Medicine › Pediatrics, Perinatology and Child Health

Assisted Reproductive Technology and Twin Pregnancy

Works Count: 67688

Wikipedia

Description

This cluster of papers explores the impact of assisted reproductive technology, particularly in vitro fertilization, on perinatal outcomes, including the risk of birth defects, imprinting disorders, and neurological sequelae. It also delves into the management of twin pregnancies, the use of fetoscopic laser coagulation, and the benefits of selective embryo transfer.

Keywords

Assisted Reproductive Technology; In Vitro Fertilization; Twin Pregnancy; Birth Defects; Perinatal Outcome; Monozygotic Twins; Imprinting Disorders; Fetoscopic Laser Coagulation; Selective Embryo Transfer; Neurodevelopmental Outcome

Going to college: How social, economic and educational factors influence the decisions students make

2001-02-01

Charlotte H. Scott

Obstetrics: Normal and Problem Pregnancies

2017-01-01

Steven G. Gabbe , Jennifer R. Niebyl , Joe Leigh Simpson

Clinical Implications of Attachment

2015-11-17

Jay Belsky , Teresa M. Nezworski

Contents: Part I:General Issues. J. Belsky, T. Nezworski, Clinical Implications of Attachments. L.A. Sroufe, The Role of Infant-Caregiver Attachment Development. Part II:Determinants of Attachment Security and Insecurity. J. Belsky, R. … Contents: Part I:General Issues. J. Belsky, T. Nezworski, Clinical Implications of Attachments. L.A. Sroufe, The Role of Infant-Caregiver Attachment Development. Part II:Determinants of Attachment Security and Insecurity. J. Belsky, R. Isabella, Maternal, Infant, and Social-Contextual Determinant Attachment Security. S.J. Spieker, C.L. Booth, Maternal Antecedents of Attachment Quality. P.M. Crittenden, Relationships at Risk. Part III:Consequences of Attachment Security and Insecurity. M.T. Greenberg, M.L. Speltz, Attachment and the Ontogeny of Conduct Problems. K.H. Rubin, S.P. Lollis, Origins and Consequences of Social Withdrawal. J.E. Bates, K. Bayles, Attachment and the Development of Behavior Problems. J. Cassidy, R.R. Kobak, Avoidance and Its Relations to Other Defensive Processes. A.F. Lieberman,J.H. Pawl, Clinical Applications of Attachment Theory. T. Nezworski, W.J. Tolan, J. Belsky, Intervention in Secure Infant Attachment. S.I. Greenspan, A.F. Lieberman, A Clinical Approach to Attachment.

Incidence of Premature Ovarian Failure

1987-03-01

Carolyn B. Coulam , Steven C. Adamson , John F. Annegers

Department of Obstetrics and Gynecology, Division of Family Medicine, and Department of Medical Statistics and Epidemiology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota Obstet. Gynecol. 67: 604, 1986 Department of Obstetrics and Gynecology, Division of Family Medicine, and Department of Medical Statistics and Epidemiology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota Obstet. Gynecol. 67: 604, 1986

Deliveries and children born after in-vitro fertilisation in Sweden 1982–95: a retrospective cohort study

1999-11-01

T. Bergh , A Ericson , Torbjörn Hillensjø +2 more

Staging of Twin-Twin Transfusion Syndrome

1999-12-01

Rubén A. Quintero , Walter J. Morales , Mary Allen +3 more

Births: final data for 2005.

2007-12-05

Joyce A Martin , Brady E Hamilton , Paul D Sutton +4 more

This report presents 2005 data on U.S. births according to a wide variety of characteristics. Data are presented for maternal demographic characteristics including age, live-birth order, race, Hispanic origin, marital … This report presents 2005 data on U.S. births according to a wide variety of characteristics. Data are presented for maternal demographic characteristics including age, live-birth order, race, Hispanic origin, marital status, and educational attainment; maternal lifestyle and health characteristics (medical risk factors, weight gain, and tobacco use); medical care utilization by pregnant women (prenatal care, obstetric procedures, characteristics of labor and/or delivery, attendant at birth, and method of delivery); and infant characteristics (period of gestation, birthweight, Apgar score, congenital anomalies, and multiple births). Also presented are birth and fertility rates by age, live-birth order, race, Hispanic origin, and marital status. Selected data by mother's state of residence are shown, as well as data on month and day of birth, sex ratio, and age of father. Trends in fertility patterns and maternal and infant characteristics are described and interpreted.Descriptive tabulations of data reported on the birth certificates of the 4.1 million births that occurred in 2005 are presented. Denominators for population-based rates are postcensal estimates derived from the U.S. 2000 census.In 2005, 4,138,349 births were registered in the United States, 1 percent more than in 2004. The 2005 crude birth rate was 14.0, unchanged from the previous year; the general fertility rate increased slightly to 66.7. Teenage childbearing continued to decline, dropping to the lowest levels recorded. Rates for women aged 20-29 were fairly stable, whereas childbearing among women 30 years of age and older increased. All measures of unmarried childbearing rose substantially in 2005. Smoking during pregnancy continued to decline. No improvement was seen in the timely initiation of prenatal care. The cesarean delivery rate climbed to more than 30 percent of all births, another all-time high. Preterm and low birthweight rates also continued to rise; the twin birth rate was unchanged and the rate of triplet and higher order multiple births declined for the 7th consecutive year.

Endoscopic Laser Surgery versus Serial Amnioreduction for Severe Twin-to-Twin Transfusion Syndrome

2004-07-07

Marie‐Victoire Sénat , Jan Deprest , Michel Boulvain +3 more

Monochorionic twin pregnancies complicated by severe twin-to-twin transfusion syndrome at midgestation can be treated by either serial amnioreduction (removal of large volumes of amniotic fluid) or selective fetoscopic laser coagulation … Monochorionic twin pregnancies complicated by severe twin-to-twin transfusion syndrome at midgestation can be treated by either serial amnioreduction (removal of large volumes of amniotic fluid) or selective fetoscopic laser coagulation of the communicating vessels on the chorionic plate. We conducted a randomized trial to compare the efficacy and safety of these two treatments.Pregnant women with severe twin-to-twin transfusion syndrome before 26 weeks of gestation were randomly assigned to laser therapy or amnioreduction. We assessed perinatal survival of at least one twin (a prespecified primary outcome), survival of at least one twin at six months of age, and survival without neurologic complications at six months of age on the basis of the number of pregnancies or the number of fetuses or infants, as appropriate.The study was concluded early, after 72 women had been assigned to the laser group and 70 to the amnioreduction group, because a planned interim analysis demonstrated a significant benefit in the laser group. As compared with the amnioreduction group, the laser group had a higher likelihood of the survival of at least one twin to 28 days of age (76 percent vs. 56 percent; relative risk of the death of both fetuses, 0.63; 95 percent confidence interval, 0.25 to 0.93; P=0.009) and 6 months of age (P=0.002). Infants in the laser group also had a lower incidence of cystic periventricular leukomalacia (6 percent vs. 14 percent, P=0.02) and were more likely to be free of neurologic complications at six months of age (52 percent vs. 31 percent, P=0.003).Endoscopic laser coagulation of anastomoses is a more effective first-line treatment than serial amnioreduction for severe twin-to-twin transfusion syndrome diagnosed before 26 weeks of gestation.

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Maternal-Fetal Medicine: Principles and Practice

1985-04-01

Robert Welch

During the past ten to 15 years, maternal-fetal medicine has seen the publication of several books aimed at providing the subspecialist with a comprehensive text/reference work. These attempts, however, have … During the past ten to 15 years, maternal-fetal medicine has seen the publication of several books aimed at providing the subspecialist with a comprehensive text/reference work. These attempts, however, have more often than not missed the mark because of incomplete content, inadequate depth beyond that found in textbooks of obstetrics, excessively specialized chapters by multiple contributors focused on their own research, or a nonobstetric perinatal perspective. Contrary to their predecessors, Creasy and Resnik have masterfully encompassed the boundaries of the subspecialty in their textbook,<i>Maternal-Fetal Medicine: Principles and Practice</i>. This work is logically separated into four parts: early fetal development and the environment, diagnostic modalities in maternal-fetal medicine, maternal and fetal pathophysiology, and the neonate. Each part is subdivided into chapters written by leaders in the field, many of whom are both scientists and practicing academic obstetric perinatologists. The flavor is, therefore, distinctly practical with as firm a basis in

Annual Summary of Vital Statistics: 2006

2008-04-01

Joyce A Martin , Hsiang-Ching Kung , T J Mathews +4 more

US births increased 3% between 2005 and 2006 to 4265996, the largest number since 1961. The crude birth rate rose 1%, to 14.2 per 1000 population, and the general fertility … US births increased 3% between 2005 and 2006 to 4265996, the largest number since 1961. The crude birth rate rose 1%, to 14.2 per 1000 population, and the general fertility rate increased 3%, to 68.5 per 1000 women 15 to 44 years. Births and birth rates increased among all race and Hispanic-origin groups. Teen childbearing rose 3% in 2006, to 41.9 per 1000 females aged 15 to 19 years, the first increase after 14 years of steady decline. Birth rates rose 2% to 4% for women aged 20 to 44; rates for the youngest (10–14 years) and oldest (45–49) women were unchanged. Childbearing by unmarried women increased steeply in 2006 and set new historic highs. The cesarean-delivery rate rose by 3% in 2006 to 31.1% of all births; this figure has been up 50% over the last decade. Preterm and low birth weight rates also increased for 2006 to 12.8% and 8.3%, respectively. The 2005 infant mortality rate was 6.89 infant deaths per 1000 live births, not statistically higher than the 2004 level. Non-Hispanic black newborns continued to be more than twice as likely as non-Hispanic white and Hispanic infants to die in the first year of life in 2004. For all gender and race groups combined, expectation of life at birth reached a record high of 77.9 years in 2005. Age-adjusted death rates in the United States continue to decline. The crude death rate for children aged 1 to 19 years decreased significantly between 2000 and 2005. Of the 10 leading causes of death for children in 2005, only the death rate for cerebrovascular disease was up slightly from 2000, whereas accident and chronic lower respiratory disease death rates decreased. A large proportion of childhood deaths, however, continue to occur as a result of preventable injuries.

Births: final data for 2013.

2015-01-15

Joyce A Martin , Brady E Hamilton , Michelle J K Osterman +2 more

This report presents 2013 data on U.S. births according to a wide variety of characteristics. Data are presented for maternal age, live-birth order, race and Hispanic origin, marital status, attendant … This report presents 2013 data on U.S. births according to a wide variety of characteristics. Data are presented for maternal age, live-birth order, race and Hispanic origin, marital status, attendant at birth, method of delivery, period of gestation, birthweight, and plurality. Birth and fertility rates are presented by age, live-birth order, race and Hispanic origin, and marital status. Selected data by mother's state of residence and birth rates by age and race of father also are shown. Trends in fertility patterns and maternal and infant characteristics are described and interpreted.Descriptive tabulations of data reported on the birth certificates of the 3.93 million U.S. births that occurred in 2013 are presented.A total of 3,932,181 births were registered in the United States in 2013, down less than 1% from 2012. The general fertility rate declined to 62.5 per 1,000 women aged 15-44. The teen birth rate fell 10%, to 26.5 per 1,000 women aged 15-19. Birth rates declined for women in their 20s and increased for most age groups of women aged 30 and over. The total fertility rate (estimated number of births over a woman's lifetime) declined 1% to 1,857.5 per 1,000 women. Measures of unmarried childbearing were down in 2013 from 2012. The cesarean delivery rate declined to 32.7%. The preterm birth rate declined for the seventh straight year to 11.39%, but the low birthweight rate was essentially unchanged at 8.02%. The twin birth rate rose 2% to 33.7 per 1,000 births; the triplet and higher-order multiple birth rate dropped 4% to 119.5 per 100,000 total births.

The Diagnosis of Twin Zygosity

1966-01-01

Ralph C. Nichols , Jr. Bilbro W.C.

Theory of Fertility Decline.

1983-03-01

Tanja Schultz , John C. Caldwell

The Risk of Major Birth Defects after Intracytoplasmic Sperm Injection and in Vitro Fertilization

2002-03-07

Michèle Hansen , Jennifer J. Kurinczuk , Carol Bower +1 more

It is not known whether infants conceived with use of intracytoplasmic sperm injection or in vitro fertilization have a higher risk of birth defects than infants conceived naturally. It is not known whether infants conceived with use of intracytoplasmic sperm injection or in vitro fertilization have a higher risk of birth defects than infants conceived naturally.

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THE ASSESSMENT OF FETAL GROWTH

1968-09-01

A. M. Thomson , W. Z. Billewicz , F. E. Hytten

Ovarian Hyperstimulation Syndrome

1989-06-01

Abraham Golan , Raphaël Ron-El , ARlE HERMAN +1 more

Department of Obstetrics and Gynecology, Assaf Harofe Medical Center, Zerifin, Israel ZVI WEINRAUB and ELIAHU CASPl Department of Obstetrics and Gynecology, Assaf Harofe Medical Center, Zerifin, Israel ZVI WEINRAUB and ELIAHU CASPl

Perinatal Outcomes in Singletons Following In Vitro Fertilization: A Meta-Analysis

2004-03-01

Rebecca Jackson , Kimberly A. Gibson , Yvonne W. Wu +1 more

In Brief OBJECTIVE: To estimate whether singleton pregnancies following in vitro fertilization (IVF) are at higher risk of perinatal mortality, preterm delivery, small for gestational age, and low or very … In Brief OBJECTIVE: To estimate whether singleton pregnancies following in vitro fertilization (IVF) are at higher risk of perinatal mortality, preterm delivery, small for gestational age, and low or very low birth weight compared with spontaneous conceptions in studies that adjusted for age and parity. DATA SOURCES: We searched MEDLINE, BIOSIS, Doctoral Dissertations On-Line, bibliographies, and conference proceedings for studies from 1978–2002 using the terms "in vitro fertilization," "female infertility therapy," and "reproductive techniques" combined with "fetal death," "mortality," "fetal growth restriction," "small for gestational age," "birth weight," "premature labor," "preterm delivery," "infant," "obstetric," "perinatal," and "neonatal." METHODS OF STUDY SELECTION: Inclusion criteria were singleton pregnancies following IVF compared with spontaneous conceptions, control for maternal age and parity; 1 of the above outcomes; and risk ratios or data to determine them. Study selection and data abstraction were performed in duplicate after removing identifying information. TABULATION, INTEGRATION, AND RESULTS: Fifteen studies comprising 12,283 IVF and 1.9 million spontaneously conceived singletons were identified. Random-effects meta-analysis was performed. Compared with spontaneous conceptions, IVF singleton pregnancies were associated with significantly higher odds of each of the perinatal outcomes examined: perinatal mortality (odds ratio [OR] 2.2; 95% confidence interval [CI] 1.6, 3.0), preterm delivery (OR 2.0; 95% CI 1.7, 2.2), low birth weight (OR 1.8; 95% CI 1.4, 2.2), very low birth weight (OR 2.7; 95% CI 2.3, 3.1), and small for gestational age (OR 1.6; 95% CI 1.3, 2.0). Statistical heterogeneity was noted only for preterm delivery and low birth weight. Sensitivity analyses revealed no significant changes in results. Early preterm delivery, spontaneous preterm delivery, placenta previa, gestational diabetes, preeclampsia, and neonatal intensive care admission were also significantly more prevalent in the IVF group. CONCLUSION: In vitro fertilization patients should be advised of the increased risk for adverse perinatal outcomes. Obstetricians should not only manage these pregnancies as high risk but also avoid iatrogenic harm caused by elective preterm labor induction or cesarean. In vitro fertilization singletons have higher odds of perinatal mortality, preterm delivery, low and very low birth weight, small for gestational age, and other adverse outcomes than spontaneous conceptions.

Low and Very Low Birth Weight in Infants Conceived with Use of Assisted Reproductive Technology

2002-03-07

Laura A. Schieve , Susan Meikle , Cynthia Ferré +3 more

The increased risk of low birth weight associated with the use of assisted reproductive technology has been attributed largely to the higher rate of multiple gestations associated with such technology. … The increased risk of low birth weight associated with the use of assisted reproductive technology has been attributed largely to the higher rate of multiple gestations associated with such technology. It is uncertain, however, whether singleton infants conceived with the use of assisted reproductive technology may also have a higher risk of low birth weight than those who are conceived spontaneously.

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Assisted reproductive technologies and the risk of birth defects—a systematic review

2004-11-27

Michèle Hansen , Carol Bower , Elizabeth Milne +2 more

The risk of birth defects in infants born following assisted reproductive technology (ART) treatment is a controversial question. Most publications examining the prevalence of birth defects in ICSI and IVF … The risk of birth defects in infants born following assisted reproductive technology (ART) treatment is a controversial question. Most publications examining the prevalence of birth defects in ICSI and IVF infants compared to spontaneously conceived infants have serious methodological limitations; despite this, most researchers have concluded that there is no increased risk.We carried out a systematic review to identify all papers published by March 2003 with data relating to the prevalence of birth defects in infants conceived following IVF and/or ICSI compared with spontaneously conceived infants. Independent expert reviewers used criteria defined a priori to determine whether studies were suitable for inclusion in a meta-analysis. Fixed effects meta-analysis was performed for all studies and reviewer-selected studies.Twenty-five studies were identified for review. Two-thirds of these showed a 25% or greater increased risk of birth defects in ART infants. The results of meta-analyses of the seven reviewer-selected studies and of all 25 studies suggest a statistically significant 30-40% increased risk of birth defects associated with ART.Pooled results from all suitable published studies suggest that children born following ART are at increased risk of birth defects compared with spontaneous conceptions. This information should be made available to couples seeking ART treatment.

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Changes in the Gestational Age Distribution among U.S. Singleton Births: Impact on Rates of Late Preterm Birth, 1992 to 2002

2006-02-01

Michael J. Davidoff , Todd Dias , Karla Damus +6 more

Effective Care in Pregnancy and Childbirth

1990-11-01

D. B. Paintin

The establishment and maintenance of pregnancy using in vitro fertilization and embryo donation in a patient with primary ovarian failure

1984-01-01

P. Lutjen , Alan Trounson , John Leeton +3 more

Births: final data for 2002.

2003-12-17

Joyce A Martin , Brady E Hamilton , Paul D Sutton +3 more

This report presents 2002 data on U.S. births according to a wide variety of characteristics. Data are presented for maternal demographic characteristics including age, live-birth order, race, Hispanic origin, marital … This report presents 2002 data on U.S. births according to a wide variety of characteristics. Data are presented for maternal demographic characteristics including age, live-birth order, race, Hispanic origin, marital status, and educational attainment; maternal characteristics (medical risk factors, weight gain, tobacco, and alcohol use); medical care utilization by pregnant women (prenatal care, obstetric procedures, complications of labor and/or delivery, attendant at birth, and method of delivery); and infant characteristics (period of gestation, birthweight, Apgar score, abnormal conditions, congenital anomalies, and multiple births). Also presented are birth and fertility rates by age, live-birth order, race, Hispanic origin, and marital status. Selected data by mother's State of residence are shown, as well as data on month and day of birth, sex ratio, and age of father. Trends in fertility patterns and maternal and infant characteristics are described and interpreted.Descriptive tabulations of data reported on the birth certificates of the 4.022 million births that occurred in 2002 are presented. Denominators for population-based rates are derived from the 2000 U.S. census. Rates for 1991-2001 may differ from those published previously based on the 1990 U.S. census.There were 4,021,726 live births in 2002, essentially unchanged from 2001. The birth rate, fertility rate, and total fertility rates all declined 1 percent in 2002. The teenage birth rate dropped 5 percent, reaching another record low. The birth rates for women 20-24 years declined, whereas the rate for women 25-29 years was stable. The birth rate for women 30-34 years declined, but the rate for women 35-44 years continued to rise. Births to unmarried women changed very little. Smoking during pregnancy was down again. The timeliness of prenatal care continued to improve. The cesarean delivery rate climbed to the highest level ever reported in the United States (26.1 percent) and the rate of vaginal birth after previous cesarean plummeted 23 percent to 12.6 percent. Preterm and low birthweight levels both rose for 2002. The twin birth rate continued to climb, but the rate of triplet/+ births was down slightly.

Elective Single-Embryo Transfer versus Double-Embryo Transfer in in Vitro Fertilization

2004-12-01

Ann Thurin , Jon Hausken , Torbjörn Hillensjø +4 more

The risks of premature birth and perinatal death are increased after in vitro fertilization. These risks are mainly due to the high incidence of multiple births, which relates to the … The risks of premature birth and perinatal death are increased after in vitro fertilization. These risks are mainly due to the high incidence of multiple births, which relates to the number of embryos transferred.We performed a randomized, multicenter trial to assess the equivalence of two approaches to in vitro fertilization with respect to the rates of pregnancy that result in at least one live birth and to compare associated rates of multiple gestation. Women less than 36 years of age who had at least two good-quality embryos were randomly assigned either to undergo transfer of a single fresh embryo and, if there was no live birth, subsequent transfer of a single frozen-and-thawed embryo, or to undergo a single transfer of two fresh embryos. Equivalence was defined as a difference of no more than 10 percentage points in the rates of pregnancy resulting in at least one live birth.Pregnancy resulting in at least one live birth occurred in 142 of 331 women (42.9 percent) in the double-embryo-transfer group as compared with 128 of 330 women (38.8 percent) in the single-embryo-transfer group (difference, 4.1 percentage points; 95 percent confidence interval, -3.4 to 11.6 percentage points); rates of multiple births were 33.1 percent and 0.8 percent, respectively (P<0.001). These results do not demonstrate equivalence of the two approaches in rates of live births, but they do indicate that any reduction in the rate of live births with the transfer of single embryos is unlikely to exceed 11.6 percentage points.In women under 36 years of age, transferring one fresh embryo and then, if needed, one frozen-and-thawed embryo dramatically reduces the rate of multiple births while achieving a rate of live births that is not substantially lower than the rate that is achievable with a double-embryo transfer.

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Sperm DNA integrity assessment in prediction of assisted reproduction technology outcome

2006-08-18

M. Bungum , Peter Humaidan , Anna Axmon +4 more

BACKGROUND: The sperm chromatin structure assay (SCSA) has been suggested as a predictor of fertility in vivo as well as in vitro. The available data however, have been based on … BACKGROUND: The sperm chromatin structure assay (SCSA) has been suggested as a predictor of fertility in vivo as well as in vitro. The available data however, have been based on limited numbers of treatments. We aimed to define the clinical role of SCSA in assisted reproduction. METHODS: A total of 998 cycles [387 intrauterine insemination (IUI), 388 IVF and 223 ICSI] from 637 couples were included. SCSA results were expressed as DNA fragmentation index (DFI) and high DNA stainable (HDS) cell fractions. Outcome parameters were biochemical pregnancy (BP), clinical pregnancy (CP) and delivery (D). RESULTS: For IUI, the odds ratios (ORs) for BP, CP and D were significantly lower for couples with DFI >30% as compared with those with DFI ≤30%. No statistical difference between the outcomes of ICSI versus IVF in the group with DFI ≤30% was seen. In the DFI >30% group, the results of ICSI were significantly better than those of IVF. CONCLUSIONS: DFI can be used as an independent predictor of fertility in couples undergoing IUI. As a result, we propose that all infertile men should be tested with SCSA as a supplement to the standard semen analysis. When DFI exceeds 30%, ICSI should be the method of choice.

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Demographic and medical consequences of the postponement of parenthood

2011-10-11

Lone Schmidt , Tomáš Sobotka , J. G. Bentzen +1 more

BACKGROUNDAcross the developed world couples are postponing parenthood. This review assesses the consequences of delayed family formation from a demographic and medical perspective. One main focus is on the quantitative … BACKGROUNDAcross the developed world couples are postponing parenthood. This review assesses the consequences of delayed family formation from a demographic and medical perspective. One main focus is on the quantitative importance of pregnancy postponement.

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Perinatal outcome of singletons and twins after assisted conception: a systematic review of controlled studies

2004-01-29

Frans M. Helmerhorst

To compare the perinatal outcome of singleton and twin pregnancies between natural and assisted conceptions. To compare the perinatal outcome of singleton and twin pregnancies between natural and assisted conceptions.

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Assisted reproductive technology and intrauterine inseminations in Europe, 2005: results generated from European registers by ESHRE

2009-02-18

A. Nyboe Andersen , V. Goossens , Siladitya Bhattacharya +4 more

BACKGROUNDResults of assisted reproductive techniques from treatments initiated in Europe during 2005 are presented in this ninth report. Data were mainly collected from existing national registers. BACKGROUNDResults of assisted reproductive techniques from treatments initiated in Europe during 2005 are presented in this ninth report. Data were mainly collected from existing national registers.

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Reproductive Technologies and the Risk of Birth Defects

2012-05-05

Michael J. Davies , Vivienne Moore , Kristyn Willson +5 more

The extent to which birth defects after infertility treatment may be explained by underlying parental factors is uncertain.We linked a census of treatment with assisted reproductive technology in South Australia … The extent to which birth defects after infertility treatment may be explained by underlying parental factors is uncertain.We linked a census of treatment with assisted reproductive technology in South Australia to a registry of births and terminations with a gestation period of at least 20 weeks or a birth weight of at least 400 g and registries of birth defects (including cerebral palsy and terminations for defects at any gestational period). We compared risks of birth defects (diagnosed before a child's fifth birthday) among pregnancies in women who received treatment with assisted reproductive technology, spontaneous pregnancies (i.e., without assisted conception) in women who had a previous birth with assisted conception, pregnancies in women with a record of infertility but no treatment with assisted reproductive technology, and pregnancies in women with no record of infertility.Of the 308,974 births, 6163 resulted from assisted conception. The unadjusted odds ratio for any birth defect in pregnancies involving assisted conception (513 defects, 8.3%) as compared with pregnancies not involving assisted conception (17,546 defects, 5.8%) was 1.47 (95% confidence interval [CI], 1.33 to 1.62); the multivariate-adjusted odds ratio was 1.28 (95% CI, 1.16 to 1.41). The corresponding odds ratios with in vitro fertilization (IVF) (165 birth defects, 7.2%) were 1.26 (95% CI, 1.07 to 1.48) and 1.07 (95% CI, 0.90 to 1.26), and the odds ratios with intracytoplasmic sperm injection (ICSI) (139 defects, 9.9%) were 1.77 (95% CI, 1.47 to 2.12) and 1.57 (95% CI, 1.30 to 1.90). A history of infertility, either with or without assisted conception, was also significantly associated with birth defects.The increased risk of birth defects associated with IVF was no longer significant after adjustment for parental factors. The risk of birth defects associated with ICSI remained increased after multivariate adjustment, although the possibility of residual confounding cannot be excluded. (Funded by the National Health and Medical Research Council and the Australian Research Council.).

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Definition and prevalence of subfertility and infertility

2005-04-01

Christian Gnoth , E. Godehardt , Petra Frank‐Herrmann +3 more

A common definition of sub- and infertility is very important for the appropriate management of infertility. Subfertility generally describes any form of reduced fertility with prolonged time of unwanted non-conception. … A common definition of sub- and infertility is very important for the appropriate management of infertility. Subfertility generally describes any form of reduced fertility with prolonged time of unwanted non-conception. Infertility may be used synonymously with sterility with only sporadically occurring spontaneous pregnancies. The major factor affecting the individual spontaneous pregnancy prospect is the time of unwanted non-conception which determines the grading of subfertility. Most of the pregnancies occur in the first six cycles with intercourse in the fertile phase (80%). After that, serious subfertility must be assumed in every second couple (10%) although--after 12 unsuccessful cycles--untreated live birth rates among them will reach nearly 55% in the next 36 months. Thereafter (48 months), approximately 5% of the couples are definitive infertile with a nearly zero chance of becoming spontaneously pregnant in the future. With age, cumulative probabilities of conception decline because heterogeneity in fecundity increases due to a higher proportion of infertile couples. In truly fertile couples cumulative probabilities of conception are probably age independent. Under appropriate circumstances a basic infertility work-up after six unsuccessful cycles with fertility-focused intercourse will identify couples with significant infertility problems to avoid both infertility under- and over-treatment, regardless of age: Couples with a reasonably good prognosis (e.g. unexplained infertility) may be encouraged to wait because even with treatment they do not have a better chance of conceiving. The others may benefit from an early resort to assisted reproduction treatment.

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Why do singletons conceived after assisted reproduction technology have adverse perinatal outcome? Systematic review and meta-analysis

2012-11-14

Anja Pinborg , Ulla‐Britt Wennerholm , Liv Bente Romundstad +6 more

Assisted reproduction technology (ART) is used worldwide, at increasing rates, and data show that some adverse outcomes occur more frequently than following spontaneous conception (SC). Possible explanatory factors for the … Assisted reproduction technology (ART) is used worldwide, at increasing rates, and data show that some adverse outcomes occur more frequently than following spontaneous conception (SC). Possible explanatory factors for the well-known adverse perinatal outcome in ART singletons were evaluated. PubMed and Cochrane databases from 1982 to 2012 were searched. Studies using donor or frozen oocytes were excluded, as well as those with no control group or including <100 children. The main outcome measure was preterm birth (PTB defined as delivery <37 weeks of gestation), and a random effects model was used for meta-analyses of PTB. Other outcomes were very PTB, low-birthweight (LBW), very LBW, small for gestational age and perinatal mortality. The search returned 1255 articles and 65 of these met the inclusion criteria. The following were identified as predictors for PTB in singletons: SC in couples with time to pregnancy (TTP) > 1 year versus SC singletons in couples with TTP ≤ 1 year [adjusted odds ratio (AOR) 1.35, 95% confidence interval (CI) 1.22, 1.50]; IVF/ICSI versus SC singletons from subfertile couples (TTP > 1 year; AOR 1.55, 95% CI 1.30, 1.85); conception after ovulation induction and/or intrauterine insemination versus SC singletons where TTP ≤ 1 year (AOR 1.45, 95% CI 1.21, 1.74); IVF/ICSI singletons versus their non-ART singleton siblings (AOR 1.27, 95% CI 1.08, 1.49). The risk of PTB in singletons with a 'vanishing co-twin' versus from a single gestation was AOR of 1.73 (95% CI 1.54, 1.94) in the narrative data. ICSI versus IVF (AOR 0.80, 95% CI 0.69–0.93), and frozen embryo transfer versus fresh embryo transfer (AOR 0.85, 95% CI 0.76, 0.94) were associated with a lower risk of PTB. Subfertility is a major risk factor for adverse perinatal outcome in ART singletons, however, even in the same mother an ART singleton has a poorer outcome than the non-ART sibling; hence, factors related to the hormone stimulation and/or IVF methods per se also may play a part. Further research is required into mechanisms of epigenetic modification in human embryos and the effects of cryopreservation on this, whether milder ovarian stimulation regimens can improve embryo quality and endometrial conditions, and whether longer culture times for embryos has a negative influence on the perinatal outcome.

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Obstetric and perinatal outcomes in singleton pregnancies resulting from IVF/ICSI: a systematic review and meta-analysis

2012-05-19

Shilpi Pandey , Ashalatha Shetty , Mark Hamilton +2 more

BACKGROUNDEarlier reviews have suggested that IVF/ICSI pregnancies are associated with higher risks. However, there have been recent advances in the way IVF/ICSI is done, leading to some controversy as to … BACKGROUNDEarlier reviews have suggested that IVF/ICSI pregnancies are associated with higher risks. However, there have been recent advances in the way IVF/ICSI is done, leading to some controversy as to whether IVF/ICSI singletons are associated with higher perinatal risks. The objective of this systematic review was to provide an up-to-date comparison of obstetric and perinatal outcomes of the singletons born after IVF/ICSI and compare them with those of spontaneous conceptions.

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APPROPRIATE TECHNOLOGY FOR BIRTH

1985-10-01

Ben Moore

Pathogenesis of Disciform Detachment of the Neuroepithelium

1967-03-01

J. Donald , Margery Gass

Assisted reproductive technology in Europe, 2004: results generated from European registers by ESHRE

2008-01-31

A. Nyboe Andersen , V. Goossens , Anna Pia Ferraretti +4 more

European results of assisted reproductive techniques from treatments initiated during 2004 are presented in this eighth report.Data were mainly collected from existing national registers. From 29 countries, 785 clinics reported … European results of assisted reproductive techniques from treatments initiated during 2004 are presented in this eighth report.Data were mainly collected from existing national registers. From 29 countries, 785 clinics reported 367,066 treatment cycles including: IVF (114,672), ICSI (167,192), frozen embryo replacement (FER, 71,997), egg donation (ED, 10 334), preimplantation genetic diagnosis/screening (PGD/PGS, 2701) and in vitro maturation (IVM, 170). Overall, this represents only a marginal increase since 2003, due to a huge reduction in treatments in Germany. European data on intrauterine insemination using husband/partner's semen (IUI-H) and donor semen (IUI-D) were reported from 20 countries. A total of 115,980 cycles (IUI-H, 98,388; IUI-D, 17,592) were included.In 14 countries where all clinics reported to the IVF register, a total of 248,937 ART cycles were performed in a population of 261.6 million, corresponding to 1095 cycles per million inhabitants. For IVF, the clinical pregnancy rates per aspiration and per transfer were 26.6% and 30.1%, respectively. For ICSI, the corresponding rates were 27.1% and 29.8%. After IUI-H, the clinical pregnancy rate was 12.6% in women below 40. After IVF and ICSI, the distribution of transfer of 1, 2, 3 and 4 or more embryos was 19.2%, 55.3%, 22.1% and 3.3%, respectively. Compared with 2003, fewer embryos were transferred, but huge differences still existed between countries. The distribution of singleton, twin and triplet deliveries after IVF and ICSI combined was 77.2%, 21.7% and 1.0%, respectively. This gives a total multiple delivery rate of 22.7% compared with 23.1% in 2003 and 24.5% in 2002. After IUI-H in women below 40 years of age, 11.9% were twin and 1.3% triplet gestations.Compared with earlier years, the reported number of ART cycles in Europe increased and the pregnancy rates increased marginally, even though fewer embryos were transferred and the multiple delivery rates were reduced.

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International Committee for Monitoring Assisted Reproductive Technology (ICMART) and the World Health Organization (WHO) revised glossary of ART terminology, 2009∗

2009-10-15

Fernando Zegers-Hochschild , G. David Adamson , J. de Mouzon +5 more

Births: final data for 2004.

2006-09-29

Joyce A Martin , Brady E Hamilton , Paul D Sutton +3 more

This report presents 2004 data on U.S. births according to a wide variety of characteristics. Data are presented for maternal demographic characteristics including age, live-birth order, race, Hispanic origin, marital … This report presents 2004 data on U.S. births according to a wide variety of characteristics. Data are presented for maternal demographic characteristics including age, live-birth order, race, Hispanic origin, marital status, and educational attainment; maternal lifestyle and health characteristics (medical risk factors, weight gain, and tobacco use); medical care utilization by pregnant women (prenatal care, obstetric procedures, characteristics of labor and/or delivery, attendant at birth, and method of delivery); and infant characteristics (period of gestation, birthweight, Apgar score, congenital anomalies, and multiple births). Also presented are birth and fertility rates by age, live-birth order, race, Hispanic origin, and marital status. Selected data by mother's state of residence are shown, as well as data on month and day of birth, sex ratio, and age of father. Trends in fertility patterns and maternal and infant characteristics are described and interpreted.Descriptive tabulations of data reported on the birth certificates of the 4.1 million births that occurred in 2004 are presented. Denominators for population-based rates are post-censal estimates derived from the U.S. 2000 census.In 2004, 4,112,052 births were registered in the United States, less than 1 percent more than the number in 2003. The crude birth rate declined slightly; the general fertility rate increased by less than 1 percent. Childbearing among teenagers and women aged 20-24 years declined to record lows. Rates for women aged 25-34 and 45-49 years were unchanged, whereas rates for women aged 35-44 years increased. All measures of unmarried childbearing rose in 2004. Smoking during pregnancy continued to decline. No improvement was seen in the timely initiation of prenatal care. The cesarean delivery rate jumped 6 percent to another all-time high, whereas the rate of vaginal birth after previous cesarean fell by 13 percent. Preterm and low birthweight rates continued their steady rise. The twinning rate increased, but the rate of triplet and higher order multiple births was down slightly.

The International Committee for Monitoring Assisted Reproductive Technology (ICMART) and the World Health Organization (WHO) Revised Glossary on ART Terminology, 2009

2009-10-04

Fernando Zegers-Hochschild , G. David Adamson , J. de Mouzon +5 more

Many definitions used in medically assisted reproduction (MAR) vary in different settings, making it difficult to standardize and compare procedures in different countries and regions. With the expansion of infertility … Many definitions used in medically assisted reproduction (MAR) vary in different settings, making it difficult to standardize and compare procedures in different countries and regions. With the expansion of infertility interventions worldwide, including lower resource settings, the importance and value of a common nomenclature is critical. The objective is to develop an internationally accepted and continually updated set of definitions, which would be utilized to standardize and harmonize international data collection, and to assist in monitoring the availability, efficacy, and safety of assisted reproductive technology (ART) being practiced worldwide.Seventy-two clinicians, basic scientists, epidemiologists and social scientists gathered together at the WHO headquarters in Geneva, Switzerland in December, 2008. Several months in advance, three working groups were established which were responsible for terminology in three specific areas: clinical conditions and procedures, laboratory procedures and outcome measures. Each group reviewed the existing ICMART glossary, made recommendations for revisions and introduced new terms to be considered for glossary expansion.A consensus was reached on 87 terms, expanding the original glossary by 34 terms, which included definitions for numerous clinical and laboratory procedures. Special emphasis was placed in describing outcome measures such as cumulative delivery rates and other markers of safety and efficacy in ART.Standardized terminology should assist in analysis of worldwide trends in MAR interventions and in the comparison of ART outcomes across countries and regions. This glossary will contribute to a more standardized communication among professionals responsible for ART practice, as well as those responsible for national, regional and international registries.

Amniotic fluid volume assessment with the four-quadrant technique at 36-42 weeks' gestation.

1987-07-01

Jeffrey P. Phelan , C. V. Smith , Paula Broussard +1 more

An ultrasound approach was developed to identify normal amniotic fluid volume. The uterine cavity was divided into four quadrants. With the use of linear-array, real-time B-scanning, the vertical diameter of … An ultrasound approach was developed to identify normal amniotic fluid volume. The uterine cavity was divided into four quadrants. With the use of linear-array, real-time B-scanning, the vertical diameter of the largest pocket in each quadrant was measured. The sum of these four quadrants was used to provide a single number for the amniotic fluid volume and termed the amniotic fluid index. This approach is simple, requires little time and gives a semiquantitative estimate of amniotic fluid volume. Based on our observations, the normal amniotic fluid index in term gestation is 12.9 +/- 4.6 cm. Evaluation of the relationship between amniotic fluid volume and fetal outcome is under investigation.

Births: Final Data for 2014.

2015-12-01

Brady E Hamilton , Joyce A Martin , Michelle J K Osterman +2 more

This report presents 2014 data on U.S. births according to a wide variety of characteristics. Data are presented for maternal age, live-birth order, race and Hispanic origin, marital status, attendant … This report presents 2014 data on U.S. births according to a wide variety of characteristics. Data are presented for maternal age, live-birth order, race and Hispanic origin, marital status, attendant at birth, method of delivery, period of gestation, birthweight, and plurality. Birth and fertility rates are presented by age, live-birth order, race and Hispanic origin, and marital status. Selected data by mother's state of residence and birth rates by age and race of father also are shown. Trends in fertility patterns and maternal and infant characteristics are described and interpreted.

Multiple Pregnancy

1973-06-14

Kurt Benirschke , Chung K. Kim

Everybody is, or should be, interested in twins.H. H. NewmanTWINNING occurs often enough — approximately 1:80 pregnancies — to constitute an important biologic event. Because of the frequency with which … Everybody is, or should be, interested in twins.H. H. NewmanTWINNING occurs often enough — approximately 1:80 pregnancies — to constitute an important biologic event. Because of the frequency with which obstetric and neonatal hazards accompany multiple pregnancy, it is recognized as having considerable medical importance. Although it has long been known that two classes of twins exist, so-called identical and fraternal twins, it was not until Sir Francis Galton, the cousin of Charles Darwin, proposed twins as model for the understanding of disease that twin research became an active field.1 Galton suggested that by comparison of various findings . . .

Births: final data for 2009.

2011-11-03

Joyce A Martin , Brady E Hamilton , Stephanie J. Ventura +4 more

This report presents 2009 data on U.S. births according to a wide variety of characteristics. Data are presented for maternal characteristics including age, live-birth order, race and Hispanic origin, marital … This report presents 2009 data on U.S. births according to a wide variety of characteristics. Data are presented for maternal characteristics including age, live-birth order, race and Hispanic origin, marital status, hypertension during pregnancy, attendant at birth, method of delivery, and infant characteristics (period of gestation, birthweight, and plurality). Birth and fertility rates by age, live-birth order, race and Hispanic origin, and marital status also are presented. Selected data by mother's state of residence are shown, as well as birth rates by age and race of father. Trends in fertility patterns and maternal and infant characteristics are described and interpreted.Descriptive tabulations of data reported on the birth certificates of the 4.13 million births that occurred in 2009 are presented. Denominators for population-based rates are postcensal estimates derived from the U.S. 2000 census.The number of births declined to 4,130,665 in 2009, 3 percent less than in 2008. The general fertility rate declined 3 percent to 66.7 per 1,000 women aged 15-44 years. The teenage birth rate fell 6 percent to 39.1 per 1,000. Birth rates for women in each 5-year age group from 20 through 39 years declined, but the rate for women 40-44 years continued to rise. The total fertility rate (estimated number of births over a woman's lifetime) was down 4 percent to 2,007.0 per 1,000 women. The number and rate of births to unmarried women declined, whereas the percentage of nonmarital births increased slightly to 41.0. The cesarean delivery rate rose again, to 32.9 percent. The preterm birth rate declined to 12.18 percent; the low birthweight rate was stable at 8.16 percent. The twin birth rate increased to 33.2 per 1,000; the triplet and higher-order multiple birth rate rose 4 percent to 153.5 per 100,000.

Births: preliminary data for 2012.

2013-09-01

Brady E Hamilton , Joyce A Martin , Stephanie J. Ventura

Objectives-This report presents preliminary data for 2012 on births in the United States. U.S. data on births are shown by age, live-birth order, race, and Hispanic origin of mother. Data … Objectives-This report presents preliminary data for 2012 on births in the United States. U.S. data on births are shown by age, live-birth order, race, and Hispanic origin of mother. Data on marital status, cesarean delivery, preterm births, and low birthweight are also presented. Methods-Data in this report are based on 99.96% of 2012 births.Records for the few states with less than 100% of records received are weighted to independent control counts of all births received in state vital statistics offices in 2012. Comparisons are made with final 2011 data. Results-The preliminary number of births for the United States in 2012 was 3,952,937, essentially unchanged (not statistically significant) from 2011; the general fertility rate was 63.0 births per 1,000 women aged 15-44, down only slightly from 2011, after declining nearly 3% a year from 2007 through 2010. The number of births and fertility rate either declined or were unchanged for most race and Hispanic origin groups from 2011 to 2012; however, both the number of births and the fertility rate for Asian or Pacific Islander women rose in 2012 (7% and 4%, respectively). The birth rate for teenagers aged 15-19 was down 6% in 2012 (29.4 births per 1,000 teenagers aged 15-19), yet another historic low for the United States, with rates declining for younger and older teenagers and for nearly all race and Hispanic origin groups. The birth rate for women in their early 20s also declined in 2012, to a new record low of 83.1 births per 1,000 women. Birth rates for women in their 30s rose in 2012, as did the birth rate for women in their early 40s. The birth rate for women in their late 40s was unchanged. The nonmarital birth rate declined in 2012 (to 45.3 birth per 1,000 unmarried women aged 15-44), whereas the number of births to unmarried women rose 1% and the percentage of births to unmarried women was unchanged (at 40.7%). The cesarean delivery rate for the United States was unchanged in 2012 at 32.8%. The preterm birth rate fell for the sixth straight year in 2012 to 11.54%. The low birthweight rate also declined in 2012, to 7.99%.

Revised American Fertility Society Classification of Endometriosis: 1985

1985-03-01

Teratology: Principles and Techniques.

1965-08-01

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Births: preliminary data for 2009.

2010-12-01

Brady E Hamilton , Joyce A Martin , Stephanie J. Ventura

Objectives-This report presents preliminary data for 2009 on births in the United States. U.S. data on births are shown by age, live-birth order, race, and Hispanic origin of mother. Data … Objectives-This report presents preliminary data for 2009 on births in the United States. U.S. data on births are shown by age, live-birth order, race, and Hispanic origin of mother. Data on marital status, cesarean delivery, preterm births, and low birthweight (LBW) are also presented. Methods-Data in this report are based on 99.95 percent of births for 2009. The records are weighted to independent control counts of all births received in state vital statistics offices in 2009. Comparisons are made with final 2008 data. Results-The 2009 preliminary number of U.S. births declined 3 percent from 2008, to 4,131,019; the 2009 general fertility rate (66.7 per 1,000 women) and the total fertility rate (2,007.5 births per 1,000 women) declined (3 to 4 percent). The number of births and birth rates declined for all race and Hispanic origin groups in 2009. c The birth rate for U.S. teenagers 15-19 years fell 6 percent to 39.1 per 1,000, a record low for the United States. c Birth rates for younger and older teenagers and for Hispanic, non-Hispanic white, non-Hispanic black, and Asian or Pacific Islander teenagers all reached historic lows in 2009. c The birth rates for women in their early 20s fell (7 percent, the largest percentage decline for this age group since 1973), as did the rates for women in their late 20s and 30s; the birth rate for women in their early 40s increased in 2009. c The birth rate for unmarried women declined almost 4 percent to 50.6 per 1,000 aged 15-44. The number of nonmarital births fell 2 percent to 1,693,850 in 2009, the first decline since 1996-1997. c The percentage of births to unmarried women, however, continued to increase in 2009. c The cesarean delivery rate rose to 32.9 percent in 2009, another record high. c The preterm birth rate declined for the third straight year to 12.18 percent of all births. c The LBW rate was essentially unchanged between 2008 and 2009 at 8.16 percent in 2009 but is down from 2006.

Recommendations for the Use of Folic Acid to Reduce the Number of Cases of Spina Bifida and Other Neural Tube Defects

1992-01-01

Spina bifida and anencephaly are common and serious birth defects. Available evidence indicates that 0.4 mg (400 micrograms) per day of folic acid, one of the B vitamins, will reduce … Spina bifida and anencephaly are common and serious birth defects. Available evidence indicates that 0.4 mg (400 micrograms) per day of folic acid, one of the B vitamins, will reduce the number of cases of neural tube defects (NTDs). In order to reduce the frequency of NTDs and their resulting disability, the United States Public Health Service recommends that: All women of childbearing age in the United States who are capable of becoming pregnant should consume 0.4 mg of folic acid per day for the purpose of reducing their risk of having a pregnancy affected with spina bifida or other NTDs. Because the effects of higher intakes are not well known but include complicating the diagnosis of vitamin B12 deficiency, care should be taken to keep total folate consumption at less than 1 mg per day, except under the supervision of a physician. Women who have had a prior NTD-affected pregnancy are at high risk of having a subsequent affected pregnancy. When these women are planning to become pregnant, they should consult their physicians for advice.

Twinning

2003-08-01

Judith G. Hall

Infertility

2025-06-25

Rachel Horton | Bristol University Press eBooks

Twin reversed arterial perfusion sequence in monochorionic twin pregnancy going undetected up to delivery: A case report

2025-06-25

Rajvir Kaur , Japleen Kaur , Sushmita Sharma +1 more | Journal of Indira Gandhi Institute Of Medical Sciences

Abstract Acardiac malformation is a well-known complication of monozygotic twins. Pathogenesis involves the pumping of blood from a donor twin to an acardiac twin through its umbilical arteries anastomosing at … Abstract Acardiac malformation is a well-known complication of monozygotic twins. Pathogenesis involves the pumping of blood from a donor twin to an acardiac twin through its umbilical arteries anastomosing at the level of the placenta through abnormal connections (twin reversed arterial perfusion [TRAP] sequence). We wish to highlight the significance of vigilant fetal monitoring in monochorionic twins. A 25-year-old woman with G5P1L1A3 was diagnosed as twin gestation with early fetal demise detected at 11.6 weeks. She was taken up for cesarean section at 38.5 weeks for breech. The cesarean delivery resulted in the birth of a live baby girl and the challenging extraction of a surprise acardiac anceps. Surviving twin succumbed to death on day 16 of life. A high index of suspicion could have diagnosed it as a case of TRAP sequence earlier for favorable maternal and fetal outcomes.

FETO MATERNAL OUTCOME IN POSTDATED PREGNANCY IN A TERTIARY CARE CENTRE

2025-06-25

Kavita Kuldeep , Vineeta Garg , Pravin Sasane +1 more | International Journal of Advanced Research

Introduction: Postdated pregnancy contributes significantly to perinatal morbidity and mortality.Identifying its outcomes is crucial for developing context-specific care guidelines. Objective:Toassessmaternalmorbidity, mortality,andfetaloutcomes in postdated pregnancies in a tertiary care hospital. Materials … Introduction: Postdated pregnancy contributes significantly to perinatal morbidity and mortality.Identifying its outcomes is crucial for developing context-specific care guidelines. Objective:Toassessmaternalmorbidity, mortality,andfetaloutcomes in postdated pregnancies in a tertiary care hospital. Materials and Methods: This prospective observational study was conducted from April 2023 to July2023 in the Department ofObstetrics and Gynecology at Govt. RDBP Jaipuria Hospital, Jaipur. A total of 108 women with singleton, cephalic, postdated pregnancies were enrolled using purposive sampling. Women with high-risk conditions or prior caesarean sections were excluded. After informed consent, detailed obstetric history, clinical examinations, and intrapartum monitoring were conducted. Labour was managed based on Bishops score, and outcomesweredocumenteduntil hospitaldischarge. Statisticalanalysis was performed using Microsoft Office 365, with p-values <0.05 considered significant.

Rising Demand for Fetoscopic Laser Therapy for Twin-to-Twin Transfusion Syndrome: Trends, Maternal Age Insights, and Future Challenges in Germany

2025-06-24

Anna Dionysopoulou , Kathrin Stewen , Yaman Degirmenci +4 more | Journal of Clinical Medicine

Background/Objectives: The twin-to twin transfusion syndrome (TTTS) is the most common complication of monochorionic twin pregnancies. Fetal laser therapy (FLT) and serial amniondrainage (SAD) have been used as treatment options … Background/Objectives: The twin-to twin transfusion syndrome (TTTS) is the most common complication of monochorionic twin pregnancies. Fetal laser therapy (FLT) and serial amniondrainage (SAD) have been used as treatment options for TTTS. This study examines how the management of TTTS in Germany has evolved in the past years and addresses future patient needs and potential challenges for healthcare providers and healthcare systems. Methods: The number of TTTS-related interventions between the years 2005 and 2021 were extracted from the German Federal Statistical Office. The trajectory of FLT and SAD procedures over the study period was analyzed. The historical data were used to make projections for future years and address future FLT surgical needs. Further, we aimed to determine age-related influences in monochorionic twin pregnancies requiring FLT. Results: A statistically significant increase in the number of FLT surgeries and a noteworthy decline in the number of SAD procedures with respect to both the number of deliveries per year and the number of multiple pregnancies per year were noted. For the first time, we showed that the percentage of multiple pregnancies requiring FLT was significantly higher in younger mothers under 25 years of age, than in all other age groups. Conclusions: For the moment, FLT poses the only direct and causative treatment of TTTS. The results of our analysis reveal an increasing demand for FLT surgeries for future years. We highlight the need to train more maternal–fetal medicine specialists to be able to perform the procedure safely and to allocate resources efficiently to accommodate the rising number of cases.

Infertility

2025-06-22

| Bristol University Press eBooks

Neonatal Outcomes Among Infants of Mothers With Advanced Maternal Age: A National Cohort Study

2025-06-22

Simon Voss , Ann Josefsson , C. Ekéus | Acta Paediatrica

ABSTRACT Aim Maternal age has increased steadily worldwide over the last few decades. This study aimed to investigate how different degrees of advanced maternal were associated with adverse neonatal outcomes. … ABSTRACT Aim Maternal age has increased steadily worldwide over the last few decades. This study aimed to investigate how different degrees of advanced maternal were associated with adverse neonatal outcomes. Methods A nationwide register‐based study was conducted using the Swedish Medical Birth Register. This comprised all singleton births to women aged 35 years plus from 2010 to 2022. The women were divided into three groups based on maternal age: 35–39 was the reference group, and 40–44 and 45 years plus were the advanced and very advanced maternal age groups, respectively. Results We studied 312 221 singleton pregnancies. There were increased odds risks (95% confidence intervals) for infants born to women aged 40–44 (17.8%) and 45 years plus (1.1%), compared to those aged 35–39. These included stillbirths at 1.27 (1.12–1.45) and 1.80 (1.24–2.61) and infants being small for gestational age at 1.26 (1.19–1.33) and 1.46 (1.22–1.75). Risks for preterm birth, Apgar scores below seven at 5 min, and hypoglycaemia also increased. Conclusion Severe adverse neonatal outcomes were uncommon in Sweden but were higher in the advanced and very advanced maternal age groups than the younger reference group. Healthcare providers make women more aware of the risks of postponed childbearing.

Cardiorespiratory fitness and muscle strength in offspring conceived through assisted reproductive technologies: results from the Munich heARTerY-study

2025-06-21

Marie Kramer , Pengzhu Li , Magdalena Langer +7 more | European Journal of Pediatrics

Children conceived through assisted reproductive technologies (ART) potentially display an increased cardiovascular morbidity. Despite cardiorespiratory fitness (CRF) and muscle strength being key indicators of cardiovascular outcomes, they have not been … Children conceived through assisted reproductive technologies (ART) potentially display an increased cardiovascular morbidity. Despite cardiorespiratory fitness (CRF) and muscle strength being key indicators of cardiovascular outcomes, they have not been investigated in ART offspring yet. This observational pilot cohort study aimed to evaluate CRF and muscle strength in ART participants and spontaneously conceived controls. Anthropometric variables, diet quality, level of physical activity, and sedentary behavior were evaluated. Participants performed a 6-min walking test (6MWT) and a 20-m shuttle run test (20mSRT). 6MWT distance and the number of archived laps were assessed, the maximal oxygen uptake (V̇O2max) was estimated, and pulse rate recovery was calculated. Maximal hand grip strength (HGS) was determined as a marker of muscle strength. Generalized linear models were used to adjust data for age, birthweight, and gestational age. Sixty-seven ART participants and 86 spontaneously conceived peers were included. Both groups did not differ significantly in age (11.3 (IQR 8.1-18.2) vs. 11.9 (IQR 8.7-18.3) years), gender ratio, anthropometric variables, diet quality, level of physical activity and sedentary behavior. The amount of 20mSRT laps (Padj=0.02), estimated VO2max (45.0 (IQR 37.9-47.1) vs. 45.8 (IQR 43.1-48.0) ml·kg⁻1·min⁻1, Padj=0.04), and pulse rate recovery (Padj=0.03) were significantly lower in ART participants after adjustment. HGS did not differ between groups. Conclusion: This study indicates a significantly lower CRF in ART participants. Significant differences in muscle strength were not demonstrated between groups. Future studies should validate these results by using cardiopulmonary exercise testing for VO2max assessment.

Dichorionic twin pregnancy with selective fetal growth restriction: prognosis, complications and implications of Doppler abnormalities

2025-06-21

K. Tse , Yu Ning , Kwok Leung +1 more | Ultrasound in Obstetrics and Gynecology

ABSTRACT Objectives To evaluate maternal and perinatal outcomes in dichorionic (DC) twin pregnancies complicated by selective fetal growth restriction (sFGR), and to investigate the occurrence of Doppler abnormalities, their natural … ABSTRACT Objectives To evaluate maternal and perinatal outcomes in dichorionic (DC) twin pregnancies complicated by selective fetal growth restriction (sFGR), and to investigate the occurrence of Doppler abnormalities, their natural progression during gestation and their associations with adverse outcome in these pregnancies. Methods This was a retrospective study of all DC twin pregnancies that delivered between January 2011 and December 2023 at a single hospital in Hong Kong. sFGR was defined according to Delphi consensus criteria. The rates of intrauterine death (IUD), neonatal death (NND), perinatal death (PND) (sum of IUD and NND), composite neonatal morbidity, admission to the neonatal intensive care unit (NICU), 5‐min Apgar score < 7 and pre‐eclampsia or related conditions were compared between pregnancies with sFGR and those without. Outcomes were also compared between pregnancies with early vs late sFGR, using a cut‐off of 32 weeks of gestation, and between those with vs without umbilical artery (UA) Doppler abnormality, middle cerebral artery (MCA) Doppler abnormality and oligohydramnios. The mean interval between stages of deterioration of Doppler indices was characterized. Results Of 865 eligible DC twin pregnancies, 96 (11.1%) were diagnosed with sFGR. sFGR was associated with a higher risk of IUD (odds ratio (OR), 8.24 (95% CI, 1.64–41.40)), PND (OR, 5.53 (95% CI, 1.53–19.96)), composite neonatal morbidity (OR, 2.51 (95% CI, 1.61–3.92)), NICU admission (OR, 3.05 (95% CI, 1.96–4.74)), and pre‐eclampsia or related complications (OR, 3.72 (95% CI, 2.17–6.37)). Early sFGR was associated with a higher rate of composite neonatal morbidity and Doppler abnormality in the UA and MCA. DC twin pregnancies with UA Doppler abnormality had a significantly higher risk of IUD, PND and composite neonatal morbidity. The mean intervals from normal UA pulsatility index (PI) to high UA‐PI (> 95 th centile), from high UA‐PI to absent end‐diastolic velocity (AEDF) and from AEDF to reversed end‐diastolic velocity were 26.67, 9.67 and 46.67 days, respectively. Conclusions DC twin pregnancies with sFGR, especially those with abnormal Doppler studies, have a higher risk for adverse perinatal outcome compared to DC twins without sFGR. These findings support the management of sFGR in DC twins according to guidelines for singleton pregnancy. © 2025 International Society of Ultrasound in Obstetrics and Gynecology.

Ayurvedic Management and Outcomes of Retained Products of Conception: A Case Series

2025-06-21

Avanika Gunjiyal , Meenakshi Pandey , Sujata Kadam +1 more | International Journal of AYUSH Case Reports

This case series highlights the efficacy and safety of Ayurvedic treatments for retained products of conception (RPOC) in five patients. Each patient underwent Anuvasana Basti using Siddharthakadi Taila and Niruha … This case series highlights the efficacy and safety of Ayurvedic treatments for retained products of conception (RPOC) in five patients. Each patient underwent Anuvasana Basti using Siddharthakadi Taila and Niruha Basti with Siddharthakadi Kwatha, administered over a total treatment period of 8 days (max.). Outcomes were assessed via follow-up ultrasounds, haematological tests, and clinical evaluations. All cases achieved successful resolution without surgical intervention, with improved symptoms and stable haematological parameters. One conservatively treated patient had RPOC resolved, while another had a benign ovarian cyst monitored. Findings suggest Ayurvedic therapies have potential non-invasive alternative to conventional procedures.

The effect of breastfeeding on treatment outcomes in in-vitro fertilization frozen embryo transfer cycles

2025-06-20

Alyssa Hochberg , Nir Kugelman , Uri Amikam +4 more | Journal of Assisted Reproduction and Genetics

Pregnancy

2025-06-19

| Cambridge University Press eBooks

Analysis of cases complicated by twin reversed arterial perfusion sequence in monochorionic twins: A case series of 14 patients from a single tertiary care center

2025-06-19

Özgür Kara , Merve Öztürk Ağaoğlu , Bergen Laleli Koç +4 more | International Journal of Gynecology & Obstetrics

Understanding CONJOINT TWINS

2025-06-19

A.Neha | International Journal of Contemporary Medicine

Background *poster presentation focuses on CONJOINT TWINS, delving into •Embryological development,•Types and classifications•Prenatal Diagnosis•some surgical seperation techniquesEmotional Support and well being of the twins Methods *Refference: Textbook of paediatrics and … Background *poster presentation focuses on CONJOINT TWINS, delving into •Embryological development,•Types and classifications•Prenatal Diagnosis•some surgical seperation techniquesEmotional Support and well being of the twins Methods *Refference: Textbook of paediatrics and OBG And Articles from PMC(Pub med centre) ResultsThis poster helps in detailed understanding of conjoint twins, incidence of conjoint twins and development theories and contributing factors and antenatal diagnosis of conjoint twins and categorisation of conjoint twins, surgical seperation of conjoint twins and mainly the psychological and emotional support the conjoint twins require Conclusion *Knowing about the surgical seperation of conjoint twins is helpful in successfully separating them and if not the case the psychological and emotional support the conjoint twins needed is to be known

Correction: Evaluating a novel reproduction number estimation method: a comparative analysis

2025-06-19

Katsuro Anazawa | Scientific Reports

Fetus in fetu (FIF)

2025-06-19

Chamali Athauda | Radiopaedia.org

Spontaneous Stage 4 TAPS in Extreme Preterm Monochorionic Twins

2025-06-19

Deepika Rustogi , Raj Mohan , Anudh K. Jain | The Indian Journal of Pediatrics

[Perinatal outcomes of single intrauterine fetal demise in monochorionic diamniotic twins].

2025-06-18

Wenjun Bian , Wei Zhou , Tianchen Wu +7 more | PubMed

To compare the pregnancy outcomes of surviving fetuses in monochorionic diamniotic (MCDA) twin pregnancies after selective feticide or spontaneous single intrauterine fetal demise (sIUFD), and to explore the influencing factors … To compare the pregnancy outcomes of surviving fetuses in monochorionic diamniotic (MCDA) twin pregnancies after selective feticide or spontaneous single intrauterine fetal demise (sIUFD), and to explore the influencing factors of prognosis. A total of 219 cases of intra-uterine death of one fetus in MCDA twin pregnancies admitted to Peking University Third Hospital from September 2010 to August 2021 were collected. According to the mode of fetal death, they were divided into the spontaneous sIUFD group (120 cases) and the selective feticide group (99 cases). Data on the maternal conditions during pregnancy, the situation of the intrauterine-dead fetus, and pregnancy outcomes were collected for retrospective case-analysis. The live-birth rates of surviving fetuses in the spontaneous sIUFD group and the selective feticide group were 85.0% and 81.8% respectively, and the total perinatal survival rates of surviving fetuses were 73.3% and 81.8% respectively, and there were no statistically significant differences. Compared with the spontaneous sIUFD group, the selective feticide group had a greater gestational week at delivery, and lower rate of preterm birth before 37 weeks, neonatal asphyxia, and early neonatal mortality. Using the gestational week at delivery as the outcome variable, Cox regression analysis showed that the mode of fetal death was not a risk factor affecting the gestational week at delivery of the surviving fetus, while gestational hypertension and the gestational week of fetal death were independent risk factors affecting the gestational week at delivery of the surviving fetus. Using preterm birth before 37 weeks, intrauterine death of the surviving fetus, and abnormal neonatal cranial ultrasound as outcome variables respectively, unconditional logistic regression analysis showed that the mode of fetal death, the gestational week of fetal death, the position of the dead fetus, and fetal complications were independent risk factors affecting the outcomes of the above-mentioned surviving fetuses. According to the results of the univariate analysis, the above risk factors were included in the multivariate regression analysis, and the results were the same as those of the univariate analysis. For MCDA twin pregnancy patients with severe twin-related complications, the prognosis of surviving fetuses after selective feticide is better. The proactive intrauterine intervention and treatment are of great significance for improving the prognosis of surviving fetuses.

Diagnostic Accuracy of Ultrasound-Determined Amniotic Fluid Index Versus Measured Amniotic Fluid Volume at Caesarean Delivery and Its Impact on Perinatal Outcomes

2025-06-16

Shaherzad Sohail , Faiza Iqbal , Syed Ali Imran +2 more | Journal of University College of Medicine and Dentistry

Objective: To assess the reliability of ultrasound-based amniotic fluid index (AFI) in estimating amniotic fluid volume by comparing it with intraoperative findings during caesarean section, and to evaluate its association … Objective: To assess the reliability of ultrasound-based amniotic fluid index (AFI) in estimating amniotic fluid volume by comparing it with intraoperative findings during caesarean section, and to evaluate its association with neonatal clinical outcomes in low-risk term pregnancies. Methodology: This prospective observational study was conducted at the Department of Obstetrics and Gynaecology, Shalamar Hospital, Lahore, from January to June 2024. A total of 100 pregnant women between 37 and 40 weeks of gestation who underwent caesarean section, were enrolled. Participants were divided into two groups based on AFI measured by ultrasound: Group 1 with low AFI (<5 cm) and Group 2 with normal AFI (5–25 cm). Intraoperative amniotic fluid volume was estimated using a suction apparatus. Neonatal outcomes, including Apgar scores at 1 and 5 minutes and NICU admissions, were recorded and compared. Results: In the low AFI group, 74% of patients had low amniotic fluid volume confirmed during surgery, while 26% had normal levels. In the normal AFI group, 80% had normal intraoperative fluid volume, and 20% showed reduced levels. Poor Apgar scores at 1 minute were seen in 62% of neonates in the low AFI group versus 16% in the normal group. At 5 minutes, 12% in the low AFI group and 2% in the normal group had low scores. NICU admission was required in 34% of neonates in the low AFI group compared to 8% in the normal group (p < 0.05). Conclusion: There is a moderate correlation between AFI and intraoperative fluid volume. Low AFI is associated with adverse neonatal outcomes, supporting its role in antenatal risk assessment.

STUDY OF THE INFLUENCE OF MEDICAL AND SOCIAL FACTORS ON PREGNANCY AFTER THE USE OF ASSISTED REPRODUCTIVE TECHNOLOGIES

2025-06-16

Davletova D.M. , O. V. Tyumina | Medical & pharmaceutical journal Pulse

The study is devoted to the influence of medical and social factors on pregnancy after the use of assisted reproductive technologies (ART). A retrospective observational cohort study was conducted based … The study is devoted to the influence of medical and social factors on pregnancy after the use of assisted reproductive technologies (ART). A retrospective observational cohort study was conducted based on the ART Department of the State Budgetary Healthcare Institution "Dynasty Medical Center". Analytical and statistical methods were used. Data were collected retrospectively based on medical records for 5 years from 2000 to 2024 using a continuous method. Inclusion criteria for the main group (OG - 250 women): women with infertility, with a singleton pregnancy after a successful cycle of in vitro fertilization (IVF) using fresh sperm, which ended in an abortive outcome (non-viable pregnancy, miscarriage). Inclusion criteria for the control group (CG - 500 women): women with infertility, with a singleton pregnancy after a successful cycle of in vitro fertilization (IVF) using fresh sperm, which ended in childbirth. Exclusion criteria for both groups: use of donor oocytes or cryopreserved embryos, sperm. Results: the main risk factors for miscarriage after ART were identified: the presence of 5 or more chronic diseases in a woman; aggravated obstetric and gynecological history, habitual miscarriage, thrombophilia; the woman's age is over 36 years. The study emphasizes the need for careful medical support for women using assisted reproductive technologies, taking into account the identified risk factors.

Medical Versus Surgical Management In Early Pregnancy Failure

2025-06-15

Shahanaz Parvin , Maha Abdul-Aziz Ahmed | Journal of Shaheed Suhrawardy Medical College

Introduction: Misoprostol is increasingly used to manage early pregnancy loss, including incomplete abortion, blighted ovum, missed abortion, and inevitable abortion during the first trimester. It offers a simple, non-invasive, and … Introduction: Misoprostol is increasingly used to manage early pregnancy loss, including incomplete abortion, blighted ovum, missed abortion, and inevitable abortion during the first trimester. It offers a simple, non-invasive, and widely acceptable alternative to traditional surgical methods. While surgical management reduces hospital stay and overall costs, misoprostol provides an effective, patient-friendly option. Objective: To assess the efficacy and safety of misoprostol for uterine evacuation in early pregnancy loss and compare the results with surgical methods. Materials and Methods: This prospective randomized study was conducted on 30 patients at the Department of Obstetrics and Gynecology, CMH RAMU, Cox's Bazar, from June 2021 to July 2022. Fifteen patients received misoprostol, and 15 underwent surgical management. Results: Of the 15 women treated with misoprostol, 13 (86%) had complete expulsion within 24 hours, and 14 (90%) within seven days. Treatment failed in 1 patient (6.6%), requiring surgical evacuation. Among responders, 98% were satisfied and stated they would use misoprostol again if needed. Conclusion: Misoprostol is an effective, affordable, and non-invasive alternative to surgery, with a success rate of approximately 90% and manageable side effects. It should be prioritized over surgical methods for eligible patients. J Shaheed Suhrawardy Med Coll 2023; 15(2): 21-24

ГОРМОНАЛЬНИЙ ПРОФІЛЬ ОВУЛЯЦІЇ

2025-06-15

Андрій Луцький , I. Yu. Kuzmina , Svitlana Lutska | PROBLEMS OF ENDOCRINE PATHOLOGY

Для підвищення ефективності екстракорпорального запліднення (ЕКЗ) необхідно визначити точний час розрива фолікула, що має значення при удосконаленні протоколів кріопереносів та гормонального профілю жінки. Мета дослідження – вивчити гормональні зміни в … Для підвищення ефективності екстракорпорального запліднення (ЕКЗ) необхідно визначити точний час розрива фолікула, що має значення при удосконаленні протоколів кріопереносів та гормонального профілю жінки. Мета дослідження – вивчити гормональні зміни в організмі жінки під час овуляції з метою встановлення точного часу розрива фолікула для підвищення результативності кріопереносів. Матеріали та методи. Під наглядом знаходилось 50 жінок у яких зберігались в кріобанку еуплоїдні ембріони. Середній вік паціенток склав 34,7±0,6 р. Кожен день, починая з 10 дня циклу, спостерігали за динамікою росту фолікула та часу його розриву. Досліджували концентрацію в крові прогестерону, естрадіолу, лютеїнізуючего гормону імуноферментним методом за допомогою наборів реагентів виробництва «DRG Instruments GmbH» (Німеччина) у всі дні обстежень. Як критерій порівняння обирався непараметричний парний критерій Уїлкоксона (Z; p) для пов'язаних вибірок. Результати. Середній рівень кожного гормону істотно (р<0,05) відрізняється по днях. Як предиктори використовувалися рівні трьох статевих гормонів: прогестерон, ЛГ (лютеїнізуючий гормон) та естрадіол. На їх основі була отримана дискримінантна модель з високою статистичною значущістю дискримінантних функцій. Теоретично будь-який з цих трьох гормонів можна використовувати як маркер для діагностики овуляції, але для визначення гормонального маркера овуляції (ГМО) було обрано естрадіол та прогестерон. Отримано ROC-криву, яка свідчить про її відмінну дискримінантну здатність у визначенні наявності овуляції. Наведені порогові значення показників, яким відповідає певна чутливість та специфічність критерію щодо визначення дня циклу. Висновки. На основі комплексного підходу з оцінкою гормонального фону та ультразвукового дослідження розроблено гормональний маркер овуляції та визначено його порогове значення. Отримані данні допоможуть визначити день перенесення ембріона в ендометрій, найбільш сприятливий імплантації, що, в свою чергу, підвищить шанс настання вагітності.

Prenatal Expectations as Predictors of Postnatal Coparenting: Moderation Effect of Psychological Distress

2025-06-15

Emmi Lindroos , Eija Räikkönen , Kaisa Malinen +3 more | Journal of Marriage and Family

ABSTRACT Objective To investigate whether parents' prenatal expectations of coparenting predict their own and their spouse's postnatal coparenting quality, both at the individual level and in terms of daily variability, … ABSTRACT Objective To investigate whether parents' prenatal expectations of coparenting predict their own and their spouse's postnatal coparenting quality, both at the individual level and in terms of daily variability, and whether prenatal psychological distress at the family level moderates these associations. Background Previous research has shown a link between prenatal and postnatal coparenting, and between poorer coparenting and psychological distress. However, few studies have examined whether prenatal coparenting expectations impact both the level and variability of postnatal coparenting quality or consider psychological distress as a moderator of early coparenting development. Method The coparenting relationship was examined with a longitudinal design that utilized survey data and daily diary data among 144 Finnish couples expecting their first child, through 6 months post‐birth. Structural equation modeling was used to estimate both one's own (actor) and their spouse's (partner) associations between prenatal expectations of coparenting (measured by the CRS‐CPV) and postnatal coparenting (as measured by the D‐COP), and how prenatal psychological distress (assessed using the MHI‐5) might moderate these associations. Results Parents' prenatal expectations of coparenting predicted level of their own postnatal coparenting, but little of the variability in daily postnatal coparenting quality. Family's prenatal psychological distress shaped some associations between prenatal and postnatal coparenting. No gender differences were found. Conclusion These findings shed light on the importance of both parents' prenatal expectations as an early indicator of coparenting and the risks of prenatal psychological distress for the later development of coparenting in early parenthood, even among parents with nonclinical levels of distress.

Chapter 10 MOBILITIES AND VALUE OF MATERIA MEDICA IN CHINESE MEDICINE FOR CHILDBIRTH

2025-06-14

Mee Kam Ng | Amsterdam University Press eBooks

Roots of strength: a life shaped by kidney challenges

2025-06-14

Addie Majed | Journal of Nephrology

Sociodemographic Factors and Perinatal Outcomes After Laser Surgery for Twin‐Twin Transfusion Syndrome: A Retrospective Cohort Study

2025-06-13

Kedeja V. Williams , Mara Rosner , Camille Shantz +5 more | BJOG An International Journal of Obstetrics & Gynaecology

ABSTRACT Objective To evaluate the relationship between socioeconomic status (SES) and race with perinatal survival following fetoscopic laser surgery (FLS) for Twin‐Twin Transfusion Syndrome (TTTS). Design Retrospective observational study. Setting … ABSTRACT Objective To evaluate the relationship between socioeconomic status (SES) and race with perinatal survival following fetoscopic laser surgery (FLS) for Twin‐Twin Transfusion Syndrome (TTTS). Design Retrospective observational study. Setting Fetal therapy referral center in the US Mid‐Atlantic region. Population Consecutive patients having FLS for TTTS between 2014 and 2024. Methods SES was quantified by Distress Community Index (DCI) and Area Deprivation Index (ADI) with particular consideration of race and health insurance (commercial or government funded). The DCI and ADI scores reflect the community median income, housing vacancies, education level, poverty rate, business growth, and unemployment based on the ZIP code and patient address, respectively. Scores were stratified by quartiles which indicate prosperous (0–24.9), mid‐tier (25–49.9), at‐risk (50–74.9) and distressed (75–100) neighbourhoods. Maternal factors, DCI, ADI, self‐reported race, insurance status, TTTS severity and peri‐operative factors were analysed to determine if there was an association to procedure‐related complications, individual twin survival, overall perinatal survival and delivery gestational age. Bivariate and logistic regression analyses were used to identify determinants of survival at discharge from the nursery. Main Outcome Measures Double neonatal survival (DNS). Results In 478 patients undergoing FLS, the median DCI was 31.6% [IQR 13%–52.9%] and ADI 33% [IQR 17%–54%] which is equivalent to mid‐tier socioeconomic status. In our cohort, 75.5% ( n = 361) were White, 78.7% ( n = 342) had commercial insurance, 75.3% ( n = 360) resided out of state, and 74.5% ( n = 347) had DNS. Patients with DNS were more likely to reside in prosperous or mid‐tier DCI (74.8 vs. 62%) and ADI quartile neighbourhoods (74% vs. 60.3%), more likely to be White (78.7% vs. 66.1%) and have commercial insurance (81.8% vs. 71.9%, all p < 0.05). Cases of stage III TTTS had higher rates of single or no neonatal survivors (58.7% vs. 37.0%) and estimated fetal weight discordance (EFWD) > 25% (51.2% vs. 29.4%, all p < 0.001). DNS was less likely with Quintero stage III and coexisting EFWD > 25%, with previable preterm birth or membrane rupture and non‐White racial group as independent contributors ( r 2 0.33, p < 0.001). Conclusion Patients with lower perinatal survival after fetoscopic laser surgery were more likely to reside in less affluent neighbourhoods, but the non‐white racial group emerged as the key independent factor. Further research is needed to explore how individual sociodemographic factors influence outcomes in specialised fetal therapy.

Predicting time to live birth with deep learning embryo ranking: a novel multiple imputation approach

2025-06-13

Lorena Bori , Martin Berg Johansen , Jørgen Berntsen +2 more | Human Reproduction

Abstract STUDY QUESTION What is the clinical utility of embryo selection algorithms in estimating the time to live birth (TTLB)? SUMMARY ANSWER Using multiple imputations, the clinical utility of embryo … Abstract STUDY QUESTION What is the clinical utility of embryo selection algorithms in estimating the time to live birth (TTLB)? SUMMARY ANSWER Using multiple imputations, the clinical utility of embryo selection algorithms was estimated, showing their potential to improve prediction of TTLB compared to manual ranking. WHAT IS KNOWN ALREADY Estimation of the clinical utility of embryo selection algorithms is challenging due to the unknown outcomes of non-transferred embryos. Existing studies have tried to mitigate the unknown outcome by using a biased subsample of the observed treatments or constructing treatments based on embryos from different patients. STUDY DESIGN, SIZE, DURATION Retrospective cohort study in a university-affiliated private IVF center. Treatments performed from 2015 through 2022 were included. PARTICIPANTS/MATERIALS, SETTING, METHODS Three thousand seven hundred and eighty-three treatments with a total of 17 914 usable embryos, among these, 7571 embryos were transferred in either fresh or vitrified/warmed transfers. The outcome of non-transferred embryos was estimated using the multiple imputation by chained equations (MICE) procedure. MAIN RESULTS AND THE ROLE OF CHANCE The average TTLB for the deep learning algorithm was 1.68 (95% CI: 1.63–1.72) transfers which was 6.1% shorter than the average TTLB of 1.78 (95% CI: 1.73–1.83) transfers for manual ranking. Measuring the algorithm ranking performance on the population level resulted in an area under the receiver operating characteristic curve (AUC) of 0.633 (95% CI: 0.620–0.645) while the average performance on the treatment level was 0.672 (95% CI: 0.656–0.687). LIMITATIONS, REASONS FOR CAUTION The proposed methods rely on an accurate prediction of the missing outcomes. As many other factors besides embryo quality will impact the actual outcome, the estimated TTLB can only approximate the actual clinical utility. In addition, the estimated TTLB in this study is only applicable to the specific dataset. WIDER IMPLICATIONS OF THE FINDINGS This study suggests that embryo selection algorithms could potentially improve clinical outcomes in IVF treatments by increasing the likelihood of live births compared to traditional morphological gradings hence increasing the efficacy and success rates of assisted reproductive technology. STUDY FUNDING/COMPETING INTEREST(S) No funding was received to support this study. L.B. reports Contract in Fundación IVI, Instituto de Investigación Sanitaria, La Fe (Valencia, Spain). M. J. is an employee at Vitrolife A/S. J.B. is an employee and shareholder at Vitrolife A/S. E.T.P. has no financial or personal interests related to the research. M.M. reports funding from ISCIII (PI21/00283), cofounded by ERDF, ‘A way to make Europe’ awarded to M.M. for the submitted work; Contract in Fundación IVI, Instituto de Investigación Sanitaria, La Fe (Valencia, Spain), and Contract in IVIRMA Valencia; and honoraria from various companies, including Merck, Vitrolife, MSD Ferring, AiVF, Theramex, Gedeon Richter, Genea Biomedx, and Life Whisperer. TRIAL REGISTRATION NUMBER N/A.

Evidence Based Homoeopathy in Primary Infertility - A Case Report

2025-06-13

Archana Rai | International Journal of Science and Research (IJSR)

Pregnancy and Breastfeeding in Neurosurgery: A Pilot Cross-Sectional Study

2025-06-13

Olabisi Sanusi , Richard U. Kalu , Eniola Otukoya +6 more | Neurosurgery

BACKGROUND AND OBJECTIVES: There has been an increase in the recruitment of women into neurosurgery. Despite this, there is limited research on their childbearing experiences. This study explores the experiences … BACKGROUND AND OBJECTIVES: There has been an increase in the recruitment of women into neurosurgery. Despite this, there is limited research on their childbearing experiences. This study explores the experiences and challenges of women in neurosurgery with a focus on preterm delivery and breastfeeding. METHODS: We conducted a cross-sectional survey (August-December 2023) of neurosurgery residents and faculty at American College of Graduate Medical Education-accredited programs collecting data on demographics, obstetric history, and breastfeeding experiences. Only participants who had themselves been pregnant were included in this analysis. The primary outcome was preterm delivery, while secondary outcomes were Neonatal Intensive Care Unit admission and length of breastfeeding. Univariate and multivariate logistic regression was performed with statistical significance set at a P -value <.05. RESULTS: There were 49 participants who were eligible for this subanalysis. The mean age at first pregnancy was 32 years. Most (95.8%) intended to breastfeed for an average of 10.6 months with 54.3% reporting a gap between desired and achieved breastfeeding length. The mean achieved breastfeeding length was 8.5 months (± 6.02). Preterm delivery was significantly associated with requiring Neonatal Intensive Care Unit care ( P = .019). The number of operative hours per week during the third trimester was not associated with preterm delivery ( P = .401). On multivariate analysis, age (odds ratio [OR]: 1.11 95% CI: 1.011-1.22; P = .029) and having multiple children (OR: 11.28 95% CI: 1.2-104, P .033) were significantly associated with preterm delivery. With every 5-year increase in age, there is a 71% increased odd of preterm delivery (OR: 1.7, 95% CI 1.05-2.79). CONCLUSION: Our study shows a higher age at first pregnancy for women in neurosurgery and that an increase in age is associated with increased risk of preterm delivery. Larger studies are needed to identify and address barriers to childbearing in neurosurgery.

Are All Frozen Embryo Transfer Protocols Equal: A Retrospective Cohort Study Comparing Single Day 3, Double Day 3, Single Blastocyst, and Double Blastocyst Transfers with Natural Cycle, Modified Natural Cycle, and Hormonal Replacement Therapy Cycles for Endometrial Preparation

2025-06-09

Prashant Nadkarni , Yun-Hsuen Lim , Poo Keen Sim | International Journal of Infertility & Fetal Medicine

Obstetric Anaesthesia

2025-06-09

| Cambridge University Press eBooks

Every second counts: the association of embryo transfer duration with live birth following 2267 single, euploid, frozen embryo transfer

2025-06-05

Blake Vessa , Devika Sachdev , Leah M. Roberts +6 more | Journal of Assisted Reproduction and Genetics

Interventions to prevent preterm birth following fetoscopic laser surgery for twin‐to‐twin transfusion syndrome: systematic review and meta‐analysis

2025-06-05

Nashwa Eltaweel , F. D'Antonio , Smriti Prasad +2 more | Ultrasound in Obstetrics and Gynecology

ABSTRACT Objective To assess the impact of intervention with cervical cerclage, cervical pessary or vaginal progesterone on the risk of preterm birth (PTB) in monochorionic diamniotic (MCDA) twin pregnancies undergoing … ABSTRACT Objective To assess the impact of intervention with cervical cerclage, cervical pessary or vaginal progesterone on the risk of preterm birth (PTB) in monochorionic diamniotic (MCDA) twin pregnancies undergoing fetoscopic laser surgery (FLS) for twin‐to‐twin transfusion syndrome (TTTS). Methods The MEDLINE, Embase and Cochrane databases were searched from inception to November 2023. The inclusion criteria were studies on MCDA twin pregnancies undergoing FLS for TTTS, comparing those receiving with those not receiving an intervention to prevent PTB, including vaginal progesterone, cervical cerclage and cervical pessary. The primary outcome was gestational age (GA) at birth. The secondary outcomes included the interval between FLS and birth, PTB prior to 34, 32, 28 and 24 weeks' gestation, delivery within 2 and 4 weeks after FLS, preterm prelabor rupture of membranes, chorioamnionitis, double survival, survival of at least one twin, no survival, overall fetal or perinatal loss, and overall fetal or perinatal survival. All outcomes were explored in the overall population of MCDA twin pregnancies undergoing FLS for TTTS according to different cut‐offs of cervical length (CL) for intervention. Random‐effects meta‐analysis was used to directly compare the risk of each outcome. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology was used to assess the quality of the retrieved evidence. Results Ten studies (1159 MCDA pregnancies) were included in the systematic review, of which seven were included in the meta‐analysis. There was no significant difference in mean gestational age at birth in MCDA twin pregnancies undergoing FLS for TTTS in women receiving vs not receiving cervical cerclage, with CL < 30, < 25, < 20 or < 15 mm. There was also no significant difference in the mean interval between FLS and delivery, and in the risk of fetal or perinatal loss between women receiving vs not receiving cervical cerclage. Similarly, intervention with cervical pessary was not associated with a higher gestational age at birth compared with no intervention. It was not possible to perform any comprehensive pooled data synthesis for women receiving progesterone. In women with CL < 30 mm, intervention with cervical pessary was not associated with a reduced risk of PTB < 32, < 28 or < 24 weeks' gestation, or with delivery within 2 or 4 weeks after FLS or perinatal loss. Finally, in women with CL < 25 mm, cervical pessary did not reduce the risk of PTB < 32 weeks or perinatal loss. On GRADE assessment, the quality of evidence was very low in showing that cervical cerclage and cervical pessary can affect gestational age at birth in MCDA twin pregnancies that underwent FLS for TTTS, irrespective of the degree of cervical shortening. Conclusions There is currently no evidence that intervention with cervical cerclage or pessary leads to a greater gestational age at birth or reduces the risk of PTB in MCDA twin pregnancies complicated by TTTS and undergoing FLS in women with a short CL, while the level of evidence for intervention with vaginal progesterone is insufficient for evaluation. However, the small sample sizes of the included studies, lack of comparison in the original publications and lack of stratification of the observed outcomes according to Quintero stage, gestational age at FLS and CL cut‐off highlight the need for appropriately powered studies. © 2025 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

A prediction model of low birthweight risk in singleton pregnancies reduced from dichorionic twin pregnancies

2025-06-05

Minyue Tang , Qingfang Li , Guiquan Wang +3 more | Reproductive Biology and Endocrinology