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Background Endometriosis is found in 0.5-5% of fertile women and 25-40% of infertile women. It is known that endometriosis is associated with infertility, but there is uncertainty whether women with endometriosis have adverse pregnancy outcomes in in vitro fertilisation ( IVF) treatment. Objectives To explore the association between endometriosis and IVF outcome. Search strategy Searches were conducted on MEDLINE, EMBASE, Cochrane Library and Web of Science (inception, December 2012) in all languages, together with reference lists of retrieved papers. Selection criteria Studies comparing IVF outcome in women with endometriosis with women without endometriosis. Patients were classified by stage of endometriosis. The outcomes were fertilisation, implantation, clinical pregnancy and live birth rates. Study selection was conducted independently by two reviewers. The Newcastle- Ottawa Quality Assessment Scale was used for quality assessment. Data collection and analysis Data extraction was conducted independently by two reviewers. Relative risks from individual studies were meta-analysed. Main results Twenty-seven observational studies were included, comprising 8984 women. Meta-analysis of these studies showed that fertilisation rates were reduced in stage I/ II of endometriosis (relative risk [RR] = 0.93, 95% confidence interval [95% CI] 0.87-0.99, P = 0.03). There was a decrease in the implantation rate (RR = 0.79, 95% CI 0.67-0.93, P = 0.006) and clinical pregnancy rate (RR = 0.79, 95% CI 0.69-0.91, P = 0.0008) in women with stage III/ IV endometriosis undergoing IVF treatment. Conclusion The presence of severe endometriosis (stage III/ IV) is associated with poor implantation and clinical pregnancy rates in women undergoing IVF treatment. [ABSTRACT FROM AUTHOR]

Please cite this paper as: Tandberg A, Melve K, Nordtveit T, Bjørge T, Skjaerven R. Maternal birth characteristics and perinatal mortality in twin offspring. An intergenerational population-based study in Norway, 1967-2008. BJOG 2011;118:698-705. To investigate the relationship between maternal preterm birth and fetal growth in one generation and perinatal mortality of twin offspring in the next generation. Population-based cohort study. The Medical Birth Registry of Norway from 1967 to 2008. Linked generational data with 9426 mother-twin pair units. Twin offspring were linked to their mothers by means of the unique national identification numbers. Perinatal mortality in twin offspring. The twin prevalence was not dependent on the mother's gestational age at birth, but increased with increasing birthweight in term mothers. Maternal gestational age was strongly and inversely associated with a risk of perinatal death in one or both of her twin offspring. Compared with term mothers, preterm mothers born at 27-31 and 32-34 weeks had relative risks (RRs) for perinatal loss of 3.83 [95% confidence interval (CI), 1.56-9.36] and 2.41 (95% CI, 1.29-4.50), respectively. This effect was even stronger after the use of assisted reproductive technologies (ART), with a significant interaction between maternal gestational age and ART ( P = 0.03). Further, term mothers with birthweight-by-gestational age Z-scores of −2 or less had more than twice the risk of a perinatal loss in their twin offspring relative to mothers with the most favourable birthweight Z-scores (1-1.99) [RR, 2.42 (95% CI, 1.37-4.29)]. Women born preterm had an increased risk of perinatal mortality in their twin offspring, particularly after ART treatment. The same was true for women who were growth restricted at term. A twin pregnancy is a high-risk pregnancy in general, but even more so if the mother herself was born preterm or was growth restricted at birth. [ABSTRACT FROM AUTHOR]

Please cite this paper as: Tandberg A, Bjørge T, Nygård O, Børdahl P, Skjaerven R. Trends in incidence and mortality for triplets in Norway 1967–2006: the influence of assisted reproductive technologies. BJOG 2010; DOI: 10.1111/j.1471-0528.2010.02530.x. Objective To assess changes in incidence rates and outcomes of triplets over 40 years with a particular focus on the influence of assisted reproductive technology (ART). Design Population-based cohort study. Setting The Medical Birth Registry of Norway. Population 2.18 million pregnancies, including 448 sets of triplets and 27 575 twin pairs, covering the years 1967–2006. Since 1988, pregnancies from ART have been available through a separate registry and linked with the birth record. Methods Incidence rates and outcomes for triplets were analysed and compared with those for singletons and twins. Relative risks were estimated between time periods and between ART and non-ART pregnancies. Main outcome measures Incidence rates, birthweight, gestational age and perinatal mortality. Results The total triplet rate per 10 000 pregnancies increased from 1.0 during 1967–71 to 3.5 during 1987–92, followed by a decline to 2.7 during 2002–06. After excluding ART pregnancies, the incidence was more than doubled at the end of the study period. The mean gestational age and birthweight of triplets were significantly lower during 1988–2006 than 1967–87, but similar for ART and non-ART triplets in the last period. The caesarean rate in triplets increased from 47 to 92%. The relative risk of perinatal death in triplets relative to singletons did not change after the introduction of ART [before: relative risk, 8.9 (95% confidence interval, 6.8–11.7); after: relative risk, 10.4 (95% confidence interval, 8.3–13.0)]. Conclusions The triplet incidence rate in Norway has more than doubled during the last 40 years, even after excluding ART pregnancies. The risk of perinatal death in triplets is ten times higher relative to singletons and has not changed during this 40-year period, independent of the introduction of ART. [ABSTRACT FROM AUTHOR]

Background: In vitro methods of conception are associated with adverse perinatal outcomes. It is unclear if the risk of stillbirth is increased also. Objective: This systematic review and meta‐analysis aimed to estimate the risk of stillbirth in singleton gestations following in vitro methods of conception compared to non‐in vitro conceptions. Search strategy: A comprehensive search in PubMed, Embase, CINAHL, and Cochrane Library was undertaken from database inception to February 2021, with backward citation tracking. Selection criteria: Eligible studies included randomized controlled trials, cohort studies, or case‐control studies that assessed stillbirth following in vitro fertilisation and/or intracytoplasmic sperm injection in comparison to non‐in vitro methods of conception, including spontaneous conceptions, intrauterine insemination, and ovarian stimulation. Data collection and analysis: The Newcastle‐Ottawa Scale was used to assess risk of bias. A summary odds ratio (OR) for stillbirth following in vitro methods of conception compared to non‐in vitro methods was calculated using a random‐effects model for meta‐analysis. Main results: Thirty‐three cohort studies met inclusion criteria. There was an increased risk of stillbirth with in vitro methods: OR 1.41 (95% CI 1.20–1.65); however, the crude baseline risk of stillbirth was low (4.44/1000 total births). Subgroup analysis did not demonstrate an increased risk when in vitro methods were compared to conception without in vitro methods in the context of subfertility. Conclusions: Compared to non‐in vitro conceptions, in vitro conceptions have an increased risk of stillbirth. However, there is insufficient evidence to demonstrate whether this risk is associated with in vitro techniques or underlying subfertility. This meta‐analysis found an increased risk of stillbirth in singletons from in vitro methods of conception. This meta‐analysis found an increased risk of stillbirth in singletons from in vitro methods of conception. [ABSTRACT FROM AUTHOR]

Objective: To assess academic performance in singletons aged 15–16 years conceived after frozen embryo transfer (FET) compared with singletons born after fresh embryo transfer (ET) in Danish cohorts born from 1995 to 2001. Design: Danish national registry‐based cohort study. Setting: Danish national registries. Population: All 6495 singletons conceived after assisted reproductive technology (ART) treatment in Denmark from 1995 to 2001 [FET (n) = 423; fresh ET (n) = 6072]. Methods: Mean test scores on a national standardised and international comparable grading‐scale. Comparisons of test score were first made in univariate analysis (Model 1) and secondly in a multivariate linear model (Model 2) adjusting for relevant reproductive and socio‐demographic covariates such as the occupational and educational level of the parents. Sensitivity analyses on FET‐IVF (in vitro fertilisation) versus fresh ET‐IVF and FET‐ICSI (intracytoplasmic sperm injection) versus fresh ET‐ICSI were made. Linear mixed models were used to account for the correlation in test scores of siblings for continuous outcome. Main outcome measures: Mean overall test score and test score in Danish, mathematics, English, and physics/chemistry. Results: Crude and adjusted mean test scores were similar for adolescents conceived after FET compared with fresh ET. The crude mean difference was +0.11 (95% CI −0.11; 0.34), and the adjusted mean difference was +0.12 (95% CI −0.09; 0.34). Conclusions: Adolescents conceived after FET had similar academic performance at 15–16 of years of age compared with children conceived after fresh ET. Using frozen embryos in fertility treatment does not affect school performance in Danish adolescents aged 15–16 years. Using frozen embryos in ART treatment does not affect school performance in Danish adolescents aged 15–16 years. [ABSTRACT FROM AUTHOR]

Background: Assisted reproductive techniques are associated with an increased risk of adverse pregnancy outcomes, including low birthweight and intrauterine growth restriction. Yet, the long-term follow-up on the growth of these children is limited.Objective: To systematically review the literature on post-neonatal height and weight among children conceived following in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) treatment, compared with that of children born after spontaneous conception.Search Strategy: A systematic computerised literature search using the online databases PubMed, Embase, and Scopus.Selection Criteria: Cohort or case-control studies with an exposed group of singletons conceived following IVF or ICSI along with a control group of spontaneously conceived singletons.Data Collection and Analysis: Studies were reviewed by at least two authors. Meta-analyses were conducted using Cochrane Review Manager. The quality of the studies was assessed with the Newcastle-Ottawa Scale.Main Results: Twenty studies were included, with 13 of these eligible for meta-analyses. The meta-analyses compared 3972 children born after IVF/ICSI with 11 012 spontaneously conceived children and revealed no statistically significant difference in child weight [mean difference (MD) in weight of -160 g; 95% confidence interval (95% CI) -360, 3]. When stratifying by age of child at follow-up, we found a significant lower weight in children aged 0-4 years conceived following IVF/ICSI treatment (MD -180 g; 95% CI -320, -4), but this was no longer significant in children from 5 years of age (MD -160 g; 95% CI -580, 260). The pooled analysis revealed no statistically significant difference in childhood height.Conclusions: In vitro fertilisation/ICSI was not associated with long-term weight and height.Tweetable Abstract: Children born following IVF/ICSI do not have impaired long-term weight or height compared with spontaneously conceived children. [ABSTRACT FROM AUTHOR]

Objective: To detect if removing the cervical mucus before performing intrauterine insemination (IUI) could improve pregnancy outcomes in patients with unexplained infertility.Design: Prospective randomized study.Setting: An Egyptian University Hospital.Population: Seven hundred and fourteen couples with unexplained infertility who underwent intrauterine insemination (IUI) with or without cervical mucus removal.Methods: Using computer-generated numbers, patients were randomly allocated to cervical-mucus-removal (removed from both internal and external os) or non-mucus-removal groups. Only participants were blinded as to group assignment.Main Outcome Measures: The clinical pregnancy rate.Results: Of 714 IUI patients between November 2014 and March 2017, 361 were in the mucus removal group, and 353 in the non-mucus-removal group. Difficult catheterization was encountered in 17 cases out of 666 (2.6%) 12 in the cervical-mucus-removal group and five in the non-mucus-removal group). A total of 666 IUI cycles were completed while 48 were either cancelled or lost in their follow-up. The clinical pregnancy rate was significantly higher in the mucus-removal group [31.0% (n = 112)] than in the non-mucus-removal group [21.8% (n = 77); P = 0.005]. Ovarian hyperstimulation developed in 33 (4.6%) cases: 18 cervical mucus-removal and 15 non-mucus-removal. All except one were mild and managed with outpatient care.Conclusions: Cervical mucus removal before IUI could improve pregnancy outcomes in women with unexplained infertility.Tweetable Abstract: Cervical mucus removal before IUI can improve pregnancy outcomes. [ABSTRACT FROM AUTHOR]

Background: Women following unilateral oophorectomy (UO) are occasionally encountered during assisted reproduction treatment.Objective: To explore the impact of UO on ovarian reserve in assisted reproduction.Search Strategy: An electronic database search was performed using PubMed, EBSCO, ISI, Trip, ClinicalTrial.gov and the Cochrane library followed by a manual search to identify published research between January 1978 and December 2015.Selection Criteria: Controlled studies that compared infertile women following UO undergoing IVF-ET treatment with women with two intact ovaries.Data Collection and Analysis: Two reviewers independently extracted the data concerning the impact of UO on ovarian reserve tests, ovarian response to controlled ovarian hyperstimulation and clinical pregnancy rate. Meta-analysis was performed using these measures.Main Results: Twenty-one studies were eligible for quantitative analysis. They included 1045 and 18 172 IVF cycles in women with one and two intact ovaries, respectively. Basal FSH weighted mean difference (WMD) was significant (2.01 IU/l; 95% CI: 0.24-3.79, P = 0.026). Similarly, the WMD of serum E2 level on the day of hCG administration was significant (WMD: -431 pg/ml; 95% CI: -616 to -246, P < 0.001). However, the weighted overall odds ratio (OR) of clinical pregnancy between women with a single ovary and women with two ovaries was comparable (overall OR: 0.76; 95% CI: 0.57-1.00, P = 0.054). All eligible studies were retrospectively conducted and the heterogeneity among ovarian response measures was high.Conclusions: Available pooled data supports an adverse effect of UO on ovarian reserve involving the quantity but not the quality of the ovarian pool.Tweetable Abstract: Review finds women with one ovary removed have less IVF capacity but the same pregnancy rate as women with two ovaries. [ABSTRACT FROM AUTHOR]

Objective To compare the psychological impact following early miscarriage between women who conceived naturally and women who conceived following assisted reproduction. Design Prospective cohort study. Setting Assisted reproduction clinic and general gynaecological unit in a university-affiliated, tertiary referral hospital. Population A cohort of 150 women (75 after natural conception; 75 after assisted reproduction). Methods Completed semi-structured interviews using two standard questionnaires [the 12-item General Health Questionnaire ( GHQ-12) and the 22-item Revised Impact of Events Scale ( IES- R)], at 1, 4, and 12 weeks after a diagnosis of first-trimester miscarriage. Main outcome measures The GHQ-12 and IES- R scores for the two groups of women. Results The GHQ-12 and IES- R scores were significantly higher in the assisted reproduction group than the scores in the natural conception group, at 4 weeks and 12 weeks after miscarriage. Further breakdown of the scores revealed significantly higher hyperarousal symptoms at 4 and 12 weeks in the assisted reproduction group, indicating the traumatic effect of miscarriage to these women. Conclusions Following first-trimester miscarriage, subfertile women who conceived after assisted reproduction had higher stress and anxiety-depression levels, and experienced more traumatic impact from the event, than those after natural conception. A timely support and psychological intervention would be beneficial in the management of this group of women. [ABSTRACT FROM AUTHOR]

There is little doubt that all methods of assisted reproduction increase the likelihood of multiple pregnancy and, as a result, increase the likelihood of preterm birth. Data from the East Flanders Prospective Twin Study clearly show that the proportion of spontaneous to iatrogenic twins has changed from 25:1 to 1:1 over the past two decades. Data from the very low birthweight (VLBW) Infant Database of the Israel Neonatal Network showed that 10% of VLBW singletons were a result of assisted reproduction compared with 60% of the VLBW twins and 90% of the VLBW triplets. Irrespective of plurality, an association between preterm birth and assisted reproduction has long been suspected and was related to causes such as iatrogenic preterm birth (in the so-called ‘premium’ pregnancies), fertility history, past obstetric performance and to underlying medical conditions of the female partner. With more data available, a clearer picture is defined. Two different, recent meta-analyses showed that singleton pregnancies resulting from in vitro fertilisation (IVF) have increased rates of preterm birth at <33 weeks of gestation (OR 2.99; 95% CI 1.54–5.80), at <37 weeks of gestation (OR 1.93; 95% CI 1.36–2.74) and a relative risk of 1.98 (95% CI 1.77–2.22) for preterm birth in singleton pregnancies resulting from in vitro fertilisation embryo transfer/gamete intra fallopian transfer (IVF-ET/GIFT) compared with naturally conceived pregnancies. Since there is no way to predict which pregnant woman is at increased risk of preterm birth, it may be advisable to consider all pregnancies after assisted reproduction as being at risk. In any case, the most appropriate endpoint after assisted reproduction should also include preterm or term birth as measure of success. [ABSTRACT FROM AUTHOR]

In developed countries, antiretroviral treatment has increased life quality and expectancy of HIV-infected individuals and led to a drop in mother-to-child transmission (MCT) risk to below 1%. Fertility has been shown to be reduced in both men and women with HIV. As a result of these factors, the demand for reproductive care in this population is rising. In discordant couples where the man is positive, sperm washing significantly reduces viral transmission risk to the uninfected female partner over unprotected intercourse. Positive women do not necessarily need specialised fertility treatment but should be monitored closely during pregnancy to minimise MCT risk. [ABSTRACT FROM AUTHOR]