Spontaneous Conception Research Articles

Psychosocial Consequences of Disclosing Misattributed Paternity: A Narrative Review

Unlike adoption and donor-assisted reproduction, misattributed paternity occurring within the context of spontaneous conception and outside of formally recognised practices of having a child remains largely an understudied phenomenon. Despite being an age-old phenomenon affecting a substantial population, the psychosocial consequences of disclosing and discovering misattributed paternity continue to lack empirical understanding. The current paper delineates misattributed paternity from other paternal discrepancies and reviews the limited body of scholarly arguments regarding the potential psychosocial consequences of disclosure/non-disclosure for individuals with paternal discrepancy. Four major categories of pro- and anti-disclosure arguments have been identified and reviewed: arguments concerned with potential disclosure/non-disclosure consequences for the child; for the parents; for the child-parent relationship and for the family unit. The review highlights the dearth of empirical knowledge on the psychosocial consequences of misattributed paternity and advocates a more nuanced exploration of this phenomenon and the need for specialist support.

Amniotic Sludge and Prematurity: Systematic Review and Meta-analysis.

To perform a systematic review and meta-analysis of studies on maternal, fetal, and neonatal outcomes of women with singleton pregnancies, after spontaneous conception, and with the diagnosis of amniotic sludge before 37 weeks of gestational age. We conducted a search on the PubMed, Cochrane, Bireme, and Theses databases until June 2022. Using the keywords intra-amniotic sludge or fluid sludge or echogenic particles, we found 263 articles, 132 of which were duplicates, and 70 were discarded because they did not meet the inclusion criteria. The articles retrieved were analyzed by 2 reviewers; 61 were selected for full-text analysis, 18 were included for a qualitative analysis, and 14, for a quantitative analysis. Among the maternal outcomes analyzed, there was an increased risk of preterm labor (95% confidence interval [95%CI]: 1.45-2.03), premature rupture of ovular membranes (95%CI: 1.99-3.79), and clinical (95%CI: 1.41-6.19) and histological chorioamnionitis (95%CI: 1.75-3.12). Regarding the fetal outcomes, there was a significant increase in the risk of morbidity (95%CI: 1.80-3.17), mortality (95%CI: 1.14-18.57), admission to the Neonatal Intensive Care Unit (NICU; 95%CI: 1.17-1.95), and neonatal sepsis (95%CI: 2.29-7.55). The results of the present study indicate that the presence of amniotic sludge is a risk marker for preterm delivery. Despite the heterogeneity of the studies analyzed, even in patients with other risk factors for prematurity, such as short cervix and previous preterm delivery, the presence of amniotic sludge increases the risk of premature labor. Moreover, antibiotic therapy seems to be a treatment for amniotic sludge, and it may prolong pregnancy.

Retrospective comparison of monochorionic diamniotic twin pregnancies stratified by spontaneous or artificial conception.

To compare outcomes of monochorionic diamniotic (MCDA) twin pregnancies by invitro fertilization (IVF) vs. spontaneously conceived counterparts. Retrospective comparison. Data about MCDA twin pregnancies, conceived spontaneously or by IVF, attending the Twin Pregnancy Care Unit of Sant'Anna Hospital in Turin (Italy) between January 1st 2010 and March 31st 2022, were collected retrospectively. Obstetric, fetal, and neonatal outcomes of MCDA twin pregnancies by IVF were compared to those of spontaneously conceived counterparts. Data were described by univariate and multivariate analysis. 541 MCDA twin pregnancies were included in the study, among which 45 conceived by IVF and 496 spontaneously conceived. Women with IVF twins were older than those who conceived spontaneously (36.7±5.7 vs. 32.1±5.2 years; p<0.001). No significant difference in the prevalence ofpregnancy complications between the two groups was found, except for an increased incidence of hypertensive disorders among IVF pregnancies (17.8 vs. 8.5 %; p=0.039), which resulted nonsignificant after adjusting for maternal age and parity (aOR 1.9, 95 % CI 0.8-4.6). Data about 1,046 live born babies (90 conceived by IVF and 956 spontaneously) were also collected: perinatal outcomes did not differ between the two groups. Our results suggest that MCDA twin pregnancies following IVF are not at increased risk of adverse outcomes compared to spontaneous MCDA twin pregnancies.

The association between type of conception through medically assisted reproduction and childhood cognition: a Danish population-wide cohort study.

Previous research has indicated that children conceived through medically assisted reproduction (MAR) generally have cognitive outcomes comparable to or better than naturally conceived children. However, previous studies have been limited in their ability to examine this relationship at a population level and consider variations across different types of MAR. This study utilizes data from all live births in Denmark between 2006 and 2009 (n = 259 608), including a subset of births resulting from MAR conceptions (n = 13 566). The dependent variable is the standardized test scores obtained in the second and third grades of primary schools. A comparison is made between the test scores of children spontaneously conceived (SC) and those conceived through intrauterine insemination (IUI) and assisted reproductive technologies (ART). Ordinary least squares regressions are employed, with a baseline model adjusted only for birth year, as well as models that additionally account for conception-related confounders and sociodemographic family characteristics. In the baseline analysis, ART- and IUI-conceived children displayed better test scores compared with their SC peers. However, after adjusting for relevant factors, ART-conceived children performed worse than SC peers, while IUI-conceived children performed equally well as SC peers and better than ART-conceived children. These results likely reflect differences in the selection process of potential parents into the type of MAR, as well as the consequences of variations in fecundability. Nevertheless, the differences observed across conception types were overshadowed by test score disparities in socioeconomic background.

Using serum anti-Müllerian hormone levels to predict the chance of live birth after spontaneous or assisted conception: a systematic review and meta-analysis.

Is serum anti-Müllerian hormone (AMH) level predictive of cumulative live birth (CLB) rate after ART or in women trying to conceive naturally? Serum AMH level is linked to CLB after IVF/ICSI but data are lacking after IUI or in women trying to conceive without ART. Serum AMH level is a marker of ovarian reserve and a good predictor of ovarian response after controlled ovarian stimulation. It is unclear whether AMH measurement can predict CLB in spontaneous or assisted conception. A systematic review and meta-analysis was undertaken to assess whether serum AMH level may predict chances of CLB in infertile women undergoing IVF/ICSI or IUI and/or chances of live birth in women having conceived naturally. A systematic review and meta-analysis was performed using the following keywords: 'AMH', 'anti-mullerian hormone', 'live-birth', 'cumulative live birth'. Searches were conducted from January 2004 to April 2021 on PubMed and Embase. Two independent reviewers carried out study selection, quality, and risk of bias assessment as well as data extraction. Odds ratios were estimated using a random-effect model. Pre-specified sensitivity analyses and subgroup analyses were performed. The primary outcome was CLB. A total of 32 studies were included in the meta-analysis. Overall, 27 articles were included in the meta-analysis of the relation between AMH and CLB or AMH and LB after IVF/ICSI. A non-linear positive relation was found in both cases. A polynomial fraction was the best model to describe it but no discriminant AMH threshold was shown, especially no serum AMH level threshold below which live birth could not be achieved after IVF/ICSI. After IVF-ICSI, only four studies reported CLB rate according to AMH level. No statistically significant differences in mean serum AMH levels were shown between patients with and without CLB, but with a high heterogeneity. After exclusion of two studies with high risks of bias, there was no more heterogeneity [I2 = 0%] and the mean AMH level was statistically significantly higher in women with CLB. There were not enough articles/data to assess the ability of AMH to predict CLB rate or find an AMH threshold after IUI or in women without history of infertility trying to conceive without ART. The systematic review and meta-analysis had some limitations owing to the limits and bias of the studies included. In the present meta-analysis, heterogeneity may have been caused by different baseline characteristics in study participants, different stimulating protocols for ART, different serum AMH level thresholds used and the use of various assays for serum AMH. This could explain, in part, the absence of a discriminating AMH threshold found in this analysis. Serum AMH level is linked to CLB rate after IVF/ICSI but no discriminating threshold can be established, therefore low serum AMH level should not be used as the sole criterion for rejecting IVF treatment, especially in young patients. Data are lacking concerning its predictive value after IUI or in women trying to conceive without ART. Our findings may be helpful to counsel candidate couples to IVF-ICSI. No external funding was obtained for this study. There are no conflicts of interest. PROSPERO CRD42021269332.

Influence of Letrozole and Co Q10 on Sex Hormones and Spermiogram in Infertile Men; sample of Iraqi patients

Background: The definition of World Health Organization (WHO) to the infertile couple is the failure of female get pregnancy in spite of having regular sexual activity for at least 1 year without using any contraceptive methods, worldwide it is estimated that 15 % of reproductive-age couples are struggling with infertility.&#x0D; In many cases, infertility cannot be treated, new treatment options with promising value were involved in the recent clinical trials.&#x0D; Aim: This study was designed to evaluate the effects of letrozole plus coenzyme Q10 combination on spermiogram and sex hormones in men with idiopathic oligoasthenoteratozoospermia (iOAT) syndrome.&#x0D; Patient and methods: fifty-five patients are enrolled in this study, but only 40 patients complete the study, they are treated with a combination of Letrozole 2.5 mg tablet orally twice a week plus Co-enzyme Q10 400mg per day for three months. Seminal fluid sample, follicle-stimulating hormone, estradiol, and testosterone were analyzed before starting the treatment and at the end of month 1, 2 and 3.Results: sperm concentration, sperm morphology, total sperm count and motility, serum testosterone and follicle stimulation hormone levels, in addition to testosterone/estradiol ratio were significantly improved, while estradiol levels significantly decreased after 3 months of treatment. However, seminal fluid volume showed no significant change. Finally, as a notable outcome, one spontaneous conception occurred after treatment as well as three azoospermia cases responded well after completing the course of treatment.&#x0D; Conclusions: a combination of Letrozole and CO Q10 can effectively improve sperm parameters in Iraqi men with iOAT.

How does IVF conception affect pregnancy complications in an older cohort of women, at least 38years of age? Study of a population database.

To compare perinatal outcomes in in-vitro fertilization (IVF) pregnancies versus spontaneous conceptions in woman of advanced maternal age (AMA), and to evaluate the effect of increasing age on IVF pregnancies' outcomes. A retrospective population-based cohort study including pregnant women who delivered between 2008-2014 in the US. First, we included women aged 38-43years and compared those with IVF conceptions (cases) to women with spontaneous conceptions (controls). Thereafter, we compared IVF pregnancies in women aged 38-43years to IVF pregnancies at < 38years of age. Multivariate logistic regression was performed to compare both groups regarding pregnancy,delivery, and neonatal outcomes after adjusting for plausible confounders. Three hundred nine thousand five hundred sixty-seven pregnant women aged 38-43years were identified, with 2,762 composing the IVF group, and 306,805 composing the control group. After adjusting for confounders, the IVF group had a higher risk of several adverse obstetrical outcomes, including hypertensive disorders of pregnancy (aOR 1.31,95%CI 1.06-1.62), gestational diabetes (aOR 1.26,95%CI 1.13-1.41),preterm delivery (aOR 1.45,95%CI 1.16-1.81), cesarean section (CS) (aOR 1.84,95%CI 1.55- 2.19),postpartum hemorrhage (aOR 1.68,95%CI 1.27- 2.24), and maternal infection (aOR 1.90,95%CI 1.31-2.77), with comparable neonatal outcomes. For the second analysis, 9712 IVF pregnancies were included (n = 6950 < 38years, and n = 2762 ≥ 38years). Women ≥ 38years who underwent IVF were more likely to experience hypertensive disorders of pregnancy, CS, hysterectomy and blood transfusion, with comparable neonatal outcomes. IVF AMA pregnancies have a significant increase in myriad perinatal complications compared to spontaneous AMA pregnancies. Younger women undergoing IVF have mildly less complications than their older counterparts.

Inflammatory bowel disease meets fertility: A physician and patient survey.

Inflammatory bowel disease (IBD) can affect patients during their childbearing years. Literature evidence is scarce regarding the level of knowledge among health care professionals (HCPs) and patients about the impact of IBD on fertility. The aim of this survey was to investigate HCPs' and patients' knowledge on fertility, pregnancy, and sexual function, to evaluate how HCPs approach this topic and to report patients' reproductive outcomes. Subjects were invited to anonymously complete an online questionnaire collecting data on demographics, patients' disease characteristics, Crohn's and colitis pregnancy-specific disease-related knowledge (CCPKnow), family planning, reason of childlessness, pregnancy outcomes, need for assisted reproductive technology, impact on sexual function, and availability of patients' information regarding IBD and pregnancy. A total of 257 HCPs from 40 countries and 793 patients (615 females, 176 males and 2 who preferred not to disclose their gender; 396 (50%) with ulcerative colitis, 381 (48%) with Crohn's disease, 14 (1.8%) with undetermined IBD) from 4 countries completed the survey. In total, 98.4% of HCPs had good or very good pregnancy-specific knowledge according to CCPKnow score, compared to only 29.3% of patients. Of the women surveyed, 56.3% had no children (14.1% due to a voluntary choice). A total of 427 pregnancies and 401 live births were reported in 266 women. Twenty-four pregnancies (5.6%) in 22 women required assisted reproductive technologies (ART). There were no more complications in pregnancies resulting from ART compared with spontaneous conception (5/24; 20.8% vs 81/401; 20.2%). Three quarters of IBD patients (75.6%) had breastfed. An impaired sexual function was found in one-fifth (21.9%) of men with IBD, while two-thirds (66.1%) of the women reported sexual function impairment. Surprisingly, 63% of patients reported not having received any information about IBD and pregnancy, and only 10% of patients had received information from their IBD specialist. In addition, 42.1% and 36% of HCPs had already referred a patients to a medically assisted reproduction center to receive general information about their reproductive health and about options of fertility preservation (e.g., cryopreservation), respectively. IBD patients have a poor knowledge about the impact of IBD on fertility and pregnancy and HCPs do not sufficiently inform their patients. More information on these topics is needed for IBD patients.

Anxiety and depression in expectant parents: ART versus spontaneous conception.

Do expectant parents experience increased anxiety and depression during pregnancies conceived through ART compared to spontaneous conception? Among all expectant parents in the sample, those who conceived through ART reported overall lower levels of anxiety and depression in pregnancy compared to expectant parents who conceived spontaneously, while in the subsample of parents who conceived both through ART and spontaneous conception, expectant mothers experienced increased anxiety and depression in early pregnancy following ART compared to spontaneous conception. Previous research on expectant parents' psychosocial adjustment in response to ART has found mixed results, with some studies suggesting ART is associated with increased anxiety and depression, and other studies suggesting improved mental health or no relationship. Mixed findings may relate to the use of cross-sectional designs that do not account for confounding differences between groups, or variability in the timing of assessment. This prospective cohort study used data from the Norwegian Mother, Father and Child Cohort Study (MoBa), which includes 2960 pregnant women who underwent ART and 108183 women who conceived spontaneously. Of these, a subsample of expectant parents had two consecutive pregnancies with one pregnancy resulting from ART and one conceived spontaneously (n = 286 women, n = 211 partners). Women self-reported their composite symptoms of anxiety and depression at two timepoints during each pregnancy (gestational weeks 17 and 30). Their partners self-reported composite symptoms of anxiety and depression at 17 weeks gestation during each pregnancy. Couples reported their relationship satisfaction at 17 weeks gestation. Using a conventional full-cohort analysis we found that ART was associated with less total anxiety and depression and greater relationship satisfaction, compared to spontaneous conception among both women and men. However, in the subsample of parents who experienced both ART and spontaneous pregnancies, ART was associated with increased levels of maternal anxiety and depression at gestational age 17 weeks (M = 1.19), compared to spontaneous pregnancies (M = 1.15), 95% CI of the mean difference 0.006, 0.074. At 30 weeks gestation, anxiety and depression were similar across both types of pregnancies. Expectant fathers reported similar levels of anxiety and depression at 17 weeks gestation during both pregnancies. Among women relationship satisfaction was higher following ART conception than spontaneous conception. There is potential for selection effects in the sample, as women who have conceived through both ART and spontaneous conception in their first two pregnancies are rare. In addition, several factors that may be important predictors of mental health in this context, such as previous miscarriages and long-term infertility, were not assessed in the current study. Our findings indicate that previous discrepancies in the literature may be related to inherent differences between the groups of parents receiving reproductive treatment and those who do not. This study addresses that limitation by prospectively comparing different types of pregnancies within the same expectant parents. Earlier inconsistencies may also relate to variations in gestational age when anxiety and depression were assessed. By examining symptoms at two timepoints in each pregnancy, we were able to examine the relation between gestational age and symptoms of anxiety and depression. The MoBa is supported by the Norwegian Ministry of Health and the Norwegian Research Council/FUGE (grant number 151918/S10). This work was also supported by the Research Council of Norway grant number 288083 and 301004. The authors have no conflicts of interest to declare. N/A.

P-774 Congenital Heart Disease in Children Born after Assisted Reproductive Technology: A Nordic Cohort Study.

Abstract Study question Do children conceived after assisted reproductive technology (ART) have a higher risk of Congenital Heart Disease (CHD) in comparison with children born after spontaneous conception? Summary answer Children born after ART have a higher risk of a major CHD compared with children born after spontaneous conception. What is known already It is well-known that children born after ART have higher risk of birth defects compared to children born after spontaneous conception. Congenital heart disease (CHD) is the most common birth defect, accounting for almost 50% of all major birth defects. Several cohort studies and systematic reviews have also found an increased risk of CHD in children born after ART, a recent review included 41 studies and 25 856 ART children covering CHDs in ART children. Conflicting results have been reported for specific CHDs. Study design, size, duration This Nordic registry-based cohort study from CoNARTaS (Committee of Nordic ART and Safety) included 171 774 live births born after use of ART and 7 772 474 live births born after spontaneous conception during a study period of up to three decades (Denmark 1994-2014, Finland 1990-2014, Norway 1984-2015, and Sweden 1985-2015). National data from ART registries, medical birth registries, malformation registries, patient registries, cause of death registries, and population registries were crosslinked. Participants/materials, setting, methods International Classification of Diseases (ICD) versions 8, 9, 10 were used for CHD codes at birth and up to one year of age. Major CHDs were defined according to European Concerted Action on Congenital Anomalies and Twins (EUROCAT). According to EUROCAT, 26 of the major CHDs were considered as severe. All major CHDs were further classified into six different groups in a hierarchical order. Minor CHDs as well as stillbirths and pregnancy terminations were excluded. Main results and the role of chance Data from Sweden included a total of 3 228 526 singletons and multiples; 62 243 children conceived after use of ART and 3 166 283 children after spontaneous conception. Among ART children, 2.27% (n = 1411) were diagnosed with any major non-chromosomal CHD during their first year of life, corresponding figures for children born after spontaneous conception was 1.43% (n = 45 310) (Odds Ratio [OR] 1.60; 95% Confidence Interval (CI) 1.51 to 1.69, p &amp;lt; 0.0001). Severe CHD occurred in 0.40% (n = 249) in the ART group and 0.31% (n = 9 795) in the spontaneous conception group (OR 1.29; 95% CI 1.14 to 1.47, p &amp;lt; 0.0001). Ventricular septal defect was the most common CHD, 0.97% (n = 603) in the ART vs 0.64% (n = 20 343) in the spontaneous conception group (OR 1.51; 95% CI 1.39 to 1.64, p &amp;lt; 0.0001), followed by atrial septal defect; 0.84% (n = 525) in the ART and 0.42% (n = 13 363) in the spontaneous conception group (OR 2.00; 95% CI 1.83 to 2.19, p &amp;lt; 0.0001). Limitations, reasons for caution This analysis included only non-adjusted Swedish data. Further analysis will include Danish, Finnish, and Norwegian data with adjustments, and subgroup analysis on singletons and multiples. No data are available on prenatal diagnosis, or pregnancies not ending to a live birth. A skewed distribution in these outcomes might introduce a bias. Wider implications of the findings Pregnancies conceived after use of ART may benefit from screening with fetal echocardiography. Although most children with CHD reach adulthood, the mortality rate is still high for this group during the first years of life. Early detection with antenatal diagnosis and pre/postnatal intervention may be beneficial and improve the outcome. Trial registration number Not applicable

O-151 Intrahepatic cholestasis of pregnancy and relevant neonatal outcomes in IVF versus spontaneous conception: a prediction nomogram-based study

Abstract Study question Does the incidence of intrahepatic cholestasis of pregnancy (ICP) differ in spontaneous conception(SC) versus in vitro fertilization (IVF) conception? Summary answer We observed that the ICP rate was higher in IVF than in SC, and first built a prediction nomogram to find the predictors of ICP. What is known already There are limited clinical studies comparing intrahepatic cholestasis of pregnancy(ICP) and neonatal outcomes in puerperae who spontaneously conceived and those who conceived via assisted reproductive technology. Several studies comparing the maternal, laboratory, and perinatal characteristics of in-vitro fertilization(IVF) and spontaneous pregnancies concerning ICP show that IVF treatment has an increased risk of ICP in singleton and multiple deliveries. However, given that it is difficult to collect big data, most research on IVF patients with ICP involve small sample size or case reports. Study design, size, duration This was a retrospective real-world data study that linked the information from puerperae and neonates. We included 4,467 puerperae who conceived via ART, and 28,336 puerperae who conceived spontaneously. Participants/materials, setting, methods Cochran–Mantel–Haenszel (CMH) analysis and a general linear model (GLM) were used to control bias. We compared the related serum-derived indicators and neonatal outcomes of ICP patients with in vitro fertilization (IVF) and SC. Multivariate logistic regression analysis, a forest plot, and nomogram were used to assess impact factors and risk prediction. Main results and the role of chance Logistic analysis adjusted for confounders revealed significant differences in the ICP rate of singleton delivery (4.24% vs. 3.41%, adjusted OR = 1.26 [95% confidence interval (CI) 1.03–1.53], P=0.025) and in groups with total bile acids(TBA) ≥40 and &amp;lt;100 µmol/L (14.77% vs. 10.39%, aOR=1.31[95% CI 1.06–1.63], P=0.023) between IVF and SC. When we divided newborns into singleton and twins delivery, the GLM revealed a higher rate with Apgar score &amp;lt;7 (13.44% vs. 3.87%; aOR=3.85 [95% CI: 2.07–7.17], P &amp;lt;0.001) and fetal distress for IVF in comparison with SC (19.32% vs. 5.55%; OR = 3.48 [95%CI: 2.39–6.95], P &amp;lt;0.001) in the singleton group. In multivariate logistic regression analysis, five factors were independent predictors of ICP: body mass index (BMI) (aOR=1.75 [95% CI 1.03–2.13], P=0.036), number of embryo transferred (ET) (single ET vs. double ET: aOR=4.82 [95% CI 3.83–6.05], P&amp;lt;0.001), E2 level on the ET day (aOR=2.79 [95% CI 1.79–4.05], P=0.011), fresh ET which compared with frozen ET (FET) (aOR=1.40 [95% CI 1.09–1.80], P=0.008), and severe ovarian hyperstimulation syndrome which compared with non-OHSS (aOR=3.97 [95% CI 1.79–8.80], P&amp;lt;0.001). These predictive factors in the logistic regression model were integrated into the nomogram (C-index=0.735 [95% CI, 0.702–0.764]); for each patient, higher total points indicated a higher risk of ICP. Limitations, reasons for caution The limitations of this study include its retrospective nature, and the balance in baseline characteristics between IVF and SC measured using statistical methods. Wider implications of the findings Our results provide evidence for the incidence of ICP between spontaneously conceived and those who conceived via IVF, and found predictors of ICP in IVF treatment. It could assist physicians in making clinical decisions avoiding risk factors during IVF, and taking preventive countermeasures for patients. Trial registration number not applicable

P-663 Serum anti-Müllerian hormone level to predict the chance of live birth after spontaneous or assisted conception: a systematic review and meta-analysis

Abstract Study question Is Serum anti-Müllerian hormone (AMH) level predictive of cumulative live birth (CLB) rate after assisted reproductive technologies (ART) or in women trying to conceive naturally? Summary answer Serum AMH level is linked to CLB after IVF/ICSI but data are lacking after intrauterine insemination (IUI) or in women trying to conceive without ART. What is known already Serum AMH level is a marker of ovarian reserve and a good predictor of ovarian response after controlled ovarian hyperstimulation. Literature is unclear whether its measurement can predict CLB in spontaneous or assisted conception. Study design, size, duration A systematic review and meta-analysis, following PRISMA guidelines, was undertaken to assess whether serum AMH level may predict chances of CLB in infertile women undergoing IVF/ICSI or IUI and/or chances of live birth in women having conceived naturally. Participants/materials, setting, methods A systematic review and meta-analysis was performed using the following keywords: “AMH”, “Anti-Müllerian Hormone”, “Live-Birth”, “Cumulative live birth”. Searches were conducted from January 2004 to May 2021 on PubMed and Embase. Two independent reviewers carried out study selection, quality assessment and bias assessment with QUIPS tool scale and data extraction. Odds ratio were estimated using random-effect model. Pre-specified sensitivity analyses and subgroup analyses were performed. The primary outcome was CLB. Main results and the role of chance A total of 32 studies were included in the meta-analysis. After IVF-ICSI, only 4 studies reported CLB rate according to AMH level. No statistically significant differences in mean serum AMH levels was shown between patients with and without CLB, but with a high heterogeneity [Difference in Means (95% CI) = 0.97 (-0.25;2.19) ng/mL; I² = 99%; p = 0.12; n = 4]. After exclusion of 2 studies with high risks of bias, there were no more heterogeneity [I²=0%] and the mean AMH level was statistically significantly higher in women with CLB [Difference in Means (95% CI)=0.86 (0.53;1.19) ng/mL; p &amp;lt; 0.00001; n = 2]. Overall, 27 articles were included in the meta-analysis of the relationship between AMH and CLB or AMH and LB after IVF/ICSI. A non-linear positive relationship was found in both cases. A polynomial fraction was the best model to describe it but no discriminant AMH threshold was shown. There were not enough articles/data to assess the ability of AMH to predict CLB rate or find an AMH threshold after IUI or in women without history of infertility trying to conceive without ART. Limitations, reasons for caution Systematic review and meta-analysis have some limitations due to the limits and bias of the studies included. In the present meta-analysis, heterogeneity may have been caused by different baseline characteristics in study participants, different stimulating protocols for ART, different serum AMH level threshold used and various assays of serum AMH. Wider implications of the findings Serum AMH level is linked to CLB rate after IVF/ICSI but no discriminating threshold can be established. Data are lacking concerning its predictive value after IUI or in women trying to conceive without ART. Our findings may be helpful to counsel candidate couples to IVF-ICSI. Trial registration number not applicable

P-778 Same mother-different Oocyte: Comparison of obstetric and perinatal outcomes between pregnancies achieved through oocyte donation versus those achieved through spontaneous conception for the same mother

Abstract Study question Is there a difference in obstetrical and perinatal outcomes between pregnancies achieved through oocyte donation versus those achieved through spontaneous conception for the same mother Summary answer OD pregnancies show higher incidences of preterm labor and pregnancy-induced hypertension, and lower incidences of small for gestational age, compared to spontaneous pregnancies What is known already Oocyte donation (OD) is an integral part of modern assisted reproductive care and has been used for over three decades. OD pregnancies have an increased rate of hypertension, cesarean section, and preterm labor. Yet most of these complications are attributed to the mothers going through OD, not to the biological effect of different oocyte sources (autologous Vs. donation). Study design, size, duration This study is a retrospective cohort study that utilizes electronic data from Maccabi Healthcare Services. This 2.5-million-patient integrated care organization represents 25% of the pregnant population in the country. The data used in this study were collected from 2000 through 2018. Participants/materials, setting, methods The study included mothers who experienced both a spontaneous conception (SP) pregnancy and later an oocyte donation (OD) pregnancy. The study compared obstetric and perinatal outcomes, including the incidence of preterm labor (PTL) and small for gestational age (SGA). Mother's obstetric outcomes such as pregnancy induced hypertension (PIH), gestational diabetes, malpresentation, and postpartum hemorrhage were also analyzed. A paired t-test was performed to compare each outcome for the same mother Main results and the role of chance The cohort included 194 mothers who had a first spontaneous pregnancy and a second pregnancy with oocyte donation. The mean age of the mother during her OD pregnancy was statistically older than the OD pregnancy (mean difference 2.2 years, p = 0.0028). No difference was found between pregnancies regarding the BMI (p = 0.216). A trend toward a higher prevalence of PIH was found in the OD pregnancy compared to the SP (mean difference 2.5, p = 0.058). No difference was found between pregnancies regarding gestational diabetes (p = 0.7), malpresentation (p = 1), retained placenta (p = 0.318), and Cesarean section (p = 0.565). Perinatal outcomes show a higher prevalence of premature labor before the 34th week and 32nd week in the OD pregnancies compared to SC pregnancies (mean difference 3.6, p = 0.034 and mean difference 3, p = 0.33 respectively). No difference was found between pregnancies regarding labor before the 37th week (p = 1). A statistically lower prevalence of SGA was found in the OD pregnancy compared to the SP (p = 0.0057). Limitations, reasons for caution Due to its retrospective character, some information is lacking. Information regarding indications leading to OD/AO are missing which might have elaborated our findings Wider implications of the findings OD pregnancies should be considered high-risk, primarily due to the increased risk of PTL and PIH. Adequate recommendations should be considered, including cervical length surveillance, frequent blood pressure measurements, and perhaps prophylactic low-dose aspirin to reduce the risk of preeclampsia. Trial registration number 0046-18-BBL

O-199 Imprinting disorders in singletons conceived by assisted reproductive technology in Sweden

Abstract Study question Is singleton birth from assisted reproductive technology (ART) associated with imprinting disorders (IDs) independent of parental infertility and other background factors? Summary answer Singletons conceived using intracytoplasmic sperm injection (ICSI) and frozen embryos have higher risks of Beckwith-Wiedemann syndrome (BWS), Prader-Willi syndrome (PWS) and Silver-Russell syndrome (SRS). What is known already Previous studies have suggested elevated risk of IDs in children conceived with ART compared with children conceived with spontaneous conception (SC). It is not clear to what extent the observed associations could be explained by parental infertility and related risk factors. Knowledge on specific ART procedures and their association with IDs is also limited. Study design, size, duration A nationwide register-based cohort study was carried out in which all liveborn singletons in 1997-2017 in Sweden were included with follow-up to 2018. Participants/materials, setting, methods Among 1 998 825 singletons, 60 210 were conceived using ART. The International Classification of Diseases (ICD) version 10 was used to identify three distinct ID groups: PWS/SRS, BWS, and central precocious puberty (CPP). Cox regression, combined with inverse probability treatment weights to account for birth year, parity, pregnancy loss history, parental age and country of origin, was used to compare ART singletons with all SC singletons and those born to couples with known infertility. Main results and the role of chance A total of 1012 children were diagnosed with the IDs of interest (654 PWS/SRS, 255 BWS, and 109 CPP), and 49 of them were conceived through ART. Compared with all SC singletons, higher risk of PWS/SRS and BWS was observed in ART singletons and the weighted hazard ratios (wHRs) were 1.57 [95% CI, 1.09-2.26] and 2.57 [95% CI, 1.60-4.12], respectively. The elevated risks remained when comparison was restricted to SC singletons of couples with known infertility, though the wHR for BWS was somewhat attenuated (1.87, 95% CI: 1.04-3.36). No difference in risk of CPP was observed between singletons conceived with and without ART irrespective of parental infertility. Further subgroup analysis revealed that ICSI in combination with frozen embryo transfer was responsible for the higher risks of PWS/SRS (wHR 6.32, 95% CI: 3.34-11.95) and BWS (wHR 9.04, 95% CI: 4.34-18.82). Limitations, reasons for caution The use of the Swedish ICD-10 did not allow distinction of PWS and SRS. The number of CPP cases in ART singletons was too small (N = 3) to make inference. Wider implications of the findings This study found that ART-conceived singletons, particularly those conceived using ICSI and frozen embryos, had a higher risk of IDs independent of parental infertility. However, the underlying mechanism is not clear, and the role of type and severity of infertility warrants further investigation. Trial registration number not applicable

P-447 Gestational weight gain in relation to time-to-pregnancy and conception by assisted reproductive technology

Abstract Study question Does the gestational weight gain trajectory differ across levels of time-to-pregnancy (TTP) for spontaneously conceived pregnancies and pregnancies conceived by assisted reproductive technology (ART)? Summary answer Women with ART pregnancies had lower weekly weight gain during the third trimester compared with women with spontaneous conceptions with TTP ≤3. What is known already Studies suggest that both prolonged TTP and conception by ART may increase the risk of pregnancy complications and affect perinatal outcomes such as birthweight. Suboptimal gestational weight gain might further increase the risk of adverse pregnancy outcomes. However, it remains unclear whether there may be differences in gestational weight gain according to TTP and ART, which contribute to the subsequent risk of adverse pregnancy outcomes. Study design, size, duration We studied 69,121 singleton planned pregnancies contributed by 60,847 women participating in the Norwegian Mother, Father and Child Cohort Study. Participants completed questionnaires at 15 weeks’ gestation (study entry), 30 weeks’ gestation, and six months postpartum on sociodemographic, reproductive, and behavioral factors. Participants reported their TTP, and up to four weight measurements and corresponding gestational age from preconception through delivery. We identified use of ART in the Medical Birth Registry of Norway. Participants/materials, setting, methods We fitted gestational weight gain trajectories using mixed-effects linear regression models and included an interaction term between time (gestational weeks) and the exposure groups, TTP ≤3 (reference); TTP 4-6; TTP 7-11, TTP ≥12 months, and ART, to assess differences across levels of TTP and conception by ART. The analyses were adjusted for maternal age at start of pregnancy, pre-pregnancy height, educational attainment, pre-pregnancy smoking, parity, and gestational age at birth. Main results and the role of chance The adjusted average weekly weight gain was -15g (95% CI: −19; −12) during the first trimester, 620g (95% CI: 615; 624) during the second trimester, and 491g (95% CI: 489; 494) during the third trimester. When we compared differences in average weekly weight change during the first trimester, we observed little difference between the exposure groups. During the second trimester, compared with TTP≤3 months women with TTP 4-6 months, TTP 7-11 months or TTP ≥12 months gained on average 7g (95% CI: −18; 3), 19g (95% CI: −33; −5) and 15g (95% CI: −29; −1) less per week, respectively, whereas women with ART pregnancies gained 11g more per week (95% CI: −13; 34). However, the results for TTP 4-6 and ART pregnancies were imprecise. During the third trimester, average weekly weight gain did not differ according to TTP for spontaneous conceptions, while women who conceived after ART gained 35g (95% CI: −49; −22) less than women with TTP≤3 each week. Limitations, reasons for caution Because TTP and gestational weight gain were self-reported, non-differential misclassification may have influenced our results. Wider implications of the findings Decelerated weight gain during the third trimester in ART pregnancies compared with women who conceived spontaneously within 3 months might be associated with adverse pregnancy outcomes. Although our findings are imprecise and need to be replicated, monitoring gestational weight gain trajectories might support identification of pregnancies at increased risk. Trial registration number Not applicable

P-770 Risk factors for placenta accreta spectrum among pregnant women conceived with assisted reproductive technology

Abstract Study question What are the risk factors for placenta accreta spectrum (PAS) among women conceived with assisted reproductive technology (ART)? Summary answer The risk of PAS was associated with elevated estradiol and progesterone levels during COH, and HRT protocol, and abnormal endometrial thickness when preforming FET. What is known already Increasing evidence suggests an association between ART and PAS. Some studies have reported a high rate of diagnosis of PAS after embryo transfer compared to those with spontaneous conception. Despite this, little is known about the detailed risk factors for PAS during the procedures of ART. Study design, size, duration This retrospective case-control study included 1541 pregnant women with live birth conceived ART between 2013 and 2019 in a university hospital. Participants/materials, setting, methods Pregnant women were categorized into case and control group according to the postpartum diagnosis of PAS. The associations between PAS and ART procedures were estimated using multivariate logistic regression, and represented as adjusted odds ratio (aOR) and 95% confidential interval (CI). Main results and the role of chance Among all pregnant women in this study, 118 were delivered with PAS, and 1423 were delivered without PAS. During the procedures of COH and oocytes retrieval, elevated levels of estradiol (aOR=1.03, 95% CI: 1.01-1.06) and progesterone (aOR=1.02, 95% CI: 1.00-1.04) were found to be associated with the risk of PAS. The number of oocytes retrieved over 10 were also found to have an association with PAS (aOR=1.58, 95% CI: 1.05-2.37). Additionally, FET was another risk factor forPAS (aOR=1.93, 95% CI: 1.06-3.51). Among pregnant women with FET, preparing the endometrium using HRT protocol increased the risk of PAS (aOR=2.46, 95% CI: 1.57-3.84). Notably, PAS was also found to have an association with abnormal endometrial thickness after preparing the endometrium, whether too thin (&amp;lt;7mm: aOR=15.90, 95% CI: 4.42-57.21) or too thick (&amp;gt;14mm: aOR=6.56, 95% CI: 1.84-23.45). Limitations, reasons for caution As a hospital-based study, several confounders related to medical procedures have been taken into consideration. However, it is not possible to rule out unknown confounders. Wider implications of the findings Caution is warranted when preforming COH, and endometrial preparation before FET due to the increased risk of PAS after deliveries. Trial registration number NA

O-055 Efficacy of Laparoscopic Abdominal Cerclage in Women With Prior 2nd Trimester Losses/Preterm Birth: Perinatal Outcomes of Case Series

Abstract Study question What is the efficacy of laparoscopic abdominal cerclage (LAC) that placed during periconceptional period in singletons with prior 2nd trimester pregnancy losses/preterm deliveries (PTDs)? Summary answer LAC seems to prolong pregnancy duration and enhance perinatal outcomes in singletons prior 2nd trimester losses/PTDs. What is known already Cervical insufficiency (CI) is defined as the inability of the uterine cervix to retain a pregnancy till term without the signs and symptoms of clinical contractions ,with an incidence up to 1% (Berghella, 2011). Cervical cerclage (CC) has been proposed as an effective treatment for CI in terms of successfully prolonging the pregnancy period and improving the perinatal prognosis. The common clinical approach is transvaginal cervical cerclage (TVC), which is a feasible and relatively easy technique. However, some group of women may experience late abortions and/or PTD and LAC has been proposed to enhance pregnancy outcomes. Study design, size, duration Case series consisting of singletons with at least 2 prior PTDs and managed with LAC was reviewed between January 2019-November 2022. After placement of LAC, reproductive and perinatal outcomes of women were reviewed for 2 years. Participants/materials, setting, methods All women with at least 2 prior 2nd trimester losses and/or PTDs were offered to LAC procedure during the period. After having informed consents, total of 28 LAC procedures were performed. All surgeries were performed by a single experienced laparoscopist in the same center. Non-absorbable mersilene tape was placed during preconceptional period. Reproductive outcomes including spontaneous and assisted conception cycles and perinatal outcomes were reported. Main results and the role of chance A total of 28 LAC proceudres were performed during the period. Mean age of women was 34±2 and mean numbers of previous 2nd trimester losses/PTDs was 2.8±0.8, of which all of them were &amp;lt;24 weeks. Total of 8 women have had gynecologic surgery in their history. Less than 12 months interval, 19 out of 28 women got pregnent; 13/28 conceived spontaneously and 6/28 conceived with after IVF treatment. For the perinatal outcomes; there were no single case of 2nd trimester losses/PTDs &amp;lt;24 weeks in the entire cohort. 15 women delivered &amp;gt;34 weeks and remaining 4 delivered at term (&amp;gt;37 weeks). During the gestation, no additional medication was provided to pregnants such as progesterone treatment. The mean gestational age was 35 4/7 weeks. There were no remarkable adverse events during the pregnancy. All newborns were healthy without remarkable issues, only 2 infants required intensive care for less than 2 weeks. Limitations, reasons for caution Small sample size, lack of a control group and randomization and heterogenious patient population. Wider implications of the findings LAC appears to have favorable pregnancy outcomes in singletons with prior pregnacy losses and/or PTDs. To precisely conclude, randomized controlled trials are needed with different intervention arms in the same population. Trial registration number non applicable

P-450 Prediction models for estimating treatment independent conception in unexplained infertility – a systematic review

Abstract Study question What are the best prediction models which can estimate the chance of natural conception in couples with unexplained infertility? Summary answer The best quality clinical prediction models were those generated by Hunault et al (2004), Van Eekelen et al (2017) and McLernon et al. (2019). What is known already Although couples with unexplained infertility have a chance of natural conception, a formal estimate of prognosis is not part of routine clinical decision making in most settings. In the UK, NICE recommends IVF after two years of unexplained infertility in all couples, regardless of their individual chances of conception without treatment. This approach risks overtreatment for some whilst delaying access to IVF for others. Since the last systematic review on this topic 10 years ago, several models which aim to predict natural conception in infertile couples have been published, but few are in routine clinical use Study design, size, duration We searched OVID MEDLINE, OVID EMBASE, and OVID PsycINFO systematically for primary articles published between 1978 and 2022, reporting on the development and/or validation of models in predicting spontaneous conception, pregnancy, or live birth. No language or any other restrictions were applied. Participants/materials, setting, methods We included couples with unexplained infertility / those with no major barriers to natural conception. Women who underwent any form of fertility treatment immediately after the initial diagnostic work up were excluded. The methodological quality of the included papers was assessed using criteria within the CHARMS checklist. Risk of bias was evaluated using the PROBAST tool while discrimination and calibration results, which rate the performance of the prediction model, were also reported. Main results and the role of chance Eighteen publications reported on 23 prediction models with natural conception, pregnancy, ongoing pregnancy and live birth as outcomes. Of 11 studies involving model development, internal and external validation were reported in 4 and 2 publications respectively . Two studies published extended versions of the same model (Hunault et al, 2004) while 3 studies focussed on independent validation of existing models. The methodological rigour of the models has improved over time, as demonstrated by accuracy measures including discrimination and calibration. Three models (Hunault et al, 2004, Van Eekelen et al, 2017, and McLernon et al, 2019) had low risk of bias. The static Hunault model can be used to determine the chance of conception at a single point in time – usually at the conclusion of the initial fertility work up, whereas the Van Eekelen and McLernon models are dynamic models that can estimate chances of conception at different time points. The discriminatory ability of models ranged between 0.59-0.64 in the internal validation and external validation studies. The calibration slope for the Hunault’s static model was 0.6 to 1.0 and for the dynamic models it ranged from 0.62 to 1.01 for Van Eekelen’s model and 0.65to 1.06 for McLernon’s model. Limitations, reasons for caution The quality of prediction models which predated the CHARMS checklist and PROBAST tool could not be adequately assessed. The population with most models went beyond unexplained infertility and included other couples with a chance of natural conception e.g. mild male infertility and minimal endometriosis. Wider implications of the findings Of the 3 models which are of high quality, the Hunault model can only be used once but the Van Eekelen and McLernon models have the potential to be used more flexibly, following further external validation in different settings and larger populations. Trial registration number not applicable

Review of socioeconomic risk factors for cesarean births: a population-based study.

The reasons for increased cesarean section (CS) rates are complex and multifactorial. The goal of this study was to look at different social and economic factors that might be causing more cases of CS in the population. A retrospective population-based cohort study. Data was taken from the Perinatal Neonatal Outcomes Research study in the Arabian Gulf (PEARL study) registry. Data from 60,728 live births ≥ 24 weeks of gestation were analyzed. In this study, various socioeconomic factors, such as maternal nationality, religion, educational level, employment status, parental income, consanguinity, housing, preterm birth, and tall stature, were examined for women undergoing cesarean section (CS) and their economic outcomes. Women who underwent vaginal delivery (VD) were compared. There are risks associated with pregnancy, smoking, assisted conception, and prenatal care. 60,728 births ≥ 24 weeks gestation were included in the analysis. 17,535 women delivered by CS (28.9%). Women with university-level -education and above were more likely to deliver by CS (61%), as compared to illiterate women or women with basic education at elementary or secondary levels (OR 0.73, CI 95%: P: <0.0001). Working women were more likely to deliver by CS (OR 1.40, CI 95%, P value <0.0001). Women living in rented houses were less likely to achieve a normal delivery (71.8%) (OR 1.40, CI 95%; P: <0.0001) as compared to women living in owned houses (74.7%). Women over 20 years old tended to achieve more VD compared to women less than 20 years old. P value <0.0001. Smoking was associated with lower chances of VD, with 42.4% of smokers delivered by CS compared to 28.3% of non-smokers (OR 1.87, CI 95%; P: <0.0001). Assisted conception was associated with higher CS rates as compared to spontaneous conceptions (OR 0.39; P: <0.0001). We found no statistically significant differences in how babies were born based on the mother's nationality, the father's job, or the mother's income. Higher education, employed mothers, smoking, and living in rented houses were socioeconomic factors associated with a higher rate of CS in our population. Furthermore, women who had regular antenatal care were more at risk for delivery by cesarean section, which could be related to other comorbidities increasing the likelihood of cesarean birth rather than antenatal care itself. In our population, assisted reproduction was associated with a higher probability of cesarean delivery.

Fetal Growth Velocity according to the Mode of Assisted Conception

Introduction: Pregnancies conceived through assisted reproductive techniques (ARTs) are on the rise worldwide and have been associated with a higher risk of placental-related disease in the third trimester. Methods: A cohort was created of singleton pregnancies after assisted reproduction, admitted at our institution for delivery, between January 2020 and August 2022. Fetal growth velocity from the second trimester to delivery was compared against a gestational-age-matched group of pregnancies spontaneously conceived according to the origin of the selected oocyte (i.e., autologous vs. donated). Results: 125 singleton pregnancies conceived through ART were compared to 315 singleton spontaneous conceptions. Overall, after adjusting for possible confounders, multivariate analysis demonstrated that ART pregnancies had a significantly lower estimated fetal weight (EFW) z-velocity from the second trimester to delivery (adjusted mean difference = −0.002; p = 0.035) and a higher frequency of EFW z-velocity in the lowest decile (adjusted OR = 2.32 [95% CI, 1.15–4.68]). Also, when ART pregnancies were compared according to the type of oocyte, those conceived with donated oocytes showed a significantly lower EFW z-velocity from the second trimester to delivery (adjusted mean difference = −0.008; p = 0.001) and a higher frequency of EFW z-velocity in the lowest decile (adjusted OR = 5.33 [95% CI, 1.34–21.5]). Conclusions: Pregnancies achieved through ART exhibit a pattern of lower growth velocity across the third trimester, especially those conceived with donated oocytes. The former represents a sub-group at the highest risk of placental dysfunction that may warrant closer follow-up.