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A pilot study was carried out to test the efficacy of the autologous mitochondrial transfer therapy (AUGMENT) technique. No improvements in pregnancy rate, development, or embryo quality were observed in the AUGMENT-treated group versus the Control group in this study. The main objective of this research is to analyze whether AUGMENT technology did have any impact on the obstetric and perinatal outcomes of pregnancies and children resulting from treated oocytes. Follow up study of women with a livebirth who participated in a pilot randomized controlled trial in which sibling MII oocytes were randomly allocated to AUGMENT + intracytoplasmic sperm injection (ICSI) (AUGMENT group) or ICSI alone (control group). Preimplantation genetic testing for aneuploidy was performed in both groups. Pregnancy and neonatal outcomes of 14 women (15 pregnancies) and their 18 children were analyzed. The information was retrieved by reviewing the medical records or through questionnaires sent to the patients. No differences were found in this small case series between the AUGMENT and control groups regarding the rate of gestational complications, birth defects, gestational age at delivery (271.4 ± 12.56 vs 278 ± 10.4 days), birthweight (3.1 ± 0.6 kg vs. 3.1 ± 0.4 kg) and neonatal outcome. The few pregnancies achieved using AUGMENT oocyte therapy had similar outcomes than controls in this very small series. Our very preliminary data need to be confirmed in larger samples. The long term follow up of these children also needs to be analyzed. • Transfer of embryos derived from AUGMENT apparently does not influence gestational variables. • Transfer of embryos derived from AUGMENT apparently does not influence perinatal variables. • The information obtained is relevant to experts in assisted reproductive techniques. • Our very preliminary findings need to be validated in larger samples. [ABSTRACT FROM AUTHOR]

To evaluate the efficacy of vaginal progesterone for the prevention of preterm birth and adverse perinatal outcomes in twin gestations. MEDLINE, Embase, LILACS, and CINAHL (from their inception to January 31, 2023), Cochrane databases, Google Scholar, bibliographies, and conference proceedings. Randomized controlled trials that compared vaginal progesterone to placebo or no treatment in asymptomatic women with a twin gestation. The systematic review was conducted according to the Cochrane Handbook for Systematic Reviews of Interventions. The primary outcome was preterm birth <34 weeks of gestation. Secondary outcomes included adverse perinatal outcomes. Pooled relative risks with 95% confidence intervals were calculated. We assessed the risk of bias in each included study, heterogeneity, publication bias, and quality of evidence, and performed subgroup and sensitivity analyses. Eleven studies (3401 women and 6802 fetuses/infants) fulfilled the inclusion criteria. Among all twin gestations, there were no significant differences between the vaginal progesterone and placebo or no treatment groups in the risk of preterm birth <34 weeks (relative risk, 0.99; 95% confidence interval, 0.84–1.17; high-quality evidence), <37 weeks (relative risk, 0.99; 95% confidence interval, 0.92–1.06; high-quality evidence), and <28 weeks (relative risk, 1.00; 95% confidence interval, 0.64–1.55; moderate-quality evidence), and spontaneous preterm birth <34 weeks of gestation (relative risk, 0.97; 95% confidence interval, 0.80–1.18; high-quality evidence). Vaginal progesterone had no significant effect on any of the perinatal outcomes evaluated. Subgroup analyses showed that there was no evidence of a different effect of vaginal progesterone on preterm birth <34 weeks of gestation related to chorionicity, type of conception, history of spontaneous preterm birth, daily dose of vaginal progesterone, and gestational age at initiation of treatment. The frequencies of preterm birth <37, <34, <32, <30, and <28 weeks of gestation and adverse perinatal outcomes did not significantly differ between the vaginal progesterone and placebo or no treatment groups in unselected twin gestations (8 studies; 3274 women and 6548 fetuses/infants). Among twin gestations with a transvaginal sonographic cervical length <30 mm (6 studies; 306 women and 612 fetuses/infants), vaginal progesterone was associated with a significant decrease in the risk of preterm birth occurring at <28 to <32 gestational weeks (relative risks, 0.48–0.65; moderate- to high-quality evidence), neonatal death (relative risk, 0.32; 95% confidence interval, 0.11–0.92; moderate-quality evidence), and birthweight <1500 g (relative risk, 0.60; 95% confidence interval, 0.39–0.88; high-quality evidence). Vaginal progesterone significantly reduced the risk of preterm birth occurring at <28 to <34 gestational weeks (relative risks, 0.41–0.68), composite neonatal morbidity and mortality (relative risk, 0.59; 95% confidence interval, 0.33–0.98), and birthweight <1500 g (relative risk, 0.55; 95% confidence interval, 0.33–0.94) in twin gestations with a transvaginal sonographic cervical length ≤25 mm (6 studies; 95 women and 190 fetuses/infants). The quality of evidence was moderate for all these outcomes. Vaginal progesterone does not prevent preterm birth, nor does it improve perinatal outcomes in unselected twin gestations, but it appears to reduce the risk of preterm birth occurring at early gestational ages and of neonatal morbidity and mortality in twin gestations with a sonographic short cervix. However, more evidence is needed before recommending this intervention to this subset of patients. [ABSTRACT FROM AUTHOR]

The first case in the English-language medical literature of anti-Jr a antibody during pregnancy in a Spanish woman is described. The few reported cases to date about this issue are reviewed, with advice as to an obstetric guideline to follow for pregnant women with this antibody. (Am J Obstet Gynecol 2001;184:75-6.) [ABSTRACT FROM AUTHOR]

Objective To assess outcomes after oocyte vitrification on obstetric and perinatal outcomes compared with those achieved with fresh oocytes. Design Retrospective cohort study. Setting Private university-affiliated IVF center. Patient(s) Children born after use of vitrified oocytes (1,027 from 804 pregnancies) and fresh oocytes (1,224 from 996 pregnancies). Singleton and multiples pregnancies from own and donated ova were included. Intervention(s) Oocyte vitrification by the Cryotop method. Main Outcome Measure(s) Pregnancy, delivery, and neonatal outcomes. Result(s) Vitrification had no clinically relevant adverse effects on obstetric and perinatal outcomes after adjusting for potential confounders. No differences were found between the vitrified and fresh oocyte groups in the rate of obstetric problems (including diabetes, pregnancy-induced hypertension, preterm birth, anemia, and cholestasis), gestational age at delivery, birth weight, Apgar scores, birth defects, admission to neonatal intensive care unit (ICU), perinatal mortality, and puerperal problems. Only a greater number of invasive procedures (adjusted odds ratio 2.12; 95% confidence interval 1.41–3.20), and a reduced occurrence of urinary tract infection (adjusted odds ratio 0.51; 95% confidence interval 0.28–0.91), were observed in the vitrified oocytes group. Conclusion(s) Although our data, the largest series to date, suggest that oocyte vitrification does not increase adverse obstetric and perinatal outcomes in children conceived with vitrified oocytes, further studies with larger samples are required to reinforce our conclusions. [ABSTRACT FROM AUTHOR]

Presents a letter to the editor discussing whether antenatal steroids can be considered a fetal stress test in cases of severe placental insufficiency

Objective: To compare obstetric and perinatal outcomes of singleton pregnancies resulting from embryos incubated in a time-lapse system (TLS) with those of embryos grown in standard IVF incubators (SI).Design: Retrospective description of a cohort of patients who conceived during a randomized, controlled trial.Setting: Private university-affiliated IVF center.Patient(s): Of 856 randomized patients, 378 gave birth to a live-born infant: 216 of the deliveries originated from embryos incubated in TLS, and 162 deliveries were from embryos cultured in SI.Intervention(s): Embryo incubation and selection in TLS.Main Outcome Measure(s): Delivery and neonatal outcomes.Result(s): No significant differences were observed in the baseline characteristics of the study population. The delivery rate was 49.3% (TLS) vs. 40.0% (SI), and multiple deliveries were higher in the TLS group: 31.0% (67 of 216) vs. 24.7% (40 of 162) in the SI group. When singleton pregnancies were analyzed no differences were found between the two groups in the rate of obstetric problems with respect to weeks at delivery: 38.8 (95% confidence interval [CI] 38.4-39.1) (TLS) vs. 39.5 (95% CI 38.0-39.9) (SI); preterm births (<37 weeks): 10.7% (TLS) vs. 12.3% (SI); and very preterm births (<34 weeks): 2.9% (TLS) vs. 3.3% (SI). No statistical differences were found in neonatal outcomes such as birth weight: 3,163 g (95% CI 3,035-3,292 g) (TLS) vs. 3,074 (95% CI 2,913-3,236) (SI); low birth weight (<2,500 g): 12.8% (TLS) vs. 12.3% (SI); very low birth weight (<1,500 g): 2.0% (TLS) vs. 2.4% (SI); or height: 50.3 cm (95% CI 49.6-50.9 cm) (TLS) vs. 49.7 (95% CI 48.9-50.4 cm) (SI). No major malformations or perinatal mortality were found in either of the two groups.Conclusion(s): No detrimental effects were observed in obstetric and perinatal outcomes when a time-lapse incubator was used rather than a more widely used conventional incubator. As far as we know this is the first report from a randomized study of the neonatal outcomes of time-lapse monitoring. Our results suggest that this technology is an effective and safe alternative for embryo incubation, though trials of larger numbers of patients are required to further confirm our conclusions.Clinical Trial Registration Number: NCT01549262. [ABSTRACT FROM AUTHOR]

Objective: First, to assess if there are any differences in birth weight or gestational length in newborns from egg-donation pregnancies delivering singletons, originating from either fresh or frozen-thawed embryos when they were developed and delivered within the same mothers. Second, to determine if there are any clinical, phenotypic, or laboratory factors influencing this relationship, including the origin of the oocyte (same or different donor), the order of the children (first fresh or first frozen-thawed embryo transfer), the embryo freezing technique (vitrification or slow freezing), the in vitro embryo culture length, and the duration that embryos remained frozen.Design: Retrospective cohorts study.Setting: University-affiliated infertility centers.Patient(s): A total of 360 women undergoing oocyte donation (OD), delivering (>28 weeks) at least two babies, each one from a single pregnancy, originating from at least one fresh and one frozen-thawed embryo transfer, controlling maternal and laboratory characteristics, to test the effect of embryo freezing on children size (n = 731).Intervention(s): None.Main Outcome Measure(s): Birth weight, gestational age, weight percentile, being large for gestational age (LGA), small for gestational age (SGA), size out of normal range (ONR = LGA + SGA), and macrosomy.Result(s): From fresh versus thawed embryos, respectively, mean birth weight of children was 3,183.7 g versus 3,226.4 g, gestational age was 272.1 days versus 268.8 days, and mean weight percentiles were 47.6 versus 50.1. The proportions and corresponding odds ratios (ORs) from fresh versus thawed embryos, respectively, were for LGA 13.6% versus 11.3% (OR 0.81), for SGA 9.4% versus 12.5% (OR 1.37), for ONR 23.1% versus 23.8% (OR 1.04), and for macrosomy 0.3% versus 0.8% (OR 3.1). After adjusting for clinically relevant variables, the ORs were for LGA 0.96, for SGA 1.40, for ONR 1.20, and for macrosomy not computable. None of the stated measures were significantly different. Also, independent analyses run on the origin of the oocytes, cryopreservation technique, cleavage stage of the embryos, and time that embryos remained frozen did not reveal any significant trends.Conclusion(s): This study comparing siblings from OD cycles, and eliminating the independent variables that affect early events in pregnancy, revealed no difference in duration of gestation and live birth weights between fetuses obtained after the replacement of fresh or frozen embryos. Moreover, no clinical, phenotypic, or laboratory factors appeared to be relevant, once statistically controlled. [ABSTRACT FROM AUTHOR]

Objective To evaluate cost-effectiveness of transfemoral TAVR vs surgical replacement (SAVR) and its determinants in patients with severe symptomatic aortic stenosis and comparable risk. Methods Patients were prospectively recruited in 6 Spanish hospitals and followed up over one year. We estimated adjusted incremental cost-effectiveness ratio (ICER) (Euros per quality-adjusted life-year [QALY] gained) using a net-benefit approach and assessed the determinants of incremental net-benefit of TAVR vs SAVR. Results We analyzed data on 207 patients: 58, 87 and 62 in the Edwards SAPIEN (ES) TAVR, Medtronic-CoreValve (MC) TAVR and SAVR groups respectively. Average cost per patient of ES-TAVR was ∊8800 higher than SAVR and the gain in QALY was 0.036. The ICER was ∊148,525/QALY. The cost of MC-TAVR was ∊9729 higher than SAVR and the QALY difference was - 0.011 (dominated). Results substantially changed in the following conditions: 1) in patients with high preoperative serum creatinine the ICERs were ∊18,302/QALY and ∊179,618/QALY for ES and MC-TAVR respectively; 2) a 30% reduction in the cost of TAVR devices decreased the ICER for ES-TAVR to ∊32,955/QALY; and 3) imputing hospitalization costs from other European countries leads to TAVR being dominant. Conclusions In countries with relatively low health care costs TAVR is not likely to be cost-effective compared to SAVR in patients with intermediate risk for surgery, mainly because of the high cost of the valve compared to the cost of hospitalization. TAVR could be cost-effective in specific subgroups and in countries with higher hospitalization costs. [ABSTRACT FROM AUTHOR]

In our series, a very high prevalence of chromosomal abnormalities was observed in spontaneous miscarriages, irrespective of how pregnancy was achieved, by assisted reproductive technology (ART) or natural conception. This high prevalence was equally represented in both groups, with no statistical difference in type of chromosomal abnormalities or in total frequency; however, the incidence of monosomy X is increased and the polyploidies are decreased in abortus after intracytoplasmic sperm injection (ICSI) when it is compared with miscarriages after spontaneous gestations. [Copyright &y& Elsevier]

Objective: To analyze the potential role of extraovarian factors such as endometrium in the reproductive outcome of obese patients. Design: Retrospective study. Setting: University-affiliated infertility clinic, between January 2001 and July 2005. Patient(s): Women undergoing a total of 2656 first ovum donation (OD) cycles with good quality embryos. Intervention(s): The oocyte donors underwent controlled ovarian hyperstimulation, and recipients received a well-established hormonal replacement therapy for endometrial preparation. In vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) was performed according to semen characteristics. All first cycles (n = 2656) of ovum donation used good quality embryos and were divided into groups according to body mass index: <20 kg/m2 (n = 471), 20 to 24.9 kg/m2 (n = 1613), 25 to 29.9 kg/m2 (n = 450), and ≥30 kg/m2 (n = 122). Main Outcome Measure(s): The recipient body mass index groups were compared regarding IVF outcome. Result(s): The rates of implantation, pregnancy, miscarriage, and ongoing pregnancy were similar among the body mass index groups, although there was a negative trend when body mass index increased. Ongoing pregnancy rates per cycle were poorer in the overweight and obese groups than in the underweight and normal groups. In addition, women under 25 kg/m2 presented an ongoing pregnancy rate per cycle of 45.5%, compared with 38.3% for those with ≥25 kg/m2. Conclusion(s): Excess weight exerts an extraovarian detrimental effect. The role of the endometrium or its environment seems to be subtle but should be taken into account. [Copyright &y& Elsevier]

: ObjectiveTo assess the potential of direct embryo and chorion biopsies obtained by hysteroembryoscopy for karyotyping early missed abortions.: DesignClinical prospective descriptive study.: SettingInstituto Valenciano de Infertilidad, Valencia, Spain.: Patient(s)Sixty-eight women (71 gestational sacs) with missed abortions. The gestational age on ultrasound was 6.3 weeks (range, 4–10 weeks).: Intervention(s)Transcervical hysteroembryoscopy before curettage.: Main outcome measure(s)Comparison between the cytogenetic results from hysteroembryoscopic biospies and those of the curettage material.: Result(s)Hysteroembryoscopic biopsies could be taken in 97.2% of the gestational sacs. Direct embryo and chorion biopsies were suitable for chromosomal analysis. Selective samples identified misdiagnoses of the conventional curettage karyotype due to maternal contaminating tissues in 22.2% of the cases. Direct hysteroembryoscopic biopsies also enabled the diagnosis of a true placental mosaicism and the study of the individual karyotype of each gestational sac in bizygotic twin missed abortions.: Conclusion(s)In early missed abortions, karyotypes from direct hysteroembryoscopic biopsies were more accurate than those from the curettage material. The finding of a 46,XX karyotype in the curettage material is not a reliable result. [Copyright &y& Elsevier]

Objective: To analyze whether assisted conceptions need adjustments in first-trimester Down syndrome screening and why modifications in screening markers occur. Design: Eleven-year cohort retrospective analysis. Setting: Maternal-fetal medicine unit. Patient(s): Two thousand eleven naturally conceived normal singleton pregnancies and 2,042 normal singleton pregnancies achieved with assisted conception: 350 by IUI and 1,692 with IVF (n = 328) or intracytoplasmic sperm injection (ICSI; n = 1,364), using nondonor (n = 1,086) or donated ova (n = 606), with fresh (n = 1,432) or frozen (n = 260) embryos. Intervention(s): Comparison of ultrasound and biochemical markers of first-trimester Down syndrome screening according to the mode of conception and considering the clinical and laboratory parameters related. Main Outcome Measure(s): Nuchal translucency (NT), PAPP-A and free βhCG maternal serum concentrations, and false-positive rates (FPRs). Result(s): NT is unaffected by the mode of conception. Singleton pregnancies achieved by IVF and ICSI with nondonor oocytes have reduced maternal serum PAPP-A and increased FPR, which are significant only in ICSI cycles. Pregnancies from frozen embryos with hormone therapy also show decreased PAPP-A but without affecting the FPR. Elevated maternal serum fβhCG levels in oocyte donation do not influence the FPR. Conclusion(s): Among assisted conceptions, only nondonor IVF/ICSI singleton pregnancies need adjustments of the maternal serum PAPP-A in first-trimester Down syndrome screening. [ABSTRACT FROM AUTHOR]