Is there any truth in the myth that IVF treatments involve weight gain?

Purpose: To examine body weight change in women undergoing in vitro fertilization and embryo transfer (IVF-ET) using antagonist protocol after up to three treatment cycles. Methods: A prospective cohort study among IVF patients treated between 2018 and 2019. Each patient underwent weight measurement three times during the treatment cycle: before treatment, at the beginning of the hormonal stimulation, and at the completion of the cycle, on the day of the pregnancy test. Data were also analyzed according to the body mass index (BMI) groups for normal weight, overweight, and obese patients. Finally, weight changes were recorded following altogether 519 treatment cycles, 240, 131, and 148 cycles, for normal weight, overweight, and obese patients, respectively. Results: The change in the patient's weight was clinically non-significant either during the waiting period or during gonadotropin administration, and overall, during the first, second, or third treatment cycles. The recorded mean total weight change of 0.26 ± 1.85, 0.4 ± 1.81, and 0.17 ± 1.7, after the first, second, or third treatment cycles, represent a change of 0.36%, 0.56%, and 0.23% of their initial weights, respectively. This change of less than 1% of the body weight falls short of the clinically significant weight gain of 5%-7%. Analyzing the data for the various BMI groups, the changes observed in body weight were under 1%, hence with no clinical significance. Conclusion: The findings of the study reject the myth that hormone therapy involves clinically significant weight gain, and this can lower the concerns of many patients who are candidates for treatment of assisted reproductive technology.

Does progesterone to oocyte index have a predictive value for IVF outcome? A retrospective cohort and review of the literature.

The potential adverse effect of Serum progesterone (SP) elevation on the day of hCG administration is a matter of continued debate. Our study aimed to evaluate the relative value of progesterone to a number of aspirated oocytes ratio (POI) to predict clinical pregnancy (CP) and live birth (LB) in fresh IVF cycles and to review the relevant literature. A retrospective analysis of GnRH Antagonist IVF-ET cycles. POI was calculated by dividing the SP on the day of hCG by the number of aspirated mature oocytes. A multivariate logistic regression analysis was performed to evaluate the predictive value of POI for CP and LB. Cycle outcome parameters included clinical pregnancy, live-birth and miscarriage. A total of 2,693 IVF/ICSI cycles were analyzed. POI was inversely associated with CP adjusted OR 0.063 (95% CI 0.016-0.249, p < .001) and with LB adjusted OR 0.036 (95% CI 0.007-0.199, p < .001). For prediction of LB, the area under the curve (AUC) was 0.68 (95% CI 0.64-0.71, p < .001) for the POI model. POI above the 90th percentile with a value of 0.36 ng/mL/oocyte results in CP and LB rates of 8.0 and 5.9%, respectively. POI is a simple index for the prediction of IVF-ET cycle outcomes, it can advocate a limit above which embryo transfer should be reconsidered.

Lower complication rates with office-based D&C under ultrasound guidance for missed abortion.

BACKGROUND: Missed abortion (MA) can be managed expectantly, medically or surgically. Surgical management has been performed safely in the office setting by suction dilation and curettage (D&C). Prior studies suggest that intraoperative ultrasound guidance (USG) may reduce complications for first-trimester therapeutic abortion. The aim of this study was to evaluate the safety of office D&C for MA using real-time USG. METHODS: This retrospective cohort study included 255 patients who underwent office D&C under USG for first trimester MA at a single university-affiliated fertility clinic during January 2011-December 2013. Transabdominal USG was utilized during the procedure and was immediately followed by a transvaginal ultrasound examination to confirm full evacuation. Intra- and postoperative complication rates were compared to previously published data. RESULTS: There were no intraoperative complications, including excessive blood loss or uterine perforation. Two of the 255 patients (0.87%) were diagnosed with RPOCs requiring uterine re-evacuation. This rate of RPOCs was superior to rates previously reported for D&Cs without USG (2.6-4.9%, P=0.046). There were no other post procedure complications identified. CONCLUSIONS: We observed very low complications rate in Office-based D&C under USG, lower than those reported in the literature with unguided D&C.

Assisted reproduction involving gestational surrogacy: an analysis of the medical, psychosocial and legal issues: experience from a large surrogacy program.

STUDY QUESTION: What are the medical, psychosocial and legal aspects of gestational surrogacy (GS), including pregnancy outcomes and complications, in a large series? SUMMARY ANSWER: Meticulous multidisciplinary teamwork, involving medical, legal and psychosocial input for both the intended parent(s) (IP) and the gestational carrier (GC), is critical to achieve a successful GS program. WHAT IS KNOWN ALREADY: Small case series have described pregnancy rates of 17-50% for GS. There are no large case series and the medical, legal and psychological aspects of GS have not been addressed in most of these studies. To our knowledge, this is the largest reported GS case series. STUDY DESIGN, SIZE AND DURATION: A retrospective cohort study was performed. Data were collected from 333 consecutive GC cycles between 1998 and 2012. PARTICIPANTS/MATERIALS, SETTING, METHODS: There were 178 pregnancies achieved out of 333 stimulation cycles, including fresh and frozen transfers. The indications for a GC were divided into two groups. Those who have 'failed to carry', included women with recurrent implantation failure (RIF), recurrent pregnancy loss (RPL) and previous poor pregnancy outcome (n = 96; 132 cycles, pregnancy rate 50.0%). The second group consisted of those who 'cannot carry' including those with severe Asherman's syndrome, uterine malformations/uterine agenesis and maternal medical diseases (n = 108, 139 cycles, pregnancy rate 54.0%). A third group, of same-sex male couples and single men, were analyzed separately (n = 52, 62 cycles, pregnancy rate 59.7%). In 49.2% of cycles, autologous oocytes were used and 50.8% of cycles involved donor oocytes. MAIN RESULTS AND THE ROLE OF CHANCE: The 'failed to carry' group consisted of 96 patients who underwent 132 cycles at a mean age of 40.3 years. There were 66 pregnancies (50.0%) with 17 miscarriages (25.8%) and 46 confirmed births (34.8%). The 'cannot carry pregnancy' group consisted of 108 patients who underwent 139 cycles at a mean age of 35.9 years. There were 75 pregnancies (54.0%) with 15 miscarriages (20.0%) and 56 confirmed births (40.3%). The pregnancy, miscarriage and live birth rates between the two groups were not significantly different (P = 0.54; 0.43; 0.38, respectively). Of the 178 pregnancies, 142 pregnancies were ongoing (surpassed 20 weeks) or had ended with a live birth and the other 36 pregnancies resulted in miscarriage (25.4%). Maternal (GS) complication rates were low, occurring in only 9.8% of pregnancies. Fetal anomalies occurred in only 1.8% of the babies born. LIMITATIONS, REASONS FOR CAUTION: Although it is a large series, the data are retrospective and conclusions must be drawn accordingly while considering bias, confounding and power. Due to the retrospective nature of this study, follow-up data on 6.3% of birth outcomes were incomplete. In addition, long-term follow-up data on GCs and IPs were not available to us at the time of publication. WIDER IMPLICATIONS OF THE FINDINGS: To our knowledge, this is the largest GS series published. We have included many details regarding not only the medical protocol but also the counseling and legal considerations, which are an inseparable part of the process. Data from this study can be included in discussions with future intended parents and gestational carriers regarding success rates and complications of GS.

Comparison of IVF Outcomes between Minimal Stimulation and High-Dose Stimulation for Patients with Poor Ovarian Reserve.

We examined whether treatment with minimum-dose stimulation (MS) protocol enhances clinical pregnancy rates compared to high-dose stimulation (HS) protocol. A retrospective cohort study was performed comparing IVF and pregnancy outcomes between MS and HS gonadotropin-antagonist protocol for patients with poor ovarian reserve (POR). Inclusion criteria included patients with an anti-Müllerian hormone (AMH) ≤8 pmol/L and/or antral follicle count (AFC) ≤5 on days 2-3 of the cycle. Patients from 2008 exclusively had a HS protocol treatment, while patients in 2010 had treatment with a MS protocol exclusively. The MS protocol involved letrozole at 2.5 mg over 5 days, starting from day 2, overlapping with gonadotropins, starting from the third day of letrozole at 150 units daily. GnRH antagonist was introduced once one or more follicles reached 14 mm or larger. The HS group received gonadotropins (≥300 IU/day) throughout their antagonist cycle. Clinical pregnancy rate was significantly higher in the MS protocol compared to the HS protocol (P = 0.007). Furthermore, the live birth rate was significantly higher in the MS group compare to the HS group (P = 0.034). In conclusion, the MS IVF protocol is less expensive (lower gonadotropin dosage) and resulted in a higher clinical pregnancy rate and live birth rate than a HS protocol for poor responders.

Bacteruria with group-B streptococcus: is it a risk factor for adverse pregnancy outcomes?

OBJECTIVE: To investigate pregnancy outcomes of patients with and without group-B streptococcus (GBS) bacteriuria. METHODS: A retrospective study comparing pregnancy outcomes of women with GBS bacteriuria during pregnancy, those with positive GBS vaginal cultures and those without GBS colonization during pregnancy was conducted. RESULTS: A significant linear association was found with regard to intrapartum fever (U-GBS 0.5%, V-GBS 0.3%, no GBS 0.1%, p = 0.001) and chorioamnionitis (U-GBS 3.3%, V-GBS 1%, no GBS 0.7%, p = 0.001). In addition preterm delivery (15.3% vs. 7.9%, p = 0.001) and premature rupture of membranes (10.7% vs. 7.9, p = 0.001) were significantly higher in the U-GBS group compared to no GBS. Woman with U-GBS had higher rates of diabetes mellitus, hypertensive disorders, and habitual abortions as well as a higher risk for intrauterine growth restriction (IUGR). In addition patients with U-GBS underwent induction of labor and cesarean delivery more frequently. CONCLUSIONS: Our study showed a significant association between U-GBS and adverse obstetrical outcomes. In addition a linear association was found between GBS culture location and obstetric complications. However, GBS was not associated with adverse perinatal outcome in our population.

Trace elements' concentrations in maternal and umbilical cord plasma at term gestation: a comparison between active labor and elective cesarean delivery.

OBJECTIVE: Trace elements are minerals required in minute quantities to maintain proper physical functioning. The role of trace elements in the process of parturition is poorly understood. This study was aimed to determine levels of trace elements' concentration in maternal plasma and umbilical venous and arterial plasma at term during active labor vs elective cesarean delivery (CD). STUDY DESIGN: A prospective case-control study was conducted. Forty healthy parturients in active labor at term with their newborns were compared to 40 healthy parturients matched for maternal age, parity, and gestational age, who delivered by elective CD (before commencement of labor). Samples of maternal venous blood and umbilical cord arterial and venous blood were drawn immediately following delivery. Trace elements' concentrations were measured using the inductively coupled plasma mass spectrometer (ICP-MS). RESULTS: Significant higher levels of manganese (Mn) and selenium were found in maternal venous plasma during active labor vs elective CD. Magnesium (Mg) levels were significantly higher in maternal venous blood during elective CD compared to active labor. Umbilical cord artery levels of Mg, Mn, and zinc (Zn) were significantly higher in active term labor vs elective CD. Also, significant higher levels of copper and Zn were found in umbilical cord vein between active labor and elective CD. CONCLUSION: Trace elements' concentrations differ significantly in fetal blood during active labor vs elective CD. Hence, trace elements may play a crucial role in the process of human parturition.

Severe pre-eclampsia is associated with abnormal trace elements concentrations in maternal and fetal blood.

OBJECTIVE: The study was aimed to compare trace elements concentrations in women with and without severe pre-eclampsia (PE). METHODS: A prospective case-control study was conducted comparing 43 parturients with severe PE (who received magnesium sulfate [MgSO4]) and 80 healthy parturients and their newborns, matched for gestational age and mode of delivery. Inductively coupled plasma mass spectrometry (ICPMS) was used for the determination of zinc (Zn), copper (Cu), selenium (Se) and magnesium (Mg) levels in maternal as well as arterial and venous umbilical cord serum. RESULTS: Zn levels (µg/L) were significantly higher in fetal arterial and venous blood of the PE group (947.3 ± 42.5 vs. 543.1 ± 226, 911.1 ± 220.2 vs. 422.4 ± 145, p < 0.001; respectively). Se levels (µg/L) were significantly lower in maternal and fetal arterial and venous cord blood of the PE group (98.6 ± 24.2, 110.7 ± 19.4, 82 ± 17.8 vs. 111.6 ± 17.6, 82.1 ± 17.4 vs. 107.1 ± 25.7, p < 0.001; respectively). Cu levels (µg/L) were significantly lower in fetal arterial and venous cord blood (581.6 ± 367.4 vs. 949 ± 788.8, p = 0.022, 608.3 ± 418.1 vs. 866.9 ± 812.6, p = 0.001 respectively) but higher in maternal blood (2264.6 ± 751.7 vs. 1048 ± 851.1, p < 0.001). These differences remained significant while controlling for the mode of delivery. Mg levels were significantly higher in the PE group as compared with the control group. CONCLUSIONS: Severe PE is associated with abnormal concentrations of Zn, Cu and Se. Therefore, trace elements may have a crucial role in the pathogenesis of severe PE.

Sexually transmissible infections among female sex workers: an international review with an emphasis on hard-to-access populations.

BACKGROUND: Women who work commercially in sex work (female sex workers [FSW]) are considered a high-risk group for sexually transmissible infections (STI), yet the level of reported pathogens varies in studies around the world. This study reviewed STI rates reported in 42 studies of FSW around the world published between 1995 and 2006 and analysed the trends and types of populations surveyed, emphasising difficult to access FSW populations. METHODS: Studies were retrieved by PUBMED and other search engines and were included if two or more pathogens were studied and valid laboratory methods were reported. RESULTS: The five most commonly assessed pathogens were Neisseria gonorrhea (prevalence 0.5-41.3), Chlamydia trachomatis (0.61-46.2), Treponema pallidum (syphilis; 1.5-60.5), HIV (0-76.6), and Trichomonas vaginalis (trichomoniasis; 0.11-51.0). Neisseria gonorrhea and C. trachomatis were the most commonly tested pathogens and high prevalence levels were found in diverse areas of the world. HIV was highly prevalent mostly in African countries. Although human papillomavirus infection was surveyed in few studies, prevalence rates were very high and its aetiological role in cervical cancer warrant its inclusion in future FSW monitoring. Hard-to-access FSW groups tended to have higher rates of STI. CONCLUSIONS: The five most commonly detected pathogens correspond to those that are highly prevalent in the general population, however there is an urgent need to develop rapid testing diagnostics for all five pathogens to increase prevention and treatment, especially in outreach programs to the most vulnerable groups among FSW.

Early maternal feeding following caesarean delivery: a prospective randomised study.

OBJECTIVE: To evaluate the effect of early maternal feeding on maternal satisfaction and gastrointestinal complications on patients following simple and complicated caesarean delivery (CD). METHODS: A prospective, randomised study was designed including 179 women undergoing first or repeated CD. Women who were assigned to the early feeding group received clear fluids and solid food within 8 h of surgery, in accordance with their request. The traditionally fed women received clear fluids 8-12 h after the surgery subsequent to physician examination confirming bowel sounds. RESULTS: Some 82 women were assigned to the traditionally fed group and 97 women were assigned to the early fed group. Maternal satisfaction was significantly higher among the early fed women. No significant differences were noted between the groups regarding post-operative complications. CONCLUSIONS: Early maternal feeding following CD is associated with higher maternal satisfaction. However, it is not associated with higher rates of post-operative complications.

Maternal and neonatal outcome following cerebrovascular accidents during pregnancy.

OBJECTIVE: To assess the clinical characteristics of maternal and neonatal outcome among women with cerebrovascular accidents (CVA) during pregnancy. METHODS: Our computerized database was used to identify patients with CVA during pregnancy and puerperium from January 1988 to March 2004. Their medical records were identified and reviewed. RESULTS: There were 16 cases of CVA among 173,803 deliveries, giving a risk of almost one case per 10,000 pregnant women. Out of 16 patients, 14 (88%) had a stroke and the remaining two cases were diagnosed with venous thrombosis. Of those 14 cases, nine (64%) had ischemic strokes and five (36%) had hemorrhagic strokes. Ten of the CVAs occurred antepartum, two intrapartum and four postpartum. Hypertensive disorders were diagnosed in 75% (12/16) of the patients. Out of these 12 patients with hypertension, 9 (75%) suffered from preeclampsia. One woman had a history of chronic hypertension. Smoking was associated with 63% (10/16) of the cases. There were two maternal deaths, both in women who had hemorrhagic strokes, and both in the first half of the study (1994 and 1996). Nine out of 16 women (56%), were delivered within 48 hours of the CVA including 7 (78%) antepartum, and two (22%) intrapartum. Cesarean deliveries were performed in 11/16 women (69%) including 8/10 with CVAs occurring antepartum, 1/2 intrapartum and 2/4 postpartum. One case of neonatal mortality was identified in a patient who was delivered at 24 gestational weeks. CONCLUSIONS: (1) Hypertensive disorders and smoking were the most important factors associated with CVA during pregnancy. (2) Maternal mortality was high among patients with CVA during pregnancy. (3) Neonatal outcome was considered generally good in cases of CVA.

Sexually transmissible infections among illegal female sex workers in Israel.

Due to the mobile and clandestine nature of those who enter a country illegally, female sex workers (FSWs) who are working without papers or work permits often have no access to sexual health care. This study reports on the sexually transmissible infection (STI) prevalence among a sample of 43 sex workers working illegally. Brothel workers from republics of the Former Soviet Union (FSU), working in two locales in Israel were tested for the presence of eight pathogens and the presence of pathology by Pap smear. Of these brothel workers, 48.8% had at least one positive STI result, 14% had two STIs and one woman had three STIs. There were no cases of HIV, gonorrhoea or malignancy detected; high rates of ureaplasma (26.8%) and chlamydia were found (16.7%). Four cases of hepatitis C (9%) and three cases of hepatitis B (7%) and mycoplasma (7%) were detected. There was no relationship between reported symptoms and the detection of STIs. The level of STIs is high among this population of FSWs and it is imperative to develop more accessible health services for these women.