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• Interval from pregnancy loss to next IVF did not affect chances of conception • Shorter cycle interval post-biochemical or spontaneous vs. medical or surgical loss • Miscarriage type and number embryos transferred affected chance of next pregnancy • Pregnancy chance lower after medical or surgical vs. biochemical or spontaneous loss • Higher chance of live birth with shorter interval to first cycle post-miscarriage Is the interval length between an early pregnancy loss and the following treatment cycle a predictor for achieving clinical pregnancy among IVF patients? This retrospective cohort study of 257 women who reinitiated treatment after first-trimester IVF pregnancy loss was conducted at a tertiary, university-affiliated medical centre between 1 January 2014 to 1 January 2018. Women aged 18–40 years, with normal uterine cavity, who experienced first-trimester pregnancy loss at less than 14 weeks after IVF, were included. Miscarriages were classified as spontaneous, biochemical, medical or surgical. Among 257 women, interval to subsequent IVF treatment was not associated with achieving pregnancy. Patients after biochemical pregnancy (72.7 ± 56.4, median 60 days) or spontaneous miscarriage (97.7 ± 93.1, median 66 days) had shorter intervals to next cycle, compared with medical (111.9 ± 103.2, median 65 days) or surgical (123.4 ± 111.1, median 84 days) (Kaplan–Meier, P = 0.03) miscarriages. Logistic regression analysis showed that the chance of subsequent pregnancy was affected by the number of embryos transferred (P = 0.009) and the type of miscarriage. Medical (P = 0.005) and surgical (P = 0.017) miscarriages were related to lower likelihood of pregnancy compared with biochemical pregnancy (reference group). When pregnancy was achieved in the first post-miscarriage cycle, the chance of live birth increased with shorter intervals (median 57.5 days), whereas second miscarriage was related to longer intervals (median 82.5 days) between miscarriage and subsequent IVF cycle (P = 0.03). On the basis of this cohort, IVF should not be postponed after pregnancy loss, as shorter intervals were associated with greater likelihood of live birth. [ABSTRACT FROM AUTHOR]

The redacted classification of placental lesions identifies in the group of fetal-stromal vascular lesions a subgroup called villous capillary lesions. The causes of villous capillary lesions appear to involve excessive angiogenesis. These conditions include chorangiosis, chorangiomatosis, chorangioma and a rare variant of the latter called multiple chorangioma syndrome where multiple chorangiomas, ranging from very small early precursor lesions to typical macroscopic chorangioma, occupy up to 80% of the total placental parenchyma. We present the first case of multiple chorangioma syndrome in an oncologic patient who obtained the pregnancy by egg donation, comparing the clinical case with ones available in literature. Fifteen cases have been previously published in literature but only 11 were eligible for the present review. We compared clinical characteristics and fetal outcomes with our clinical case, to highlight similarities and differences useful for a better understanding of this rare and partially unknown disease. Multiple chorangioma syndrome is a rare villous capillary lesion associated with poor fetal condition. All cases analyzed have been conceived naturally and our case is the first described in an IVF pregnancy. We believe that in our case the advanced maternal age, the method of conception and the previous chemo-therapeutic treatments might have played an important role in determining the manifestation of this rare placental condition. However, there is not appropriate literature supporting our consideration and, for future studies, it could be reasonable investigate the incidence of this condition, or even the incidence of all cluster of villous capillary lesions, in oncologic and IVF patients. [ABSTRACT FROM AUTHOR]

What is the influence of the Caesarean section–pregnancy interval (CSPI) on the risk of uterine rupture, and what are the repercussions on IVF pregnancy rates of prolonging it? Systematic searches were performed using PubMed MEDLINE to identify studies published up until July 2017 for articles with the following keywords: 'interdelivery interval' and 'uterine rupture'; 'interpregnancy interval' and 'uterine rupture'; 'interpregnancy interval' and 'cesarean section'; and 'uterine rupture' and 'cesarean section'. The search identified 1609 articles, of which six were included (involving 56,419 women). Four reported significantly higher uterine rupture rates in cases of a short CSPI. From the analysis, the uterine rupture rate can be modelled by a formula corresponding to a hyperbolic curve. There is no clear cut-off in uterine rupture in relation to CSPI. The curve showed a sharp decrease in uterine rupture until the 10th month of CSPI (uterine rupture rate 0.7%), then a moderate and steady decrease until the 40th month (uterine rupture rate 0.4%) and afterwards a very mild decrease. From the data it is possible to calculate, according to the age of the woman, the expected reduction in IVF rates and uterine rupture as CSPI increases. The risk of uterine rupture in relation to CSPI can be represented by means of a hyperbolic curve. After a 10-month CSPI, the expected uterine rupture rate is close to 0.7%. The impact of prolonging or reducing this interval on IVF pregnancy rates can be easily obtained from the table included in the article. This should be helpful in the decision-making process for both patients and physicians. [ABSTRACT FROM AUTHOR]

Highlights • IVF pregnancy was associated with elevated hair As, Hg, Li, K, and Na levels. • Hair Fe, Si, and Zn content was reduced in women with IVF pregnancy. • Children from IVF pregnancy had lower hair Cr, Fe, Mg, Sr, and Al levels. • Hair Hg and Mo were increased in children from IVF pregnancy. Abstract The objective of the present study was to assess toxic and nutritional trace element and mineral status in hair of women with IVF pregnancy and their children. Inductively-coupled plasma mass-spectrometry was used to assess hair trace element levels of 50 women with IVF pregnancy and 158 controls with spontaneous pregnancy and their children. Women with IVF pregnancy were characterized by significantly elevated hair As, Hg, Li, K, Na, and reduced Fe, Si, and Zn contents. Children from IVF pregnancy had significantly lower values of hair Cr, Fe, Mg, Sr, and Al content when compared to the control values, whereas hair Hg and Mo levels were higher. Hair trace element levels were associated with pregnancy complications and infertility, but not newborn characteristics. The results suggest the need for preconceptional monitoring and correction of the levels of toxic and essential elements in women in order to improve the course pregnancy and child development. [ABSTRACT FROM AUTHOR]

Abstract Research question Does the blastocyst development stage on embryo transfer day affect serum β-human chorionic gonadotrophin (β-HCG) concentration 9 and 16 days after embryo transfer in women whose pregnancy progresses beyond 13 weeks? Design Retrospective study involving 204 cases where pregnancy progressed beyond 13 weeks of single blastocyst transfer in fresh (n = 66) or frozen embryo transfer (FET) (n = 138) cycles from January 2015 to September 2016. Results β-HCG concentrations 9 and 16 days after embryo transfer in FET cycles (median 223 IU/l and 4378 IU/l, respectively) were significantly (P < 0.001) higher than in fresh cycles (157 IU/l and 2813 IU/l). Among fresh cycles, faster-growing blastocysts (expanded + hatching + hatched blastocysts) produced significantly (P < 0.001) higher β-HCG concentrations 9 days after embryo transfer (191 IU/l) than slower-growing blastocysts (cavitating + full blastocyst, 106 IU/l); however no significant difference was found between the faster- and slower-growing groups by day 16 (2359 IU/l and 3025 IU/l, respectively). Among FET cycles, there was no difference in β-HCG concentration between blastocysts of different development stages 9 and 16 days after transfer. Conclusions Faster-growing blastocysts produced significantly higher serum β-HCG concentrations 9 days after transfer than slower-growing blastocysts in fresh cycles, but the difference was not significant by day 16 after transfer. Also, β-HCG concentrations 9 and 16 days after embryo transfer in FET cycles were higher than in fresh embryo transfer cycles. Interpretation of β-HCG results 9 days after blastocyst transfer should consider the blastocyst growth rate and whether fresh or cryopreserved embryo was transferred. [ABSTRACT FROM AUTHOR]

Folic acid supplements are commonly used by infertile women which leads to a positive folate status. However, the effect of folic acid supplements on pregnancy outcome in women with unexplained Infertility has not been well investigated. This study evaluated folic acid supplement use and folate status in women with unexplained infertility in relation to IVF pregnancy outcome. In addition, use of folic acid supplements and folate status were compared between women with unexplained infertility and fertile, nonpregnant control women. Women with unexplained infertility used significantly more folic acid supplements and had higher median total folic acid intake from supplements compared with fertile control women (both P < 0.001). Women with unexplained infertility also had significantly higher median plasma folate and lower median plasma homocysteine concentrations than fertile women (both P < 0.001), but folic acid supplementation or folate status were not related to pregnancy outcome in women with unexplained infertility. In conclusion, folic acid supplementation or good folate status did not have a positive effect on pregnancy outcome following infertility treatment in women with unexplained infertility. [ABSTRACT FROM AUTHOR]

We introduce two rare obstetric entities. They show very similar image findings, but the prognosis is different. Prognosis is generally favorable for complete hydatidiform mole with coexisting fetus (CHMCF), but placental mesenchymal dysplasia (PMD) has high fetal and neonatal mortality. Differential diagnosis is essential to management of pregnancy. Twin pregnancies with CHMCF are characterized by the coexistence of complete mole (diploid without fetal parts) and a normal live fetus with a normal placenta. US Findings: 1. Normal fetus and normal placenta with umbilical cord insertion 2. Separated molar placenta, vesicular sonographic pattern Differential Diagnosis: Partial mole (Triploid) Hematoma in placenta (normal β-hCG level) Placental mesenchymal dysplasia Biochemistry: β-hCG concentrations are extremely high • Chorionic villus sampling can be useful to differentiate in early pregnancy between CHMCF and partial hydatidiform mole • Amniocentesis or fetal blood sampling • Genotype of a CHM is entirely of paternal origin • Management of pregnancies with CHMCF has not been standardized • Continuation of CHMCF is an acceptable option: Intensive maternal follow up ultrasonography and β-hCG level monitoring • The chance of a live birth is 7 - 37%. • Complications: Fetal death, vaginal bleeding, preeclampsia, hyperthyroidism, gestational trophoblastic neoplasia Case 1: A 31-year old woman, gravida 2, para 0 CC: IUP at 17 weeks with abnormal placenta. Serum β-hCG levels: 234,358 mIU/mL (elevated) Fetal US: IUP at 17 weeks Twin pregnancy with complete H-mole and coexisting fetus Emergency Cesarian section for fetal distress at 27 wks Delivery: Boy, Apgar score 1'-1, 5'-1 Cytogenetic report: 46, XY, normal Pathological Diagnosis: Complete hydatidiform mole with coexisting fetus Case 2: A 32-year old woman, gravida 1, para 0 CC: IVF pregnancy follow up Serum β-hCG levels: 1,873,485 mIU/mL (elevated) Fetal US: IUP at 8 weeks Twin pregnancy with complete H-mole and coexisting fetus Dilatation and evacuation for vaginal bleeding at 10 weeks Pathological Diagnosis: Complete hydatidiform mole with coexisting fetus Part I: multiple fragments of placental tissue (about 5cc) with variable sized cysts (up to 0.7cm) Part II: multiple fragments of placental tissue (5 × 3cm) without grape like cystic change Developed persistent trophoblastic disease and 18 cycle chemotherapy Case 3: A 34-year old woman, gravida 1, para 0 CC: IVF pregnancy follow up fetus Serum β-hCG levels: 306,645 mIU/mL (elevated) Fetal US: IUP at 17 weeks Twin pregnancy with complete H-mole and coexisting fetus Rare placental lesion estimated to occur in 0.02% of pregnancies. Placental enlargement, dilated and tortuous chorionic vessels, and a focal distribution of cystically enlarged villi. US Findings: Typical large and thickened with multicystic, hypoechoic areas Differential Diagnosis: Partial mole, complete hydatidiform mole with coexisting fetus (CHMCF), chorangioma, intervillous hematoma, infarct or nonspecific hydropic changes • Characteristic morphologic features • Lack of trophoblastic hyperplasia –> maternal serum β-hCG levels are not elevated or only slightly elevated • No known risk of persistent gestational trophoblastic disease • No other specific maternal serum markers • Perinatal demise: not certain, but high as 43% • Cause of fetal death: Massive fetal hemorrhage secondary to rupture of delated periumbilical chorionic vessels Case 4: A 34-year old woman, gravida 1, para 0 CC: IUP at 12 weeks weeks Twin pregnancy with complete H-mole and coexisting fetus Serum β-hCG levels: 39,249 mIU/mL Fetal US: IUP at 12 weeks Twin pregnancy with complete H-mole and coexisting fetus Chorionic Villus Sampling (12 weeks) • Normal appearing placenta: 46, XX Normal • Abnormal appearing placenta: 46, XX Normal QF-PCR: placental mesenchymal dysplasia Pathological Diagnosis: Placental mesenchymal dysplasia Case 5: A 35-year old woman, gravida 2, para 1 CC: IUP 19 weeks, abnormal enlarged and honeycomb shaped placenta Serum β-hCG levels: none Fetal US: IUP at 20 weeks Twin pregnancy with complete H-mole and coexisting fetus R/O Placental mesenchymal dysplasia Amniocenthesis: Mosaicism 47,XY +15[3]/46,XX[31] Pathological Diagnosis: Placental mesenchymal dysplasia Complete Hydatidiform Mole with Coexisting Fetus vs Placental Mesenchymal Dysplasia We proposed two differential diagnosis points 1. Proportion of two patterns of placenta - CHMCF: similar size of two patterns of placenta - PMD: dominant vesicular pattern placenta 2. Umbilical cord insertion - CHMCF: center of normal placenta - PMD: junction of two different patterns of placenta → finally insert into abnormal placenta [ABSTRACT FROM AUTHOR]

Objective: To reexamine whether low sperm HspA2 ratios (formerly sperm CK-M ratio) are predictive for failure to cause pregnancies by in vitro fertilization (IVF) and to explore whether there are other male or female factors that may be predictive for IVF pregnancy outcome.Design: Retrospective, cohort study.Setting: University-based IVF program.Patient(s): In 119 IVF cycles, three patient groups were studied: 25 men had a <10% sperm HspA2 ratio and a lack of pregnancies (HS <10% group), 50 men had a >10% sperm HspA2 ratio and no pregnancies (HS >10%NP group), and another 44 couples had a >10% sperm HspA2 ratio but did achieve pregnancies (HS >10%P group).Intervention(s): Sperm HspA2 ratio determinations within 1 year of the IVF cycles and analysis of male and female IVF cycle parameters.Main Outcome Measure(s): Sperm HspA2 ratio determinations within 1 year of the IVF cycles and analysis of male and female IVF cycle parameters.Result(s): In the three groups, male and female ages, number and maturation level of oocytes, and morphology of embryos were similar. In the HS < 10% group, mean sperm concentration and motility were close to normal, the fertilization and cleavage rates were lower, and cycles without any oocyte fertilization were higher. These parameters were similar in the two HS > 10% groups. The receiver operating characteristic curve in men with sperm HspA2 ratios of <17% (diminished and borderline sperm maturity) provided a cutoff value of 10.84% HspA2 ratio with a 100% positive predictive value for failure to achieve pregnancy, whether the men were oligospermic or normospermic.Conclusion(s): HspA2 ratios of <10% in the diminished sperm maturity range predict the failure to cause pregnancies by IVF. Thus, IVF should be bypassed in favor of ICSI. The occurrence of pregnancy with ICSI depends on the maturity of sperm selected, and it may not be as likely as in other indications for ICSI. [ABSTRACT FROM AUTHOR]

Jaundice in early pregnancy after in vitro fertilization (IVF) is extremely rare. We report a case of severe jaundice in an IVF treated patient, with a clinical picture similar to intrahepatic cholestasis of pregnancy (ICP). We suggest strategies to prevent similar cases in the future. [Copyright &y& Elsevier]

This study compared the odds of adverse obstetrical outcomes of pregnancies in women who conceived from IVF ( n = 464) versus spontaneous conception ( n = 1171) after stratification into three body mass index (BMI) groups: normal weight (18.5–24.9 kg/m 2 ), overweight (25.0–29.9 kg/m 2 ) and obese (>30 kg/m 2 ). With increasing BMI, incidences of complications between IVF and spontaneously conceived groups narrowed. Among women with normal BMI, IVF pregnancies were associated with increased odds of placental ischaemic disorders (11.3% versus 7.0%, adjusted odds ratio [aOR] = 2.24; 95% confidence interval [CI] = 1.25–4.04) and low birthweight <2500 g (10.6% versus 8.0%, aOR = 2.08; 95% CI = 1.12–3.88). Among overweight women, only low birthweight (<2500 g) was significantly increased (15.6% versus 6.2%, aOR = 4.33; 95%, CI = 1.61–11.63). For obese women, there were no differences between IVF and spontaneously conceived pregnancies for either placental ischaemic disorders (12.5 versus 20.2%, OR = 0.43, 95% CI = 0.17–1.1) or low birthweight (10.0% versus 11.0%, aOR = 0.7, 95% CI = 0.24–2.08). Overall, the odds of adverse obstetrical outcomes were not significantly greater in IVF singleton pregnancies compared with those conceived spontaneously as BMI increased. [ABSTRACT FROM AUTHOR]

Objective: To compare obstetric and perinatal outcomes between pregnancies conceived using in vitro fertilization (IVF) and natural pregnancies of the same women.Design: This was a case-control study of deliveries between November 2008 and January 2020 in which each IVF pregnancy was matched to a natural pregnancy of the same woman (1:1 ratio).Setting: University hospital.Patient(s): We included women with consecutive live singleton deliveries (>24 weeks of gestation) at the Edith Wolfson Medical Center. We excluded IVF pregnancies attained using egg donation.Intervention(s): In vitro fertilization-attained pregnancies (as compared with natural ones).Main Outcome Measure(s): Primary outcome: preterm birth (PTB).Secondary Outcomes: small for gestational age (SGA) neonates and pregnancy-induced hypertension (PIH; gestational hypertension or pre-eclampsia).Result(s): A total of 544 IVF pregnancies were matched to 544 natural pregnancies, each in the same woman. In 292 women (53.7%), the natural pregnancy preceded the IVF pregnancy. Maternal age was significantly higher in IVF deliveries. Gestational age at delivery and the rates of PTB, PIH, instrumental delivery, cesarean delivery, and SGA neonates were comparable between IVF and natural pregnancies. Birth weight was slightly lower in IVF pregnancies. On multivariate analysis, IVF was not independently associated with PTB, SGA, or PIH after adjustment for confounders.Conclusion(s): When compared in a cohort of the same women, natural and IVF-attained pregnancies did not differ with regard to obstetric and perinatal outcomes. [ABSTRACT FROM AUTHOR]

Purpose: We assessed the reliability and validity of Taiwan's version of FertiQoL, with a focus on the association between quality of life (QoL) and in-vitro-fertilization (IVF) pregnancy.Methods: 410 women undergoing IVF treatment were included. QoL measured by Taiwan's version of FertiQoL was assessed before embryo transfer. Item properties were examined using corrected item-total correlation, Rasch mean-square (MnSq), and internal consistency. Known-group validity was assessed using IVF pregnancy (i.e., chemical pregnancy, ongoing pregnancy, live birth) as the outcomes of interest.Results: Five FertiQoL items, namely Q4, Q5, Q15, Q21, and T5, had low corrected item-total correlation (i.e., -0.146-0.290) in their embedded domains; three other items, namely Q11, Q14, and T2, did not have acceptable MnSq values in the Rasch analysis (i.e., infit MnSq: 1.31-2.28; outfit MnSq: 1.95-4.57). These items were removed and a refined Taiwan's FertiQoL was generated. The internal consistency for the refined Taiwan's FertiQoL was improved (α = 0.928) with the capability of distinguishing women who had successful live birth from those who had failed live birth (i.e., 72.40 ± 12.71vs. 69.21 ± 13.26; p = 0.019).Conclusion: The study results demonstrate that the refined Taiwan's FertiQoL is valid and reliable, suggesting that this FertiQoL should refined to be culturally and language appropriate for Taiwanese population. [ABSTRACT FROM AUTHOR]