Effects of parity on preterm delivery in twin gestations conceived with in vitro fertilization.

Objective: To determine the relationship between prior obstetrical history and gestational age at delivery in a twin pregnancy. Design: Retrospective cohort study using the United States Society for Assisted Reproductive Technology Clinic Outcomes Reporting System database. Setting: Clinic-based data. Patients: Patients undergoing in vitro fertilization (IVF) in the United States with live delivery of twins. Interventions: None. Main outcome measures: The main outcome measures are median gestational age at delivery and rate of preterm delivery (before 37 weeks). Results: The median gestational age at delivery of IVF-conceived twins was 36.3 (interquartile rate 34.4, 37.6) weeks for nulliparous women, 35.9 (34.0, 37.1) weeks for parous women with a prior preterm birth, and 36.7 (35.1, 37.7) weeks for parous women without a prior preterm birth. The rate of preterm delivery was 61% for nulliparous women, 70% for parous women with a prior preterm birth, and 55% for parous women without a prior preterm birth. Conclusions: Parous women without a history of preterm delivery had lower rates of preterm delivery in a subsequent twin pregnancy than nulliparous women. Nulliparous women had lower rates of preterm delivery compared with parous women with a history of preterm delivery.

Cancer survivors of gynecologic malignancies are at risk for decreased opportunity for fertility preservation.

BACKGROUND: Cancer survivors rate fertility as one of the most important determinants of their quality of life in the years after cancer treatment. We seek to describe the reproductive goals of women affected by gynecologic cancers and investigate their specific challenges during fertility preservation (FP) counseling. METHODS: Univariate & multivariate logistic regression were used for quantitative analysis of objective FP counseling measures between women with gynecologic (GYN) and non-gynecologic (non-GYN) cancers from a cross sectional survey. Framework analysis was conducted on patient perception of physician-patient interactions. RESULTS: Of the 2537 women contacted, 1892 responded and 1686 reported treatment with potential to impact fertility. Among women with GYN cancers 52% wanted future children. Women <35 years were interested in FP (74%). Women with Gyn cancers received less FP counseling than women with non Gyn cancer (OR 0.5 95% CI 0.4-0.6). Three hundred twenty-four patients gave qualitative answers. Patient identified barriers included incomplete FP information (59%), nondisclosure (29%), a disinterest in FP (5%), and a perceived urgency to start treatment (7%). CONCLUSIONS: Women with gynecologic cancers are less likely to be counseled about FP in comparison to women not affected by gynecologic cancers despite having similar fertility goals. We have identified patient perceived barriers to optimal FP counseling which may be improved upon to increase the value of FP and optimize quality of life for cancer survivors of gynecologic malignancies.