Terms Of Reproductive Outcome Research Articles

Single-layer vs double-layer uterine closure during cesarean delivery: 3-year follow-up of a randomized controlled trial (2Close study)

BackgroundThe rising rate of cesarean sections (CS) has led to an increased incidence of long long-term complications, including niche formation in the uterine scar. Niche development is associated with various gynecological complaints and complications in subsequent pregnancies, such as uterine rupture and placenta accreta spectrum disorders. Although uterine closure technique is considered a potential risk factor for niche development, consensus on the optimal technique remains elusive. ObjectiveWe aim to evaluate the effect of single- versus double-layer closure of the uterine incision on live birth rate at a 3-year follow-up with secondary objectives focusing on gynecological, fertility and obstetric outcomes at the same follow-up. Study DesignA multicenter, double-blind, randomized controlled trial was performed at 32 hospitals in the Netherlands. Women ≥18 years undergoing a first CS were randomly assigned (1:1) to receive either single-layer or double-layer closure of the uterine incision. The primary outcome of the long-term follow-up was the live birth rate with secondary outcomes including pregnancy rate, the need for fertility treatment, mode of delivery, and obstetric and gynecologic complications. This trial is registered on the International Clinical Trials Registry Platform www.who.int (NTR5480; trial finished). ResultsBetween 2016 and 2018, the 2Close study randomly assigned 2292 women, with 830/1144 and 818/1148 responding to the 3-year questionnaire in the single-layer and double-layer closure. No differences were observed in live birth rates, also no differences in pregnancy rate, need for fertility treatments, mode of delivery or uterine ruptures in subsequent pregnancies. High rates of gynecological symptoms including spotting (30-32%), dysmenorrhea (47-49%) and sexual dysfunction (FSFI score 23)-are reported in both groups. ConclusionThe study did not demonstrate the superiority of double-layer closure over single-layer closure in terms of reproductive outcomes after a first CS. This challenges the current recommendation favoring double-layer closure, and we propose that surgeons can choose their preferred technique. Furthermore, the high risk of gynecological symptoms after a CS should be discussed with patients.

Sperm cryopreservation does not affect live birth rate in normozoospermic men: analysis of 7969 oocyte donation cycles.

Does sperm cryopreservation influence the reproductive outcomes of normozoospermic patients in oocyte donation cycles? After controlling for confounders, the use of cryopreserved semen from normozoospermic patients does not affect pregnancy and live birth rates after elective ICSI. Sperm cryopreservation by slow freezing is a common practice in ART. While frozen-thawed semen typically presents reduced motility and vitality, its use for ICSI is generally considered adequate in terms of reproductive outcomes. Nevertheless, most studies comparing reproductive outcomes between fresh and cryopreserved sperm include patients with severe male factor (testicular sperm, oligo-, and/or asthenozoospermia) or women of advanced maternal age, where the altered quality of the gametes can partially mask the full effect of freezing/thawing. The study included a retrospective cohort of 7969 couples undergoing their first oocyte donation cycle between January 2013 and December 2019 in one large clinic, using normozoospermic semen from the male partner. All cycles involved elective ICSI, fresh oocytes, and a fresh embryo transfer, either at cleavage or blastocyst stage. Two study groups were established based on the sperm status: fresh (n = 2865) and cryopreserved (n = 5104). A slow freezing protocol was used for all sperm cryopreservation. Sperm washing, capacitation, and selection prior to ICSI were performed identically for fresh and frozen-thawed samples, using pellet swim-up. Fertilization rate (FR), pregnancy (biochemical and ongoing), and live birth rates were compared between study groups using univariate and multivariate regression analyses. Male and female age, sperm concentration and motility after ejaculation, and number of oocytes inseminated were similar between cycles using fresh or cryopreserved sperm. Analysis by Student's t-test did not indicate a significant difference in FR between fresh and cryopreserved sperm (P = 0.0591); however, after adjusting for confounders, this difference reached statistical significance: 74.65% FR for fresh (CI 95%: 73.92-75.38) versus 73.66% for cryopreserved sperm (CI 95%: 73.11-74.20), P = 0.0334. The adjusted regression analysis revealed higher odds of biochemical pregnancy when using fresh sperm (odds ratio (OR): 1.143, P = 0.0175), but no significant effects of sperm cryopreservation were observed for ongoing pregnancy (OR: 1.101, P = 0.0983) and live birth (OR: 1.082, P = 0.1805). Caution should be exerted when extrapolating these results to different protocols for sperm cryopreservation and selection, or to IVM, advanced maternal age and classical IVF cycles, which were excluded from analysis. Owing to the retrospective nature of the study, some uncontrolled for variables may affect the results. Sperm cryopreservation does not affect pregnancy and live birth rates in normozoospermic patients, and although it may lower FR s slightly, this would not be clinically relevant. In line with previous studies that included patients with an apparent male or female factor, sperm cryopreservation is a safe and convenient technique. The study received no external funding and all authors have no conflicts of interest to declare. N/A.

Comparison of pregnancy outcomes of 7515 same donor oocyte cycle fresh and cryopreserved-thawed oocytes in 609 donor oocyte recipient cycles: A single institution analysis

ObjectiveOocyte donation (OD) cycles have been used extensively over the last decades due to high success regarding live birth rate (LBR). We evaluated the reproductive outcomes of fresh and vitrified sibling oocytes in terms of fertilization rates, blast ratio, clinical pregnancy rates, and LBR. Materials and methodsThis retrospective cohort study was conducted at a tertiary in vitro fertilization (IVF) center. A total of 7515 metaphase II (MII) donor oocytes from 304 donor cycles for 609 oocyte recipients undergoing embryo transfers with either fresh or cryopreserved-thawed donor oocytes. Donor cycles that provided both 12 fresh MII oocytes to be used for one recipient and at least 12 MII oocytes which were suitable for vitrification to be used for another recipient at another time were analyzed. Fertilization rates, blastocyst ratios, clinical pregnancy rates (CPR), LBR were evaluated as main outcome measures. ResultsWhen the fresh and cryopreserved-thawed OD cycles were compared, there was no significant differences between two groups in terms of age of the recipient (41.9 ± 5.7 and 40.3 ± 6.8, p = NS), number of MII oocytes (12.1 ± 0.3 and 12.6 ± 0.8, p = NS), number of 2 pronuclear (PN) (9.1 ± 1.6 and 9.7 ± 2.0, p = NS), blastocyst ratio (58.9 ± 21.7 and 51.3 ± 21.2, p = NS) and number of transferred embryos (1.9 ± 0.3 and 1.9 ± 0.3, p = NS). There was no significant difference between fresh and cryopreserved-thawed sibling donor oocyte cycles in terms of CPR (66.8 % and 60.7 % respectively, p = NS) or LBR (59.5 % and 55.1 %, respectively; p = NS). Miscarriage and multiple gestation rates were similar between groups (p = NS). Log-binomial regression analysis revealed that the use of fresh sibling oocytes was not associated with CPR or LBR, when compared to cryopreserved-thawed oocytes. ConclusionsThere was no significant difference in terms of reproductive outcomes between sibling fresh OD and cryopreserved-thawed OD cycles.

Teenage Pregnancy and Associated Risk Factors and Outcome in Nepal From 2000-2020: A Systematic Review and Meta-Analysis

Background Teenage pregnancy is considered a high-risk pregnancy in terms of reproductive outcome and the subsequent financial constraint.
 Objective To assess the prevalence of teenage pregnancy, associated risk factors, and outcomes in the context of Nepal.
 Method We searched electronic databases to search relevant articles published from January 2000 till October 2020 using the keywords with appropriate Boolean operators. All the data were extracted into a standardized form designed in Excel. We conducted a statistical analysis using Comprehensive Meta-Analysis Software (CMA) version 3. Data pooled for proportion with 95% confidence interval (CI). A Forest plot was used to visualize the degree of variation between studies.
 Result Fourteen studies were included in the analysis after the rigorous screening of 4425 studies. Prevalence of teenage pregnancy was 13.2% (Proportion, 0.132; CI, 0.077- 0.215). Among teenage pregnancies, 11.8% were already multigravida (Proportion, 0.118; CI, 0.029-0.374). Among teen pregnancies, 18.6% were illiterate; among the literate, only 25.9% were of education above grade 10,31.9% were unaware of contraceptive methods, and only 3.2% reported using any contraception methods. 75.4% of teenage pregnancies had a vaginal delivery with or without episiotomy, 6.5% by instrumental deliveries, and 21.5% by cesarean section. Preterm delivery was 12.0%, and post-term delivery was 8.2%. Abortion was reported in 11.1% of teenage pregnancies. Major tears were reported in 52.9%, obstructed labor was in 4%, and pre-labor rupture of the membrane was in 7.0% of teenage pregnancies. The low birth weight of newborns was 19.4%. Stillbirth and neonatal deaths were 1.7% and 1.4%, respectively.
 Conclusion The prevalence of teenage pregnancy in Nepal was 13.2%. The majority of them did not use any form of contraceptives; and had low education. Several maternal and neonatal complications were reported among teenage pregnancies.

P–708 Comparison of reproductive outcomes after progestin-primed ovarian stimulation with dydrogesterone versus cetrorelix to inhibit spontaneous ovulation in oocyte donation

Abstract Study question Is dydrogesterone (DYG) equivalent compared to cetrorelix with respect to clinical pregnancy rate, ongoing pregnancy rate and live birth rate in oocyte donation (OD) cycles? Summary answer DYG is comparable to cetrorelix in terms of clinical pregnancy, but higher rates of ongoing pregnancy and live birth were observed in the DYG group What is known already Progestin-primed ovarian stimulation (PPOS) is an ovarian stimulation regimen based on a freeze-all strategy using progestin as an alternative to GnRH analog for suppressing a premature LH surge. DYG is an oral progestin that has been studied in PPOS protocols. Published reports indicate that length of ovarian stimulation, dose of gonadotrophin needed and number of MII retrieved from PPOS cycles are comparable to short protocol of GnRH agonists during OD cycles. However, while some studies noted no differences in terms of live births, worse pregnancy rates have been reported in recipients of oocytes from PPOS cycles compared to GnRH antagonists. Study design, size, duration Prospective controlled study to assess the reproductive outcomes of OD recipients in which the donors were subjected to the DYG protocol (20mg/day) compared with those subjected to the short protocol with cetrorelix (0.25 mg/day) from Day 7 or since a leading follicle reached 14 mm. The OD cycles were triggered with triptoreline acetate and the trigger criterion was ≥3 follicles of diameter >18mm. Participants/materials, setting, methods 202 oocyte donors were included, 92 under DYG and 110 under cetrorelix. The study was performed in a private infertility center between January 2017 and December 2020. The main outcome included the rates of clinical pregnancy, ongoing pregnancy and live births. Secondary outcomes included the number of oocytes retrieved, number of MII, fertilization rate, length of stimulation and total gonadotropin dose. Differences were tested using a Student’s t-test or a Chi2 test, as appropriate. Main results and the role of chance Compared to antagonist cycles, cycles under DYG had fewer days of stimulation (9.9 ± 0.9 vs. 10.8 ± 1.1, p<.001) and a lower total gonadotropin dose (1654 ± 402.4 IU vs. 1844 ± 422 IU, p<.001). The number of MII retrieved was no different: 16.9 (SD 6.2) with DYG and 15.4 (SD 5.8) with cetrorelix (p = 0.072). Recipients and embryo transfer (ET) characteristics were also similar between groups. The mean number of MII assigned to each recipients was 6.7 (SD 1.8) in DYG and 6.6 (SD 1.7) in cetrorelix (P = 0.446). The fertilization rate was 66.2% in DYG versus 67.6% in cetrorelix (P = 0.68). Regarding the reproductive outcomes, the overall clinical pregnancy rate in DYG group (65/87: 74.7%) and cetrorelix group (66/104: 63.4%) (p = 0.118) was similar. Meanwhile, the DYG group compared to cetrorelix group had higher rates of ongoing pregnancy (63.2% vs 45.1%; p = 0.014) and live births (54,9% vs 37.8%; p = 0.040). Limitations, reasons for caution These results should be evaluated with caution. The limitations of this study include the limited number of participants enrolled and the limited data on pregnancy outcomes. A randomized controlled trial is necessary to provide more evidence on the efficacy of the DYG protocol. Wider implications of the findings: The efficacy of PPOS protocol compared to GnRH-antagonist protocol in terms of reproductive outcomes has been little studied. PPOS using DYG yields comparable clinical pregnancy rates compared to cetrorelix in OD cycles. The differences found regarding the rates of ongoing pregnancy and live births should be further investigated. Trial registration number Not applicable

P–013 Sperm freezing does not affect live birth rates: results from 6,594 cycles in normozoospermic patients

Abstract Study question Does sperm cryopreservation influence the reproductive outcomes of normozoospermic patients undergoing elective ICSI? Summary answer After controlling for confounders, the use of cryopreserved semen from normozoospermic patients does not affect pregnancy and live birth rates after ICSI. What is known already Sperm cryopreservation with slow freezing is a common practice in ART. While frozen-thawed semen typically presents reduced motility and vitality, its use for ICSI is generally considered adequate in terms of reproductive outcomes. Nevertheless, most studies comparing reproductive outcomes between fresh versus cryopreserved sperm include patients with oligo- and/or asthenozoospermia, where the altered quality of the sample can partially mask the full effect of freezing/thawing. The objective of this study is to ascertain whether ICSI using fresh or cryopreserved semen from normozoospermic patients results in similar fertilization rates and reproductive outcomes. Study design, size, duration Retrospective cohort of 6,594 couples undergoing their first elective ICSI cycle between January 2011 and December 2019, using normozoospermic partner semen (fresh or cryopreserved). All cycles involved a fresh embryo transfer, either at cleavage or blastocyst stage. Cycles were divided in 4 groups: fresh semen with partner’s oocytes (FSPO, n = 1.878), cryopreserved semen with partner’s oocytes (CSPO, n = 142), fresh semen with donor oocytes (FSDO, n = 2.413), and cryopreserved semen with donor oocytes (CSDO, n = 2.161). Participants/materials, setting, methods A slow freezing protocol using GM501 SpermStore medium (Gynemed, Lensahn) was used for all sperm cryopreservation. Sperm washing, capacitation, and selection prior to ICSI were performed equally for fresh and frozen-thawed samples, using pellet swim-up in IVF® medium (Vitrolife, Göteborg). Fertilization rate (FR), pregnancy (biochemical, clinical, and ongoing) and live birth (LB) rates were compared among study groups using Pearson’s Chi square and Student’s t-test. A p-value <0.05 was considered statistically significant. Main results and the role of chance Male and female age, sperm concentration and motility after ejaculation, and number of oocytes inseminated were similar between study groups compared (FSPO vs. CSPO, FSDO vs. CSDO). As expected, oocyte donation cycles resulted in higher LB rate than cycles in which partner’s oocytes were used (30.04% vs 18.17%, p < 0.001). In cycles using partner’s oocytes, no significant differences were observed between fresh and cryopreserved sperm in FR, pregnancy and LB rates (p > 0.05 for all outcomes). However, in oocyte donation, the mean FR after ICSI using cryopreserved semen (73.6 ± 19.6) was lower than the FR obtained with fresh semen (75.1 ± 19.2), p = 0.010. Similarly, in oocyte donation cycles, the biochemical pregnancy rate was significantly lower when using cryopreserved semen (48.5% in CSDO vs. 52.3% in FSDO, p = 0.009), while clinical, ongoing pregnancy and LB rates were similar between both semen status (p > 0.05). In oocyte donation, a subgroup analysis including only the ICSI cycles with embryo transfer at blastocyst stage (n = 1.187 for FSDO, n = 337 for CSDO) confirmed that the LB rate was comparable between fresh and cryopreserved semen groups (34.7% vs 35.6% respectively, p = 0.76), without significant differences in pregnancy rates neither (p > 0.05 for all outcomes). Limitations, reasons for caution Caution should be exerted when extrapolating these results to different protocols for sperm cryopreservation and selection, or to IVM and classical IVF cycles, which were excluded from analysis. Due to the retrospective nature of the study, some uncontrolled for variables may affect the results. Wider implications of the findings: Sperm cryopreservation does not affect pregnancy and live birth rates in normozoospermic patients, although it may lower slightly fertilization rates. In line with previous studies including patients with an apparent male factor detected after routine semen analysis, sperm cryopreservation is a safe and convenient technique. Trial registration number Not applicable

Pregnancy After Breast Cancer: A Systematic Review and Meta-Analysis.

Many patients and physicians remain concerned about the potential detrimental effects of pregnancy after breast cancer (BC) in terms of reproductive outcomes and maternal safety. This systematic review and meta-analysis aimed at providing updated evidence on these topics. A systematic literature review was conducted to identify studies including patients with a pregnancy after BC (PROSPERO number CRD42020158324). Likelihood of pregnancy after BC, their reproductive outcomes, and maternal safety were assessed. Pooled relative risks, odds ratios (ORs), and hazard ratios (HRs) with 95% CIs were calculated using random effects models. Of 6,462 identified records, 39 were included involving 8,093,401 women from the general population and 112,840 patients with BC of whom 7,505 had a pregnancy after diagnosis. BC survivors were significantly less likely to have a subsequent pregnancy compared with the general population (relative risk, 0.40; 95% CI, 0.32 to 0.49). Risks of caesarean section (OR, 1.14; 95% CI, 1.04 to 1.25), low birth weight (OR, 1.50; 95% CI, 1.31 to 1.73), preterm birth (OR, 1.45; 95% CI, 1.11 to 1.88), and small for gestational age (OR, 1.16; 95% CI, 1.01 to 1.33) were significantly higher in BC survivors, particularly in those with previous chemotherapy exposure, compared with the general population. No significantly increased risk of congenital abnormalities or other reproductive complications were observed. Compared to patients with BC without subsequent pregnancy, those with a pregnancy had better disease-free survival (HR, 0.66; 95% CI, 0.49 to 0.89) and overall survival (HR, 0.56; 95% CI, 0.45 to 0.68). Similar results were observed after correcting for potential confounders and irrespective of patient, tumor, and treatment characteristics, pregnancy outcome, and timing of pregnancy. These results provide reassuring evidence on the safety of conceiving in BC survivors. Patients' pregnancy desire should be considered a crucial component of their survivorship care plan.

Approaches to Improve Endometrial Receptivity in Case of Repeated Implantation Failures.

Repeated implantation failures are a constant challenge in reproductive medicine with a significant impact both on health providers and on infertile couples. Several approaches have been proposed so far as effective; however, accumulative data have clarified that most of the treatment options do not have the evidence base for a generalized application to be suggested by the relevant societies. Implantation failures are attributed to either poor quality embryos or to defected endometrial receptivity. The current review aims to summarize in a systematic way all the new trends in managing RIF via interference with endometrial receptivity. The authors focus mainly, but not exclusively, on endometrial injury prior to embryo transfer and endometrial priming with autologous cells or biological agents. To this direction, a systematic search of the Pubmed database has been conducted taking into account the emerged evidence of the last two decades. All the suggested interventions are herein presented and analyzed in terms of reproductive outcomes. It is evident that properly powered and designed randomized trials are needed to support a new standard approach in RIF treatment that will safely be incorporated in national and international guidelines.

Efficacy of the delayed start antagonist protocol for controlled ovarian stimulation in Bologna poor ovarian responders: a systematic review and meta-analysis.

Patients with a poor ovarian response (POR) represent the most difficult group of population to deal with in the clinical fertility practice. Bologna criteria are the first uniform definition of POR. Choosing a suitable controlled ovarian stimulation (COS) protocol which could give adequate oocytes to maximize the chance of obtaining at least one euploid blastocyst is crucial in the management for such patients. The delayed start antagonist protocol is a novel COS protocol designed for POR patients, however, its real efficacy is controversial compared to conventional protocols. The present study aims to summarize all available studies on this topic and perform a meta-analysis to explore the real treatment effect of this novel protocol in terms of reproductive outcomes. PubMed, EMBASE, Google Scholar, and the Cochrane Library from database establishment to June 2019 were searched. Randomized controlled trials (RCTs), which compared delayed start antagonist protocol (Del) to conventional controlled ovarian stimulation (COS) protocols (Con) in terms of reproductive outcomes, were included. The RevMan 5.3 was used to perform statistical analysis. The primary outcomes were the cycle cancellation rate, the clinical pregnancy rate and the miscarriage rate. 5 RCTs yielding 514 patients were eligible, of which 5, 5, 4 studies were included in analyzing the cycle cancellation rate, the clinical pregnancy rate, and the miscarriage rate respectively. Synthesized data of meta-analysis showed: delayed start antagonist protocol introduced a lower risk of cycle cancellation [risk ratio (RR) = 0.63, 95% confidence interval (CI) (0.45, 0.90), P = 0.01; 5 RCTs, 514 women (Del:Con = 256:258); I2 = 0%; with rates of 16.02% (Del) vs. 26.36% (Con)], an increased chance to get clinical pregnancy [RR = 2.30, 95% CI (1.38, 3.82), P = 0.001; 5 RCTs, 514 women (Del:Con = 256:258); I2 = 0%; with rates of 16.80% (Del) vs. 7.36% (Con)], and a comparable miscarriage rate [RR = 0.55, 95% CI (0.24, 1.23), P = 0.15; 4 RCTs, 58 women (Del:Con = 41:17) I2 = 17%; with rates of 19.51% (Del) vs. 35.29% (Con)] compared to conventional COS protocols. Delayed start antagonist protocol was a potentially valuable alternation for poor ovarian responders. However, future RCTs with large sample size and more scientific design are needed to verify its validity and draw a sound conclusion.

Reproductive and obstetrical outcomes with the overall survival of fertile-age women treated with fertility-sparing surgery for borderline ovarian tumors in Sweden: a prospective nationwide population-based study

To assess the efficacy of fertility-sparing surgery (FSS) in terms of reproductive outcomes by following FSS for borderline ovarian tumors (BOTs) and comparing the safety of FSS versus radical surgery (RS). Nationwide cohort study based on prospectively recorded data. Sweden. All women of reproductive age (18-40 years) treated in Sweden for stage I BOT with the use of FSS or RS from 2008 to 2015, identified in the Swedish Quality Registry for Gynecologic Cancer (SQRGC). FSS or RS. Reproductive outcomes: natural conception, use of assisted reproductive technology (ART), live birth and obstetrical outcomes. Safety outcome: overall survival (OS) rates, comparing women undergoing FSS versus RS. The FSS cohort was linked to the Swedish Medical Birth Register to identify all women who had given birth after FSS and to obtain detailed obstetrical data. For information on ART treatment, the National Quality Registry for Assisted Reproduction was consulted. OS rate comparisons were conducted by means of Kaplan-Meier estimates. Of the 277 women with BOTs, 213 (77%) underwent FSS, 183 (86%) unilateral salpingo-oophorectomy, and 30 (14%) cystectomy. Following FSS, 50 women gave birth to 62 healthy children, 8% of which were preterm. Only 20 (9%) of the women underwent ART treatment. OS was similar in women treated with FSS and RS. Natural fertility was maintained after FSS; only 9% required ART treatment. FSS was also deemed to be equivalent to RS regarding survival outcome.

Sperm chromosomal abnormalities and their contribution to human embryo aneuploidy.

In this work we reviewed 18years of experience using fluorescence in situ hybridization (FISH) for sperm aneuploidy testing. We evaluated parameters associated with increased numerical sperm chromosome abnormalities and determined the male contribution to embryo aneploidies in terms of reproductive outcome by increased sperm aneuploidy. This retrospective study analyzed data from 2008 sperm samples of infertile males undergoing FISH analysis because of clinical history of repetitive implantation failure, recurrent miscarriage, impaired sperm parameters, or mixed causes. Sperm concentration was the only sperm parameter associated with FISH results-we observed a gradual increase of abnormal sperm FISH results in males with decreasing sperm concentration. However, a great proportion of normozoospermic males also showed increased sperm aneuploidies, suggesting that sperm parameters alone do not enable identification of a substantial proportion of infertile males at risk of sperm aneuploidies. Regarding reproductive outcomes, couples with normal sperm FISH results for the male had similar outcomes regardless of conventional in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), or preimplantation genetic testing for aneuploidies (PGT-A). However, couples with abnormal sperm FISH results for the male showed better clinical outcomes after PGT-A, suggesting a potential contribution of sperm to embryo aneuploidy. Moreover, PGT-A cycles showed better clinical outcomes when 24 chromosomes were analyzed by array comparative genome hybridization (aCGH) or next-generation sequencing (NGS) instead of only nine chromosomes analyzed by FISH. In conclusion, sperm FISH analysis offers clinical prognostic value to evaluate reproductive possibilities in infertile couples. Therefore, couples with abnormal sperm FISH results should be offered genetic counseling and presented with clinical options such as PGT-A.

Is ICSI superior to conventional IVF in severe male factor: a 3 year prospective observational study

To study whether IVF (in-vitro fertilisation) yields better outcome in severe male factor infertility over Intracytoplasmic sperm injection (ICSI) in terms of live-birth ,obstetric outcome and congenital anomalies. This prospective observational study included 253 women whose male partner had TMC (Total motile count) <1million and underwent conventional IVF or ICSI from January 2014 to December 2016. All subjects were between 25-37 years. Records of prenatal care of mother and neonates were reviewed. Developmental wellbeing of children born after IVF/ICSI were followed for three years. The 253 male partners who had semen analysis on day of oocyte retrieval with <1million motile sperm and morphology>4% after wash, were included and divided into Group A (GrA) (n=121) in which conventional insemination was done and Group B (GrB)(n=132) where ejaculated ICSI was done. Antagonist protocol was performed. Total fertilization failure were 6/121(4.9%) in GrA and 3/132(2.2%) in GrB. Rest 244 patients with 295 cycles were analysed. Other female factors-PCOS, endometriosis, tubal factors and uterine defects were excluded. Both groups were comparable in terms of age of both partners, BMI, dose of gonadotropins, estradiol on day of oocyte retrieval, endometrial thickness and number of oocytes retrieved. Conventional IVF group (496/840, 59.01%) had significantly lower fertilization rate than ejaculated ICSI (591/910, 64.94% p=0.0119). although number of day 3 embryos were comparable in both groups (GrA 407/496, 82.05% vs GrB 467/591,79.01%). Pregnancy rate per embryo transfer in GrA was 42.2% and GrB was 47.61% (p=ns). Pregnancy per oocyte retrieval was also comparable-38.58% in conventional IVF and 42.85% in ICSI. Live birth rate per oocyte retrieval was also similar in both groups (GrA 30.6% vs GrB 26.4%). Missed abortion, though higher in ICSI group was not significantly different than conventional IVF (GrA 26.53% vs GrB 29.1%). Antenatally two patients in ICSI group had pre-eclamptic toxaemia (PET) while none had the condition in IVF group. One baby in ICSI group was terminated due to chromosomal defect and two babies born after ICSI had birth defects (one hypospadius and the other imperforate anus). In IVF group one baby had posterior urethral valve. Incidence of PET and congenital anomalies could be chance findings in this study. In our study conventional IVF is as good as ejaculated ICSI in terms of reproductive outcome, where male partner had <1million motile sperm in post wash sample. IVF could be the first choice over ICSI in severe male factor infertility especially in developing countries which will decrease the cost of ART.

Female plumage coloration signals status to conspecifics

Intrasexual competition in female birds is a widespread phenomenon but remains scarcely explored. Females compete for limited resources and the expression of signals that indicate their social status will be favoured by natural selection, generating a dominance hierarchy among individuals. However, which signals might be involved in female–female competition is unclear. In this study, we tested the role of rump coloration as a badge of status within a context of intrasexual competition using common kestrels, Falco tinnunculus, in two populations over 3 years. We used natural decoys with two different ‘phenotypes’, since the expression of this melanin-pigmented trait within the brown–grey range has been suggested to be a reliable proxy of individual quality in female common kestrels. By showing natural decoys with grey and brown rumps to breeding females, we simulated territorial invasions of high- and low-quality females, respectively. Our results show that rump coloration generates a differential response during territorial invasions. Specifically, we found that grey-rumped decoys (high quality) elicited lower levels of aggressiveness. In addition, female agonistic response was negatively associated with clutch size. Based on our results, we suggest that female rump coloration works as a badge of status in breeding female kestrels. This trait may signal female competitive ability and can generate a dominance hierarchy among individuals in our population. We also suggest that aggressiveness can be costly to females in terms of reproductive outcome. Overall, we provide evidence that melanin-pigmented traits in females can play a key role in intrasexual competition.

Hysteroscopic adhesiolysis: efficacy and safety.

To evaluate the efficacy and safety of hysteroscopic adhesiolysis in patients with intrauterine adhesions (IUAs). Minia Maternity University Hospital, Egypt. Prospective cohort study. This study included 61 patients presented with infertility (primary or secondary) or recurrent pregnancy losses caused by IUAs. The adhesions were divided by semi-rigid scissors introduced under direct vision through hysteroscopy. Three months later, second-look hysteroscopy was performed. Primary outcome parameters were reproductive parameters (pregnancy rate, duration of pregnancies, life births rate, time lag between the intervention and diagnosis of pregnancy). Secondary outcome parameters were the changes in post-operative menstrual pattern, number and duration of intervention and type of intra- and post-operative complications. Pregnancy rate changed from 18 to 65.5%, while live birth rate improved from 14.7 to 36%. The mean time until the first conception was 10.2months (range 2-60months) after the operation. There was significant negative correlation between the degree of IUAs and the improvement in reproductive performance. Hysteroscopic adhesiolysis significantly improved menstrual pattern in 60.7% of patients complaining of hypomenorrhea or amenorrhea. (p=0.0017). The average operative time was 29±10.2 (10-52)min and the hospital stay was 12.5±2.1 (9-24)h. Uterine perforation occurred on 3 (4.9%), and cervical laceration occurred in one case (1.6%). Hysteroscopic adhesiolysis of IUAs is safe and effective in terms of reproductive outcome. The outcome is significantly affected by degree of intrauterine adhesions rather than the main complaint before the procedure.

Anatomical causes of female infertility and their management

The main female anatomical causes of infertility include post-infectious tubal damage, endometriosis, and congenital/acquired uterine anomalies. Congenital (septate uterus) and acquired (myomas and synechiae) diseases of the uterus may lead to infertility, pregnancy loss, and other obstetric complications. Pelvic inflammatory disease represents the most common cause of tubal damage. Surgery still remains an important option for tubal factor infertility, with results in terms of reproductive outcome that compare favorably with those of in vitro fertilization. Endometriosis is a common gynecologic condition affecting women of reproductive age, which can cause pain and infertility. The cause of infertility associated with endometriosis remains elusive, suggesting a multifactorial mechanism involving immunologic, genetic, and environmental factors. Despite the high prevalence of endometriosis, the exact mechanisms of its pathogenesis are unknown. Specific combinations of medical, surgical, and psychological treatments can ameliorate the quality of life of women with endometriosis. In the majority of cases, surgical treatment of endometriosis has promoted significant increases in fertilization rates. There are obvious associations between endometriosis and the immune system, and future strategies to treat endometriosis might be based on immunologic concepts.

Metroplasty in a Large Population of Women with Septate Uterus

Study Objective To determine the reproductive outcome after hysteroscopic metroplasty in women with septate uterus. Design Retrospective comparative single-center study (Canadian Task Force classification II-3). Setting University-affiliated hospital. Patients Two hundred forty-six patients with septate uterus undergoing hysteroscopic metroplasty between January 1998 and December 2007. The diagnosis was based on hysteroscopy and 3-dimensional ultrasonography. In the most cases laparoscopy was also available. The subjects were divided into 2 age-matched groups. Group 1 consisted of 108 women with unexplained infertility, and group 2 consisted of 138 women suffering from recurrent abortion. Interventions Patients underwent hysteroscopic metroplasty by use of resectoscopy with an equatorial semicircular loop cutting at 0 degree with monopolar energy. All septa were completely removed without complications of bleeding, infection, risk of perforation, visceral injury, or uterine dehiscence during pregnancy. Measurement and Main Results The 2 groups were compared in terms of reproductive performance in mean ± SD follow-up of 37 ± 18 months. In group 1, 61 (56.5%) patients achieved pregnancy. Seventy-one pregnancies ensued, including 1 twin gestation. Fourteen of the 71 pregnancies (19.7%) ended in miscarriage. In group 2, 90 (65.3%) patients achieved pregnancy. One hundred twenty-nine pregnancies ensued, including 2 twin gestations. Forty-four of the 129 pregnancies (34.1%) ended in miscarriage. The 2 groups have no significant differences in terms of reproductive outcome after surgery, except for the number of abortions, which was higher in group 2 (p <.05). Conclusion This study confirms that hysteroscopic metroplasty is a simple, safe, and rapid surgical procedure with no complications for achieving normal uterine architecture, which is peculiar to a good reproductive outcome. The use of an equatorial semicircular loop may give satisfactory and similar results to those obtained with Collin’s loop.

Ultra-conservative fertility-sparing strategy for bilateral borderline ovarian tumours: an 11-year follow-up

This is a prospective long-term extension study of a randomized controlled trial aimed to assess the risk-benefit ratio of an ultra-conservative fertility-sparing approach in patients with bilateral borderline ovarian tumours (BOTs). The experimental group (n = 15) was treated with an ultra-conservative surgical approach consisting of bilateral cystectomy, whereas the control group (n = 17) received a less conservative surgery consisting of oophorectomy plus controlateral cystectomy alone. All patients received a complete laparoscopic staging followed by a fertility enhancement programme. Patients who completed childbearing were treated with a non-conservative standard treatment at the first recurrence. After a follow-up period of 128 (9 interquartile range (IQR); 115-150 range) and 132 (7 IQR; 117-152 range) months for the experimental and control groups, respectively (P = 0.25), the time to first baby-in-arm (P < 0.02) and the relative rate (RR) of baby-in-arm (8.05 [95% confidence interval (CI), 1.20-9.66; P < 0.01]) were significantly lower and higher, respectively, for the experimental compared with the control group. Although the time to first recurrence was significently (P < 0.01) shorter for the experimental group, in the regression analysis the difference did not reach the statistic significance (P = 0.14), and the RR of recurrence (1.23 [95% CI, 0.62-3.17; P = 0.41]) was not significant. Finally the number needed to treat for pregnancy was three, the number needed to harm for radical surgery was only two. The ultra-conservative fertility-sparing approach is more effective than the standard approach in terms of reproductive outcomes, but presents a higher oncological risk.

Salpingoscopy.

Salpingoscopy is an endoscopic technique that allows direct evaluation of the ampullary tubal mucosa at the time of laparoscopy. It has been reported that the presence of ampullary mucosal adhesions can negatively affect reproductive outcome and increase the risk of ectopic tubal pregnancy. Various studies have suggested that the extent of intra-luminal adhesions may not correlate with the nature and extent of periadnexal adhesions. Further studies on salpingoscopic and laparoscopic correlations with regard to fertility outcome have been reported in the literature. Recently microsalpingoscopy has been introduced, with the number of nuclei stained by methylene blue dye employed as a prognostic factor of conception in women with infertility. As an alternative to salpingoscopy performed during laparoscopy, which requires hospitalization and general anesthesia, two groups have described salpingoscopy as an office procedure performed during transvaginal hydrolaparoscopy or in conjunction with fertiloscopy. The prognostic value of salpingoscopy during operative laparoscopy for tubal factor infertility in terms of reproductive outcome has been confirmed. The prognostic significance of microsalpingoscopy needs further validation in large-scale clinical trials. Transvaginal hydrolaparoscopy and fertiloscopy appear to be an alternative to hysterosalpingography as a first line procedure to investigate female infertility.

Zygote intrafallopian transfer or in vitro fertilization and embryo transfer for the treatment of male-factor infertility: a prospective randomized trial

To compare zygote intrafallopian transfer (ZIFT) and in vitro fertilization and embryo transfer (IVF-ET) as treatments of male-factor infertility. Patients were prospectively randomized to ZIFT or IVF-ET. In vitro fertilization program of the Centre for Reproductive Medicine of the Dutch-speaking Brussels Free University, Belgium, which is a tertiary referral institution. One hundred fifty-seven couples were enrolled in the study. Inclusion criteria allowed only first trials of couples with long-standing infertility caused by a male factor. Female factors were excluded. In ZIFT, up to three fertilized oocytes were transferred into one single patient fallopian tube by means of laparoscopy 18 hours after insemination. In IVF-ET, cleaving embryos were replaced into the uterine cavity about 48 hours after insemination. Fertilization and transfer rates, implantation and pregnancy rates, pregnancy outcome, and cost per procedure were evaluated. Implantation rates of 12.3% and 10% per replaced conceptus were achieved for ZIFT and IVF-ET, respectively. This study demonstrates no therapeutic advantage of ZIFT over IVF-ET in male-factor infertility in terms of reproductive outcome or economic benefit.