Use Of Assisted Reproductive Techniques Research Articles

Heterotopic pregnancy and the influence of letrozole

Introduction: Heterotopic pregnancy has become increasingly common following increased use of assisted reproductive techniques. We will examine one uncommon instance of a heterotopic pregnancy occurring in the setting of a young woman undergoing letrozole therapy for primary infertility, making it an uncommonly seen case. Case Report: We report a young otherwise healthy female G1P0 at approximately 6 weeks gestation, who was referred from her primary care office to the Emergency Department with progressive abdominal pain that started 12 hours prior and had started to exhibit signs of hemodynamic instability. History was significant for difficulty with conception requiring letrozole treatment. Emergency laparoscopy was performed and confirmed additional ectopic pregnancy in the right fallopian tube with blood originating from the fimbriated end. Evacuation of hemoperitoneum and removal of ectopic pregnancy was completed without complication. She was discharged from the hospital in stable condition. Conclusion: In any woman of reproductive age presenting with lower abdominal pain or abnormal bleeding, there should be a strong suspicion for a pregnancy until confirmed otherwise. These patients may benefit from prompt imaging with pelvic ultrasound to assist in earlier detection of ectopic embryo implantation and, subsequently, earlier intervention. Salpingectomy, ideally via laparoscopic approach, remains the gold standard for diagnosis and treatment of patients with a ruptured ectopic pregnancy in the setting of a heterotopic pregnancy, although surgical intervention is associated with poorer outcomes for the intrauterine pregnancy.

Does Sperm SNRPN Methylation Change with Fertility Status and Age? A Systematic Review and Meta-Regression Analysis.

Background: The Small Nuclear Ribonucleoprotein Polypeptide N (SNRPN) gene is a paternally expressed imprinted gene, whose abnormal methylation appears to be associated with syndromes associated with the use of assisted reproductive techniques (ART), such as Angelman and Prader-Willi. Data present in the literature suggest the association between aberrant sperm SNRPN gene methylation and abnormal sperm parameters. The latest meta-analysis on the methylation pattern of this gene in spermatozoa of infertile patients published in 2017 reported a higher degree of methylation in the spermatozoa of infertile patients compared to fertile controls. Objectives: Here we provide an updated and comprehensive systematic review and meta-analysis of the sperm methylation pattern of the SNRPN gene in patients with abnormal sperm parameters/infertility compared to men with normal sperm parameters/fertile. For the first time in the literature, we performed a meta-regression analysis to evaluate whether age or sperm concentration could influence the methylation status of this gene at the sperm level. Methods: This meta-analysis was registered in PROSPERO (n. CRD42023397056). The Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) and the MOOSE guidelines for meta-analyses and systematic reviews of observational studies were strictly followed in our meta-analysis. According to our Population Exposure Comparison Outcome (PECO) question, we included data from original articles assessing the levels of SNRPN gene methylation at the sperm level in infertile patients or patients with abnormalities in one or more sperm parameters compared to fertile or normozoospermic men. Results: Only six of 354 screened studies were included in the quantitative synthesis. Our analysis showed significantly higher levels of SNRPN gene methylation in patients compared to controls. However, significant heterogeneity was found between studies. In sensitivity analysis, no studies were sensitive enough to skew the results. The Egger test showed no publication bias. In the meta-regression analysis, the results were independent of age and sperm concentration in the overall population. The same results were found in the control group. However, when analyzing the patient group, a direct correlation was found between SNRPN methylation and age, indicating that the degree of methylation of the SNRPN gene increases with advancing age. Conclusions: Fertility status or abnormality of sperm parameters is associated with a change in the methylation pattern of the SNRPN gene, with higher levels found in infertile patients or those with abnormal sperm parameters compared to fertile men or men with normal sperm parameters. In the group of infertile patients/patients with abnormal sperm parameters, age was directly correlated to the degree of SNRPN methylation, highlighting the presence of a mechanism that explains the age-related altered sperm quality and the risk of ART. Despite some limitations present in the analyzed studies, our results support the inclusion of SNRPN methylation in the genetic panel of prospective studies aimed at identifying the most representative and cost-effective genes to analyze in couples who want to undergo ART.

Multiple Gestations: Neonatal and Maternal Characteristics

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

Effects of bovine ovarian storage conditions and vitrification on isolated preantral follicle viability.

The decreasing rate of successful pregnancies, both naturally and through assisted conception, has led to innovations in the way eggs, sperm, and embryos are stored. Despite these advances, the use of assisted reproductive techniques to preserve endangered or rare species remains unexplored. Since the location where samples are collected and facilities are often far apart, we aim to address part of this challenge by comparing different methods to store and handle ovarian tissue before freezing. This may pave the way for further research in preserving endangered species, despite the challenges posed by the distance between sample collection sites and suitable facilities.

Short-term preservation of canine sperm-binding ability and other metrics using the INRA-96 in comparison to Tris-egg yolk extender.

The use of assisted reproductive techniques, such as chilled semen, contributes to the maintenance and genetic improvement of canine breeding. The INRA-96 extender is a commercially available, chemically defined medium that was initially developed for the preservation of equine semen and exhibits preservation potential in the canine species. This research aims to evaluate the INRA-96 extender as an alternative for the short-term preservation of canine semen in terms of sperm quality parameters such as motility and kinetic parameters, integrity and functionality of the plasma membrane in fresh and chilled-rewarmed samples, as well as the sperm-binding ability using the perivitelline membrane of the chicken egg as an indicator of the fertilizing capacity of the preserved semen. A total of 18 ejaculates from 9 French bulldogs (two ejaculates per dog) were collected and divided into two aliquots that were diluted in Tris-egg yolk 20% (control) or INRA-96 to a final concentration of 100 × 106 sperm/mL. Samples were refrigerated in a biological incubator at 5°C and evaluated at 0, 24 and 48 h time points. Comparing the two treatments after 48 h of refrigeration, both extenders showed similar values (p < .5) for the majority of kinetic parameters, with the INRA-96 group promoting a total motility of 88.1 ± 2.9%. In addition, the morphology, integrity and functionality of the plasma membrane were preserved above 70% in this group. Dilution with INRA-96 also provided a significantly higher amount of sperm bound (256.2 ± 21.1) to the perivitelline membrane of the egg yolk compared to the sperm-binding rates (p < .05) achieved at the use of Tris-egg yolk (215.2 ± 21 bound spermatozoa) at 48 h. Our study proved similar functional properties of dog sperm cells treated with INRA-96 in comparison to commonly used home-made Tris-based extender during short-time storage.

Pregnancy and assisted reproductive technology use in Australian female transfusion-dependent haemoglobinopathy patients: a 20-year retrospective analysis.

In the last few decades, the life expectancy of patients with transfusion-dependent thalassaemia (TDT) and sickle cell disease (SCD) has improved significantly, in part because of improved iron chelation. Fertility challenges and pregnancy complications have historically limited reproductive options in this group; however, improved multi-disciplinary care has made infertility a chronic disease complication requiring attention. Despite this, there are very few reports and no Australian data describing fertility and pregnancy outcomes in this population. To identify the rate of assisted reproductive technologies (ART) utilisation in our female transfusion-dependent haemoglobinopathy patients and to establish the nature of maternal and neonatal complications in this cohort. A 20-year retrospective analysis (1997-2017) at an Australian centre captured data on conception rates, use of assisted reproductive techniques (ART), and pregnancy and neonatal outcomes in female transfusion-dependent haemoglobinopathy patients. Conception was attempted in 14 women (11 TDT and three SCD) during the study period. A total of 28 pregnancies resulting in 25 live births were recorded. ART supported 13 conceptions. A positive association was not identified between elevated mean serum ferritin and ART use; however, all patients with an established diagnosis of hypogonadotropic hypogonadism (HH) required ART. Maternal complications included gestational diabetes mellitus and post-partum haemorrhage. There were no cardiac complications. Two-thirds of women underwent lower segment caesarean section, with prematurity complicating 20% of births. There were no neonatal or maternal deaths. Pregnancy is an achievable goal for women with transfusion-dependent haemoglobinopathies, although the support of ART may be required in a subset of patients.

Cryobiology and fertility preservation: A perspective on past, current and future studies

Cryopreservation has been used over many decades for the maintenance of viable biological specimens. Its expansion into the area of fertility preservation has been a natural outcome of the increased risks to human fertility from diseases, such as cancer and its treatment protocols, including radiation and chemo-therapy, and thegeneral lifestyle trend to later marriages. The use of assisted reproductive techniques (ART) in preserving fertility have benefitted significantly from new scientific approaches, such as cryostorage, in which live cells and tissues are stored at low temperatures and revived when necessary. This review focuses on "cryopreservation science monitoring in reproductive biomedicine" to evaluate knowledge, trends, driving forces, impetus, and emerging technologies in order to draw a future roadmap for this field. Our analysis of the field of cryobiology emphasises the significance of strategic planning of cryobiology research to support more its extensive use in therapeutics in the future. The Royan Institute (Tehran, Iran) recognises this need and has developed a plan to engage in multidisciplinary research on the application of cryobiology, including in disease mitigation. We hope that this study can help improve the quality and of public discourse and expert awareness of the role for cryopreservation in fertility within ART.

Beckwith-Wiedemann Syndrome in a patient with full-term pregnancy, case report

Beckwith-Wiedemann Syndrome (BWS) is a rare congenital disorder caused by alterations to the IGF2 gene. Its incidence has increased with the use of assisted reproduction techniques. We present a case of a patient with BWS who experienced anaphylactic shock during delivery, likely related to oxytocin use. Multidisciplinary management is necessary in cases of prenatal diagnosis, with a focus on early correction of hypoglycemia and structural defects. BWS is associated with an increased risk of childhood cancer, and the use of assisted reproduction techniques may further increase this risk. Clinicians should be aware of the potential complications associated with BWS in pregnant patients and their newborns.

Bilateral Tubal Pregnancies Presenting 11 Days Apart: A Case Report.

Ectopic pregnancy is the most common cause of maternal mortality in the first trimester. Bilateral tubal pregnancy is the rarest subset with an estimated incidence of one in 725 to 1,580 ectopic pregnancies. Of the cases of bilateral tubal pregnancy reported in the literature, most were associated with the use of assisted reproductive techniques. Here we present the case of a patient, without a prior history of reproductive technology use, who underwent treatment for a tubal pregnancy and was subsequently found to have a second, contralateral tubal pregnancy 11 days later. A 35-year-old female gravida eight para two with a history of left tubal pregnancy and salpingectomy 11 days prior, presented to the emergency department (ED) with two days of left lower and upper quadrant abdominal pain. The patient's last menstrual period had been several months prior. A physical examination revealed left lower quadrant abdominal tenderness, rebound, guarding, and left adnexal tenderness. Her vital signs were unremarkable, and her laboratory studies revealed normal white blood cell and hemoglobin values. Her human chorionic gonadotropin had tripled from her last presentation 11 days prior. Transvaginal ultrasound showed a possible ectopic pregnancy adjacent to the right ovary. She promptly underwent a right salpingectomy. Pathology findings confirmed a tubal pregnancy, and the patient's postoperative course was uneventful. This case highlights the importance of maintaining a high index of suspicion for ectopic pregnancy in all biologically female patients of reproductive age who present to the ED with abdominal pain.

Fetus papyraceous: a rare clinical image

Fetus papyraceous is characterized by the intrauterine fetal demise of a twin occurring early in pregnancy, which is then compressed between membranes and the uterine wall. After a while, the fetus becomes mummified and resembles parchment paper. It is a rare complication with an incidence of 1 in 12,000, mostly among twin pregnancies. Predisposing factors may include: multiple pregnancies, use of assisted reproductive techniques, certain intrauterine conditions like membranous cord insertion. Insufficiency of the placenta or twin-to-twin transfusion syndrome. A 26-year-old unbooked para 2 living 1 with 39 weeks 6 days of gestation with previous vaginal delivery came to a casualty with complaints of lower abdomen pain. Blood investigations and term ultrasound were found to be normal. The patient´s vitally stable. On examination, per abdomen, adequate contractions with a cephalic presentation, fetal heart rate of 150 beats/min present. Per vaginal examination, the cervix is fully dilated and effaced, and membranes present with the adequate pelvis. After spontaneous rupture of membranes, delivered a live term baby with a 2.6 kg birth weight, the baby cried immediately after birth. On examination of the placenta and membranes, there was an incidental finding of a hard, paper-like flattened structure: a shrunken dead fetus-fetus papyraceous. Differential diagnosis of this condition depends on the time of diagnosis antenatal -vanishing twin syndrome in the first trimester, fetus papyraceous in the second trimester, macerated twin in the third trimester.

Türk İnfertil Erkeklerde Y kromozomu Mikrodelesyonlarının Sıklığı: Tek Merkez Deneyimi

Objective: Infertility is defined as the failure to achieve a clinical pregnancy after twelve months of regular unprotected sexual intercourse. Both genetic and environmental factors affect infertility. The aim of the study is to establish the frequency of the Y chromosome microdeletions in Turkish infertile men who were referred to our center (2016-2020) with severe oligozoospermia and azoospermia.&#x0D; Methods: A retrospective chart review study on patients who referred to our center between 2016-2020 due to infertility were included in the study. We evaluated microdeletions of the Y-chromosome STS markers AZFa, AZFb and AZFc, ZFX/ZFY, and terminal sY160 regions. Y-chromosome STS markers were evaluated by DNA fragment analysis. &#x0D; Results: The chart review indicated that a total of 319 men applied to our genetic diagnosis center between 2016 and 2020 due to infertility (mean age 32 ±7). Among the 319 infertile men, we determined 21 cases with Y chromosome microdeletions (6.89%), with the most common AZFc deletion (n=11, 52.3%) which is consistent with literature.&#x0D; Conclusion: Y-microdeletions are among the most common genetic causes of male infertility. In azoospermic and oligospermic patients, cytogenetic tests, Y-chromosome microdeletions and NGS panel screening tests can give effective information before the use of assisted reproductive techniques.

Predicting serum hormone concentration by estimation of urinary hormones through a home-use device.

Can a home-use device be used to predict serum hormone levels? A home-use device can predict urinary hormone values which are well-correlated to serum concentrations of respective hormones and hence can be used as a proxy for serum measurements. Home-use devices that predict ovulation are calibrated against the actual day of ovulation. However, the correlation of any quantitative system to serum hormone concentrations has not been established. A total of 73 data points obtained from 20 participants across different phases of the menstrual cycle, i.e. bleeding days, follicular phase and luteal phase were used to establish the correlation between serum hormones and urinary metabolite values. Single data points from 20 random users were used to assess the correlation established. Participants were women in the fertile age groups and only current users of the home-use device. Selection was done based on inclusion and exclusion criteria. Blood hormones were tested using chemiluminescent immunoassays and urinary measurements were taken on the home-use device at home. Serum estradiol (E2), progesterone (P4) and LH were correlated with urinary estrone-3-glucuronide (E3G), pregnanediol glucuronide (PdG) and LH with an R 2 of 0.96, 0.95 and 0.98, respectively. Repredicted serum concentration obtained by using the correlation equation had a correlation of 0.92, 0.94 and 0.93 in unknown samples. The study was designed to include women who have normal cycle lengths regularly; therefore, the values obtained were in the normal range. Certain infertility conditions may cause the values to be higher and correlation in such cases needs to be established. The results of this study imply a new tool that can be used by fertility specialists as a proxy for blood tests whenever required. Extended study on this system can enable its use in assisted reproductive techniques as well. No funding was received for this study. S.P. and D.D. are employees of the research and development division of Samplytics Technologies Pvt. Ltd. which is a forwarder for Inito Inc., USA. A.R. and V.A.V. are co-founders of Inito Inc., USA. The trial was registered at the International Standard Randomised Controlled Trial Number (ISRCTN) registry (Identifier: ISRCTN15534557).

Gestational diabetes prevalence and outcomes in women undergoing assisted reproductive techniques (ART)

Infertility affects millions worldwide and use of assisted reproductive techniques (ART) is in high demand. AimsTo investigate whether women that underwent ART at our hospital had a higher incidence of GDM than women who conceived spontaneously, if the ART subtype affects the GDM rate and to study obstetrical outcomes in women with GDM in both groups. MethodsThis was a retrospective analysis of prospectively collected data of singleton pregnancies attended at Hospital Universitari Dexeus between 2008 and 2019. Age<18 years, pregestational diabetes, metformin prior to pregnancy and multiple pregnancies were excluded. ResultsA total of 29,529 patients were included. Pregnancy was achieved by ART in 2596 (8.8%): in vitro fertilisation (IVF/ICSI) 32.8%, frozen embryo transfer (FET) 37.7%, oocyte donor receptors (ODR) 17.2% and insemination 12.2%. The GDM rate was 8.9% (12.7% in ART vs 8.5% in non-ART, p<0.001). The GDM was 11.2% in IVF/ICSI, 17.7% in ODR, 13% in FET and 9.1% in the insemination group (p=0.001). In a multivariable analysis adjusting for age, parity and BMI, ART was not associated with GDM [OR 1.03 (0.90–1.19)], nor was type of ART. Pregnancy outcomes in GDM patients were similar in both groups except for C-section rates (30.0% in ART vs 15.9% in non-ART (p<0.001). ConclusionsDespite a higher prevalence of GDM in ART pregnancies, ART was not associated with an increased risk of GDM when adjusting for age, parity and BMI. The prognosis of GDM in ART and non-ART was similar except for C-section rates.

The Controversies and Challenges in the Management of Twin Pregnancy: From the Perspective of International Federation of Gynecology and Obstetrics Guidelines

Abstract The rate of multiple pregnancy is increasing, mainly because of the widespread use of assisted reproduction techniques and families’ desire for twins. Twin pregnancy accounts for a higher risk of chromosomal abnormalities, structural malformations, and neonatal adverse events than singleton pregnancy. The presence of artery-vein anastomoses, unbalanced placenta sharing, and abnormal cord insertion in monochorionic twins is associated with twin complications such as twin-to-twin transfusion syndrome, selective intrauterine growth restriction, and twin anemia polycythemia sequence. Although many guidelines and studies have established and improved the processes about the antenatal surveillance and management of twin pregnancy, they also raise more controversies and challenges. This review aims to highlight the international consensus on the antenatal care of twin pregnancies and analyze the controversies and predicaments based on the published International Federation of Gynecology and Obstetrics guidelines and research.

P-785 Assisted reproduction techniques and the risk of ovarian tumors

Abstract Study question Are fertility treatments associated with increased risk of subsequent development of ovarian tumors? Summary answer Results from recent studies have been primarily reassuring. However, further investigation is needed to determine whether fertility drug use increases the risk of ovarian tumors. What is known already In the last decades, the number of fertility treatments is rising worldwide due to postponing childbearing to a later age. The increasing exposure to fertility drugs has brought probable long term sequelae into focus, notably correlation with gynaecological malignancies. Two theories on the association between fertility drugs and ovarian cancer have been proposed, the “incessant ovulation” and the “elevated gonadotropin levels” theory. Use of assisted reproduction techniques (ART) is highly associated with many factors that are known to affect ovarian cancer risk such as parity. Study design, size, duration Summary of relevant clinical literature and review of all research studies that address the possible relation of assisted reproductive treatments with ovarian tumors. Participants/materials, setting, methods Published literature in PubMed, Medline and Google Scholar databases from 2011 to 2021 was screened using the following keywords: assisted reproductive techniques, in vitro fertilization, fertility drugs, ovarian cancer, and borderline ovarian tumors. Articles that were written in non- Latin alphabet were excluded for translational reasons. At least two review authors independently evaluated articles for eligibility. Main results and the role of chance Sixteen cohort and three case-control studies were selected. The majority of included studies reported no increase in ovarian cancer risk among subfertile women treated with ART, compared to either general population or subfertile non-treated women. In eight cohort and one case control studies, the type of fertility drug was clearly reported, including clomiphene citrate, gonadotropins, GnRH (gonadotropin releasing hormone) analogues, alone or in mixed protocols, while in the rest, the type of drug was not specified. Some studies showed a trend for a causative role of increasing dosage or number of IVF (in vitro fertilization) cycles, though statistically insignificant. Based on existing data, genetically vulnerable BRCA mutation carriers should not be excluded from use of ART, although extensive information of the potential association of ovarian stimulating drugs with ovarian tumors should be provided. Data on the association of fertility drug use with borderline ovarian tumors were contradictory. All included studies adjusted or matched for one or more possible confounding factors, such as age, parity and oral contraceptive use. Stratification by cause of infertility, showed an increased risk of ovarian cancer in treated women, with female factor infertility, which was more prominent in case of endometriosis. Limitations, reasons for caution High clinical and methodological heterogeneity of the included studies, with adjustment for varying confounding factors, relatively short follow–up periods and small samples sizes were noticed. Wider implications of the findings Ovarian cancer is the deadliest among all gynaecological malignancies. Considering the increasing use of ART worldwide, further clarification of the association between the two is crucial. For this reason larger, prospective studies are needed with sufficient follow-up exceeding 20years so that treated women will reach the ovarian cancer age range. Trial registration number not applicable

Maternal, Perinatal and Neonatal Outcomes of Triplet Pregnancies According to Chorionicity: A Systematic Review of the Literature and Meta-Analysis.

Triplet pregnancies are rare events that affect approximately 93 in 100,000 deliveries in the world, especially due to the increased use of assisted reproductive techniques and older maternal age. Triplet pregnancies are associated with a higher risk of fetal and maternal morbidity and mortality compared to twins and singletons. Chorionicity has been proposed as a major determinant of perinatal and maternal outcomes in triplet pregnancies, although further evidence is needed to clarify the extent and real influence of this factor. Thus, the aim of this study was to conduct a systematic review of the literature and a meta-analysis of the maternal and perinatal outcomes of triplet pregnancies, evaluating how chorionicity may influence these results. A total of 46 studies with 43,653 triplet pregnancies and 128,145 live births were included. Among the main results of our study, we found a broad spectrum of fetal and maternal complications, especially in the group of monochorionic and dichorionic pregnancies. Risk of admission to NICU, respiratory distress, sepsis, necrotizing enterocolitis, perinatal and intrauterine mortality were all found to be higher in non-TCTA pregnancies than in TCTA pregnancies. To date, our meta-analysis includes the largest population sample and number of studies conducted in this field, evaluating a wide variety of outcome measures. The heterogeneity and retrospective design of the studies included in our research represent the main limitations of this review. More evidence is needed to fully assess outcome measures that could not be studied in this review due to scarcity of publications or insufficient sample size.

Effects of Multiple Pregnancies on Mother and Foetus

Background: The incidence of multiple pregnancies is on rising due to a variety of reasons like increased use of assisted reproductive techniques and an increasing number of women having a pregnancy at an advanced age. A mother with twin pregnancy needs to be taken under the special care category. Objectives: We are intended to observe the effects associated with twin or higher-order pregnancy. Materials and Methods: This is a descriptive type of cross-sectional observational study conducted in the Department of Gynae and Obstetrics, Bangabandhu Sheik Mujib Medical University and Dhaka medical college hospital over a period of six months from 1st July to 31st December 2014. Total fifty patients were included in the study. Inclusion criteria were pregnant women who would be admitted with multiple pregnancies in BSMMU &amp; DMCH. Results: Average age of the responding patients was 24.54 years with standard deviation of ±3.93. Forty-two (84%) patients had ANC. Maximum (34%) patients had no complication, 8(16%) patients had GDM, 8(16%) patients had Preterm labor (PTL), 12 (24%) patients had Preeclampsia and only 5(10%) patients had PROM. Maximum (50%) babies had no significant fetal outcome, 30% babies had low birth weight, 16% babies were very low birth weight and 4(8%) patients had fetal demise. Conclusion: Now a days the incidence of multiple pregnancies is increasing due to ART. Multiple pregnancies are high-risk pregnancies with more complications in comparison to a single pregnancy. Our study reveals that nearly half of the cases had no maternal or fetal complication, Commonest maternal complications were preterm labor, Premature rupture of membranes (PROM), preeclampsia, and fetal outcomes were premature and low birthweight babies. KYAMC Journal. 2022;12(04): 196-199

23 Corneal ectopic pregnancy attended at a maternity hospital in the Western Amazon: Case report

Introduction: Corneal pregnancy represents about 1% of ectopic pregnancies. Risk factors include pelvic inflammatory disease, previous pelvic surgery, uterine abnormalities and the use of assisted reproduction techniques. In most cases, the diagnosis can be made by blood BhCG levels and transvaginal ultrasound. Laparoscopy has become the gold standard treatment for corneal pregnancies in recent years and has replaced laparotomic procedures. Objectives: to report a case of corneal pregnancy attended at a maternity hospital in the Western Amazon.

Gestational diabetes prevalence and outcomes in women undergoing assisted reproductive techniques (ART)

Infertility affects millions worldwide and use of assisted reproductive techniques (ART) is in high demand. AimsTo investigate whether women that underwent ART at our hospital had a higher incidence of GDM than women who conceived spontaneously, if the ART subtype affects the GDM rate and to study obstetrical outcomes in women with GDM in both groups. MethodsThis was a retrospective analysis of prospectively collected data of singleton pregnancies attended at Hospital Universitari Dexeus between 2008 and 2019. Age<18 years, pregestational diabetes, metformin prior to pregnancy and multiple pregnancies were excluded. ResultsA total of 29,529 patients were included. Pregnancy was achieved by ART in 2596 (8.8%): in vitro fertilisation (IVF/ICSI) 32.8%, frozen embryo transfer (FET) 37.7%, oocyte donor receptors (ODR) 17.2% and insemination 12.2%. The GDM rate was 8.9% (12.7% in ART vs 8.5% in non-ART, p<0.001). The GDM was 11.2% in IVF/ICSI, 17.7% in ODR, 13% in FET and 9.1% in the insemination group (p=0.001). In a multivariable analysis adjusting for age, parity and BMI, ART was not associated with GDM [OR 1.03 (0.90–1.19)], nor was type of ART. Pregnancy outcomes in GDM patients were similar in both groups except for C-section rates (30.0% in ART vs 15.9% in non-ART (p<0.001). ConclusionsDespite a higher prevalence of GDM in ART pregnancies, ART was not associated with an increased risk of GDM when adjusting for age, parity and BMI. The prognosis of GDM in ART and non-ART was similar except for C-section rates.

Torsión anexial en una gestación espontánea. A propósito de un caso

Adnexal torsion during pregnancy is a rare event mainly associated with the use of assisted reproductive techniques. However, it can occasionally also occur in spontaneous pregnancies without any predisposing factors. Its nonspecific clinical presentation in addition to the sometimes limited sensitivity of the gold standard test, Doppler ultrasound, leads to difficulty in preoperative diagnosis. For this reason, in most cases it is necessary to perform a laparoscopy in order to directly visualize the twisted ovary to obtain diagnostic confirmation. This is why, nowadays, adnexal torsion continues to be considered a diagnostic dilemma that should not delay the therapeutic approach, since a delay over 48 hours associates several irreversible lesions of the adnexa. At present, laparoscopy is the main surgical approach in pregnant women with suspicion of adnexal torsion due to the safety and advantages it provides. Keywords: Adnexal torsion, pregnancy, ovarian cyst, gynecological laparoscopy