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We assessed whether estimation of follicular growth, rather than actual measurement of follicular size on the day of hCG trigger, affected pregnancy rates in intrauterine insemination (IUI) cycles. Patient and cycle characteristics were extracted from an existing database. Comparisons were made between the pregnant (defined as a positive beta hCG) and non-pregnant groups for the following variables: patient's age, number of previous IUI cycles, type of ovarian stimulation, endometrial thickness, number of follicles measuring 14 mm and above, pre and post wash sperm parameters, cycle day when IUI was done and number of days between last ultrasound scan and ovulation trigger. A total of 7302 cycles were included in the final analysis. In 4055 cycles (55.5%) the hCG trigger was on the day of the last ultrasound, in 2285 cycles (31.3%) the hCG trigger was 1 day after the last ultrasound, in 850 (11.6%) it was 2 days after the last ultrasound and in 112 (1.5%) it was 3 or more days after the last ultrasound. Sperm parameters, younger maternal age, and the number of follicles above 14 mm were all associated with pregnancy. No association was found between positive pregnancy test rates and the time from last ultrasound to hCG trigger. Planning IUI based on the estimation of follicular growth 1–4 days before trigger, does not affect pregnancy rates. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the combined effects of age and endometriosis on ovarian reserve in women with infertility. Methods: We conducted a cross‐sectional study using an institutional database. Women with sonographic, laparoscopic, or histologic evidence of endometriosis were defined as the study group and the remaining women served as a control group. We evaluated demographic and clinical characteristics of the groups as a whole and stratified the patients into those aged 35 years or older and those younger than 35 years at the time of ovarian reserve testing. Results: Of a total of 656 women included in the final analysis, 71 women had a diagnosis of endometriosis. When compared with women without endometriosis, the median anti‐Müllerian hormone (AMH) and antral follicular count (AFC) values were significantly lower in the group of women with endometriosis—median 2.1 ng/ml (interquartile range [IQR] 1.1–3.9) versus 1.2 ng/ml (IQR 0.6–2.4; P < 0.001) for AMH and 14 follicles (IQR 8–23) versus 7 follicles (IQR 5–14; P < 0.001) for AFC. When stratified into two age groups the association between a lower AFC and endometriosis remained significant for both age groups whereas the association between a lower AMH and endometriosis was significant only for the group of women aged 35 years oor older. Conclusion: Our study highlights a detrimental effect by endometriosis and an age enhancement effect of endometriosis on ovarian reserve. Synopsis: An endometriosis detrimental effect and age‐enhancement effect of endometriosis on ovarian reserve exists. [ABSTRACT FROM AUTHOR]

Smoking in pregnancy is associated with an increased risk of preterm birth (PTB), intrauterine growth restriction, placental abruption and perinatal death. The association between smoking and other delivery outcomes, such as chorioamnionitis, mode of delivery or postpartum hemorrhage (PPH), however, is insufficient as only few studies addressed these issues. The aim of the study was to evaluate the association between prenatal smoking and delivery outcomes in a large database, while controlling for confounding effects. A retrospective population-based study using data from the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample (HCUP‐NIS). A dataset of all deliveries between 2004 and 2014 (inclusively) was created. Our control group included all pregnant women who did not smoke during pregnancy, which was compared to pregnant women who smoked. A multivariate logistic analysis was conducted, adjusting for any statistically significant confounding effects. Our study identified 9,096,788 births between 2004 and 2014. Of which, 443,590 (4.8%) had a documented diagnosis of smoking. A significantly higher risk was found for PTB (odds ratio 1.39, CI 1.35–1.43), preterm premature rupture of membranes (odds ratio 1.52, CI 1.43–1.62) and small for gestational age (SGA) neonates (odds ratio 2.27, CI 2.19–2.35). The risks of preeclampsia (odds ratio 0.82, CI 0.78–0.85), chorioamnionitis (odds ratio 0.88, CI 0.83–0.4), PPH (odds ratio 0.94 CI 0.9–0.98) and operative vaginal delivery (odds ratio 0.9, CI 0.87–0.94) were lower among smokers. This large database confirms the findings of previous smaller studies, according to which smoking decreases the risk of preeclampsia while increasing the risk of PTB and SGA neonates. The current study also revealed a decreased risk for PPH as well as for chorioamnionitis among pregnant smokers. [ABSTRACT FROM AUTHOR]