Live birth

BACKGROUND Preimplantation genetic diagnosis (PGD) has been stated to improve live birth rates compared with natural conception in couples with recurrent miscarriage (RM) carrying a structural chromosome abnormality. It is unclear to what extent this claim can be substantiated by evidence. A systematic review of the literature was performed on the reproductive outcome of these couples after natural conception or after PGD. METHODS MEDLINE, EMBASE and the Cochrane database were searched until April 2009. Trials, patient series and case reports describing reproductive outcome in couples with RM carrying a structural chromosome abnormality after natural conception and/or after PGD were included. Since no randomized controlled trials or non-randomized comparative studies were found, separate searches for both groups were conducted. Primary outcome measure was live birth rate per couple. Secondary outcome measure was miscarriage rate per couple. RESULTS Four observational studies reporting on the reproductive outcome of 469 couples after natural conception and 21 studies reporting on the reproductive outcome of 126 couples after PGD were found. After natural conception, live birth rate per couple varied between 33 and 60% (median 55.5%) after parental chromosome analysis; miscarriage rate ranged from 21

Background: The purpose of this study was to quantify spontaneous first trimester miscarriage rates per woman among parous women. A vast amount of data has accumulated regarding miscarriage rates per recognized pregnancy as well as about recurrent miscarriage. This is the second study of miscarriage rates per woman in a parous population and the first study of recurrent and non-recurrent, spontaneous first trimester miscarriage rates per woman in a large parous population. Methods: Extraction of the following variables from all delivery room admissions from both Hadassah Medical Centers in Jerusalem Israel, 2004-2014: # of first trimester spontaneous miscarriages, # live births; # living children; age on admission, pre-pregnancy height and weight, any smoking this pregnancy, any alcohol or drug abuse this pregnancy, blood type, history of ectopic pregnancy, history of cesarean surgery (CS) and use of any fertility treatment(s). Results: Among 53,479 different women admitted to labor and delivery ward, 43% of women reported having had 1 or more first trimester spontaneous miscarriages; 27% reported having had one, 10% two, 4% three, 1.3% four, 0.6% five and 0.05% reported having 6-16 spontaneous first trimester miscarriages. 18.5% had one or more first trimester miscarriages before their first live birth. Eighty-one percent of women with 11 or more living children experienced one or more first trimester miscarriages. First trimester miscarriage rates rose with increasing age, increasing parity, after previous ectopic pregnancy, after previous cesarean surgery, with any smoking during pregnancy and prepregnancy BMI ≥30. Conclusions: Miscarriages are common among parous women; 43% of parous women report having experienced one or more first trimester spontaneous miscarriages, rising to 81% among women with 11 or more living children. One in every 17 parous women have three or more miscarriages. Depending on her health, nutrition and lifestyle choices, even a 39 year old parous woman with a history of 3 or more miscarriages has a good chance of carrying a future pregnancy to term but she should act expediently.

The success rate of IVF treatment is low. A recent systematic review and metaanalysis found that the outcome of IVF treatment could be improved in patients who have experienced recurrent implantation failure if an outpatient hysteroscopy (OH) is performed before starting the new treatment cycle. However, the trials were of variable quality, leading to a call for a large and high-quality randomised trial. This protocol describes a multi-centre randomised controlled trial to test the hypothesis that performing an OH prior to starting an IVF cycle improves the live birth rate of the subsequent IVF cycle in women who have experienced two to four failed IVF cycles. Eligible and consenting women will be randomised to either OH or no OH using an internet based trial management programme that ensures allocation concealment and employs minimisation for important stratification variables including age, body mass index, basal follicle stimulating hormone level and number of previous failed IVF cycles. The primary outcome is live birth rate per IVF cycle started. Other outcomes include implantation, clinical pregnancy and miscarriage rates. The sample size for this study has been estimated as 758 participants with 379 participants in each arm. Interim analysis will be conducted by an independent Data Monitoring Committee (DMC), and final analysis will be by intention to treat. A favourable ethical opinion has been obtained (REC reference: 09/H0804/32). Trail Registration: The trial has been assigned the following ISRCTN number: ISRCTN35859078 Only a third of in vitro fertilization (IVF) cycles started end in a pregnancy and one fourth result in a live birth . Recurrent IVF implantation failure (two or more failed IVF cycles) is a very distressing experience to patients and increases the financial burden on the cou-

Women with prior pregnancy but no live birth are inconsistently termed as either 'primary infertile' or 'secondary infertile' in psychosocial studies of infertile women. The goal of this study was to discover whether infertile women who had experienced pregnancies but no live births were more similar in attitudes and behavior to infertile women who had not experienced pregnancies or to those who had live births. We used the National Survey of Fertility Barriers (NSFB), which contains self-reported data from a probability-based sample of US women aged between 25 and 45, to accomplish our goal. In this cross-sectional analysis, infertile women who had not experienced pregnancies were compared on the basis of fertilityspecific distress (FSD) and medical help-seeking for infertility to women who had had pregnancies with live births and women with pregnancies but no live births. Women were interviewed by telephone in their homes. Data of 1,027 women who had had an infertility episode within the past 10 years were analyzed using multiple regression and logistic regression. Infertile women who had never been pregnant experience higher levels of FSD and were more likely to seek treatment than infertile women who had been pregnant, regardless of the outcome of the pregnancy.

A monitorização da prematuridade é muito importante, considerando seu impacto na morbidade e mortalidade infantis e seus custos econômicos e sociais. Este estudo utilizou dados do Sistema de Informações sobre Nascidos Vivos (SINASC), implantado em 1990 e expandido de forma gradativa até cobrir cerca de 90% de todos os nascimentos no país, para descrever a evolução da prematuridade no Brasil, regiões e capitais, entre os anos de 1994 e 2005. Observou-se um aumento na proporção de partos prematuros no país como um todo e uma diminuição no número de nascimentos sem informação da idade gestacional. As regiões Sudeste, Sul e Centro-Oeste acompanharam a tendência do país, ao contrário das regiões Norte e Nordeste. São comparados os achados do SINASC com os de estudos de base populacional. O SINASC vem apresentando progressiva melhora na cobertura e qualidade dos dados, mas ainda existem problemas com a acurácia da idade gestacional, levando a uma subestimação da prevalência de prematurida...

Background: The gestational age of a new born is an important denominator of neonatal survival, and preterm delivery remains an important perinatal health problem across the globe. Aim: To determine the pattern of preterm deliveries and their outcome in our Special Care Baby Unit (SCBU). Methodology: The study was a 1-year cross-sectional, descriptive study. The case files of 195 preterm newborns admitted to SCBU of

Homocystinuria is a rare autosomal recessive disease with multiple systemic manifestations, which is classified into three types (type's Ι-III). Here we report an 8-year-old boy who required anesthetic care during an ocular surgery including lensectomy under general anesthesia. Proper precautions should be taken during anesthetic management of such a patient since some particular Anesthetic complications like preoperative thromboembolism and hypoglycemia may worsen the course of Anesthesia. We provided successful anesthetic management for our patient and he was discharged without subsequent complications.

Homocystinuria is a rare autosomal recessive disease with multiple systemic manifestations, which is classified into three types (type's Ι-III). Here we report an 8-year-old boy who required anesthetic care during an ocular surgery including lensectomy under general anesthesia. Proper precautions should be taken during anesthetic management of such a patient since some particular Anesthetic complications like preoperative thromboembolism and hypoglycemia may worsen the course of Anesthesia. We provided successful anesthetic management for our patient and he was discharged without subsequent complications.

for their support in carrying out the study. Bonn (file number #15-08-17). Participants provided full informed consent and the data were collected in accordance with the declaration of Helsinki on research involving human subjects. Due to the sensitive nature of the data, we asked for explicit consent to make the data public. For 261 participants, we have permission to publish the data. Their data is available at osf:

IntroductionThe endometrial immune profiling is an innovative approach based on the analysis of the local immune reaction occurring in the endometrium at the time of the embryo implantation. By documenting the local immune activation during the period of uterine receptivity, we aim to detect and correct potential imbalances before and at the very beginning of placentation. The main objective of the study was to analyze in women with a history of repeated pregnancy loss (RPL) the association of personalized strategies based on immune dysregulations with live birth rates. The secondary objective was to highlight the main prognostic factors for live births.MethodsThis is an observational retrospective analysis of 104 patients with RPL, included between January 2012 and December 2019. Inclusion criteria included a spontaneous fertility with at least three miscarriages, an assessment including a three-dimension ultrasound scan, an endometrial biopsy for uterine immune profiling and a fol...

Background. De novo antineutrophil cytoplasmic antibody-associated vasculitis typically arises in post-reproductive years, but can occur during pregnancy. Concerns of treatment-related teratogenicity persist, while efficacy and safety of new therapies including intravenous immunoglobulin (IVIG) and rituximab are uncertain. There remains a paucity of maternal, fetal and pregnancy outcome data in these women, and therefore a lack of guidance on safe treatment for clinicians. Methods. We conducted a systematic review of the literature and a local, retrospective chart review of women with de novo antibody-associated vasculitis (AAV) in pregnancy. Cochrane, Embase and PubMed databases and relevant conference abstracts were searched. Patient demographics, clinical presentation, management and outcomes (maternal, fetal and pregnancy-related) were analyzed. Results. Twenty-seven cases of de novo AAV in pregnancy were included. Women presented were from 5 to 39 weeks' gestation, of which a majority were in the second trimester (median 20 weeks). The median gravida of women was 2 and the median parity was 1. Women were treated with steroids (89%), cyclophosphamide (CYC) (37%), other immunosuppressive agents [azathioprine (AZA), IVIG, plasma exchange (PLEX)] or no therapy (11%). High rates of serious complications, including preeclampsia (29%) and maternal death (7%), were reported; however, most pregnancies resulted in live birth (73%). Prematurity was common; 73% of live births occurred prior to 37 weeks' gestation and 40% prior to 34 weeks' gestation. The majority of infants were born in the third trimester (median 34.5 weeks). Rates of pregnancy termination were high (23%) and only one intrauterine death was reported, shortly after initiation of therapy (4%). Congenital abnormalities were rare, with one infant having a solitary, pelvic kidney (6%) after maternal treatment with steroids, CYC and PLEX. Use of PLEX, IVIG and AZA increased after 2005, whereas CYC use decreased. Remission often occurred postpartum (60%). Conclusions. De novo AAV in pregnancy can result in uncomplicated pregnancies; however, serious maternal risks exist. Further data on potentially pregnancy compatible therapies such as IVIG and rituximab are needed in this population.

Objective To investigate the effect of L-carnitine supplementation during the controlled ovarian stimulation (COS) cycle with antagonist protocol in patients with polycystic ovary syndrome (PCOS) diagnosis undergoing IVF/ICSI treatment. This was a double-blind clinical trial study including 110 patients with PCOS attended to Royan Institute between March 2020 and February 2023. At the beginning of the COS cycle, the eligible patients were allocated into two groups randomly according to the coding list of the drugs prepared by the statistical consultant. In the experimental group, patients received 3 tablets daily (L-carnitine 1000 mg) from the second day of menstruation of the previous cycle until the puncture day in the cases of freeze-all embryos (6 weeks) or until the day of the pregnancy test (8 weeks) in fresh embryo transfer cycle. In the control group, patients received 3 placebo tablets for the same period of time. Weight assessment and fasting blood sugar and insulin tests, as well as serum lipid profile were also measured at the baseline and ovum pick-up day. The results of the COS cycle as well as the implantation and pregnancy rates were compared between groups. Results Finally, 45 cases in L-carnitine group versus 47 cases in the placebo group were completed study per protocol. Data analysis showed that the two groups were homogeneous in terms of demographic characteristics and baseline laboratory tests and severity of PCOS. There is no statistically significant difference in terms of the oocyte recovery ratio and oocyte maturity rate, and the number and quality of embryos, as well as the rates of the fertilization, chemical and clinical pregnancy between groups. However, the means of weight (P < 0.001) and serum levels of fasting blood sugar (P = 0.021), fasting insulin (P = 0.004), triglyceride (P < 0.001) and cholesterol (P < 0.001), LDL (P < 0.001) have significantly decreased in women after consuming L-carnitine supplementation.

Background: A large number of studies have shown an association between inherited thrombophilia and recurrent miscarriage. It has been hypothesized that anticoagulant therapy might reduce the number of miscarriages and stillbirth in these women. In the absence of randomized controlled trials evaluating the efficacy of anticoagulant therapy in women with inherited thrombophilia and recurrent miscarriage, a randomized trial with adequate power that addresses this question is needed. The objective of the ALIFE2 study is therefore to evaluate the efficacy of low-molecular-weight heparin (LMWH) in women with inherited thrombophilia and recurrent miscarriage, with live birth as the primary outcome. Methods/Design: Randomized study of LMWH plus standard pregnancy surveillance versus standard pregnancy surveillance alone. Study population: pregnant women of less than 7 weeks' gestation, and confirmed inherited thrombophilia with a history of 2 or more miscarriages or intra-uterine fetal deaths, or both. Setting: multi-center study in centers from the Dutch Consortium of Fertility studies; centers outside the Netherlands are currently preparing to participate. Intervention: LMWH enoxaparin 40 mg subcutaneously once daily started prior to 7 weeks gestational age plus standard pregnancy surveillance or standard pregnancy surveillance alone. Main study parameters/endpoints: the primary efficacy outcome is live birth. Secondary efficacy outcomes include adverse pregnancy outcomes, such as miscarriage, pre-eclampsia, syndrome of hemolysis, elevated liver enzymes and low platelets (HELLP syndrome), fetal growth restriction, placental abruption, premature delivery and congenital malformations. Safety outcomes include bleeding episodes, thrombocytopenia and skin reactions.

Purpose To evaluate self-reported survey data provided by US oocyte donors on their experiences with ovarian hyperstimulation syndrome and possible correlations between OHSS severity and number of oocytes retrieved, trigger type, and prior OHSS history. Methods An 85-question retrospective survey was administered online. Survey questions included demographic information, reasons for donating, immediate per-cycle experiences and outcomes, perceptions of informed consent, and perceived impact of donation on long-term health. Quantitative Data for this study was collected between February 2019 and September 2020 via QualtricsXM (January 2019), an online survey platform. Follow-up interviews were also conducted. Participants were recruited via fertility clinics, egg donation agencies, and online forum. The research was approved by the University of California, San Francisco Institutional Review Board (#14-14765). Results Of 420 initiated US oocyte donor online surveys, 289 (68%) respond...

Background: Congenital anomalies remain a leading cause of perinatal morbidity and mortality, particularly in lowresource tertiary referral settings where case severity is often concentrated. Objective: To analyse patterns, clustering, and outcomes of fetal anomalies diagnosed in a tertiary obstetric unit in the setting of Maternal-Fetal Medicine (MFM). Methods: A prospective cohort of 147 foetuses (398 anomalies; mean 2.7 per fetus) was studied at a tertiary MFM center. Anomalies were categorized by system. Outcomes included delivery mode, survival, APGAR scores, neonatal admission, and maternal complications. Dimensional reduction with principal component analysis (PCA) and hierarchical clustering was applied to map anomaly co-occurrence. Results: CNS/NTD (n = 83), skeletal (n = 62), and cardiac (n = 52) anomalies were most prevalent. PCA identified three clusters: (1) craniofacial/neuromuscular (CNS, orofacial, skeletal), (2) urogenital/digestive (renal, GUT, digestive), and (3) thoraco-abdominal (cardiac, respiratory, abdominal wall), explaining ~70% of variance. The dendrogram confirmed these groupings. Male fetuses predominated (57%), and stillbirths accounted for 44.2% (FSB 30.6%, MSB 13.6%). Neonates with multiple anomalies had the highest NICU admission (100%) and mortality (75%). Chi-square analysis confirmed outcome distributions were highly significant (χ² = 44.5, p < 0.001). Conclusion: Congenital anomalies cluster into biologically coherent groups, reflecting known syndromic associations (Trisomy 13/18, VACTERL, Noonan/CHARGE). These findings highlight the diagnostic utility of PCA and clustering in prenatal counselling and emphasize the urgent need for prevention, genetic evaluation, and neonatal preparedness in resource-limited settings. This document gives formatting instructions for authors preparing papers for publication in the Recent Science Journals. The authors must follow the instructions given in the document for the papers to be published. You can use this document as both an instruction set and as a template into which you can type your own text.

Background: Congenital anomalies remain a leading cause of perinatal morbidity and mortality, particularly in lowresource tertiary referral settings where case severity is often concentrated. Objective: To analyse patterns, clustering, and outcomes of fetal anomalies diagnosed in a tertiary obstetric unit in the setting of Maternal-Fetal Medicine (MFM). Methods: A prospective cohort of 147 foetuses (398 anomalies; mean 2.7 per fetus) was studied at a tertiary MFM center. Anomalies were categorized by system. Outcomes included delivery mode, survival, APGAR scores, neonatal admission, and maternal complications. Dimensional reduction with principal component analysis (PCA) and hierarchical clustering was applied to map anomaly co-occurrence. Results: CNS/NTD (n = 83), skeletal (n = 62), and cardiac (n = 52) anomalies were most prevalent. PCA identified three clusters: (1) craniofacial/neuromuscular (CNS, orofacial, skeletal), (2) urogenital/digestive (renal, GUT, digestive), and (3) thoraco-abdominal (cardiac, respiratory, abdominal wall), explaining ~70% of variance. The dendrogram confirmed these groupings. Male fetuses predominated (57%), and stillbirths accounted for 44.2% (FSB 30.6%, MSB 13.6%). Neonates with multiple anomalies had the highest NICU admission (100%) and mortality (75%). Chi-square analysis confirmed outcome distributions were highly significant (χ² = 44.5, p < 0.001). Conclusion: Congenital anomalies cluster into biologically coherent groups, reflecting known syndromic associations (Trisomy 13/18, VACTERL, Noonan/CHARGE). These findings highlight the diagnostic utility of PCA and clustering in prenatal counselling and emphasize the urgent need for prevention, genetic evaluation, and neonatal preparedness in resource-limited settings. This document gives formatting instructions for authors preparing papers for publication in the Recent Science Journals. The authors must follow the instructions given in the document for the papers to be published. You can use this document as both an instruction set and as a template into which you can type your own text.

Periviable gestation commonly refers to deliveries at 20 to 25 weeks' gestation, a time frame that is considered to represent the border of viability. 1 These deliveries are rare but make a substantial contribution to infant mortality and long-term morbidity. 1 Current understanding of their causes is limited. Most studies of deliveries at periviable gestation focus on live births, although exceptions do exist. 2,3 However, stillbirths (defined here as in utero fetal deaths delivered at 20 or more weeks' gestation) comprise a substantial proportion of deliveries at 20 to 25 weeks. Stillbirth and live birth may even be considered competing outcomes during this time frame, due to variability in health care practices and reporting of these deliveries. As such, understanding the proportion of live births and stillbirths during this time frame is important because it may impact neonatal mortality estimates and comparisons within and between institutions and populations. In addition, stillbirth and preterm delivery (i.e., liveborn delivery at <37 weeks' gestation) are known to share some of the same risk factors, including maternal medical conditions such as diabetes and hypertension, obesity, and a marked black-white disparity. 7 This finding may result in part from the fact that, at least in more developed countries, most

 We compared the prevalence of and risk factors for stillbirth and live birth at periviable gestational age (20-25 weeks).  This is a cohort study of 2.5 million singleton births in California from 2007 to 2011. We estimated racial-ethnic prevalence ratios and used multivariable logistic regression for risk factor comparisons.  In this study, 42% of deliveries at 20 to 25 weeks&#39; gestation were stillbirths, and 22% were live births who died within 24 hours. The prevalence of delivery at periviable gestation was 3.4 per 1,000 deliveries among whites, 10.9 for blacks, 3.5 for Asians, and 4.4 for Hispanics. Nonwhite race-ethnicity, lower education, uninsured status, being U.S. born, older age, obesity, smoking, pre-pregnancy hypertension, nulliparity, interpregnancy interval, and prior preterm birth or stillbirth were all associated with increased risk of both stillbirth and live birth at 20 to 25 weeks&#39; gestation, compared with delivery of a live birth at 37 to 41 weeks.  Inclu...

Every year numerous females are detected infertile as infertility becomes a major problem in reproductive lives, worldwide. The purpose of this study is to evaluate the effectiveness of intrauterine infusion of autologous platelet-rich plasma (PRP) in infertile women undergoing frozen embryo transfer cycles with suboptimal endometrium. A total of 61 women between 22 to 40 years of age were included in the study. Based on hysteroscopy findings they were divided into group A (Normal hysteroscopy findings) and group B (Abnormal hysteroscopy findings). Intrauterine instillation of autologous PRP was done in women having an endometrial thickness of ≤7 even after giving Estradiol valerate therapy. After 48 and 72 hours of PRP infusion, an increase in EMT was evaluated. Embryo transfer was performed when the endometrium reached an optimal pattern in terms of thickness, appearance, and vascularity.EMT increased significantly (p 0.05) in Group B compared to Group A. Between both groups, ther...

Early childbirth has a detrimental impact on population growth and the total fertility rate. Additionally, it is among the leading factors associated with cardiovascular disease, maternal and pediatric morbidity, and mortality. The objective of this study is to estimate the timing of rst childbirth and factors that in uence the timing of rst childbirth following sexual initiation among Ugandan women aged 15-35 years. Self-reported data were extracted from the 2016 Uganda Demographic and Health Survey (UDHS), with a subsample of 9,196 women from the individual women le. Kaplan-Meier survival curve, decrement life-table analysis, and a discrete-time logit model were used to examine the timing of rst childbirth and associated factors. The mean time to rst childbirth was 6.6 years and the median time was 6.5 years, and all women had experienced their rst childbirth by the end of the fteenth year following sexual initiation. Signi cant factors found to in uence the timing of rst childbirth following sexual initiation include primary level (OR = 1.148; 95% CI = 1.02-1.28, p = 0.019); and higher education (OR = .697; 95% CI = .57-.84, p < 0.001), residing in Northern region (OR = 1.258; 95% CI = 1.05-1.50, p = 0.012), and having access to mass media (OR = 1.170; 95% CI = 1.07-1.26, p < 0.001). These ndings are expected to be valuable for policymakers and other stakeholders involved in efforts to delay childbirth. This research provides a solid foundation for evidence-based decision-making in the eld of reproductive health and family planning. Both government and non-governmental organizations should prioritize the implementation of programs aimed at reducing the age at sexual initiation, thereby lowering the age at which women experience their rst childbirth, taking into account the factors identi ed in this study.

Does the outcome of the comparison of live birth rates between the first frozen embryo transfer (ET) (in a freezeonly cycles strategy, i.e. frozen ET group) and a fresh embryo transfer (fresh ET group) differ considering the type of ovarian response? SUMMARY ANSWER: Α significantly higher probability of live birth is present in high, but not normal, responders, after the first frozen ET in a freeze-only cycle strategy as compared to a fresh ET.

The present meta-analysis provides evidence that GH addition increases the probability of clinical pregnancy and live birth in poor responders undergoing ovarian stimulation with GnRH analogues and gonadotrophins for IVF. However, the total number of patients analyzed is small and thus further RCTs are warranted to prove or disprove this finding.

Objective: To evaluate whether oocyte quality, implantation and pregnancy rates in intra-cytoplasmic sperm injection (ICSI) cycles are related to the duration of gonadotrophin-releasing hormone antagonist (GnRH-ant) use. Material and Method: A total of 138 patients who were treated with GnRH-ant protocol at the IVF Clinic from March 2010 to January 2012 were enrolled in this study. The patients were classified into three groups according to duration of GnRH-ant use. Group 1: 4 days (n=51); group 2:5 days (n=57); group 3:6 days (n=30) antagonist application. Main outcome measures were implantation rate, pregnancy rate, fertilization rate, number of oocytes retrieved (NOR), number of mature oocytes (NMO). The NOR and NMO were the lowest in group 1, intermediate in group 2, and the highest in group 3 respectively. There is no statistically significant difference between the groups in regard to total gonadotrophins used, fertilization, implantation or pregnancy rates. The pregnancy rates per ET and cycle were 37.9% and 31.8%, respectively. We noticed that longer GnRH-ant use was associated with more oocytes retrieved and more mature oocytes, but no difference in fertilization, implantation or pregnancy rates concluding that longer GnRH-ant use does not have a detrimental effect on in vitro fertilization outcome.

Objective: To evaluate whether oocyte quality, implantation and pregnancy rates in intra-cytoplasmic sperm injection (ICSI) cycles are related to the duration of gonadotrophin-releasing hormone antagonist (GnRH-ant) use. Material and Method: A total of 138 patients who were treated with GnRH-ant protocol at the IVF Clinic from March 2010 to January 2012 were enrolled in this study. The patients were classified into three groups according to duration of GnRH-ant use. Group 1: 4 days (n=51); group 2:5 days (n=57); group 3:6 days (n=30) antagonist application. Main outcome measures were implantation rate, pregnancy rate, fertilization rate, number of oocytes retrieved (NOR), number of mature oocytes (NMO). The NOR and NMO were the lowest in group 1, intermediate in group 2, and the highest in group 3 respectively. There is no statistically significant difference between the groups in regard to total gonadotrophins used, fertilization, implantation or pregnancy rates. The pregnancy rates per ET and cycle were 37.9% and 31.8%, respectively. We noticed that longer GnRH-ant use was associated with more oocytes retrieved and more mature oocytes, but no difference in fertilization, implantation or pregnancy rates concluding that longer GnRH-ant use does not have a detrimental effect on in vitro fertilization outcome.

All the available reports on the issue of infertility confirmed the increase in this population problem worldwide. Although the accurate estimate of the number of infertile people is due to several reasons, including the discrepancy in the true definition of infertility (whether it extends for one, two or five years of failed pregnancy attempts), as well as the great discrepancy in the size of the selected population groups (large population sample size versus epidemiological studies) and defining the category that diagnosed included (individuals, women, or couples). The goal of today’s IVF program is to obtain high-quality embryos with high efficiency in development, which leads to an increase in live birth rates.

Objective: : To examine the effect of paternal age on intracytoplasmic sperm injection (ICSI) outcomes in unexplained infertility Subjects and Methods: : This retrospective study, done at the Hamad Medical Corporation, Doha, Qatar screened infertile couples who underwent ICSI between 2014 and 2019 for the inclusion and exclusion criteria defining 'unexplained infertility'. Couples recruited were allocated into two groups: Group A (paternal age <35 years) and Group B (paternal age ≥35 years). Baseline characteristics, investigations including semen and advanced sperm function tests and ICSI records were compared for primary outcomes such as fertilisation, cleavage, clinical pregnancy, miscarriage and live birth; and secondary outcomes such as semen parameters and advanced sperm functions (DNA fragmentation index and oxidation reduction potential). Results: : We found that final pregnancy outcomes including clinical pregnancy rate (P = 0.231), live-birth rate (P = 0.143), and miscarriage rates (P = 0.466) were not significantly different between the two age groups. Normal fertilisation (P = 0.01) and cleavage rate after ICSI (P = 0.001) were statistically significant when the age groups were compared. Also, normal sperm morphology was found to be significantly different (P = 0.041). Conclusions: : Advanced paternal age affects sperm morphology, fertilisation and embryo cleavage in ICSI but does not appear to affect clinical pregnancy, miscarriage or live-birth rates. ICSI appears to be a valid fertility treatment option in advancing paternal age.

What are the long term trends in the total (live births, fetal deaths, and terminations of pregnancy for fetal anomaly) and live birth prevalence of neural tube defects (NTD) in Europe, where many countries have issued recommendations for folic acid supplementation but a policy for mandatory folic acid fortification of food does not exist? This was a population based, observational study using data on 11 353 cases of NTD not associated with chromosomal anomalies, including 4162 cases of anencephaly and 5776 cases of spina bifida from 28 EUROCAT (European Surveillance of Congenital Anomalies) registries covering approximately 12.5 million births in 19 countries between 1991 and 2011. The main outcome measures were total and live birth prevalence of NTD, as well as anencephaly and spina bifida, with time trends analysed using random effects Poisson regression models to account for heterogeneities across registries and splines to model non-linear time trends. Overall, the pooled total ...

Does substituting 150 mg corifollitropin alfa for 450 IU follitropin beta during the first 7 days of ovarian stimulation in proven poor responders, result in retrieval of a non-inferior number (,1.5 fewer) of cumulus oocyte complexes (COCs)? summary answer: A single s.c. dose of 150 mg corifollitropin alfa on the first day of ovarian stimulation, followed if necessary, from Day 8 onwards, with 450 IU of follitropin beta/day, is not inferior to daily doses of 450 IU follitropin beta. The 95% CI of the difference between medians in the number of oocytes retrieved was 21 to +1 within the safety margin of 1.5. what is known already: Recent data from retrospective studies suggest that the use of corifollitropin alfa in poor responders is promising since it could simplify ovarian stimulation without compromising its outcome. study design, size, duration: Seventy-nine women with previous poor ovarian response undergoing ICSI treatment were enrolled in this open label, non-inferiority, randomized clinical trial (RCT). participants/materials, setting, methods: Inclusion criteria were: previous poor response to ovarian stimulation (≤4 COCs) after maximal stimulation, age ,45 years, regular spontaneous menstrual cycle, body mass index: 18-32 kg/m 2 and basal follicle stimulating hormone ≤20 IU/l. On Day 2 of the menstrual cycle, patients were administered either a single s.c dose of 150 mg corifollitropin alfa (n ¼ 40) or a fixed daily dose of 450 IU of follitropin beta (n ¼ 39). In the corifollitropin alfa group, 450 IU of follitropin beta were administered from Day 8 of stimulation until the day of human chorionic gonadotrophin (hCG) administration, if necessary. To inhibit premature luteinizing hormone surge, the gonadotrophin releasing hormone antagonist ganirelix was used. Triggering of final oocyte maturation was performed using 250 mg of recombinant hCG, when at least two follicles reached 17 mm in mean diameter. main results and the role of chance: The number of COCs retrieved was not statistically different between the corifollitropin alfa and the follitropin beta groups [Median 3 versus 2, 95% CI 2-4, 2-3, respectively, P ¼ 0.26]. The 95% CI of the difference between medians in the number of oocytes retrieved was 21 to +1. A multivariable analysis adjusting for all the potential baseline differences confirmed this finding. No significant difference was observed regarding the probability of live birth between the corifollitropin alfa and the follitropin beta group (live birth per patient reaching oocyte retrieval: 7.9 versus 2.6%, respectively, difference +5.3%, 95% CI: 26.8 to +18.3). limitations, reasons for caution: The present study was not powered to test a smaller difference (e.g. 1 COC) in terms of COCs retrieved as well as to show potential differences in the probability of pregnancy. Moreover, it would be interesting to assess whether the continuation of stimulation in the long acting FSH arm, where necessary, with 200 IU instead of 450 IU of follitropin beta would have altered the direction or the magnitude of the effect of the type of FSH, observed on the number of COCs retrieved.

Objective: To analyze the influence of physiological and social aspects of pregnant women in perimenopausal age, with births occurring that state of Piauí in 2002 to 2012. Methodology: A descriptive epidemiological study, in which data are provided through the Statement of Live Birth obtained through query in the database of the Information System on Live Births, provided by the Department of the Unified Health System. Results: Were then quantified 582,796 Statements of Live Births, of which 39,003 belong to women aged equal to or above 35 years. The analysis of rates of congenital anomalies shows that maternal age is not a decisive parameter for the incidence of congenital malformation, since the rates on live births to mothers older than 35 years contain variations from 0.26% to 0.86%, and 0.16% to 0.59% in live births to women under the age of 35 years. Conclusion: The understanding by health professionals about social factors and perimenopausal symptoms that affect maternal and ...

To analyze the influence of physiological and social aspects of pregnant women in perimenopausal age, with births occurring that state of Piauí in 2002 to 2012. Methodology: A descriptive epidemiological study, in which data are provided through the Statement of Live Birth obtained through query in the database of the Information System on Live Births, provided by the Department of the Unified Health System. Results: Were then quantified 582,796 Statements of Live Births, of which 39,003 belong to women aged equal to or above 35 years. The analysis of rates of congenital anomalies shows that maternal age is not a decisive parameter for the incidence of congenital malformation, since the rates on live births to mothers older than 35 years contain variations from 0.26% to 0.86%, and 0.16% to 0.59% in live births to women under the age of 35 years. Conclusion: The understanding by health professionals about social factors and perimenopausal symptoms that affect maternal and fetal health can greatly contribute to the improvement of care. Descriptors: Nursing. Perimenopause. Maternal age. Congenital anomalies. RESUMO Objetivo: analisar a influência dos aspectos fisiológicos e sociais de gestantes em idade perimenopáusica, com partos ocorridos no Estado do Piauí durante 2002 a 2012. Metodologia: estudo epidemiológico descritivo, no quais os dados são fornecidos através da Declaração de Nascido Vivo, obtidos por meio de consulta à base de dados do Sistema de Informações sobre Nascidos Vivos, disponibilizados pelo Departamento de Informática do Sistema Único de Saúde. Resultados: foram quantificadas 582.796 Declarações de Nascidos Vivos, das quais 39.003 pertencem a mulheres com idade igual ou superior a 35 anos. A análise dos índices de anomalias congênitas mostra que a faixa etária materna não é parâmetro decisivo para a incidência de malformação congênita, pois as taxas de nascidos vivos de mães em idade superior a 35 anos contêm variações de 0,26% a 0,86%; e de 0,16% a 0,59% em nascidos vivos de mulheres de idade inferior a 35 anos. Conclusão: O entendimento, por parte dos profissionais de saúde acerca dos fatores sociais e sintomas perimenopáusicos que afetem a saúde materno-fetal, pode contribuir bastante para a melhora da assistência. Descritores: Enfermagem. Perimenopausa. Idade materna. Anomalia congênita. RESUMÉN Objetivo: Analizar la influencia de los aspectos fisiológicos y sociales de las mujeres embarazadas en edad perimenopáusica, con nacimientos ocurridos en el estado del Piauí durante 2002-2012. Metodología: Estudio epidemiológico descriptivo, en que los datos se proporcionan a través

STUDY QUESTION What is the rate of natural conception leading to ongoing pregnancy or livebirth over 6–12 months for infertile women of age ≥35 years? SUMMARY ANSWER Natural conception rates were still clinically relevant in women aged 35 years and above and were significantly higher in women with unexplained infertility compared to those with other diagnoses. WHAT IS KNOWN ALREADY In recent years, increasing numbers of women have attempted to conceive at a later age, resulting in a commensurate increase in the need for ART. However, there is a lack of data on natural fertility outcomes (i.e. no interventions) in women with increasing age. STUDY DESIGN, SIZE, DURATION A systematic review with individual participant data (IPD) meta-analysis was carried out. PubMed, MEDLINE, EMBASE, the Cochrane Library, clinicaltrials.gov were searched until 1 July 2018 including search terms ‘fertility service’, ‘waiting list’, ‘treatment-independent’ and ‘spontaneous conception’. Language restricti...

Objective-To provide reliable prognostic infor- mation for couples seeking assisted conception. Design-Analysis of four years ' practice (1988-91). Setting-Private university service linked with NHS reproductive medicine services. Patients-804 couples with various causes of subfertility, median duration five years, median age of women 34 years. Interventions-1280 completed cycles: 950 in vitro fertilisation, 144 gamete intrafaliopian transfer, and 186 intrauterine insemination and superovula- tion. Main outcome measures-Pregnancy and birth rates per cycle and cumulative pregnancy and take home baby rates per couple. Results-In women under 40 years and men with normal sperm, whatever the cause of infertility, results with in vitro fertilisation improved steadily reaching a pregnancy rate per cycle of 30% (95% confidence interval 26% to 35%) during 1990-1 and birth rate per cycle of 29% (23% to 35%) in 1990. Pregnancy and birth rates for gamete intrafallopian transfer were 36% (28% to 44%) and 26% (17% to 37%) and for intrauterine insemination 18% (12% to 24%) and 16% (10% to 22%). After six cycles cumu- lative probability of pregnancy was 82% and cumula- tive take home baby rate 70%. Considering only in vitro fertilisation and gamete intrafallopian transfer after four cycles the pregnancy rate was 78% (66% to 91%). Conclusions-Conception is less likely in women over 40 and men with sperm dysfunction. For other couples the prognosis for a live birth is at least as good as for fertile couples if they persist with treatment.

Background: Despite concerns about worsening pregnancy outcomes resulting from healthcare restrictions, economic difficulties and increased stress during the COVID-19 pandemic, preterm birth (PTB) rates declined in some countries in 2020, while stillbirth rates appeared stable. Like other shocks, the pandemic may have exacerbated existing socioeconomic disparities in pregnancy, but this remains to be established. Our objective was to investigate changes in PTB and stillbirth by socioeconomic status (SES) in European countries. Methods: The Euro-Peristat network implemented this study within the Population Health Information Research Infrastructure (PHIRI) project. A common data model was developed to collect aggregated tables from routine birth data for 2015-2020. SES was based on mother's educational level or area-level deprivation/maternal occupation if education was unavailable and harmonized into low, medium and high SES. Country-specific relative risks (RRs) of PTB and stillbirth for March to December 2020, adjusted for linear trends from 2015 to 2019, by SES group were pooled using random effects meta-analysis. Results: Twenty-one countries provided data on perinatal outcomes by SES. PTB declined by an average 4% in 2020 fpooled RR: 0.96 [95% confidence intervals (CIs): 0.94-0.97]g with

and at numerous assisted reproduction technique laboratories worldwide. His main research areas include timelapse imaging, embryo selection, cell stress and cryopreservation. A meta-analysis was conducted on five studies with 1637 patients. The analysis showed that the application of time-lapse monitoring together with an embryo-evaluating algorithm was associated with a significantly higher ongoing pregnancy rate, a significantly lower early pregnancy loss and a significantly higher live birth rate.

He was a member of the ESHRE executive committee and is the current president of the Slovene Society for Reproductive Medicine. His bibliography comprises over 450 articles. Use of gonadotrophin-releasing hormone (GnRH) antagonist cycles and GnRH agonist triggering is effective in reducing the risk of developing ovarian hyperstimulation syndrome in high-responding patients. Patients can be reassured that high cumulative live birth rates can be expected when all embryos are cryopreserved and transferred in the subsequent menstrual cycles. Elective embryo cryopreservation after using gonadotrophin-releasing hormone (GnRH) antagonist protocols and GnRH agonist triggering is becoming an increasingly important part of medically assisted reproduction. We designed a single-centre retrospective study to assess the cumulative probability of achieving a live birth through consecutive transfers of vitrified-warmed blastocysts after elective embryo cryopreservation in high-responding patients. Hence, 123 women identified to be at high risk for developing ovarian hyperstimulation syndrome were included. They were stimulated using GnRH antagonist protocol, and GnRH agonist was used to trigger final oocyte maturation. All embryos were vitrified at the blastocyst stage and transferred in the subsequent menstrual cycles. Using the Kaplan-Meier survival analysis, a total of 65.9% (95% CI 57.5 to 74.3) women achieved a live birth after a maximum of six embryo transfer cycles using the 'conservative' approach. Applying the 'optimistic' approach, presuming that women who still had cryopreserved embryos and did not return for embryo transfer had the same chance of achieving a live birth as those returning for transfer, the cumulative live birth rate estimated in six embryo transfer cycles was 76.6% (95% CI 69.1 to 84.1). No cases of severe ovarian hyperstimulation syndrome were recorded.

OBJETIVO. Identificar, por meio das Declarações de Nascidos Vivos (DNV) de Campinas (SP), os fatores associados com peso insuficiente (PI) ao nascimento. MÉTODOS. Foram analisadas 14.444 DNV de 2001; o peso de nascimento variou de 285g a 5.890g, com média de 3.142g; 65,1% das crianças nasceram com 3.000g ou mais e 25,7% com PI. Selecionou-se 12.770 RNs a termo, de gestação única, com peso > 2.500g. Utilizou-se o peso de nascimento como variável dependente e as características maternas, as relacionadas à gestação, ao parto e ao recém-nascido como independentes. Para análise estatística empregou-se o teste de Qui quadrado e calcularam-se valores de odds ratio (OR) brutos. Para os valores de OR ajustados, empregou-se modelo de regressão logística. RESULTADOS. Houve associação entre PI e RNs de sexo feminino (ORaj = 1,57 [IC95% 1,44 -1,70]), mães primíparas (ORaj = 1,47 [IC95% 1,35 -1,60]), as que fizeram menos que sete consultas de pré-natal (ORaj = 1,42 [IC95% 1,29 -1,58]) e as submetidas a parto vaginal (ORaj = 1,23 [IC95% 1,13 -1,34]). CONCLUSÃO. O risco para peso insuficiente foi maior para os RN do sexo feminino, os filhos de primíparas, das mulheres que fizeram pré-natal inadequado e das submetidas a parto vaginal. UNITERMOS: Peso ao nascer. Recém-nascido. Nascidos vivos. Fatores de risco.

Liver damage induced by ovarian stimulation has been demonstrated in some cases reported in the literature. However, there has never been a fruitful debate on this topic. The present manuscript tried to fill this gap. We reported a case of a 35-year-old nulliparous woman admitted to our obstetric emergency room for severe pre-eclampsia. She had been subjected to four cycles of controlled ovarian stimulation for intrauterine insemination. At 32 weeks of gestation, she developed severe pre-eclampsia, which led to HELLP syndrome complicated by fatal liver failure. The etiological link between ovarian stimulation and HELLP syndrome is intriguing. Further investigations are needed to understand whether repeated ovarian stimulation may represent a risk factor in pre-eclamptic patients.

STUDY QUESTION What is the proportion of women who experience natural conception after a livebirth via assisted reproductive technology (ART)? SUMMARY ANSWER Current evidence suggests that natural conception pregnancy may occur in at least one in five women after having a baby via IVF or ICSI. WHAT IS KNOWN ALREADY It is widely known that some women having babies via ART go on to conceive naturally. This reproductive history is of media interest and often described as ‘miracle’ pregnancies. STUDY DESIGN, SIZE, DURATION A systematic review with meta-analysis was carried out. Ovid Medline, Embase, and PsycINFO were searched until 24 September 2021 for English language, human studies from 1980. Search terms were used for the concepts of natural conception pregnancy, assisted reproduction, and livebirth. PARTICIPANTS/MATERIALS, SETTING, METHODS The inclusion criterion was studies with an outcome measure of the proportion of women experiencing natural conception pregnancy after an ART li...

Background Early pregnancy complications are common and account for the largest proportion of emergency work in gynaecology. Although early pregnancy assessment units operate in most UK acute hospitals, recent National Institute of Health and Care Excellence guidance emphasised the need for more research to identify configurations that provide the optimal balance between cost-effectiveness, clinical effectiveness and service- and patient-centred outcomes [National Institute for Health and Care Excellence (NICE). Ectopic Pregnancy and Miscarriage: Diagnosis and Initial Management. URL: http://guidance.nice.org.uk/CG154 (accessed 23 March 2016)]. Objectives The primary aim was to test the hypothesis that the rate of hospital admissions for early pregnancy complications is lower in early pregnancy assessment units with high consultant presence than in units with low consultant presence. The key secondary objectives were to assess the effect of increased consultant presence on other cli...

Background: Rituximab (RTX) is an effective treatment for pemphigus; however, the drug labeling recommends not to use RTX within 1 year before conception. Objectives: To report pregnancy outcomes of patients with pemphigus who were treated with RTX before or during pregnancy. Methods: We identified 19 pregnancies with RTX exposure before or during pregnancy. All had previously been advised not to get pregnant within 1 year of RTX administration. The cases were categorized into 3 groups of exposure of within 6 months (group A), between 6 and 12 months (group B), and longer than 12 months of conception (group C). The pregnancy outcomes of different RTX exposure intervals were compared. Results: Group A included 9 pregnancies, of which 3 had received RTX accidentally after conception. Group B and C included 4 and 6 pregnancies, respectively. There was no significant difference between the groups regarding pregnancy outcomes. Overall, there were 17 live births, 1 spontaneous abortion, a...

Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by multisystem involvement. The renal involvement of SLE may present with hematuria , proteinuria or acute kidney dysfunction. It is well established that pregnancy may trigger the disease activation in patients with SLE. Lupus nephritis (LN) may be diagnosed during pregnancy in very few patients. Preeclampsia is a pregnancy-related disorder characterized by maternal hypertension, proteinuria, and edema and is sometimes complicated by renal dysfunction, which usually occurs in the last trimester of pregnancy. However preeclampsia rarely occurs within 48 h of postpartum. In this report, we present the case of a 20-year-old patient with oliguria, proteinuria, edema, and hypertension who was diagnosed with preeclampsia starting at the 35th week of her first pregnancy. Acute kidney failure developed in the postpartum period after emergency cesarian delivery. Crescentic and diffuse LN was revealed by renal biopsy. While SLE is a risk factor for preeclampsia, LN should be considered in kidney failure in the third trimester or postpartum period.

To evaluate the association between progesterone elevation on the day of human chorionic gonadotropin (hCG) administration and clinical pregnancy rates of gonadotropin-releasing hormone (GnRH) antagonist in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycles with the transfer of embryos at different developmental stages (day-3 versus day-5 ETs). This is a retrospective analysis of fresh IVF/ICSI; 194 cycles out of 2676 conducted in a single center. Results: A total of 2676 cycles were analyzed, of which 386 had no progesterone measurements available. Two hundred eighteen cycles had progesterone elevation (p>1.5 ng/mL) giving an overall incidence of 9.5%. Twenty-four cycles were excluded from further analysis. Of the remaining 194 cycles, 151 had day-3 transfers and 43 had blastocyst transfers. There was no statistically significant difference in pregnancy and clinical pregnancy rates per transfer between the D3-ET and D5-ET groups (46% vs. 49%, and 39% vs. 35%, respectively). The results of this study suggest that blastocyst transfer does not improve cycle outcomes compared with D3 transfer in GnRH antagonist cycles with an elevated progesterone level on the day of hCG. (

Rahim, sperm ile yumurtanın döllenmesiyle oluşan embriyonun yerleştiği ve doğuma kadar gelişimini sürdürdüğü üreme organıdır. Mutlak uterin faktör infertilitesi, küresel ölçekte üreme çağındaki kısır kadınların %3 ila %5'ini etkilemektedir. Rahim naklinin deneysel çalışmalardan klinik denemelere geçmesi ve bu yolla bebek sahibi olunmaya başlanmasıyla birlikte rahim nakli, bu kadınların kendilerine genetik olarak ait çocuk sahibi olmalarını üstelik kendi rahimlerinde büyütebilmelerini sağlayabilecek bir çözüm sunmaktadır. Rahim nakli, tüp bebek ve embriyo dondurulması ön prosedürü gerekliliği nedeniyle hem yardımcı üreme teknolojisini hem de organ naklini birleştiren bir işlemdir ve bu nedenle 'ikisi arasında yeni bir iş birliği seviyesini' temsil eder. Rahim naklinin deneysel bir klinik prosedürden klinik denemelere geçişi ve olumlu erken sonuçlar vermesi ile bu çalışmada paydaşların her biri için geçerli olan etik tartışmalar, bu çalışma kapsamında biyo-etik ilkeleriyle ve belli başlı teoriler ile gözden geçirilecektir. Rahim nakli yaşam kurtarıcı olmayan fakat yaşam kalitesini arttırıcı nakillerdir. Bu bağlamda rahim nakli de Organ ve Doku Nakli Hizmetleri Yönetmeliği'nin kapsamına alınan kompozit doku nakli türü olarak kabul edilmektedir. Bununla birlikte rahim nakli, içerisinde yer aldığı kompozit doku nakillerinden de farklılıklar taşır. Türk Hukuk düzeninde Kompozit Doku Nakli Merkezleri Yönergesi'nin "donör" tanımı gereğince, yaşayan kişilerin kompozit doku verme borcu altına giremeyecekleri kabul görmektedir. Bu durumda rahim nakli de kompozit doku kapsamına girmekle hukuk düzenimize göre yalnızca ölü vericiden yapılabilecektir sonucu çıkmaktadır. Ayrıca Kompozit Doku Nakli Yönergesi'nde bu tür nakillerdeki tıbbi endikasyon türleri arasında da rahim nakilleri açık bir şekilde zikredilmemektedir. Bu hukuki belirsizlik dahi rahim nakillerinin kompozit doku nakli şemsiyesinden ayrı bir düzenleme ile ele alınması gereğine işaret etmektedir.

Young women wishing to become living kidney donors frequently ask whether nephrectomy will affect their future pregnancies. We conducted a retrospective cohort study of living kidney donors involving 85 women (131 pregnancies after cohort entry) who were matched in a 1:6 ratio with 510 healthy nondonors from the general population (788 pregnancies after cohort entry). Kidney donations occurred between 1992 and 2009 in Ontario, Canada, with followup through linked health care databases until March 2013. Donors and nondonors were matched with respect to age, year of cohort entry, residency (urban or rural), income, number of pregnancies before cohort entry, and the time to the first pregnancy after cohort entry. The primary outcome was a hospital diagnosis of gestational hypertension or preeclampsia. Secondary outcomes were each component of the primary outcome examined separately and other maternal and fetal outcomes. Gestational hypertension or preeclampsia was more common among living kidney donors than among nondonors (occurring in 15 of 131 pregnancies [11%] vs. 38 of 788 pregnancies [5%]; odds ratio for donors, 2.4; 95% confidence interval, 1.2 to 5.0; P = 0.01). Each component of the primary outcome was also more common among donors (odds ratio, 2.5 for gestational hypertension and 2.4 for preeclampsia). There were no significant differences between donors and nondonors with respect to rates of preterm birth (8% and 7%, respectively) or low birth weight (6% and 4%, respectively). There were no reports of maternal death, stillbirth, or neonatal death among the donors. Most women had uncomplicated pregnancies after donation. Gestational hypertension or preeclampsia was more likely to be diagnosed in kidney donors than in matched nondonors with similar indicators of baseline health. (Funded by the Canadian Institutes of Health Research and others.)

BACKGROUND: Since severe ovarian hyperstimulation syndrome (OHSS) is a potentially life-threatening complication of assisted reproduction, the focus of attention in such cases is placed firmly upon the health of the patient, with the endeavour to achieve a pregnancy being considered of secondary importance. The aim of this study was to focus on the pregnancy rate and pregnancy outcome in IVF patients hospitalized for severe or critical OHSS, in one centre, during a period of 6 years. METHODS: We compared the characteristics of patients with severe OHSS: those who conceived with the ones who did not conceive, and among pregnant IVF patients, those with ongoing pregnancies with those that miscarried. RESULTS: Pregnancy was achieved in 60 of 104 (58%) patients with severe OHSS. Pregnancy continued until delivery in 37 of these 60 patients (62%), whereas the remaining 23 (38%) aborted. The pregnancy and abortion rates in patients with severe OHSS were significantly higher than those of IVF patients without OHSS, during the same time period [23% (1138/4922) and 15% (169/1138) respectively, P < 0.001]. The mean duration of hospitalization for OHSS was significantly shorter in those who delivered compared with those who aborted (5.9 ⍨ 3.2 versus 10.5 ⍨ 9.6 days, P < 0.01) and in the non-pregnant patients compared with the pregnant patients (5.2 ⍨ 3.2 versus 7.6 ⍨ 6.6 days, P < 0.02). CONCLUSIONS: The clinical pregnancy rate of IVF patients with severe OHSS was significantly higher than that of patients without the syndrome. A longer stay in hospital-reflecting a more severe form of OHSS-was correlated with a higher frequency of abortions. OHSS, necessitating hospitalization, is a detrimental clinical situation not only for the mother but also for the developing pregnancy.