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Objectives: To compare the reported rate of any congenital anomaly and perinatal outcome of pregnancy following blastocyst‐ vs cleavage‐stage embryo transfer using a pairwise meta‐analysis and to evaluate the same outcomes following fresh‐blastocyst, frozen‐blastocyst, fresh‐cleavage or frozen‐cleavage embryo transfer using a network meta‐analysis. Methods: A literature search was performed in PubMed, Scopus and CENTRAL and registers for ongoing studies, from inception to February 2022, for randomized controlled trials (RCTs) with any sample size and observational studies including at least 100 live births per group, comparing the rates of any congenital anomaly and perinatal outcome of pregnancy following fresh/frozen embryo transfer at cleavage (day 2–3) vs blastocyst (day 5–7) stage. Risk ratios (RRs) along with their 95% CIs were pooled via a random‐effects model meta‐analysis. Within a frequentist network meta‐analysis framework, outcomes of all four treatment modalities (i.e. fresh‐blastocyst, fresh‐cleavage, frozen‐blastocyst, frozen‐cleavage) were compared further. Any congenital anomaly constituted the primary outcome, whereas preterm delivery (delivery < 37 weeks), low birth weight (LBW; < 2500 g), gender of the neonate (male), perinatal death and healthy neonate (defined as liveborn neonate, delivered at term, weighing ≥ 2500 g, surviving for at least 28 days postbirth and without any congenital anomaly) were considered as secondary outcomes. Subgroup analyses by plurality (liveborn singleton vs multiple pregnancy) were conducted in the pairwise and network meta‐analyses. The risk of bias was assessed using the RoB2 tool for RCTs and the ROBINS‐I tool for non‐randomized studies. Certainty of evidence was assessed using GRADE. Results: Through the literature search, 550 studies were retrieved and 33 were included in the systematic review. We found no significant difference in the risk for any congenital anomaly between blastocyst‐ and cleavage‐stage transfer (RR, 0.80 (95% CI, 0.63–1.03); 10 studies; n = 192 442; I2 = 85.5%). An increased probability of a male neonate was observed following blastocyst‐ vs cleavage‐stage transfer (RR, 1.07 (95% CI, 1.06–1.09); 18 studies; n = 227 530; I2 = 32.7%). No significant differences in other secondary outcomes or significant subgroup differences between liveborn singletons and multiple pregnancies were observed. The network meta‐analysis showed a significantly lower risk for LBW following frozen‐blastocyst vs fresh‐blastocyst (RR, 0.76 (95% CI, 0.60–0.95)) or fresh‐cleavage (RR, 0.74 (95% CI, 0.59–0.93)) transfer. Frozen‐blastocyst transfer was associated with an increased risk for perinatal death compared with the fresh‐cleavage method (RR, 2.06 (95% CI, 1.10–3.88)). The higher probability of a male neonate following blastocyst transfer remained evident in the network comparisons. All outcomes were assessed to be of very‐low certainty of evidence. Conclusions: Current very‐low certainty of evidence shows that there may be little‐to‐no difference in the risk for congenital anomaly or adverse perinatal outcome of pregnancy following blastocyst‐ vs cleavage‐stage embryo transfer, although there was a slightly increased probability of a male neonate following blastocyst transfer. When considering cryopreservation, frozen‐blastocyst transfer was associated with a reduction in the risk for LBW compared with both fresh‐transfer modalities, and fresh‐cleavage transfer may be associated with a reduction in the risk for perinatal death compared with frozen‐blastocyst transfer. High‐quality RCTs with separate data on fresh and frozen cycles and consistent reporting of culture conditions and freezing methods are mandatory. Individual participant data meta‐analyses are required to address the substantial inconsistency resulting from current aggregate data approaches. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Objectives: To assess the prevalence of congenital uterine anomalies, including arcuate uterus, and their effect on reproductive outcome in subfertile women undergoing assisted reproduction.Methods: Consecutive women referred for subfertility between May 2009 and November 2015 who underwent assisted reproduction were included in the study. As part of the initial assessment, each woman underwent three-dimensional transvaginal sonography. Uterine morphology was classified using the modified American Fertility Society (AFS) classification of congenital uterine anomalies proposed by Salim et al. If the external contour of the uterus was uniformly convex or had an indentation of < 10 mm, but there was a cavity indentation, it was defined as arcuate or septate. Arcuate uterus was further defined as the presence of a concave fundal indentation with a central point of indentation at an obtuse angle. Subseptate uterus was defined as the presence of a septum, not extending to the cervix, with the central point of the septum at an acute angle; if the septum extended to the internal cervical os, the uterus was defined as septate. Reproductive outcomes, including live birth, clinical pregnancy and preterm birth, were compared between women with a normal uterus and those with a congenital uterine anomaly. Subgroup analysis by type of uterine morphology and logistic regression analysis adjusted for age, body mass index, levels of anti-Müllerian hormone, antral follicle count and number and day of embryo transfer were performed.Results: A total of 2375 women were included in the study, of whom 1943 (81.8%) had a normal uterus and 432 (18.2%) had a congenital uterine anomaly. The most common anomalies were arcuate (n = 387 (16.3%)) and subseptate (n = 16 (0.7%)) uterus. The rate of live birth was similar between women with a uterine anomaly and those with a normal uterus (35% vs 37%; P = 0.47). The rates of clinical pregnancy, mode of delivery and sex of the newborn were also similar between the two groups. Preterm birth before 37 weeks' gestation was more common in women with uterine anomalies than in controls (22% vs 14%, respectively; P = 0.03). Subgroup analysis by type of anomaly showed no difference in the incidence of live birth and clinical pregnancy for women with an arcuate uterus, but indicated worse pregnancy outcome in women with other major anomalies (P = 0.042 and 0.048, respectively).Conclusions: Congenital uterine anomalies as a whole, when defined using the modified AFS classification, do not affect clinical pregnancy or live-birth rates in women following assisted reproduction, but do increase the incidence of preterm birth. The presence of uterine abnormalities more severe than arcuate uterus significantly worsens all pregnancy outcomes. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

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ABSTRACT Objective To evaluate whether the antral follicle count ( AFC) is underestimated in the presence of an endometrioma. Methods This was a retrospective cohort study assessing all women undergoing in-vitro fertilization ( IVF) or intracytoplasmic sperm injection ( ICSI) at our clinic between January 2011 and December 2012 who had both ovaries and unilateral endometrioma. The primary outcome of the study was the difference between AFC and the number of oocytes retrieved per ovary. Results Within the study period 787 women underwent IVF/ ICSI at our clinic. Sixty of these women had at least one endometrioma, but 23 were excluded from the analysis as six had only one ovary and 17 had bilateral endometriomas. Therefore a total of 37 women were included in this study and analysis. Compared with the contralateral ovaries, ovaries with an endometrioma were significantly larger in volume (median, 10.3 (interquartile range ( IQR), 4.7-18.9) cm3 vs median, 3.6 ( IQR, 2.7-6.5) cm3; P < 0.001) and presented a significantly lower AFC (median, 3.0 ( IQR, 1.0-6.0) vs median, 5.0 ( IQR, 2.0-6.5); P = 0.001). However, the median number of oocytes retrieved was similar ( P = 0.60) between ovaries with an endometrioma (2.0 ( IQR, 0.5-5.0)) and the contralateral ovaries (2.0 ( IQR, 0.0-4.0)). Accordingly, the median difference between AFC and number of oocytes retrieved was significantly smaller ( P = 0.005) for ovaries with an endometrioma (0.0 ( IQR, −1.0 to 1.5) than for those without (2.0 ( IQR, 0.0-4.0)). Conclusions Although the AFC is reduced in ovaries with an endometrioma, the number of oocytes retrieved is similar, suggesting that the AFC is underestimated in such ovaries. We believe that this is a consequence of an impaired ability to detect small follicles in the presence of an endometrioma. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective To establish the prevalence of risk factors for aortic dissection, such as bicuspid aortic valve, aortic coarctation and ascending aorta dilatation, in women with low-level 45,X/46, XX mosaicism undergoing an in-vitro fertilization ( IVF) procedure. Methods The study group comprised 25 women with low-level 45,X/46, XX mosaicism (ranging from 3.3% to 10.0%) who were referred to two reproductive medicine units between 2009 and 2013 because of infertility and who underwent subsequent karyotyping. In accordance with the recommendation of the Practice Committee of the American Society for Reproductive Medicine for patients with Turner syndrome ( TS), prior to the IVF procedure, all women underwent careful cardiovascular screening for congenital heart disease and thoracic aorta dilatation, including standard cardiac examination, echocardiography and non-contrast cardiac magnetic resonance imaging. Aortic size index ( ASI, diameter of the ascending aorta normalized to body surface area) and the prevalence of coarctation of the aorta and of bicuspid aortic valve were compared with findings previously reported in women with TS and the general population. Results Bicuspid aortic valve without any stenosis or regurgitation was found in one woman in the study group with low-level 45,X/46, XX mosaicism, a statistically significantly lower prevalence of bicuspid aortic valve than that reported in women with TS. Aortic coarctation was not identified in any individual. The ASI was below the 95th percentile in all cases and the mean value was significantly lower than the mean reference values for both the general population and women with TS. Conclusion Compared with the general population, the prevalence of risk factors for aortic dissection was not found to be higher in women with low-level 45,X/46, XX mosaicism without any noticeable features except infertility. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

The article discusses a randomized, placebo-controlled study to determine if low-dose aspirin reduces uteroplacental vascular impedance and improves hemodynamics in unselected in-vitro fertilization and intracytoplasmic sperm injection (IVF/ICSI). Pregnant women who underwent IVF/ICSI were assigned to receive aspirin or placebo, and Doppler ultrasound examination was conducted during different phases of gestation. The study found that low-dose aspirin lessens uteroplacental vascular impedance.

Objective To investigate changes in utero-ovarian blood flow during the peri-implantation period and their significance in successful embryo implantation. Methods A prospective longitudinal study was conducted in 317 women undergoing in-vitro fertilization-embryo transfer (IVF-ET) treatment. All of them had at least one good-quality embryo for transfer on the second or third day after oocyte retrieval. Measurement of endometrial thickness and color flow imaging with pulsed waveform analysis of uterine and ovarian arteries were performed before ET and 5–6 days after ET. Results There were no significant differences in the age of patients, duration of infertility or number of embryos transferred between women who became pregnant (n = 91) and those who did not (n = 226). There was no difference in mean endometrial thickness between the two groups before ET, while a thicker endometrium was found in women who had conceived compared with those who had not 5–6 days after ET (P = 0.02). Mean uterine arterial resistance index (RI) and pulsatility index (PI) values were significantly lower in the pregnant than in the non-pregnant group before ET (P = 0.04 and P = 0.003, respectively), but no significant differences were found between the two groups 5–6 days after ET. In contrast, the mean ovarian arterial RI and P1 values were similar between the two groups before ET, yet the pregnant group showed significantly lower RI and PI values compared with the non-pregnant group 5–6 days after ET (P = 0.002 and P = 0.01, respectively). A significantly higher peak systolic velocity (PSV) of intraovarian vessels was also noted in the pregnant group 5–6 days after ET. [ABSTRACT FROM AUTHOR]