Spontaneous Conception Research Articles

P619 Inflammatory bowel disease meets fertility: a physicians and patients survey

Abstract Background Inflammatory bowel diseases (IBD) affect patients during their childbearing years. Literature evidence is scarce regarding the level of knowledge among health care professionals (HCPs) and patients out 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. Methods 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. Results 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. The characteristics of participants are listed in Table 1. 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 211/401; 52.6%). 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 centre to receive general information about their reproductive health and about options of fertility preservation (e.g., cryopreservation), respectively. Conclusion IBD patients have a poor knowledge about the impact of IBD on fertility and pregnancy and HCPs does not sufficiently inform their patients. More information on these topics is needed for IBD patients.

Factors Associated with a Post-Procedure Spontaneous Pregnancy after a Hysterosapingo-Foam-Sonography (HyFoSy): Results from a Multicenter Observational Study.

Tubal patency testing constitutes an essential part of infertility work-up. Hysterosalpingo-foam-sonography (HyFoSy) is currently one of the best tests for assessing tubal patency. The objective of our study was to evaluate the post-procedure rate of spontaneous pregnancy among infertile women submitted for an HyFoSy exam with ExEm® foam and the factors associated with this. Multicenter, prospective, observational study performed at six Spanish centers for gynecologic sonography and human reproduction. From December 2015 to June 2021, 799 infertile women underwent HyFoSy registration consecutively. The patients' information was collected from their medical records. Multivariable regression analyses were performed, controlling for age, etiology, and time of sterility. The main outcome was to measure post-procedure spontaneous pregnancy rates and the factors associated with the achievement of pregnancy. 201 (26.5%) women got spontaneous conception (SC group), whereas 557 (73.5%) women did not get pregnant (non-spontaneous conception group, NSC). The median time for reaching SC after HyFoSy was 4 months (CI 95% 3.1-4.9), 18.9% of them occurring the same month of the procedure. Couples with less than 18 months of infertility were 93% more likely to get pregnant after HyFoSy (OR 1.93, 95% CI 1.34-2.81; p < 0.001); SC were two times more frequent in women under 35 years with unexplained infertility (OR 2.22, 95% CI 1.07-4.65; P0.033). After HyFoSy, one in four patients got pregnant within the next twelve months. Couples with shorter infertility time, unexplained infertility, and women under 35 years are more likely to achieve SC after HyFoSy.

Presentation, medical complications and development of gestational trophoblastic neoplasia of hydatidiform mole after intracytoplasmic sperm injection as compared to hydatidiform mole after spontaneous conception - a retrospective cohort study and literature review

ObjectiveTo describe the natural history of hydatidiform mole (HM) after intracytoplasmic sperm injection (ICSI), emphasizing the clinical and oncological outcomes, as compared to patients who had HM after spontaneous conception (SC). Study designRetrospective historical cohort study of patients with HM followed at the Rio de Janeiro Federal University, from January 1st 2000-December 31st 2020. ResultsComparing singleton HM after SC to those following ICSI there were differences in terms of maternal age (24 vs 34 years, p < 0.01), gestational age at diagnosis (10 vs 7 weeks, p < 0.01), preevacuation human chorionic gonadotropin levels (200,000 vs 99,000 IU/L, p < 0.01), occurrence of genital bleeding (60.5 vs 26.9%, p < 0.01) and hyperemesis (23 vs 3.9%, p = 0.02) at presentation, and time to remission (12 vs 5 weeks, p < 0.01), respectively. There were no differences observed in the cases of twin mole, regardless of the form of fertilization that gave rise to HM, except molar histology with greater occurrence of partial hydatidiform mole (10.7 vs 40.0%, p = 0.01) following ICSI. Univariate logistic regression for occurrence of postmolar GTN after ICSI identified no predictor variable for this outcome. However, after adjusting for maternal age and complete hydatidiform mole histology, multivariable logistic regression showed the risk of GTN with HM after ICSI had an adjusted odds ratio of 0.22 (95%CI:0.05–0.93, p = 0.04), suggesting a possible protective effect when compared to HM after SC. ConclusionsSingleton HM after ICSI are diagnosed earlier in gestation, present with fewer medical complications, and may be less likely to develop GTN when compared with HM after SC.

Spontaneous Conception Following Ulipristal Acetate on Treating Uterine Fibroid - A Case Report

Spontaneous Conception Following Ulipristal Acetate on Treating Uterine Fibroid - A Case Report

To study the obstetrical and neonatal outcomes in spontaneous conception v/s IVF conception

Objective: Our study aims to study the overall obstetrical and neonatal outcomes in spontaneous conception v/s IVF conception. Study design: Hospital based prospective study. Methods and Materials: The study was conducted at our hospital over a period of one and a half years from September 2014 to April 2016. It was a hospital based prospective study. A total of 100 (50 spontaneous conception and 50 IVF conception) women who were admitted for safe confinement at Obstetrics and gynecology department of hospital were included in the study. For the purpose of the study, the study group was divided in two groups IVF conception group and spontaneous conception group for comparison of obstetrical and neonatal outcome. A detailed history was taken and thorough examination findings were noted. The antenatal course was noted and also the obstetric and neonatal outcomes were noted. Results: It was observed that the obstetrical outcomes were poorer in IVF conception group than in the spontaneous conception group. Significant association was found between gestational duration, mode of delivery, NICU stay requirement with mode of conception. Association was also found between ante-partum haemorrhage (APH), preeclampsia, gestational diabetes, post-partum haemorrhage (PPH) with mode of conception. Conclusion: Maternal age, gestational duration, pre term delivery, LSCS deliveries, low birth weight babies, low APGAR score, and requirement of NICU stay in IVF conception group was significantly higher than in spontaneous conception group. Association was also found between ante-partum haemorrhage, pre-eclampsia, gestational diabetes mellitus, preterm premature rupture of membranes, post-partum haemorrhage with mode of conception.

In-vitro Fertilization vs Spontaneous Conception and Risk of Hypertensive Disease in Twin Pregnancies

In-vitro Fertilization vs Spontaneous Conception and Risk of Hypertensive Disease in Twin Pregnancies

Follicular Fluid Thyroid Hormones (T4 and T3) Levels and ICSI Outcomes

Background: Whether through spontaneous conception or through the use of assisted reproductive technologies, thyroid dysfunction is prevalent in women of childbearing age and may negatively impact fertility and pregnancy. As follicular fluid (FF) more accurately depicts the milieu surrounding the developing oocyte, it most likely offers a better assessment of exposures that might have an impact on reproductive outcomes. Objective: The purpose of this study is to examine the correlation of FF thyroid hormone (TH) (T4 and T3) levels with the intra-cytoplasmic sperm injection (ICSI) outcomes. Materials and Methods: The study was designed as an analytic cross-sectional study. Fifty subfertile couples from the in-vitro fertilization center attenders were involved in the study in whom ICSI was done for them and then compared between outcomes in relation to FF-T4 and FF-T3. Results: FF-T4 correlates positively with metaphase II (MII) and 2-PN with a P-value=0.04 and 0.03, respectively, in a statistically significant way, whereas FF-T3 correlates positively with oocyte number: MII in a statistically significant way (P-value=0.01) for both and with 2-PN in a statistically significant way (P-value=0.0). Additionally, there was a significant positive association between FF-T4 and anti-mullerian hormone and follicle stimulating hormone with a P-value of 0.05 and between FF-T3 and E2 with a P-value of 0.02. Conclusion: Folliculogenesis and oogenesis may be significantly influenced by THs. The FF also contains T3 and T4, which could have an immediate impact on the oocyte.

Hysteroscopic Retrieval of Intrauterine Retained Fetal Bones Causing Infertility in a Tertiary Teaching Hospital: A Case Series

Abstract Background: Retained fetal bone is a rare complication of unsafe abortion, causing infertility by functioning similarly to an intrauterine device. Clinical and radiological evaluation may be inconclusive. Hysteroscopic evaluation is the gold-standard diagnostic and therapeutic procedure associated with fertility restoration. Materials and Methods: Out of 300 hysteroscopies performed from September 22, 2015, to September 21, 2022, six cases of retained fetal bones were identified. Results: The incidence was 2.0%. The age range was 26 to 44 years. Five out of six were nulliparous, and all women had a previous history of unsafe abortion. The gestational age at the previous abortion ranged from 12 to 24 weeks. The fetal bones were completely removed in all cases. Two out of six cases (33.3%) had favourable outcomes with spontaneous conception and live births. Conclusion: Retained fetal bone is a rare cause of infertility associated with diagnostic challenges, especially in low-resource settings. However, the removal of the fetal bone with hysteroscopy can restore fertility.

Investigation of the relationship between fear of birth and prenatal attachment in pregnancy.

This study was conducted to examine the relationship between the fear of birth and level of prenatal attachment experienced by the pregnant women. In our descriptive and relationship-seeking study conducted between January and March 2020 in Konya, 485 pregnant women who met the inclusion criteria were included in the study. Inclusion criteria for the study were women who were pregnant at the age of 18 years and above, having Turkish literacy, had spontaneous conception were over the 28th gestational week, having a healthy fetus, and not having any existing health problems (based on self-report). The data were collected with an information form, "Prenatal Attachment Inventory" and "Wijma Birth Expectation/Experience (Version A) Scale." The mean score of the pregnant women from the "Prenatal Attachment Inventory" was 62.44 (21-84), and the mean score of the "Wijma Birth Expectation/Experience Scale/Version A" was found to be 59.45 (0-165). It was concluded that 47.2% of the pregnant women had low, 38.7% had moderate, and 14.1% had high levels of fear of birth. It was determined that there was a negative and weakly significant relationship between "Prenatal Attachment Inventory" and "Wijma Birth Expectation/Experience Scale/Version A" scores of pregnant women (r=-0.11 and p=0.23). In our study, it was determined that as the fear of birth increased, prenatal attachment levels decreased. Initiating and maintaining a healthy mother-infant bond is important for reducing fear of birth.

PS-C30-4: ASSOCIATION OF ASSISTED REPRODUCTIVE TECHNOLOGIES WITH ARTERIAL HYPERTENSION DURING NEWBORN

In Japan, infertility treatment including assisted reproductive technologies &lt; ART&gt; has become common recently, accounting for 7% of ART newborns in all births. Recently, ART has been reported to induce premature vascular aging in apparently healthy children. It is unknown whether the onset of premature vascular aging begins in the newborn period. Our study was to determine whether an increased risk of premature vascular aging is associated with ART. The study population comprised 63 newborns &lt; median gestational age&lt;GA&gt; 39 weeks, and median birth weight &lt;BW&gt; 3050g&gt;in the assisted conception &lt;AC&gt; group and 279 newborns &lt;GA 39 weeks, BW 3030g&gt; in the spontaneous conception &lt;SC&gt; group. The AC group was treated as follows: 29 patients with in vitro fertilization, or with intracytoplasmic sperm injection with ovulation-inducing agents &lt;ART group&gt;, 34 with artificial insemination, and others. After confirming the closing of the patent ductus artery using echocardiography, newborns measured their peripheral systolic &lt;sys&gt; and diastolic &lt;dia&gt; blood pressure &lt;BP&gt; values. BP measurements of newborns were performed in the left or right legs in the relaxed supine position with basically a natural sedation. At the median age of one day after birth, comparing sys and dia BP with AC and SC group, sys BP 69 and 40mmHg vs 68 and 41mmHg, there were no significant. Similarly, in the ART group, sys and dia BP was 68 and 40mmHg, with no significant differences. However, there were significant differences between maternal age, SC, AC, and ART groups, with the median of 31years, 35years, and 37years &lt;p value less than 0.001&gt;. We found no evidence of increased risk of premature vascular aging with ART for infertility treatment during the newborn period. Older maternity may alter affect childhood health and development. In addition, in vitro or extrauterine fertilization exposes gamete and embryo to variable physical and hormonal environments before implantation. Exposure is brief in fresh fertilizations and more prolonged in a gamete or embryo cryopreservation, and such epigenetic modifications of the environment may have downstream effects on the vascular system. The future of precision medicine guided approaches should incorporate emerging clinical factors, such as the history of ART conception in a growing proportion of the population.

The Renaissance of Male Infertility Management in the Golden Age of Andrology.

Infertility affects nearly 186 million people worldwide and the male partner is the cause in about half of the cases. Meta-regression data indicate an unexplained decline in sperm concentration and total sperm count over the last four decades, with an increasing prevalence of male infertility. This suggests an urgent need to implement further basic and clinical research in Andrology. Andrology developed as a branch of urology, gynecology, endocrinology, and, dermatology. The first scientific journal devoted to andrological sciences was founded in 1969. Since then, despite great advancements, andrology has encountered several obstacles in its growth. In fact, for cultural reasons, the male partner has often been neglected in the diagnostic and therapeutic workup of the infertile couple. Furthermore, the development of assisted reproductive techniques (ART) has driven a strong impression that this biotechnology can overcome all forms of infertility, with a common belief that having a spermatozoon from a male partner (a sort of sperm donor) is all that is needed to achieve pregnancy. However, clinical practice has shown that the quality of the male gamete is important for a successful ART outcome. Furthermore, the safety of ART has been questioned because of the high prevalence of comorbidities in the offspring of ART conceptions compared to spontaneous conceptions. These issues have paved the way for more research and a greater understanding of the mechanisms of spermatogenesis and male infertility. Consequently, numerous discoveries have been made in the field of andrology, ranging from genetics to several "omics" technologies, oxidative stress and sperm DNA fragmentation, the sixth edition of the WHO manual, artificial intelligence, management of azoospermia, fertility in cancers survivors, artificial testis, 3D printing, gene engineering, stem cells therapy for spermatogenesis, and reconstructive microsurgery and seminal microbiome. Nevertheless, as many cases of male infertility remain idiopathic, further studies are required to improve the clinical management of infertile males. A multidisciplinary strategy involving both clinicians and scientists in basic, translational, and clinical research is the core principle that will allow andrology to overcome its limits and reach further goals. This state-of-the-art article aims to present a historical review of andrology, and, particularly, male infertility, from its "Middle Ages" to its "Renaissance", a golden age of andrology.

Expression of Markers of Endometrial Receptivity in Obese Infertile PCOS Women before and after the Weight Loss Program-A Preliminary Study.

Obesity is an increasing worldwide problem, and it is common in women with polycystic ovaries syndrome (PCOS). It is well known that women with PCOS have lower chances of spontaneous conception as well as lower success with IVF procedures. The mechanisms by which obesity causes lower fertility are not yet fully understood. The aim of the present study was to determine the effect of a lifestyle intervention weight loss program on the expression of the endometrial genes during the window of implantation (WOI). For this purpose, 15 infertile women with obesity and PCOS were included in the study. Endometrial samples were taken during the WOI before and at the end of the program, and RNASeq analysis was performed. There were no significantly differentially expressed genes before and after the weight loss program. We then compared the results of our study with previously published studies on markers of endometrial receptivity. The biomarker genes that were found to be down-regulated during the WOI in previous studies were more down-regulated after the weight loss program in the present study. Furthermore, 25% of the women who achieved the desired 5% or more weight reduction conceived spontaneously. Our study shows that weight loss might positively impact endometrial receptivity. which may lead towards the improved fertility of obese women with PCOS.

Laparoscopically assisted hysteroscopic removal of an interstitial pregnancy

To illustrate a combined technique of hysteroscopy and laparoscopy for the management of interstitial ectopic pregnancies. A description of a patient case and demonstration of a surgical technique. Tertiary referral center. A 33-year-old woman, gravida 2, para 0-0-1-0 status post invitro fertilization cycle with single embryo transfer, was diagnosed with an unruptured right interstitial pregnancy at 5 weeks of gestation. She has a history of a pregnancy of unknown location with her first invitro fertilization transfer and received methotrexate. The beta-human chorionic gonadotropin level was 2,726 mIU/mL. She was counseled on treatment options and declined treatment with methotrexate because of the negative side effects she experienced previously. She opted for surgical management and desired to keep her fallopian tubes if possible because she wished to try for spontaneous conception. The patient underwent multipuncture video laparoscopy, and a bulge was seen at the right cornua. Video hysteroscopy initially revealed an empty uterine cavity. Using atraumatic graspers, the interstitial pregnancy was gently pushed further into the uterine cavity using a milking technique. The pregnancy was then able to be visualized hysteroscopically. Products of conception were gently dislodged and removed with graspers, followed by a suction curettage. This technique resulted in minimal blood loss, preservation of reproductive organs, and expedient return to conception planning. The postoperative course was uncomplicated, and the patient was discharged the same day as surgery. After the procedure, weekly beta-human chorionic gonadotropin was drawn until the level reached <1 mIU/mL, which occurred after 4 weeks. Hysterosalpingography was performed 2 months after the procedure and demonstrated bilateral tubal patency. In select patients, an early interstitial pregnancy can be safely removed using the described technique. Although hysteroscopic removal of interstitial pregnancies is not a new concept, the addition of simultaneous video laparoscopy provides the benefit of allowing for fertility-sparing removal of the pregnancy, even if it is not initially visualized hysteroscopically. The use of this technique may result in minimal blood loss and preservation of the fallopian tubes. Furthermore, with the myometrium integrity maintained, the patient may resume sooner attempts at conception.

Why are they not coming back? A single-center follow-up study on oncological women oocyte's storing for fertility preservation.

Oocyte cryopreservation is a valid option for female cancer patients to preserve fertility. The number of patients undergoing fertility preservation (FP) cycles has increased over the past years. Nevertheless, the rates of patients returning to use their cryopreserved material have shown to be considerably low, ranging from 5-8%, but significant data regarding the reasons of such low return rates are scarce. This study is a single-center follow-up retrospective study evaluating the return rate of oncological women who underwent FP at a tertiary care Fertility Center and assessing the reasons influencing the patients who did not return. Data about patients who returned to attempt pregnancy were retrieved from internal registries. Non-returned patients were assessed with a standardized phone survey investigating health condition, marital status and family projects, spontaneous conceptions, and the reasons why they had not returned to use their gametes. A univariate analysis between returned and non-returned patients was performed. Of the 397 patients who received counseling about FP, 171 (43.1%) underwent oocyte cryopreservation between 2001 and 2017. Nine (5%) died, and 17 (10%) were lost at follow-up. A total of 20 patients (11.7%) returned and 125 did not. In the non-returned group, 37 (29.6%) did not have a partner, 10 (8%) had a previous spontaneous conception, and 15 (12%) had recurrent malignancy at the time of follow-up. In the univariate analysis, younger age at freezing (31.8±6.2 vs. 35.2±4.7; p 0.018), lack of a partner (p 0.002), type of cancer (other than breast cancer; p 0.024) were the significant factors in the non-returned group. As for the personal reason for not coming back, patients mainly answered as follows: lack of a partner (29, 23.2%), the desire for spontaneous motherhood (24, 19.2%), previous spontaneous pregnancies after FP procedures (16, 12.8%), and still ongoing hormonal therapy for breast cancer (13, 10.4%). All patients confirmed their will to keep the storage of their oocytes. The impact of a cancer diagnosis on a woman's maternal desire, sentimental status and life priorities should be studied more thoroughly. Studies investigating hormonal therapy suppression in breast cancer patients seeking pregnancy should be encouraged. https://clinicaltrials.gov, identifier NCT05223764.

Ultrasound diagnosis of placental and umbilical cord anomalies in singleton pregnancies resulting from in-vitro fertilization

Introductionplacental anomalies can affect fetal and maternal outcome due to severe maternal hemorrhage potentially resulting in hysterectomy and cord accident including abruption that can determine fetal damage or death. The aims of our study are to determine if the rate of placental and umbilical cord anomalies are more common in IVF singleton pregnancies compared to spontaneous pregnancies; to evaluate the role of ultrasound in screening for these anomalies and to investigate if oocyte donor fertilization is an additional risk factor for the development of these anomalies. Methodsthis was a prospective cohort study involving two tertiary centers. Patients with a singleton pregnancy conceived with IVF and patients presenting with a spontaneous conception were recruited between 1st May 2019 to 31st March 2021. A total of 634 pregnancies were enrolled in the study. All patients underwent similar antenatal care, which included ultrasound examinations at 11–14, 19–22 and 33–35 weeks. Ultrasound findings of placental and/or umbilical cord abnormalities were recorded using the same protocol for both groups and confirmed after birth. ResultsIVF pregnancies had a significantly higher risk of low-lying placenta, placenta previa, bilobed placenta and velamentous cord insertion (VCI) compared with spontaneous pregnancies. In the heterologous subgroup there was a significant increased incidence of placenta accreta spectrum (PAS) disorders than in spontaneous pregnancies. All these anomalies were identified prenatally on ultrasound imaging and confirmed at birth. DiscussionIVF pregnancies in general and those resulting from donor oocyte in particular are at higher risk of placental and umbilical cord abnormalities compared to spontaneous pregnancies. These anomalies can be diagnosed accurately at the mid-trimester detailed fetal anomaly scan and our findings support the need for a targeted ultrasound screening of these anomalies in IVF pregnancies.

Reproductive and Endocrine Outcomes in a Cohort of Danish Women following Auto-Transplantation of Frozen/Thawed Ovarian Tissue from a Single Center

Ovarian tissue cryopreservation (OTC) is a method of fertility preservation in girls and young women prior to gonadotoxic treatment. It is a safe and promising method to restore fertility. The initial recovery of endocrine function is high, but the longevity of the grafted tissue varies. In this single-center, combined retro- and prospective cohort study, we report the reproductive outcome and hormonal recovery following ovarian tissue transplantation (OTT) and evaluate possible predictors of the chance of pregnancy. The study includes 40 women from eastern Denmark undergoing 53 OTTs between 2003 and 2021. Permission to obtain retrospective data was given by the Danish Patient Safety Authorities and prospective data-collection by informed consent. Initial recovery of endocrine function was seen in 18/19 women with POI, and ongoing function of the grafted tissue in 7/14 two years from OTT. Live birth rate (LBR) was 41%, with 20 children to 39 women trying to conceive. Women who conceived had higher AFC at the time of OTC than women who did not (p ± 0.04). Repeated transplantations were not successful in terms of delivery. Half of all pregnancies were achieved by ART, but PRs were lower after ART than by spontaneous conception. LBRs after OTT are encouraging. Chance of pregnancy after OTT is correlated to ovarian reserve at OTC. Repeated transplantations were not successful in terms of unfulfilled pregnancy wish.

The Rate of Spontaneous Preterm Birth and Associated Neonatal Adverse Outcomes in Low-Risk Pregnancies Conceived Spontaneously Versus Intrauterine Insemination or Infertility Medications

The objective of this work is to compare the rate of spontaneous preterm birth and associated neonatal morbidity among low-risk pregnancies conceived spontaneously versus pregnancies conceived using infertility medications/intrauterine insemination (IFM/IUI). This population-based retrospective cohort study utilized the US Vital Statistics data set from 2015 to 2019. Low-risk pregnancies, resulting in a live birth, of individuals who conceived either spontaneously or with the assistance of IFM/IUI were examined. The primary measured outcome was the rate of spontaneous preterm delivery, defined as delivery before 37 weeks’ gestation without induction of labor. Of the 19,382,574 deliveries during the study period, 7,876,515 (40.6%) met the inclusion criteria. While 7,843,328 (99.6%) conceived spontaneously, 33,187 (0.4%) conceived using IFM/IUI. The rate of spontaneous preterm delivery was significantly higher for patients who conceived using IFM/IUI (71.0 per 1,000 live births) compared to patients who conceived spontaneously (60.3 per 1,000 live births; adjusted relative risk, 1.40; 95% confidence interval, 1.35–1.46). While the rate of spontaneous preterm births and associated composite of neonatal adverse outcomes are significantly higher in pregnancies conceived using IFM/IUI than spontaneous conception, the mortality is similar.

First-line surgery vs first-line ART to manage infertility in women with deep endometriosis without bowel involvement: A multi-centric propensity-score matching comparison

ObjectiveTo compare first-line surgery with first-line assisted reproductive techniques (ART) in infertile women with deep infiltrating endometriosis (DIE) without colorectal involvement. Study designA retrospective comparative cohort study with a propensity-score matching analysis, in four tertiary-care referral centers. The population was infertile women with DIE without colorectal involvement. The patients were managed either by first-line surgery followed by spontaneous conception attempts and/or ART, or by first-line ART. 284 patients were extracted from the databases. After matching, 92 patients were compared in each group. Clinical pregnancy rates (PR) and live-birth rates (LBR) were the primary outcomes, and cumulative pregnancy rate (CPR) and cumulative live birth rate (CLBR) were the secondary outcomes. ResultsThe mean number of IVF-ICSI cycles per patient was 1.4, with a significant difference between the groups: 1.6 in the first-line ART group and 1.2 in the first-line surgery group (p = 0.006). The PR was significantly higher in the first-line surgery group (72 % vs 35 %; p < 0.001). In the first-line surgery group, non-ART pregnancies occurred in 18 % (17/92) while no non-ART pregnancies was noted in the first-line ART group. The LBR was significantly higher in the first-line surgery group (61 % vs 24 %; p < 0.001). After ART, the CPR were 72 % (47/67) in the first-line surgery group, and 35 % (32/92) in the first-line ART group (p < 0.001). ConclusionAfter matching, our results support that first-line surgery offer higher pregnancy and live-birth rates than first-line ART in patients with DIE without colorectal involvement.

ODP402 Adult height and reproductive outcome of Klinefelter men with a 46,XX/47,XXY mosaicism

Abstract Background Mosaicism in Klinefelter Syndrome (KS) is reported in 15–20%, but 46,XX/47,XXY mosaicismis extremely rare and presents either during infancy with ambiguous genitalia or during adolescence with gynecomastia or microorchidism. In view of the scarce data on adult outcomes (1,2), we here comprehensively report the skeletal and reproductive health outcome in two individuals with 46,XX/47,XXY KS. Clinical cases The first case was born at 40 weeks after a spontaneous conception with a birth length of 49 cm. At birth right cryptorchidism, but a normally developed penis and scrotum was present. Surgical intervention at the age of 1 year, showed a right abdominal testicular nubbin. He was investigated at the age of 17 years for left microorchidism (6ml) contrasting with a normal genital development (Tanner G5). Hormonal investigation showed hypergonadotropinemia with a normal serum testosterone. Peripheral blood karyotype showed mosaicism 46,XX (60%)/47,XXY (40%). At the age of 18 years, standing height was 164.5 cm (mid-parental height (MPH) 173.5 cm). BMI was 19 kg/m2. Hormonal evaluation showed an unmeasurable serum inhibin B, elevated gonadotropins (LH 43 IU/L and FSH 65 IU/L), but a normal testosterone and estradiol. Ultrasound of the left testis showed a normal echo pattern. Azoospermia was documented. Lumbar spine bone mineral density (LS-BMD) was -1 SDS. The second case was born at 37 weeks after ICSI with a birth length of 49 cm. External genitalia at birth were normal. However, routine karyotyping after ICSI conception showed a mosaicism 46,XX (50)/ 47,XXY (50). A normal pubertal development apart from an arrest in testicular development at the age of 15 years was documented. At the age of 18 years, his height was 176.8 cm (MPH 184 cm), BMI 26 kg/m2, Tanner stage G5 and testes volumes 8/8 ml. Hormonal evaluation showed low inhibin B (43.4 ng/l), slightly elevated gonadotropins (LH 16.1 IU/L and FSH 12.5 IU/L), and normal testosterone and estradiol. Ultrasonography of the scrotum showed normal testicular structure. LS-BMD SDS was 1. Conclusion 46,XX/47,XXY KS men, who present with normal male genitals at birth, can have a normal pubertal progression with the exception of a mid-pubertal testicular regression, but in contrast to men with a 46,XY/ 47,XXY constitution, appear at risk for a shorter stature than expected for parental height. References Velissariou V et al., European Journal of Medical Genetics (2006) 49, 331-337Matsuki S, Journal of Urology (1999) 161 (5), 1573-74 Presentation: No date and time listed

7344 Effect of Unilateral Hydrosalpinx on Chances of Spontaneous Conception

<h3>Study Objective</h3> The aim of the study is to present a successful surgical management of a case of unilateral hydrosalpinx resulting after cesarean delivery that appeared to have interfered with spontaneous conception from a healthy patent contralateral fallopian tube. <h3>Design</h3> Case report with 6-month post-operative follow-up. <h3>Setting</h3> Operative laparoscopy was done in a teaching hospital operation room with the patient in dorsal lithotomy position. <h3>Patients or Participants</h3> 30 years- old female with a history of primary cesarean section which was complicated by postoperative infection. She presented with a history of secondary infertility of 5 years duration and was found to have a right hydrosalpinx and a patent left fallopian tube on hysterosalpingogram. <h3>Interventions</h3> Minimally invasive preservation of the left fallopian tube was done by performing neosalpingostomy instead of salpingectomy. <h3>Measurements and Main Results</h3> The patient conceived spontaneously after two <i>months,</i> and she is currently at 14 weeks gestation. <h3>Conclusion</h3> Minimally invasive neosalpingostomy in selected patients with unilateral hydrosalpinx can increase the chances of spontaneous pregnancy by eliminating the unfavorable effect of the hydrosalpinx.