childbirth was 30.7 (SD ± 4.2) years. Most pregnancies were intended (77%). Fertility treatments were used in 13% of pregnancies. Resident mothers compared to mothers who gave birth before or after residency were more likely to report postpartum depression [26% vs. 16%, OR 1.8 (95% CI 0.93-3.58)] and shorter maternity leave < 6weeks [57% vs. 29%, OR 2.57 (CI 1.56-5.00)]; exclusive breastfeeding rates ≥ 6months were similar [38% residents vs. 41% non-residents, OR 0.80 (CI 0.44-1.43)]. Among those not finished with childbearing, 68% worried about infertility, 29% were considering oocyte/embryo cryopreservation, and 5% had already cryopreserved oocytes. Compared to the general population, the average age of first childbirth among Georgia OBGYNs was 4 years higher (30.7) with a greater proportion of pregnancies planned. Use of fertility services and obstetric course matched national rates, however postpartum depression was more prevalent among Georgia OBGYNs. Awareness of increased postpartum depression among residents may allow for improved counseling and treatment.

Exploring Multiple Dimensions of Young Women's Fertility Preferences in Malawi.

Standard survey measures of fertility preferences, such as the desire for and preferred timing of future births, do not capture the complexity of individuals' preferences. New research focuses on additional dimensions of emotions and expectations surrounding childbearing. Few quantitative studies, however, consider the influence of all three dimensions of fertility preferences concurrently. Using longitudinal survey data from the Tsogolo la Thanzi project (2009-2012) in Malawi, this study employed logistic regression analysis to investigate the influence of young women's emotions, expectations, and a standard measure of fertility preferences on pregnancy and modern contraceptive use. Young women experienced high unmet need; across survey waves, over three-quarters of women who desired a child in more than 2years were not currently using modern contraceptives and over three-quarters of women who thought a pregnancy in the next month would be bad news (garnered from a measure of emotions surrounding pregnancy) were not currently using modern contraceptives. In regression models including all three measures of fertility preferences, each was significantly associated with the likelihood of a future pregnancy. The standard measure and emotions measure were significantly associated with modern contraceptive use. Emotions and expectations surrounding pregnancy and childbirth appear to be distinct and salient aspects of fertility preferences in addition to the standard measure. A better understanding of the multidimensional nature of fertility preferences will help individuals define and achieve their reproductive goals and obtain appropriate services. Furthermore, future research should incorporate new measures of fertility preferences into surveys internationally.

‘If I had known the fertility health facts sooner…’ Knowledge gaps as a barrier to effective fertility management: findings from the understanding fertility management in contemporary Australia survey

Background: Optimal fertility management enables women and men to avoid and achieve conception and parenthood when desired. A lack of knowledge about sexual, reproductive and fertility matters may impede a person’s ability to manage their fertility effectively. Little is known about current gaps in fertility knowledge among Australians.Purpose: To identify information and knowledge gaps about fertility management among women and men of reproductive age living in Australia.Method: A sample of 18- to 50-year-old women and men (N = 2235) randomly recruited from the Australian Electoral Roll in 2013. Respondents completed a self-administered, anonymous questionnaire that concluded with the option to provide free-text comments elaborating on their fertility management. These comments were analysed thematically to identify gaps in fertility management knowledge and information.Results: Of the 519 participants’ comments, 472 were included in the analysis: 366 (77.5%) from women and 106 (22.5%) from men. Most comments related to contraception or fertility problems. Two themes about contraception were identified: (1) lack of information and knowledge about contraception and concerns about side-effects and (2) inadequate contraceptive education. Two themes about fertility problems were identified: (1) a lack of information and knowledge about fertility and (2) difficulties conceiving, including access to assisted reproductive treatments and other therapies. No major gender or age differences were identified across the themes.Conclusions: Many Australian women and men would welcome education and public health campaigns about contraceptive options and age-related fertility decline. Such interventions may enable women and men to manage their fertility and achieve their reproductive goals.

Immediate Postpartum Contraception: Intrauterine Device Insertion.

Insertion of an intrauterine device (IUD) in the immediate postpartum period is a safe, evidence-based form of contraception appropriate for most women. Despite the higher risk of expulsion as compared with interval insertion, the benefits of insertion in the immediate postpartum period are significant and include improved rates of contraception continuance and reduced instances of short interval birth. Through shared decision making, midwives and other clinicians can assist women in clarifying their reproductive goals and understanding of contraceptive options, including this method. In response to identified gaps in knowledge and insertion technique among midwives, this article provides an overview of immediate postpartum IUD insertion, risks and benefits, and eligibility criteria and describes preinsertion, insertion, and postinsertion care.

"He told me it would be extremely selfish of me to even consider [having kids]": The importance of reproductive health to women with spina bifida and the lack of support from their providers

BackgroundAs more women with spina bifida (SB) enter their reproductive years, the number having children is significantly increasing. However, little is known about their understanding of their ability to get pregnant or their experiences in considering, planning, or interacting with providers during a pregnancy. ObjectiveWe sought to determine what women have been told and understand about their reproductive health, their attitudes towards having children, and their experiences interacting with providers when seeking reproductive health care. MethodsIn this exploratory study employing qualitative research methods and following Grounded Theory, interviews with women with SB 16 years or older were transcribed verbatim and analyzed by three coders. ResultsInterviews of 25 women with SB ages 16–52 (median 26) revealed the following themes about their reproductive health perceptions and experiences: 1) poor understanding of reproductive health and potential, 2) interest in having a family, 3) facing provider's opposition to their reproductive goals, 4) going into pregnancy and delivery unprepared, 5) the importance of provider support for reproductive goals. Five women experienced an unintended pregnancy. ConclusionsAlthough having children is important to most women with SB in this study, they report a poor understanding of their reproductive potential with several noting unintended pregnancies. They feel uninformed and unprepared during pregnancy and face discouragement from providers. Those experiencing supportive providers report a more positive experience. This demonstrates the urgent need to educate women with SB about their reproductive health and the providers who care for them how to support and counsel these women.

The Restructuring of Korea's Work-Life Balance Policy and the Improvement of Social Quality

In South Korea, low fertility rate has become a big social issue, making the term ‘ultra low fertility rate’ common. Currently, South Korea, like many other leading industrialized countries, is coping with the problem of low fertility with a focus on the work-life balance policy. Unfortunately, South Korea’s work-life balance policy has been criticized as not so successful. Especially, it has been pointed out that the policy effects are being compromised because ‘it is not because there is no system, but the existing system does not work properly.’ This means that work-life balance policy in South Korea has a structural and fundamental problem. In this regard, it is necessary to reflect on policy discourses and instruments that determine the goals, directions and content of the policy. The result of the analysis in this paper reveals that South Korea’s work-life balance policy consists of the discourse of ‘raising the fertility rate’ and its policy instruments. It mobilizes citizens for the national goals of social reproduction and sustainable growth. It could be said that this reversal of purpose and means was because the policy makers and executives were buried in developmentalist thinking―in pursuit of materialistic social development. In this respect, in order for South Korea’s work-life balance policy to be on its way, it is urgently required that it should shift its policy paradigm to change practices and cultures. This paper argues that such a paradigm shift should be based on a ‘Social Quality Approach’. Only when we pursue humanistic social development in the planning and implementation of policies and continue to monitor and supplement related systems under this stance, can we achieve a stable and effective work-life balance policy.

Climatic variability and changing reproductive goals in Sub-Saharan Africa

Using 40 rounds of Demographic and Health Survey data from 18 sub-Saharan African countries, linked to high-resolution historical climate records, we analyze the relationship between climatic variability and fertility goals among reproductive-aged women. We find that, overall, women exposed to above-average temperatures report lower ideal family size and reduced probability of desiring a first or additional child. Results indicate that exposure to precipitation anomalies during the 12 months prior to the DHS survey is associated with a significant reduction in ideal family size, but longer 60-month spells of above-average precipitation are associated with increases in ideal family size. Effects of unusual precipitation are null for women’s fertility preferences at both shorter- and longer-term periods. Additional analyses show that this association varies across sub-populations defined by parity, education, residence in rural or urban areas, and region. In general, our results suggest that women exposed to adverse environmental conditions—namely abnormally hot or dry spells—will reduce their ideal family size and their preferences for having another child. In some cases, however, fertility goals may also decline during spells of favorable environmental conditions, possibly due to increased labor demands among women and their spouses. One implication of the observed links between climate variability and reproductive goals is that policymakers concerned with climate adaptation should work to ensure women have access to the necessary family planning resources needed to realize dynamic reproductive goals in a changing climate.

Tecnología y profesionalismo como herramientas que nos ayudan a mejorar los resultados en técnicas de reproducción asistida

En estos últimos años la demanda por los procedimientos de reproducción asistida se ha ido incrementando de manera considerable. Todo parece indicar que esta tendencia va a seguir por este mismo camino, lo que nos obliga a los profesionales del área reproductiva a estar actualizados en cuanto a los últimos avances en tecnología y preparación de personal, con la única finalidad de ofrecer a los pacientes mejores tasas de embarazo. El actual objetivo de la reproducción asistida es conseguir la gestación y que esta llegue a término tras la primera transferencia de un embrión único. Ello supone un gran reto, dado que implica el esfuerzo conjunto por conseguir que la mayoría de nuestras pacientes logren el ansiado bebe sano en casa. Por ello, desde hace unos años asumimos este compromiso y entendimos que la única manera de alcanzar este objetivo era utilizar todas las herramientas disponibles que la tecnología nos puede ofrecer en el ámbito reproductivo.

Age-Based Interpretation of Anti-Mullerian Hormone (AMH) Levels in Non-infertile Women [37J

INTRODUCTION: Data related to AMH levels in non-infertile women are scarce, making interpretation for this population difficult. We aimed to characterize age-based AMH levels in a non-infertile population to simplify interpretation of AMH results. This study represents the largest analysis to date of AMH levels in non-infertile women. METHODS: This retrospective cohort study includes all women undergoing fertility assessments at Extend Fertility Medical Practice, a large oocyte cryopreservation practice, from 3/1/2016 to 9/30/2018. The study was granted IRB exempt status. AMH levels were abstracted from electronic medical records. AMH levels were measure by an independent laboratory using the Gen-II ELISA platform. To simplify clinical interpretation of AMH levels, age was categorized according to the Society for Assisted Reproductive Technologies standard. Association between age and AMH was made using Kruskal-Wallis. RESULTS: 2623 subjects were included in the study. AMH was inversely associated with age (P&lt;.0001). Median [IQR] AMH values by age group were as follows: &lt;30; 2.91 [1.79-4.82] ng/mL (n=107); 30-34; 2.42 [1.38-4.22] ng/mL (n=770); 35-37; 2.03 [1.14-3.54] (n=937); 38-40; 1.50 [0.77-2.69] (n=570); 41-42; 0.92 [0.32-2.19] (n=137); &gt;42; 0.59 [0.25-1.2] (n=101). CONCLUSION: Accurate representation of physiologic AMH ranges in non-infertile women is a critical element of counseling women regarding their reproductive goals. Median AMH levels in our population were generally lower than prior published reports and more likely represent physiologic levels. Data from infertility cohorts may be confounded by anovulatory subjects with preferentially higher AMH levels. Additional studies are needed to assess what thresholds in each age group constitute a pathologic AMH level.

Pregnancy intention and contraceptive use among HIV-positive Malawian women at 4-26 weeks post-partum: A nested cross-sectional study.

BackgroundAvoiding unintended pregnancies through family planning is a WHO strategy for preventing mother to child transmission of HIV (PMTCT) and maternal morbidity/mortality. We investigated factors associated with unintended index pregnancy, unmet contraceptive need, future pregnancy intention and current contraceptive use among Malawian women living with HIV in the Option B+ era.MethodsWomen who tested HIV positive at 4–26 weeks postpartum were enrolled into a cross-sectional study at high-volume Under-5 clinics. Structured baseline interviews included questions on socio-demographics, HIV knowledge, partner's HIV status/disclosure, ART use, pregnancy intention and contraceptive use. Logistic regression was used to determine factors associated with outcomes.ResultsWe enrolled 578 HIV-positive women between May 2015-May 2016; median maternal age was 28 years (y) (interquartile-range [IQR]: 23–32), median parity was 3 deliveries (IQR: 2–4) and median infant age was 7 weeks (IQR: 6–12). Overall, 41.8% women reported unintended index pregnancy, of whom 35.0% reported unmet contraceptive need and 65.0% contraceptive failure. In multivariable analysis, unintended index pregnancy was higher in ≥35y vs. 14-24y (adjusted Odds Ratio [aOR]: 2.1, 95% Confidence Interval [95%CI]: 1.0–4.2) and in women with parity ≥3 vs. primiparous (aOR: 2.9, 95%CI: 1.5–5.6). Unmet contraceptive need at conception was higher in 14-24y vs. ≥35y (aOR: 4.2, 95%CI: 1.8–9.9), primiparous vs. ≥3 (aOR: 8.3, 95%CI: 1.8–39.5), and women with a partner of unknown HIV-status (aOR: 2.2, 95%CI: 1.2–4.0). Current contraceptive use was associated with being on ART in previous pregnancy (aOR: 2.5, 95%CI: 1.5–3.9).ConclusionsHigh prevalence of unintended index pregnancy and unmet contraceptive need among HIV-positive women highlight the need for improved access to contraceptives. To help achieve reproductive goals and elimination of MTCT of HIV, integration of family planning into HIV care should be strengthened to ensure women have timely access to a wide range of family planning methods with low failure risk.

The development of reproductive management practices in New Zealand: what will the future hold in a consumer-focused, environmentally-conscious, export-driven marketplace?

The New Zealand (NZ) economy and its dairy industry are sensitive to global consumer perception of farming practices used to generate milk products because milk exports account for >25% of national export earnings and >90% of milk produced is exported as products. Astute management of product image and market risk is, therefore, important for the viability of the industry and country. More than 95% of milk produced in NZ comes from strictly seasonal, pasture-based systems, with associated constraints on reproductive performance. Increasing herd sizes, operational changes and genetic selection priorities have further challenged dairy farmers to achieve optimal levels of herd fertility. Reproductive management practices have developed to address the need to maintain a 365-day inter-calving interval, essentially through maximizing the number of cyclic cows during the breeding period and minimizing the duration of the seasonal calving period. Aspects of the hormonal interventions developed and routinely used to achieve these objectives have been the subject of product quality and market risk concerns forcing the industry to explore alternative ways of achieving reproductive performance goals. One approach has been to exploit the inherently high level of fertility in NZ dairy herds. This approach has seen the inclusion of fertility-related traits in the national genetic evaluation system to prevent further decline in genetic fertility. More recently, a nationally coordinated extension program has been adopted to support farmers and their advisors to identify, prioritize and improve on key management areas for incremental gains in herd reproductive performance. Advances in automation and bio-sensing are yet to make a significant impact, but remain potentially valuable additions in supporting the dairy farmer to manage the areas having the largest effects on reproductive performance.

Meiotic and Mitotic Origin of Aneuploidies Detected in Preimplantation Genetic Testing

Over 90% of aneuploidies originate from maternal meiosis, with the only established cause of aneuploidy being maternal age. So it is not surprising that the reproductive age is the major indication for preimplantation genetic testing for chromosomal aneuploidy (PGT-A), which allows couples with advanced reproductive age to achieve their reproductive goals without risk for fetal loss or birth of an affected child. This is achieved through detecting and avoiding from transfer a considerable proportion of embryos with different abnormalities, which according to our experience is as high as 56.9% (1661 of 2922 blastocysts samples tested by NGS). Of these abnormalities, 8% (133 of 1661) were with mosaicism and 14.4% (240/1661) were found to have segmental chromosome abnormalities. Of these, 63.3% (154/240) were found to have one deletion, 8.3% (20/240) one duplication and 28.4% (66/240) multiple segmental abnormalities. The smallest abnormality identified was 5.8 Mb, while the largest was 139.6 MB. The p to q arm ratio of these abnormalities was found to be 1.03. Mosaicism of segmental abnormalities was observed in 59% of samples identified. Segmental chromosome abnormalities were most commonly found in chromosomes 1 (32/240; 13.3%), 5 (22/240; 9/2%), and 4 (21/240; 8.8%). No chromosome 22 or Y chromosome abnormalities were identified in this cohort. Only three of these segmental anomalies were of meiotic origin, detected also in parents, while others were de novo events, of which biological and clinical significance is unknown. These are clearly post-meiosis errors, but their impact cannot be evaluated. It cannot be excluded that they are technical errors, or chromosome specific differences of completion of S period of cell cycle. Difference in the replication pattern of certain chromosomes were demonstrated long time ago, depending on maternal and paternal origin of homologous chromosomes and on differences of cell type tested, so segmental errors may reflect a tissue specific differences of DNA replication. Technical errors cannot be excluded either in detection of mosaicism, as it may be affected by chromosome drifting caused by cell damage during blastocyst biopsy, or by the choice of methodology for 24-chromosome aneuploidy testing. One of the he major factors in reproductive outcome of mosaicism is their meiotic or meiotic origin. For example, the experience on the establishment of embryonic stem cell lines demonstrated a higher success rate of obtaining embryonic stem cell lines from mitotic rather than meiotic trisomics. While, it is not always possible to distinguish the origin of mosaicism, the available data on the prevalence and types of meiotic and mitotic error, to be summarized in this presentation, may be useful for evaluating their corresponding impact depending on the mosaicism origin.