Spontaneous Conception Research Articles

Spontaneous heterotopic pregnancy resulting in tubal rupture and complete spontaneous abortion: a case report in Tiko, Cameroon

Introduction and importance: A heterotopic pregnancy (HP) following spontaneous conception is a rare and potentially life-threatening condition. Its diagnosis can be overlooked, hence remaining one of the challenging gyneco-obstetrical emergencies, especially in the low-resource setting. Case presentation: A 24-year-old G2P0010 at 11 weeks of gestation with a history of one induced abortion and a family history of twin pregnancies presented with an acute abdomen, associated with vaginal spotting in an afebrile context. An abdominopelvic ultrasound showed retained products of conception, and the presence of a left adnexal mass suggestive of an extrauterine gestational sac at ~6 weeks of gestation. There was spontaneous expulsion of retained products of conception. The deterioration of the hemodynamic stability of the patient prompted an emergency laparotomy to be done. The patient was transfused, postsalpingectomy counseling done and was discharged on oral analgesics, blood tonics, and antibiotics on day 6 postoperation. Clinical discussion: HP following spontaneous conception is a rare and potentially life-threatening condition. This case reports on the management of spontaneous HP resulting in a ruptured ectopic pregnancy (EP) and a complete spontaneous abortion managed in a low-resource setting. This case emphasizes the importance of a systematic ultrasound to be done for all patients with a clinically confirmed abortion to rule out an associated EP. Conclusion: A spontaneous abortion without signs of peritoneal irritation can be associated with an EP. Ultrasound can help in the early diagnosis, and laparotomy can be life-saving.

Comparative cross-sectional study on sexual function of couples during pregnancy: Assisted reproductive techniques versus spontaneous conceptions.

This study aims to compare the sexual functions of couples undergoing assisted reproductive techniques (ART) with those conceiving spontaneously during pregnancy. A total of 102 couples participated in this cross-sectional study, with 68 couples in the spontaneous conception group and 34 couples in the ART group. Data collection was conducted face-to-face in the antenatal clinic using separate "Descriptive Information Form" for women and men, "Female Sexual Function Index (FSFI)" for women, and "Libido Scoring System (LSS)" for men. Descriptive statistical methods, Chi-square and Fisher exact tests, t-test, and Pearson correlation test were used for data analysis. It was observed that the mean FSFI total scores of women who conceived spontaneously and through ART during pregnancy were at a good level (≥30), while the mean LSS scores of their partners were at a moderate level (5-7). No statistically significant distinction existed among the groups. Further research is advisable by adjusting the sample selection criteria, such as gravida, duration of ART treatment, and gestational age.

Infertility treatment is associated with increased risk of postpartum hospitalization due to heart disease.

Cardiovascular disease is a major cause of maternal mortality, but the extent to which infertility treatment is implicated in heart disease remains unclear. To evaluate the association between infertility treatment and postpartum heart disease. We designed a retrospective cohort study of patients who delivered in the United States between 2010 and 2018. The primary outcome was hospitalization within 12-month post-delivery due to heart disease (including ischemic heart disease, atherosclerotic heart disease, cardiomyopathy, hypertensive disease, heart failure, and cardiac dysrhythmias). We estimated the rate difference (RD) of hospitalizations among patients who conceived with infertility treatment and those who conceived spontaneously. Associations were expressed as hazard ratios (HRs) and 95% confidence intervals (CIs), derived from Cox proportional hazards regression after adjustment for potential confounders. Infertility treatment was recorded in 0.9% (n=287,813) of 31,339,991 deliveries. Rates of heart disease hospitalizations with infertility treatment and with spontaneous conception were 550 and 355 per 100,000, respectively (RD 195, 95% CI: 143-247; adjusted HR 1.99, 95% CI: 1.80-2.20). The most important increase in risk was observed for hypertensive disease (adjusted HR 2.16, 95% CI: 1.92-2.42). This increased risk was apparent as early as 30-day post-delivery (HR 1.61, 95% CI: 1.39-1.86), with progressively increasing risk up to a year. Although the absolute risk of postpartum heart disease hospitalization is low, infertility treatment is associated with an increased risk, especially for hypertensive disease. These findings highlight the importance of timely postpartum follow-ups in patients who received infertility treatment.

Children born after assisted reproduction more commonly carry a mitochondrial genotype associating with low birthweight

Children conceived through assisted reproductive technologies (ART) have an elevated risk of lower birthweight, yet the underlying cause remains unclear. Our study explores mitochondrial DNA (mtDNA) variants as contributors to birthweight differences by impacting mitochondrial function during prenatal development. We deep-sequenced the mtDNA of 451 ART and spontaneously conceived (SC) individuals, 157 mother-child pairs and 113 individual oocytes from either natural menstrual cycles or after ovarian stimulation (OS) and find that ART individuals carried a different mtDNA genotype than SC individuals, with more de novo non-synonymous variants. These variants, along with rRNA variants, correlate with lower birthweight percentiles, independent of conception mode. Their higher occurrence in ART individuals stems from de novo mutagenesis associated with maternal aging and OS-induced oocyte cohort size. Future research will establish the long-term health consequences of these changes and how these findings will impact the clinical practice and patient counselling in the future.

Subclinical cardiac impairments in fetuses conceived through assisted reproductive technology by speckle tracking echocardiography.

To evaluate the changes of cardiac morphology and function in fetuses conceived through assisted reproductive technologies (ART) by speckle tracking echocardiography. A retrospective study was conducted in 101 spontaneously conceived (SC) fetuses and 99 ART-conceived ones. Fetal echocardiography was performed, fetal cardiac morphology and function were analyzed using two-dimensional speckle tracking software, including global sphericity index (GSI), global longitudinal strain (GLS), fractional area change (FAC) of the left and right ventricles, as well as segmental sphericity index (SI), end-diastolic diameter (ED), and fractional shortening (FS) in 24 segments. Compared to the SC fetuses, the ART-conceived fetuses exhibited decreased GSI (median [interquartile range], 1.22 [1.16-1.27] vs. 1.18 [1.11-1.24], p=0.007), decreased right ventricular GLS (24.9 [21.5-27.6] vs. 23.2 [20.4-26.8], p=0.026), and decreased right ventricular FAC (mean±standard deviation, 39.7±6.4 vs. 37.2±7.1, p=0.003). Analysis of the 24 segments showed that ART-conceived fetuses had reduced SI in the apical segments of right ventricle and increased ED in several segments of the right ventricle. Fetuses conceived through ART had a more spherical shape of the global heart and predominantly right-sided cardiac remodeling and systolic function impairment.

Abstract 11: Association Between Infertility Treatment With Assisted Reproductive Technology and Stroke in the United States

Introduction: Infertility treatment with assisted reproductive technologies (ART) has previously been associated with adverse vascular events in some, but not all studies. Endothelial damage, prothrombotic factor release, and a higher prevalence of cardiovascular risk factors in those receiving ART have been invoked to explain this association. We sought to explore the relationship between ART and stroke risk using population-level data. Methods: We conducted a retrospective cohort study using data from the National Inpatient Sample (NIS) registry from 2015-2020. We included all delivery hospitalizations for female patients aged 15-55 years. The study exposure was use of ART. Primary endpoints were ischemic stroke (IS), subarachnoid hemorrhage (SAH), intracerebral hemorrhage (ICH), and any stroke (IS, SAH, or ICH) during index delivery hospitalization. Standard International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) algorithms were used to define study exposure, comorbidities, and prespecified endpoints. In addition to reporting population-level estimates, we used propensity score (PS) adjustment by inverse probability weighting (IPW) to mimic the effects of randomization by balancing baseline clinical characteristics (including age and cardiovascular comorbidities) associated with stroke between ART and non-ART users. Results: Among 19,123,125 delivery hospitalizations, we identified 202,815 (1.1%) with prior ART. Those who received ART experienced significantly higher rates of AIS (9.9 vs. 3.4 per 100,000), SAH (7.4 vs. 1.6 per 100,000), ICH (7.4 vs. 2.0 per 100,000), and any stroke (19.8 vs. 6.6 per 100,000) in comparison to spontaneous conception (p < 0.001 for all unadjusted comparisons). Following IPW multivariable logistic regression analysis, ART was associated with AIS [aOR 2.72 (95% CI 2.49, 2.98); p < 0.001], SAH [aOR 4.11 (95% CI 3.63, 4.65); p < 0.001], ICH [aOR 5.11 (95% CI 4.58, 5.70); p < 0.001], and any stroke [aOR 2.70 (95% CI 2.53, 2.88); p < 0.001]. Conclusion: Using population-level data among patients hospitalized for delivery in the United States, we found an association between ART treatment and all stroke outcomes after adjustment for measured confounders.

Combined effects of pre-pregnancy BMI and gestational weight gain on preterm birth: comparison between spontaneous and ART conception.

Inappropriate pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) are both linked to preterm birth (PTB); however, which one plays a dominant role in PTB risk is not yet sure. We aimed to evaluate the combined effect of pre-pregnancy BMI and GWG on the risk of PTB in singleton pregnancies conceived both spontaneously and through assisted reproductive technology (ART). The data included all mothers (n = 17,540,977) who had a live singleton birth from the US National Vital Statistics System (NVSS) 2015-2019. Logistic regression models, quantile-g-computation, and generalized additive model were used to analyze the combined association of pre-pregnancy BMI and GWG with PTB. The singleton PTB rate was significantly higher in ART pregnancies (11.5%) than in non-ART pregnancies (7.9%). When compared to those women with pre-pregnancy normal weight and GWG within Institute of Medicine (IOM) guidelines, the highest PTB risk was observed in non-ART women with pre-pregnancy underweight and GWG below IOM guidelines (aOR 2.56; 95% CI 2.53-2.60) and in ART women with pre-pregnancy obese and GWG below IOM guidelines (aOR 2.56; 95%CI 2.36-2.78). GWG dominated the combined effect with its joint effect coefficient of - 0.281 (P < 0.05) in non-ART women and - 0.108 (P < 0.05) in ART women. Inappropriate GWG played a dominant role in increasing the risk of PTB in both non-ART and ART populations. Counseling regarding pre-pregnancy BMI and especially GWG appears to be even more crucial for pregnancies conceived via ART, given their impact on PTB.

Development of a single-visit protocol for the management of pregnancy of unknown location following in vitro fertilization: a retrospective study.

Can women with pregnancy of unknown location (PUL) following in vitro fertilization (IVF) be risk-stratified regarding the subsequent need for medical intervention, based on their demographic characteristics and the results of serum biochemistry at the initial visit? The ratio of serum hCG to number of days from conception (hCG/C) or the initial serum hCG level at ≥5 weeks' gestation could be used to estimate the risk of women presenting with PUL following IVF and needing medical intervention during their follow-up. In women with uncertain conception dates presenting with PUL, a single serum hCG measurement cannot be used to predict the final pregnancy outcomes, thus, serial levels are mandatory to establish a correct diagnosis. Serum progesterone levels can help to risk-stratify women at their initial visit but are not accurate in those taking progesterone supplementation, such as women pregnant following IVF. This was a retrospective study carried out at two specialist early pregnancy assessment units between May 2008 and January 2021. A total of 224 women met the criteria for inclusion, but 14 women did not complete the follow-up and were excluded from the study. We selected women who had an IVF pregnancy and presented with PUL at ≥5 weeks' gestation. A total of 30/210 (14.0%, 95% CI 9.9-19.8) women initially diagnosed with PUL required surgical intervention. The hCG/C was significantly higher in the group of women requiring an intervention compared to those who did not (P = 0.003), with an odds ratio of 3.65 (95% CI 1.49-8.89, P = 0.004). A hCG/C <4.0 was associated with a 1.9% risk of intervention, which accounted for 25.7% of the study population. A similar result was obtained by substituting hCG/C <4.0 with an initial hCG level <100 IU/l, which was associated with 2.0% risk of intervention, and accounted for 23.8% of the study population (P > 0.05). A limitation of our study is that it is retrospective in nature, and as such, we were reliant on existing data. A previous study in women with PUL after spontaneous conception found that a 2% intervention rate was considered low enough to eliminate the need for close follow-up and serial blood tests. Using the same 2% cut-off, a quarter of women with PUL after IVF could also avoid attending for further visits and investigations. No external funding was required for this study. No conflicts of interest are required to be declared. N/A.

Add-on effects of oral tocopherol supplementation to surgical varicocelectomy on the outcome of assisted reproductive technology: a single-center pilot study report.

Varicocelectomy is well known to improve the pregnancy outcome of patients with clinical varicoceles in assisted reproductive technologies as well as spontaneous conception. Therefore, this study aimed to evaluate the additional effects of oral antioxidant therapy after varicocelectomy on the pregnancy outcome in the assisted reproductive technology setting. This study was a retrospective cohort study. The subjects were couples among whom the male partner had undergone varicocelectomy and was scheduled for subsequent assisted reproductive technology. Pregnancy outcomes were followed retrospectively in 62 couples with male partners who received tocopherol (antioxidant group) and 37 couples who did not (control group). The tocopherol and control groups were assigned dependent on the decision of the physician in charge and the patient's request. The clinical pregnancy rates per couple and embryo transfer, time to pregnancy, and the number of cycles during transfer to pregnancy were evaluated. No significant differences were observed in the pregnancy rate per couple (antioxidant group 70.9% vs. control group 64.9%, P = 0.55) and per embryo transfer (50.4% vs. 39.6%, P = 0.22). Regarding the time to event analyzed by adjusted restricted mean survival time, the mean time to pregnancy was significantly shorter in the antioxidant (tocopherol) group (14.2 vs. 17.4 months, P = 0.025). No significant difference was observed in the embryo transfer cycle to pregnancy (mean embryo transfer cycles: 2.6 vs. 3.0, P = 0.238). Additional oral tocopherol nicotinate as antioxidant therapy after varicocelectomy was shown to shorten the time to pregnancy. It is recommended that add-on effects be tested in more well-designed randomized controlled trials to examine whether it improves assisted reproductive outcomes.

Multiple Gestations: Neonatal and Maternal Characteristics

Introduction Multiple gestation neonates are commonly found in older age women along with increasing use of assisted reproductive techniques. They are at an increased risk of complications and also impose financial, emotional, social, and psychological burdens on the family. There is a paucity of studies on multiple gestations in India, hence this study was conducted to evaluate the clinical profile and associated comorbidities in neonates born through multiple gestations which can help in anticipating, preparing, and managing possible complications. Methodology This was a prospective observational study conducted in a Level III neonatal intensive care unit of a tertiary care hospital. All intramural neonates delivered with multiple gestations were included. Data regarding the antenatal, perinatal, and hospital course of the neonates were documented. Results A total of 75 intramural neonates (36 twins and 1 triplet) were enrolled in the study. About 67.6% were delivered via caesarean section and 81.1% were spontaneous conception. The most common maternal complications observed were hyperemesis gravidarum (56.76%) followed by pregnancy-induced hypertension (PIH) (40.54%). About 80% of twin neonates were diamniotic dichorionic (DADC) and 42% of twin neonates had vertex-vertex presentation. Almost 22.7% of neonates required neonatal resuscitation and 98% had a birth weight &lt;2.5 kg. Initiation of breastfeeding was delayed, and longer hospital stay was observed in preterm neonates with birth weight ≤1.5 kg and birth weight discordance. Conclusion Multiple gestations are associated with significant neonatal complications owing to prematurity and low birth weight. Thorough knowledge of these complications helps in better fetal and neonatal surveillance and prevention of adverse outcomes.

Maternal and neonatal outcomes of intrahepatic cholestasis of pregnancy after in vitro fertilization

BackgroundIntrahepatic cholestasis of pregnancy (ICP) is an idiopathic disease of pregnancy. Little is known about how it specifically affects pregnancies resulting from in vitro fertilization (IVF). Our aim is to evaluate the impact of IVF on the perinatal outcomes of ICP.MethodsA retrospective study of 242 patients with intrahepatic cholestasis of pregnancy, comprising 36 conceived through IVF and 206 spontaneous conceptions (SC), enrolled between 2019 and 2021 was carried out. Data were analyzed from the medical archives of the Huazhong University of Science and Technology, Tongji Hospital.ResultsNumerical values of transaminases (ALT, alanine aminotransferase; AST, aspartate aminotransferase) and serum total bile acid (TBA) are significantly lower in the IVF group than that in the spontaneous conceived group (p < 0.05). The incidence of gestational diabetes mellitus (GDM) was higher in the IVF group than in SC group (30.6% vs. 16%, p = 0.037). The cesarean section (CS) rates are higher in the IVF group (97.2% vs. 85.4%, p = 0.023). On the other hand, the prevalence of premature rupture of membranes (PROM) was higher in the SC group (10.7%) while none was reported in the IVF-ICP group. Other maternal comorbidities and neonatal outcomes were similar between the two groups.ConclusionICP patients who underwent IVF are more likely to suffer from GDM. Therefore, monitoring and management of blood glucose should be strengthened during pregnancy. Fortunately, IVF does not seem to worsen the progression or outlook of ICP, so sticking to standard management practices is recommended.

Fertility After Endometrial Intraepithelial Neoplasia and Early Endometrial Cancer: Ovulation Induction May Shorten Time to Conception.

The purpose of this study was to determine whether utilization of assisted reproductive technology following clearance of endometrial intraepithelial neoplasia (EIN) or early endometrial cancer (EC)shortens time to conception (TTC) and reduces recurrence. Patients aged 18 to 45 with EIN or early EC who achieved pathologic response following progesterone treatment were identified via retrospective chart review. Study groups included patients who pursued ovulation induction (OI), in vitro fertilization (IVF), and spontaneous pregnancy. Primary outcomes were TTC and recurrence rate. Three hundred forty-six charts were reviewed, with 86 patients meeting inclusion criteria and 53 attempting pregnancy. Of those 53 patients, 11 became pregnant and seven had a live birth. Median times to pregnancy were 183days for IVF, 54days for OI, and 347days for spontaneous conception (p < 0.05). No differences were seen in recurrence or progression based on attempted pregnancy method, nor with duration of fertility treatment. Forty-two of 86 patients (49%) were lost to follow-up. For patients with a history of treated EIN or EC, OI may decrease TTC. Larger prospective studies are needed to definitively answer this question. Although no differences in recurrence or progression were identified, the significant loss to follow-up rate in this study is concerning and warrants further investigation.

Возможности коррекции гормонального статуса, репродуктивной функции и нейровегетативных расстройств у пациенток с преждевременной недостаточностью яичников

Background: nowadays reproductive health condition tends to worsen. One of the problems is a decrease in the ovarian reserve, manifested in the form of premature ovarian insufficiency (POI), which initiates the infertility problem on the one hand, and the issue of premature menopause with all its accompanying socio-psychological aspects on the other Aim: to study the therapeutic possibilities of the bovine epiphyseal cartilage polypeptide in POI and anovulation in female patients aged 30–45 years old. Patients and Methods: the study included 40 female patients aged 30–45 years with a BMI of 18.5–29.9 kg/m2 and POI signs, determined by the following indicators: follicle-stimulating hormone (FSH) concentration ≥12 IU/L; anti-müllerian hormone (AMH) 0.2–1.2 ng/mL; antral follicle count (AFC) ≤5 during ultrasound on the 7th±2 day of the menstrual cycle; decreased serum estradiol concentration and anovulation lasting 1 to 5 years or with failed IVF. The female cohort was randomized into 2 groups of 20 persons: for two menstrual cycles, the main group received a drug for menopausal hormone therapy (MHT) containing 2 mg of estradiol and 10 mg of didrogesterone (per os 1 tablet daily in a cyclic regimen from day 1 to day 28) and the bovine epiphyseal cartilage polypeptide (lyophilizate for the preparation of a solution for intramuscular administration, 10 mg intramuscularly daily for 10 days from the 5th to the 14th day of the cycle). The control group received only MHT in the same regimen for two menstrual cycles. During the study, the changes of endometrial thickness and follicle growth, ovulation markers (corpus luteum), FSH, estradiol and AMH concentrations, the number of female patients with a normalized menstrual cycle and spontaneous conception were evaluated in both groups Results: in the main group there was a statistically significant (p&lt;0.05) decrease in FSH and luteinizing hormone (LH) levels relative to the baseline, an increase in estradiol concentration, an increase in the AFC and endometrial thickness, whereas the similar indicator changes were statistically insignificant in the control group. Besides, complete relief of neurovegetative symptoms was noted in the main group, and restoration of the ovulatory cycle was observed in 6 (30%) cases. There were no adverse events or complications during the drug regimen. Conclusion: the results obtained indicated the efficacy of the bovine epiphyseal cartilage polypeptide in the treatment of female patients with POI and anovulation and allowed to recommend the developed treatment regimen for practical use. KEYWORDS: premature ovarian insufficiency, follicle-stimulating hormone, anti-müllerian hormone, infertility, anovulation, menopausal disorders FOR CITATION: Khardikov A.V., Netyaga O.A. Correction of hormonal status, reproductive function and neurovegetative disorders in female patients with primary ovarian insufficiency. Russian Journal of Woman and Child Health. 2024;7(2):116–122 (in Russ.). DOI: 10.32364/2618- 8430-2024-7-2-5.

Comparison of Obstetric Outcomes in Patients with Intrahepatic Cholestasis of Pregnancy Between Pregnancies Following In Vitro Fertilization and Spontaneous Conception: Four-Year Experience in a Tertiary Care Hospital

Comparison of Obstetric Outcomes in Patients with Intrahepatic Cholestasis of Pregnancy Between Pregnancies Following In Vitro Fertilization and Spontaneous Conception: Four-Year Experience in a Tertiary Care Hospital

Эффективность методов лечения бесплодия у пациенток с эндометриозом I–II стадии

Aim. To evaluate the effectiveness of surgical treatment and assisted reproductive technologies (ART) for infertility associated with stage I–II endometriosis, according to the revised American Society for Reproductive Medicine (rASRM) classification. Design. Randomized study. Materials and methods. This study included 62 women aged 25 to 41 years with infertility and stage I–II endometriosis, determined by clinical symptoms and magnetic resonance imaging data. Patients were randomized into 2 groups: group 1 (laparoscopy) — surgical treatment of endometriosis, followed by planning a spontaneous conception within 12 months (n = 35); group 2 (ART) — treatment of infertility associated with endometriosis using ART methods (n = 27). Reproductive outcomes in group 1 were assessed after 1 year from the date of surgical treatment; in group 2 — based on the results of 3 attempts of embryo transfer as part of the use of ART methods. Results. Rate of pregnancy (group 1 — 34.3%; group 2 — 33.3%; p = 0.937), pregnancy termination (group 1 — 25%; group 2 — 44.4%; p = 0.397), childbirth (group 1 — 20%; group 2 — 14.8%; p = 0.643) did not differ significantly between treatment groups. Conclusion. Surgical treatment and the use of ART methods in the treatment of infertility in patients with stage I–II endometriosis are equally effective. The choice of method may depend on the patient’s preference, medical history, characteristics and disease stage, the presence of concomitant pathology, as well as the other factors of infertility. Keywords: endometriosis, magnetic resonance imaging, surgical treatment of endometriosis, laparoscopy, infertility, assisted reproductive technologies, in vitro fertilisation, hormonal treatment.

Endometriosis and subfertility

Key content Medical management of endometriosis is often contraceptive. In contrast, surgical treatment may improve the chance of spontaneous conception. There is conflicting evidence as to whether surgery improves outcomes with assisted conception, and this should be discussed with a specialist in reproductive medicine. Surgery, particularly for ovarian endometriosis, can cause a decreased ovarian reserve and fertility preservation should be considered. There is no standard approach to managing endometriosis in the fertility setting. It is important to take a holistic approach to diagnosis and management of the subfertile couple where endometriosis may be a contributing factor. Learning objectives To understand the mechanisms by which endometriosis can contribute to subfertility. To understand the importance of a comprehensive assessment of the subfertile couple and the important factors that will inform an individualised management plan. To develop a framework for managing endometriosis in the context of subfertility including fertility preservation

Adverse outcomes in subsequent pregnancies in women with history of recurrent spontaneous abortion: A meta-analysis.

This study aimed to investigate the association between a history of recurrent spontaneous abortion (RSA) and adverse outcomes in women with spontaneous conception. A search strategy from the inception to March 3, 2023 was run in PubMed, Embase, Cochrane Library, and Web of Science databases. The odds ratio (OR), and the 95% confidence interval (CI) or point estimation were used as the evaluation indexes. Each outcome measure tested was assessed for heterogeneity using the Cochran Q test. Sensitivity analyses were performed to test the credibility of the meta-analysis results. Fifteen studies involving 1 475 389 pregnant women were included. A history of RSA was associated with gestational diabetes (OR: 2.21, 95% CI: 1.70-2.87, p < 0.001), preeclampsia (OR: 2.06, 95% CI: 1.49-2.86, p < 0.001), placenta previa (OR: 1.82, 95% CI: 1.09-3.02, p = 0.021), placental abruption (OR: 1.67, 95% CI: 1.36-2.06, p < 0.001), miscarriage (OR: 6.37, 95% CI: 3.83-10.57, p < 0.001), preterm birth (OR: 1.80, 95% CI: 1.36-2.37, p < 0.001), cesarean section (OR: 1.47, 95% CI: (1.13-1.91, p = 0.004), perinatal death (OR: 2.24, 95% CI: 1.39-3.60, p = 0.001), and neonatal intensive care unit admission (OR: 1.39, 95% CI: 1.01-1.92, p = 0.047). However, the associations of a history of RSA with gestational hypertension, small for gestational age, fetal anomalies, fetal growth restriction, and postpartum hemorrhage were not observed. This meta-analysis indicates a history of RSA was associated with increased risks of several adverse outcomes in pregnant women with spontaneous conception.

Reproductive outcomes and reproductive health care utilization among male survivors of childhood cancer: ADCCSS-LATER study.

Treatment-related gonadal dysfunction leading to fertility problems is a frequently encountered late effect in childhood cancer survivors (CCSs). This study evaluated reproductive outcomes and reproductive health care utilization among male CCSs compared with male siblings. A nationwide cohort study was conducted as part of the Dutch Childhood Cancer Survivor LATER study part 1, a questionnaire and linkage study. A questionnaire addressing reproductive outcomes and reproductive health care was completed by 1317 male CCSs and 407 male siblings. A total of 491 CCSs and 185 siblings had a previous or current desire for children and were included in this study. Fewer CCSs had biological children compared with siblings (65% vs. 88%; p<.001). The type of conception by men who fathered a child was comparable between CCSs and siblings (spontaneous conception of 90% of both groups; p=.86). The percentage of men who had consulted a reproductive specialist because of not siring a pregnancy was higher in CCSs compared with siblings (34% vs. 12%; p<.001). Following consultation, fewer CCSs underwent assisted reproductive techniques (ART) compared with siblings (41% vs. 77%; p=.001). After ART, fewer CCSs fathered a child compared with siblings (49% vs. 94%; p=.001). More male survivors consult a reproductive specialist, but fewer survivors undergo ART and father a child after ART compared with siblings. This insight is important for understanding potential problems faced by survivors regarding family planning and emphasizes the importance of collaboration between oncologists and reproductive specialists.

#299 : Sex Ratio in Children Born After Assisted Reproduction and After Spontaneous Conception in the Czech Republic

Background and Aims: Various authors described slight differences in the sex ratio in the children born after the use of various assisted reproduction techniques (ART). Our goal was to investigate this trend using population-wide datasets from the official medical registries of the Czech Republic. Method: We have used data from the official medical registries run by the Institute of Health Information and Statistics of the Czech Republic, namely the National Registry of Congenital Anomalies and the National Registry of Assisted Reproduction. The registration process in the Czech Republic is population-wide and the reporting is compulsory by the national law. We analyzed the number of births of children depending on the method of conception, the presence of a congenital defect, the twinning rate, and maternal age. Study period: 2013–2020. Results: A total of 881,975 children were born in the study period, 853,131 were born after spontaneous conception, and 28,844 after ART. The frequency of males was 50,89% in the spontaneously conceived children and 50.3% in the ART-conceived children, but the difference is not statistically significant. Among the children born with some kind of congenital anomaly, the males were more frequent, but again the difference was not statistically significant. Analyzing the different subgroups according to the twinning rate also did not identify any statistically significant trend. Conclusion: Using the population-wide data we have confirmed changes in the sex ratio in children born after ART conception (especially analyzing different study subgroups according to the presence/absence of congenital anomaly and according to the twinning rate). None of the trends was classified as statistically significant. Supported by Ministry of Health, Czech Republic – conceptual development of research organization (Thomayer University Hospital - TUH, 00064190)

Antenatal fetal growth patterns in uncomplicated pregnancies according to mode of conception and placental location

Newborns resulting from in-vitro fertilisation (IVF) had a significantly (P= 0.002) higher birthweight centile than those resulting from spontaneous conception (SC) but no significant changes were found in ultrasound estimated fetal weight (EFW) centile between 20-22 and 32–34 weeks between the IVF and SC groups. When stratified for the IVF methods used, significant (P = 0.02) fastest in-utero fetal growth (mean increase in centile of 5 between 2nd to 3rd trimester) was observed in the frozen embryo transfer (FET) subgroup compared to SC, and to IVF pregnancies resulting from fresh blastocyst transfer (FBT) or from oocyte donation (OD). Low placentation was significantly (P < 0.001) more common in the IVF group than in the SC group but was not associated with a change in growth pattern suggesting that fetal growth in-utero is independent of placental location but may be influenced by embryo freezing.