Paternal age and maternal age are risk factors for miscarriage; results of a multicentre European study

Haplotype analysis of IL-10 gene polymorphism in couples with spontaneous abortions and aborted fetuses

Spontaneous abortion is the loss of pregnancy during an early gestational period. Interleukin-10 is an anti-inflammatory cytokine which plays an important role in successful pregnancy outcome. The aim of the study is to elucidate an association of IL-10 gene promoter polymorphisms (-1082G/A, -819 C/T, -592C/A) in spontaneous abortions from Telangana state of South India. The present population-based retrospective case-control triad study includes a total of 80 case families with spontaneous abortions and 100 control families with medically terminated pregnancies. Peripheral blood from all the couples and fetal tissues of <20 weeks of gestation were collected. Genotype analysis was carried out by a standard amplification refractory mutation system-polymerase chain reaction followed by agarose gel electrophoresis. The strength of the association between IL-10 gene promoter polymorphisms and spontaneous abortions were measured by odd ratios and their respective 95% confidence intervals. Haplotype analysis was carried out for the three polymorphisms to establish an association of specific haplotypes with spontaneous abortions. The increased frequency of AA genotype and A allele of -1082G/A, TT genotype and T allele of -819C/T, and AA genotype and A allele of -592C/A was observed in case fetuses and case mothers compared to their respective controls. Haplotype analysis revealed that A-C-A, G-C-A haplotypes in fetuses and haplotypes A-C-C, G-T-C, A-T-A, and G-C-A in mothers were associated with increased risk of spontaneous abortions. IL-10 gene promoter polymorphisms may act as a major genetic regulator in the etiology of spontaneous abortions with maternal genome imprinting effects.

Cytogenetic analysis in couples with recurrent miscarriages: a retrospective study from Punjab, north India

Human reproduction is considered as the most inefficient event as ~15-20% of human pregnancies end in miscarriage and in the product of miscarriages, chromosomal anomalies are a common occurrence. The aim of the present retrospective study was to assess the frequency of chromosomal aberrations in couples with recurrent miscarriages in the region of Punjab and to compare with worldwide frequencies. In this study, a total of 440 cases were referred between the period 1995-2015. After lymphocyte culturing, giemsa-trypsin banding was done for each case to assess the chromosomal anomalies. The frequency of chromosomal aberrations among couples was found to be 3.41% in our study. Among these aberrations, balanced reciprocal translocations formed the largest group with 60% anomalies. We would conclude that clinicians should understand the importance of chromosomal analysis in these couples and refer them for karyotyping after two miscarriages to rule out the possible genetic cause of recurrent miscarriages.

Advanced paternal age and stillbirth rate: a nationwide register-based cohort study of 944,031 pregnancies in Denmark

Advanced paternal age has been associated with a variety of rare conditions and diseases of great public health impact. An increased number of de novo point mutations in sperm with increasing age have been suggested as a mechanism, which would likely also affect fetal viability. We examined the association between paternal age and stillbirth rate in a large nationwide cohort. We identified all pregnancies in Denmark from 1994 to 2010 carried to a gestational age of at least 22 completed weeks (n = 944,031) as registered in national registers and linked to individual register data about the parents. The hazard ratio of stillbirth according to paternal age was estimated, adjusted for maternal age in 1-year categories, year of outcome, and additionally parental educational levels. The relative rate of stillbirth (n = 4946) according to paternal age was found to be J-shaped with the highest hazard ratio for fathers aged more than 40 years when paternal age was modelled using restricted cubic splines. When modelled categorically, the adjusted hazard ratios of stillbirth were as follows: <25, 1.16 (95% confidence interval, CI 1.01-1.34); 25-29, 1.03 (95% CI 0.95-1.11); 35-39, 1.16 (95% CI 1.07-1.26); 40-44, 1.41 (95% CI 1.26-1.59); 45-49, 1.20 (95% CI 0.97-1.49); 50+, 1.58 (95% CI 1.18-2.11), compared with fathers aged 30-34 years. These estimates attenuated slightly when further adjusted for parental education. Our study showed that paternal age was associated with the relative rate of stillbirth in a J-shaped manner with the highest hazard ratios among fathers aged more than 40 years.

[Effects of father's age on fertility, results of ART and health of children]

Many studies exist on the impact of female age on fertility, success of assisted reproductive technologies and on obstetric, fetal and neonatal adverse outcomes. Late paternity seems commonplace especially in the media… But there are reliable scientific data which confirm decline of fertility related to male age but also an increased risk of genetic diseases for the offspring. The objective of this article is to make a synthesis of the literature on this subject.

Advanced parental age and autism risk in children: a systematic review and meta-analysis

OBJECTIVE

Advanced parental age has raised additional concern as a risk factor of autism. We conducted a meta-analysis of observational studies investigating the association between advanced parental age and risk of autism.

METHOD

PubMed, EMBASE, and Web of Science were searched for reports published up to November 11, 2015. Risk estimates from individual studies were pooled using random-effects models.

RESULTS

Twenty-seven studies were included in the meta-analysis. Compared with the reference points, the lowest parental age category was associated with a reduced risk of autism in the offspring, with adjusted odds ratios (ORs) 0.89 (95% confidence intervals [CIs] 0.75-1.06) and 0.81 (95% CI 0.73-0.89) for mother and father, respectively, and the highest parental age category was associated with an increased risk of autism in the offspring, with adjusted ORs 1.41 (95% CI 1.29-1.55) and 1.55 (95% CI 1.39-1.73) for mother and father respectively. Dose-response meta-analysis indicated that an increase of 10 years in maternal and paternal age was associated with an 18% and 21% higher risk of autism.

CONCLUSION

Advanced parental age was associated with an increased risk of autism in the offspring. More mechanistic studies are needed to further explain this positive association.

The impact of male age on embryo quality: a retrospective study using time-lapse imaging

OBJECTIVE

This study aimed to correlate male age with embryo morphokinetic parameters on D3 considering the timing and the exact moment of embryo cleavage.

METHODS

Time-lapse imaging was used to produce an ideal cleavage curve for the embryos analyzed. The percentage of embryos under the curve was analyzed and correlated with male age.

RESULTS

32.6% of the embryos from patients aged 28-33 years were under the curve; 36.2% of the embryos from patients aged 34-39 years were under the curve; 41.3% of the embryos from patients aged 40-45 years were under the curve; and 26.3% of the embryos fro patients aged 46-57 years were under the curve.

CONCLUSIONS

a statistically non-significant decrease was observed in the percentage of embryos under the optimal cleavage curve on D3 in the group of men aged between 40 and 45 years. Further studies looking into embryos in the blastocyst stage (D5 or D6) are required.

No Association between TNF-α -308G/A Polymorphism and Idiopathic Recurrent Miscarriage: A Systematic Review with Meta-Analysis and Trial Sequential Analysis

Background

Conflicting results were reported on the association between the TNF-α -308G/A polymorphism and idiopathic recurrent miscarriage (IRM). Though three meta-analyses have been conducted on this topic, the conclusions were contradictory, and the results may be unreliable as certain crucial conditions were neglected.

Method

A complete search was conducted in PubMed, Cochrane Library, and Embase, other sources like Google Scholar, ClinicalTrial.gov and reference lists of relevant articles were also retrieved. All candidate articles were accessed and screened using specific inclusion and exclusion criteria. Statistical analyses were performed on data extracted from eligible studies using the STATA 12.0 software and the TSA 0.9 beta software.

Results

Eventually, 12 case-control studies from 11 publications (with 1,807 cases and 2,012 controls) were included in this meta-analysis, and no evidence of any significant association was found in the overall analyses between the TNF-α -308G/A polymorphism and IRM risk. However, significant association was shown in Asian population (four studies from three publications) in the dominant model (AA + GA vs. GG), the allelic model (A vs. G), and the heterozygote model (GA vs. GG).

Conclusions

TNF-α -308G/A polymorphism is not associated with IRM risk. Though significant association was found in Asian population, the result needs further confirmation from more studies.

Analysis of urinary human chorionic gonadotrophin concentrations in normal and failing pregnancies using longitudinal, Cox proportional hazards and two-stage modelling

Background

Human chorionic gonadotrophin is a marker of early pregnancy. This study sought to determine the possibility of being able to distinguish between healthy and failing pregnancies by utilizing patient-associated risk factors and daily urinary human chorionic gonadotrophin concentrations.

Methods

Data were from a study that collected daily early morning urine samples from women trying to conceive (n = 1505); 250 of whom became pregnant. Data from 129 women who became pregnant (including 44 miscarriages) were included in these analyses. A longitudinal model was used to profile human chorionic gonadotrophin, a Cox proportional hazards model to assess demographic/menstrual history data on the time to failed pregnancy, and a two-stage model to combine these two models.

Results

The profile for log human chorionic gonadotrophin concentrations in women suffering miscarriage differs to that of viable pregnancies; rate of human chorionic gonadotrophin rise is slower in those suffering a biochemical loss (loss before six weeks, recognized by a rise and fall of human chorionic gonadotrophin) and tends to plateau at a lower log human chorionic gonadotrophin in women suffering an early miscarriage (loss six weeks or later), compared with viable pregnancies. Maternal age, longest cycle length and time from luteinizing hormone surge to human chorionic gonadotrophin reaching 25 mIU/mL were found to be significantly associated with miscarriage risk. The two-stage model found that for an increase of one day in the time from luteinizing hormone surge to human chorionic gonadotrophin reaching 25 mIU/mL, there is a 30% increase in miscarriage risk (hazard ratio: 1.30; 95% confidence interval: 1.04, 1.62).

Conclusion

Rise of human chorionic gonadotrophin in early pregnancy could be useful to predict pregnancy viability. Daily tracking of urinary human chorionic gonadotrophin may enable early identification of some pregnancies at risk of miscarriage.

[Social freezing - the male perspective]

BACKGROUND

In Germany there is an emerging trend for postponing parenthood due to non-medical, sociocultural reasons. This clearly impacts on the reproductive success due to an age-dependent decrease in fertility. Thus, strategies and techniques are currently discussed which could preserve the female fertility status, among which social freezing (cryopreservation of oocytes) for later fertilization is the most realistic one; however, while there is an intensive discussion on the procedure and timing of oocyte cryopreservation, virtually no attention has been paid to the male side and the aging effects on the male germ cells.

AIM

To evaluate the risk paternal age poses for the integrity of germ cells.

METHODS

For this review a literature search using PubMed, data from the Federal Statistical Office of Germany, the German in vitro fertilization (IVF) register as well as own data were used.

RESULTS

Sperm cell integrity is clearly affected by age both at the genetic as well as at the epigenetic levels. The estimated mutation rate for spermatozoa doubles every 16.5 years. Monogenic and multifactorial diseases are strongly associated with paternal age. Men aged >40 years have an increased risk of passing age-related mutations to their children.

CONCLUSIONS

Cryopreservation of spermatozoa is an option for men who postpone planning a family. Genetic counseling is recommended for couples undertaking social freezing and a male age of >40 years.

Associations of recurrent miscarriages with chromosomal abnormalities, thrombophilia allelic polymorphisms and/or consanguinity in Saudi Arabia

BACKGROUND

Recurrent pregnancy loss (RPL) or recurrent spontaneous abortion is an obstetric complication that affects couples at reproductive age. Previous reports documented a clear relationship between parents with chromosomal abnormalities and both recurrent miscarriages and infertility. However, limited data is available from the Arabian Peninsula which is known by higher rates of consanguineous marriages. The main goal of this study was to determine the prevalence of chromosomal abnormalities and thrombophilic polymorphisms, and to correlate them with RPL and consanguinity in Saudi Arabia.

METHODS

Cytogenetic analysis of 171 consent patients with RPL was performed by the standard method of 72-h lymphocyte culture and GTG banding. Allelic polymorphisms of three thrombophilic genes (Factor V Leiden, Prothrombin A20210G, MTHFR C677T) were performed using PCR-RFLP (restriction fragment length polymorphism) and gel electrophoresis.

RESULTS

Data analysis revealed that 7.6 % of patients were carrier of numerical or structural chromosomal abnormalities. A high rate of translocations (46 %) was associated to increased incidence of RPL. A significant correlation between consanguineous RPL patients and chromosomal abnormalities (P < 0.05) was found. Both Factor V Leiden and Prothrombin A20210G allelic polymorphisms were significantly associated with a higher prevalence of RPL.

CONCLUSIONS

This study demonstrated a strong association between RPL and the prevalence of chromosomal abnormalities and inherited thrombophilia. Given the high rate of consanguineous marriages in the Saudi population, these results underline the importance of systematic cytogenetic investigation and genetic counseling preferably at the premarital stage or at least during early pregnancy phase through preimplantation genetic diagnosis (PGD).

The proliferative phase underpins endometrial development: Altered cytokine profiles in uterine lavage fluid of women with idiopathic infertility

Endometrial gland development occurs during the proliferative phase of a woman's menstrual cycle, laying the foundation for the subsequent receptive, secretory phase when pregnancy is established. Idiopathic infertility has been rarely investigated with respect to the proliferative phase endometrium. We investigated whether gland development and/or altered secretion of cytokines during the proliferative phase is associated with infertility. Area of the glandular epithelium (GE) was measured in proliferative phase endometrial tissue collected from fertile (n=18) and infertile (n=14) women. Cytokines were measured in proliferative phase uterine lavage of fertile (n=15) and infertile (n=15) women. Immunohistochemistry determined cellular localisation of transforming growth factor alpha (TGFα) and interferon gamma (IFNγ) in proliferative phase endometrial tissue. For statistical analysis the cohort was divided into women <35years and ⩾35years. There were no significant differences in GE area of infertile and fertile women. C-C motif chemokine 11 (P=0.048), TGFα (P=0.049), IFNγ (P=0.033) and interleukin-1 alpha (P=0.047) were significantly elevated in uterine lavage from infertile women <35years compared to fertile but not in women ⩾35years. TGFα and IFNγ localised predominantly to GE in both the fertile and infertile endometrium. The potential impact of this altered proliferative phase environment on subsequent receptivity is discussed.

Does age of the sperm donor influence live birth outcome in assisted reproduction?

STUDY QUESTION

Does age of the sperm donor have an effect on reproductive outcomes (live birth rate and miscarriage occurrence) of donor insemination or in vitro fertilization treatment using donated sperm?

SUMMARY ANSWER

Live birth and miscarriage occurrence in assisted reproduction treatment using donor sperms was not found to be affected by the age of sperm donors up to 45 years old.

WHAT IS ALREADY KNOWN

Literature on the effect of sperm donor age on outcome of medically assisted reproduction is scarce. Most researchers agree that semen parameters deteriorate with increasing paternal age. However, there is no substantial evidence to suggest that this deterioration adversely affects the reproductive outcomes in couples undergoing medically assisted reproduction.

STUDY DESIGN, SIZE, DURATION

This retrospective cohort study analysed 46 078 first donor insemination treatments and fresh in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) cycles using donated sperm from 1991 to 2012.

PARTICIPANTS/ DURATION/METHODS

The first fresh donor insemination and IVF/ICSI treatment cycles (46 078 treatment cycles) using donated sperm from the long-term anonymized data registry from 1991 to 2012 of the HFEA, the UK regulator, were analysed by the binary logistic modelling technique for association between sperm donor age and reproductive outcomes (live birth occurrence and miscarriage occurrence). The statistical package SPSS (version 21) was used for analysis and results were considered to be statistically significant if the P-value was <0.05.

MAIN RESULTS AND THE ROLE OF CHANCE

Of 46 078 women, 84.6% (N = 38 974) underwent donor insemination treatment and the remainder, 15.4% (N = 7104), had IVF/ICSI treatment with donor sperm. The live birth occurrence decreased with increasing female age in both treatment groups; In the donor insemination treatment group, it was 11.1% in 18-34 year old women, 8.3% in 35-37 year old women and 4.7% in 38-50 year old women. The corresponding figures in the IVF/ICSI treatment group were 28.9, 22.0 and 12.9% respectively. In each of these subgroups, no evidence of declining likelihood of live birth with increasing sperm donor age was found (P > 0.05). The miscarriage occurrence (i.e. number of miscarriages per 100 women commencing treatment) was 1.3% in 18-34 year old women, 1.9% in 35-37 year old women and 1.9% in 38-50 year old women undergoing donor insemination treatment. In the sperm donation IVF/ICSI treatment group, these figures were 5.7, 8.4 and 6.8% respectively. The results were not suggestive of any unfavourable effect of advancing sperm donor age on the odds of miscarriage occurrence (P > 0.05).

LIMITATIONS, REASONS FOR CAUTION

As sperm donors are a select population based on good semen indices, the generalization of results to the paternal population at large may not be possible. Although the study subgroups were controlled for female age, treatment modality and effect of previous treatment cycles, adjustments for certain potential compounding factors, such as smoking status, BMI of women and stimulation protocol used in IVF/ICSI treatment cycles, were not possible.

WIDER IMPLICATIONS OF THE FINDINGS

Live birth and miscarriage occurrence following assisted reproduction weren't adversely affected by increasing sperm donor age up to 45 years. In view of the increasing demand for donor sperm, further studies may be required to ascertain the safe upper age limit for sperm donors.

STUDY FUNDING/COMPETING INTERESTS

No funding was received from any individual or funding agency. NG was on a Commonwealth Scholarship for the duration of the study. The authors do not have any conflicts of interest to declare.

The role of infection in miscarriage

BACKGROUND

Miscarriage is the spontaneous loss of a pregnancy before 12 weeks (early miscarriage) or from 12 to 24 weeks (late miscarriage) of gestation. Miscarriage occurs in one in five pregnancies and can have considerable physiological and psychological implications for the patient. It is also associated with significant health care costs. There is evidence that potentially preventable infections may account for up to 15% of early miscarriages and up to 66% of late miscarriages. However, the provision of associated screening and management algorithms is inconsistent for newly pregnant women. Here, we review recent population-based studies on infections that have been shown to be associated with miscarriage.

METHODS

Our aim was to examine where the current scientific focus lies with regards to the role of infection in miscarriage. Papers dating from June 2009 with key words 'miscarriage' and 'infection' or 'infections' were identified in PubMed (292 and 327 papers, respectively, on 2 June 2014). Relevant human studies (meta-analyses, case-control studies, cohort studies or case series) were included. Single case reports were excluded. The studies were scored based on the Newcastle - Ottawa Quality Assessment Scale.

RESULTS

The association of systemic infections with malaria, brucellosis, cytomegalovirus and human immunodeficiency virus, dengue fever, influenza virus and of vaginal infection with bacterial vaginosis, with increased risk of miscarriage has been demonstrated. Q fever, adeno-associated virus, Bocavirus, Hepatitis C and Mycoplasma genitalium infections do not appear to affect pregnancy outcome. The effects of Chlamydia trachomatis, Toxoplasma gondii, human papillomavirus, herpes simplex virus, parvovirus B19, Hepatitis B and polyomavirus BK infections remain controversial, as some studies indicate increased miscarriage risk and others show no increased risk. The latest data on rubella and syphilis indicate increased antenatal screening worldwide and a decrease in the frequency of their reported associations with pregnancy failure. Though various pathogens have been associated with miscarriage, the mechanism(s) of infection-induced miscarriage are not yet fully elucidated.

CONCLUSIONS

Further research is required to clarify whether certain infections do increase miscarriage risk and whether screening of newly pregnant women for treatable infections would improve reproductive outcomes.

Effect of maternal and treatment-related factors on the prevalence of birth defects after PESA-ICSI and TESE-ICSI: a retrospective cohort study

INTRODUCTION

We performed a retrospective cohort study with the aim to evaluate the effect of maternal and treatment-related factors on the prevalence of birth defects after intracytoplasmic sperm injection (ICSI) using percutaneous epididymal sperm aspiration (PESA) and testicular sperm extraction (TESE).

MATERIAL AND METHODS

643 newborns born after PESA-ICSI (n = 406) and TESE-ICSI (n = 237) in Radboud University Medical Center, after a gestational age of 12 weeks, 1 January 2002-1 January 2011 and 1 March-1 November 2014, respectively, were included in this study. Three sources of data were used for analysis: questionnaires, national obstetrics registration forms, and a lab-database of all ICSI treatments. Data were analyzed using generalized estimating equations and logistic regression analysis.

RESULTS

The prevalence of major birth defects in newborns born after PESA-ICSI was 6.9% and after TESE-ICSI was 5.9% (odds ratio 0.89, 95% confidence interval 0.46-1.75). No significant association was found between maternal or treatment-related factors and the prevalence of birth defects.

CONCLUSIONS

We found a similar overall prevalence of birth defects in newborns born after PESA-ICSI and TESE-ICSI. The maternal and treatment-related factors investigated did not show a significantly increased cumulative risk of birth defects.

Effect of Paternal Age on Reproductive Outcomes of In Vitro Fertilization

Although the adverse effects of maternal aging on reproductive outcomes have been investigated widely, there is no consensus on the impact of paternal age. Therefore, we investigated the effect of paternal age on reproductive outcomes in a retrospective analysis of 9,991 in vitro fertilization (IVF) cycles performed at the Reproductive Medicine Center of the Third Affiliated Hospital of Guangzhou Medical University (China) between January 2007 and October 2013. Samples were grouped according to maternal age [<30 (3,327 cycles), 30-34 (4,587 cycles), and 35-38 (2,077 cycles)] and then subgrouped according to paternal age (<30, 30-32, 33-35, 36-38, 39-41, and ≥42). The groups did not differ in terms of fertilization rate, numbers of viable and high-quality embryos and miscarriage rate when controlling maternal age (P >0.05). Chi-squared analysis revealed that there were no differences in implantation and pregnancy rates among the different paternal age groups when maternal age was <30 and 35-38 years (P >0.05). However, implantation and pregnancy rates decreased with paternal age in the 31-34 y maternal age group (P <0.05). Our study indicates that paternal age has no impact on fertilization rate, embryo quality at the cleavage stage and miscarriage rate. For the 30-34 y maternal age group, the implantation rate decreased with increased paternal age, with the pregnancy rate in this group being significantly higher in the paternal <30 y and 30-32 y age groups, compared with those in the 36-38 y and 39-41 y groups.

A functional polymorphism in the promoter region of interleukin-10 gene increases the risk for spontaneous abortions--a triad study

PURPOSE

Spontaneous abortion or miscarriage is the natural death of an embryo or foetus in the early stages of prenatal development. Interleukin-10 is an anti-inflammatory cytokine, produced by human cytotrophoblasts, and defects in its production result in specific pathological conditions during pregnancy. The present study is aimed to evaluate the association of IL-10 -1082G/A polymorphism in spontaneous abortions by comparing foetal, maternal and paternal groups--a triad study.

METHODS

A total of 50 families with spontaneous abortions and 60 families with medically terminated pregnancies were considered for the present study. DNA from foetal tissue and parental blood samples were extracted, and the genotype analysis of IL-10 -1082G/A promoter polymorphism was carried out by amplification refractory mutation system-polymerase chain reaction followed by agarose gel electrophoresis. A statistical analysis was applied to test for the significance of the results.

RESULTS

There was a statistically significant difference in the distribution of AA genotypes and A allele of IL-10 -1082G/A between the two family groups among foetuses (P = 0.0002) and mothers (P = 0.00005). The paternal group showed no significant difference in the genotype distribution of IL-10 between cases and controls.

CONCLUSION

In conclusion, IL-10 G-1082A gene promoter polymorphism may act as a major genetic regulator in the etiology of spontaneous abortions.

Maternal Folate Concentration in Early Pregnancy and Newborn Telomere Length

BACKGROUND/AIMS

Telomere biology plays a fundamental role in genomic integrity and cell physiology. The newborn setting of telomere length (TL) likely has important implications for telomere dynamics over the lifespan; however, its determinants are poorly understood. Folate is essential for DNA integrity. The maternal compartment is the only source of folate for the developing fetus. We, therefore, tested the hypothesis that variation in maternal folate during pregnancy is associated with newborn TL.

METHODS

A prospective, longitudinal study was conducted in 119 mother-newborn dyads. Eligible mothers were enrolled at 9.5 (SD ±2.1) weeks gestation and followed through birth. Concentrations of maternal serum folate were measured in the first trimester of pregnancy. Newborn telomere length was measured in cord blood mononuclear cells (CBMC).

RESULTS

After accounting for the effects of other established determinants of newborn TL, each 10 ng/ml increase in maternal total folate was associated with a 5.8% increase in median TL (p = 0.03). The median TL in newborns of mother in the lowest quartile of total folate levels was approximately 10% shorter than that of newborns of mothers in the highest folate quartile.

CONCLUSIONS

Our findings suggest that fetal TL exhibits developmental plasticity, and provide evidence that maternal nutrition may exert a 'programming' effect on this system.

Effects of increased paternal age on sperm quality, reproductive outcome and associated epigenetic risks to offspring

Over the last decade, there has been a significant increase in average paternal age when the first child is conceived, either due to increased life expectancy, widespread use of contraception, late marriages and other factors. While the effect of maternal ageing on fertilization and reproduction is well known and several studies have shown that women over 35 years have a higher risk of infertility, pregnancy complications, spontaneous abortion, congenital anomalies, and perinatal complications. The effect of paternal age on semen quality and reproductive function is controversial for several reasons. First, there is no universal definition for advanced paternal ageing. Secondly, the literature is full of studies with conflicting results, especially for the most common parameters tested. Advancing paternal age also has been associated with increased risk of genetic disease. Our exhaustive literature review has demonstrated negative effects on sperm quality and testicular functions with increasing paternal age. Epigenetics changes, DNA mutations along with chromosomal aneuploidies have been associated with increasing paternal age. In addition to increased risk of male infertility, paternal age has also been demonstrated to impact reproductive and fertility outcomes including a decrease in IVF/ICSI success rate and increasing rate of preterm birth. Increasing paternal age has shown to increase the incidence of different types of disorders like autism, schizophrenia, bipolar disorders, and childhood leukemia in the progeny. It is thereby essential to educate the infertile couples on the disturbing links between increased paternal age and rising disorders in their offspring, to better counsel them during their reproductive years.

Male biological clock: a critical analysis of advanced paternal age

Extensive research defines the impact of advanced maternal age on couples' fecundity and reproductive outcomes, but significantly less research has been focused on understanding the impact of advanced paternal age. Yet it is increasingly common for couples at advanced ages to conceive children. Limited research suggests that the importance of paternal age is significantly less than that of maternal age, but advanced age of the father is implicated in a variety of conditions affecting the offspring. This review examines three aspects of advanced paternal age: the potential problems with conception and pregnancy that couples with advanced paternal age may encounter, the concept of discussing a limit to paternal age in a clinical setting, and the risks of diseases associated with advanced paternal age. As paternal age increases, it presents no absolute barrier to conception, but it does present greater risks and complications. The current body of knowledge does not justify dissuading older men from trying to initiate a pregnancy, but the medical community must do a better job of communicating to couples the current understanding of the risks of conception with advanced paternal age.

Safety of Chinese herbal medicines during pregnancy

Miscarriage and infertility have long been public concerns due to the mental and physical suffering they bring to potential parents. There is a strong need for effective and affordable treatments. Chinese herbal medicines (CHMs) have been shown to be effective for preventing miscarriage and treating infertility; however, due to the limited knowledge of their pharmacological mechanisms and unknown potential toxicity, their use has been restricted. This paper reviews 24 clinical trials of CHMs to prevent miscarriage and treat infertility. Most of these studies did not meet the requirements of randomized controlled trials. Even when using quality assessments based on the Newcastle-Ottawa Scale to assess the quality of non-randomized studies, most studies did not meet the requirements. The reviewed papers were evaluated for maternal and embryonic adverse effects, including those in animal experiments. Slight maternal effects were noted, with some reports of severe toxic effects of CHMs for preventing miscarriage and severe adverse maternal effects of CHMs used for infertility. Owing to the poor quality of the randomized controlled clinical trials and the limited number of studies, it is not possible to draw a conclusion. From animal studies, for all three gestational periods, growth delay and congenital anomalies were the most commonly recorded adverse effects. However, baseline toxicological data and detailed mechanisms are still lacking. To gain a better understanding of the potential toxic effects of CHMs, additional high-quality randomized controlled trials should be conducted, and high-throughput in vitro screening method for baseline data should be considered.

The Sperm Epigenome, Male Aging, and Potential Effects on the Embryo

The effect of paternal aging on fertility, embryo quality, and offspring health is an important area of study that has received far less attention than the age effect in women. This is, in part, due to the fact that in females there are dramatic alterations to fertility and pregnancy outcomes that abruptly occur as a female ages. Such abrupt alterations to pregnancy success and/or embryonic and offspring health are not seen in males. Instead, there are subtle alterations to pregnancy success and offspring phenotypes that occur as a man ages. It is believed that, at least in part, these alterations can be explained by perturbations to the sperm epigenome that occur over time. This chapter will explore the effect of aging on the sperm epigenome and the potential impacts these perturbations may have on embryonic development and ultimately offspring health.

Consistent age-dependent declines in human semen quality: a systematic review and meta-analysis

Reduced fertility typically occurs among women in their late 30s, but increasing evidence indicates that advanced paternal age is associated with changes in reproduction as well. Numerous studies have investigated age-based declines in semen traits, but the impact of paternal age on semen parameter values remains inconclusive. Using data from 90 studies (93,839 subjects), we conducted a systematic review and meta-analysis to quantify the effect of male age on seven ejaculate traits (semen volume, sperm concentration, total sperm count, morphology, total motility, progressive motility and DNA fragmentation). Age-associated declines in semen volume, percentage motility, progressive motility, normal morphology and unfragmented cells were statistically significant and results generally seemed to be robust against confounding factors. Unexpectedly, sperm concentration did not decline with increasing male age, even though we found that sperm concentration declined over time. Our findings indicate that male age needs more recognition as a potential contributor to the negative pregnancy outcomes and reduced offspring health associated with delayed first reproduction. We suggest that greater focus on collection of DNA fragmentation and progressive motility in a clinical setting may lead to better patient outcomes during fertility treatments of aging couples.

Recurrent spontaneous miscarriage is still a challenging diagnostic and therapeutic quagmire

Recurrent spontaneous miscarriage (RSM), affecting 1-2% of women of reproductive age seeking pregnancy, has been a clinical quagmire and a formidable challenge for the treating physician. There are many areas of controversy in the definition, aetiology, investigations and treatment of RSM. This review will address the many factors involved in the aetiology of RSM which is multifactorial in many patients, with antiphospholipid syndrome (APS) being the most recognized aetiological factor. There is no identifiable cause in about 40-60% of these patients, in which case the condition is classified as idiopathic or unexplained RSM. The RSM investigations are extensive and should be undertaken in dedicated, specialized, well-equipped clinics/centres where services are provided by trained specialists. The challenges faced by the treating physician are even more overwhelming regarding the decision of what should be the most appropriate therapy offered to patients with RSM. Our review will cover the diverse modalities of therapy available including the role of preimplantation genetic testing using recent microarray technology, such as single nucleotide polymorphism and comparative genomic hybridization, as well as preimplantation genetic diagnosis; the greatest emphasis will be on the treatment of APS, and there will be important comments on the management of patients presenting with idiopathic RSM. The controversial areas of the role of natural killer cells in RSM, the varied modalities in the management of idiopathic RSM and the need for better-planned studies will be covered as well.

Infertile men older than 40 years are at higher risk of sperm DNA damage

BACKGROUND

The effect of paternal age on semen quality is controversial. In this retrospective study, the aim was to investigate the effects of advancing age on sperm parameters including reactive oxygen species (ROS), total antioxidant capacity (TAC) and sperm DNA damage in infertile men. We also examined whether paternal age >40 y is associated with higher risk of sperm DNA damage.

METHODS

A total of 472 infertile men presenting for infertility were divided into 4 age groups: group A: patients ≤ 30 y; group B: patients 31- 40 y, group C: ≤ 40 y and group D: patients >40 y. The following tests were performed - semen analysis according to WHO 2010 criteria, seminal ROS by chemiluminescence, TAC by colorimetric assay and sperm DNA damage by TUNEL assay - and the results were compared amongst the 4 age groups.

RESULTS

There was no statistical difference in conventional semen parameters, TAC and ROS with advancing paternal age as well as between different age groups. However, a significant negative association was noted between sperm DNA damage and advancing paternal age. Men >40 y showed higher levels of sperm DNA damage (24.4 ± 18.5%) compared to younger men (<30 y; 16.7 ± 11.2%; p <0.05).

CONCLUSIONS

Infertile men over the age of 40 y have a greater percentage of sperm DNA fragmentation compared to infertile men aged 40 y and below. Advanced paternal age (>40 y) may increase the risk of sperm DNA damage in infertile men.

Predictors of miscarriage: a matched case-control study

OBJECTIVES:

The risk factors for miscarriage vary across communities and countries. This study was conducted to investigate the predictors of miscarriage in the west of Iran.

METHODS:

This matched case-control study was conducted in Hamadan Province from April 2013 to March 2014. Cases were selected from women who had a recent spontaneous abortion and controls were selected from women who had a recent live birth. Two controls were selected for every case and matched for date of pregnancy and area of residence. Multivariate conditional logistic regression analysis was performed and odds ratios (ORs) and 95% confidence intervals (CIs) were calculated.

RESULTS:

Five hundred fifty cases were compared with 1,091 controls. The OR of miscarriage was 1.58 (95% CI=1.30-1.92) for every five-year increase in age, 0.20 (95% CI=0.14-0.28) for every live birth, and 3.43 (95% CI=2.03-5.79) for a history of previous spontaneous abortion. Compared to nulliparous women, primiparous or multiparous women had an OR of 17.85 (95% CI=6.65-47.91) for miscarriage. There was a strong association between miscarriage and abnormal amniotic status (OR, 2.46; 95% CI, 0.46-13.09) and also abnormal placenta status (OR, 10.44; 95% CI, 0.95-114.92); however, these associations were not statistically significant. No significant associations were observed between miscarriage and body mass index, previous history of stillbirth, low birth weight, congenital anomaly, ectopic pregnancy, impaired thyroid function, or high blood pressure.

CONCLUSIONS:

Our study suggests that miscarriage is a multifactorial outcome associated with several modifiable and non-modifiable risk factors that may vary among different communities.

[Epidemiology of loss pregnancy]

OBJECTIVES

Study of epidemiology of pregnancy loss.

MATERIALS AND METHOD

A systematic review of the literature was performed using Pubmed and the Cochrane library databases and the guidelines from main international societies.

RESULTS

The occurrence of first trimester miscarriage is 12% of pregnancies and 25% of women. Miscarriage risk factors are ages of woman and man, body mass index greater than or equal to 25kg/m(2), excessive coffee drinking, smoking and alcohol consumption, exposure to magnetic fields and ionizing radiation, history of abortion, some fertility disorders and impaired ovarian reserve. Late miscarriage (LM) complicates less than 1% of pregnancies. Identified risk factors are maternal age, low level of education, living alone, history of previous miscarriage, of premature delivery and of previous termination of pregnancy, any uterine malformation, trachelectomy, existing bacterial vaginosis, amniocentesis, a shortened cervix and a dilated cervical os with prolapsed membranes. Fetal death in utero has a prevalence of 2% in the world and 5/1000 in France. Its main risk factors are detailed in the chapter.

Prepregnancy dietary patterns and risk of pregnancy loss

BACKGROUND

Two previous case-control studies observed associations between specific food groups and risk of miscarriage; however, to our knowledge, no previous studies have investigated dietary patterns and risk of pregnancy loss.

OBJECTIVE

We aimed to assess prepregnancy adherence to the alternate Healthy Eating Index 2010 (aHEI-2010), alternate Mediterranean diet (aMED), and Fertility Diet (FD) and risk of pregnancy loss.

DESIGN

Our prospective cohort study included 15,950 pregnancies reported by 11,072 women in the Nurses' Health Study II between 1992 and 2009. Diet was assessed every 4 y starting in 1991 by using a validated food-frequency questionnaire. Prepregnancy dietary pattern scores were computed as the sum of a woman's score on each pattern's predefined components. Multivariable log-binomial regression models with generalized estimating equations were used to estimate RRs and 95% CIs.

RESULTS

Incident spontaneous abortions and stillbirths were reported in 2756 (17.3%) and 120 (0.8%) pregnancies, respectively. None of the 3 dietary patterns were associated with risk of pregnancy loss. In the multivariable model, RR of pregnancy loss for a 1-SD increase in score was 1.02 (95% CI: 0.98, 1.05) for the aMED pattern, 1.01 (95% CI: 0.98, 1.05) for the aHEI-2010 pattern, and 0.98 (95% CI: 0.95, 1.01) for the FD pattern. Results were consistent when pregnancy loss was classified as either a spontaneous abortion (loss at <20 wk) or a stillbirth (loss at ≥20 wk).

CONCLUSION

Prepregnancy adherence to several dietary patterns was not associated with risk of pregnancy loss.

Whether sperm deoxyribonucleic acid fragmentation has an effect on pregnancy and miscarriage after in vitro fertilization/intracytoplasmic sperm injection: a systematic review and meta-analysis

OBJECTIVE

To examine whether sperm DNA fragmentation has an effect on pregnancy and miscarriage after IVF and/or intracytoplasmic sperm injection (ICSI).

DESIGN

Systematic review and meta-analysis.

SETTING

University-affiliated teaching hospital.

PATIENT(S)

Infertility patient(s).

INTERVENTION(S)

An exhaustive electronic literature search was conducted on MEDLINE, Google Scholar, and the Cochrane Library, from database inception to October 2013. We included clinical trials that examined the influence of sperm DNA damage on pregnancy and miscarriage of IVF/ICSI.

MAIN OUTCOME MEASURE(S)

The outcomes of interest were pregnancy rate and miscarriage rate.

RESULT(S)

In the analysis of pregnancy, 16 cohort studies (3,106 couples) were included. Of these, 14 studies (2,756 couples, 965 pregnancies) that also mentioned miscarriage were identified in the analysis of miscarriage. Meta-analysis showed that high-level sperm DNA fragmentation has a detrimental effect on outcome of IVF/ICSI, with decreased pregnancy rate and increased miscarriage rate. The stratified analysis by type of procedure (IVF vs. ICSI) indicated that high sperm DNA damage was related to lower pregnancy rates in IVF but not in ICSI cycles, whereas it was associated with higher miscarriage rates in both IVF and ICSI cycles.

CONCLUSION(S)

The results indicate that assays detecting sperm DNA damage should be recommended to those suffering from recurrent failure to achieve pregnancy. Selection of sperm without DNA damage for use may improve the clinical outcome of ART. The data also provide a rationale for conducting further research aimed at evaluating the underlying mechanism(s) responsible for the detrimental effect of high sperm DNA fragmentation and the potential therapy.

An unexpected finding: younger fathers have a higher risk for offspring with chromosomal aneuploidies

The past decades have seen a remarkable shift in the demographics of childbearing in Western countries. The risk for offspring with chromosomal aneuploidies with advancing maternal age is well known, but most studies failed to demonstrate a paternal age effect. Retrospectively, we analyzed two case data sets containing parental ages from pre- and postnatal cases with trisomies 21, 13 and 18. The reference data set contains the parental ages of the general Swiss population. We dichotomized all couples into two distinct groups. In the first group, the mothers' integral age was as least as the father's age or older. We compared the frequency of cases in nine 5-year intervals of maternal age. In addition, we computed logistic regression models for the binary endpoint aneuploidy yes/no where paternal ages were incorporated as linear or quadratic, as well as smooth functions within a generalized additive model framework. We demonstrated that the proportion of younger fathers is uniformly different between cases and controls of live-born trisomy 21 as well, although not reaching significance, for fetuses over all mother's ages. Logistic regression models with different strategies to incorporate paternal ages confirmed our findings. The negative paternal age effect was also found in pre- and postnatal cases taken together with trisomies 13 and 18. The couples with younger fathers face almost twofold odds for a child with Down syndrome (DS). We estimated odds curves for parental ages. If confirmation of these findings can be achieved, the management of couples at risk needs a major correction of the risk stratification.

Delayed fatherhood

Birth data from developed countries indicates that the average paternal age is increasing. As the trend to older fatherhood has become established, concerns have been raised that this may be linked to adverse outcomes, such as pregnancy complications, congenital anomalies, and long-term health implications for the child. Since the sperm of older fathers may be impaired due to the general effects of ageing, their offspring may be at risk due to defects in sperm quality at conception. A literature search was performed to identify pregnancy complications, fetal anomalies and health issues for the child when the father is in an older age bracket. Evidence for impairment in the sperm and genetic material of older fathers was reviewed. With an older father, there is evidence of an increase in stillbirths and a slightly increased risk of autism, bipolar disorder and schizophrenia in the offspring later in life. The increased risk of achondroplasia has long been recognised. For the mother, there is an increased rate of Caesarean section. Investigations of other possible adverse outcomes have produced mixed findings. Further robust and longitudinal studies are needed to clarify these issues.

The association between advanced maternal and paternal ages and increased adult mortality is explained by early parental loss

The association between advanced maternal and paternal ages at birth and increased mortality among adult offspring is often attributed to parental reproductive aging, e.g., declining oocyte or sperm quality. Less attention has been paid to alternative mechanisms, including parental socio-demographic characteristics or the timing of parental death. Moreover, it is not known if the parental age-adult mortality association is mediated by socioeconomic attainment of the children, or if it varies over the lifecourse of the adult children. We used register-based data drawn from the Finnish 1950 census (sample size 89,737; mortality follow-up 1971-2008) and discrete-time survival regression with logit link to analyze these alternative mechanisms in the parental age-offspring mortality association when the children were aged 35-49 and 50-72. Consistent with prior literature, we found that adult children of older parents had increased mortality relative to adults whose parents were aged 25-29 at the time of birth. For example, maternal and paternal ages 40-49 were associated with mortality odds ratios (ORs) of 1.31 (p<.001) and 1.22 (p<.01), respectively, for offspring mortality at ages 35-49. At ages 50-72 advanced parental age also predicted higher mortality, though not as strongly. Adjustment for parental socio-demographic characteristics (education, occupation, family size, household crowding, language) weakened the associations only slightly. Adjustment for parental survival, measured by whether the parents were alive when the child reached age 35, reduced the advanced parental age coefficients substantially and to statistically insignificant levels. These results indicate that the mechanism behind the advanced parental age-adult offspring mortality association is mainly social, reflecting early parental loss and parental characteristics, rather than physiological mechanisms reflecting reproductive aging.

Sapropterin dihydrochloride use in pregnant women with phenylketonuria: an interim report of the PKU MOMS sub-registry

For pregnant women with phenylketonuria (PKU), maintaining blood phenylalanine (Phe)<360μmol/L is critical due to the toxicity of elevated Phe to the fetus. Sapropterin dihydrochloride (sapropterin) lowers blood Phe in tetrahydrobiopterin (BH4) responsive patients with PKU, in conjunction with a Phe-restricted diet, but clinical evidence supporting its use during pregnancy is limited. As of June 3, 2013, the Maternal Phenylketonuria Observational Program (PKU MOMS) sub-registry contained data from 21 pregnancies - in women with PKU who were treated with sapropterin either before (N=5) or during (N=16) pregnancy. Excluding data for spontaneous abortions (N=4), the data show that the mean of median blood Phe [204.7±126.6μmol/L (n=14)] for women exposed to sapropterin during pregnancy was 23% lower, and had a 58% smaller standard deviation, compared to blood Phe [267.4±300.7μmol/L (n=3)] for women exposed to sapropterin prior to pregnancy. Women on sapropterin during pregnancy experienced fewer blood Phe values above the recommended 360μmol/L threshold. When median blood Phe concentration was <360μmol/L throughout pregnancy, 75% (12/16) of pregnancy outcomes were normal compared to 40% (2/5) when median blood Phe was >360μmol/L. Severe adverse events identified by the investigators as possibly related to sapropterin use were premature labor (N=1) and spontaneous abortion (N=1) for the women and hypophagia for the offspring [premature birth (35w4d), N=1]. One congenital malformation (cleft palate) of unknown etiology was reported as unrelated to sapropterin. Although there is limited information regarding the use of sapropterin during pregnancy, these sub-registry data show that sapropterin was generally well-tolerated and its use during pregnancy was associated with lower mean blood Phe. Because the teratogenicity of elevated maternal blood Phe is without question, sapropterin should be considered as a treatment option in pregnant women with PKU who cannot achieve recommended ranges of blood Phe with dietary therapy alone.

[Quebec Pregnancy Cohort: prevalence of medication use during gestation and pregnancy outcomes]

OBJECTIVE

Many women are exposed to medications during pregnancy. The Quebec Pregnancy Cohort (QPC) is a prospective population-based cohort which includes all data on pregnancies and children between January 1997 and December 2008.

METHODS

We linked four administrative databases in Quebec, Canada: RAMQ (medical and pharmaceutical), MED-ECHO (hospitalizations), ISQ (births/deaths), and MELS (Ministry of Education). Pregnancies included were covered by the Quebec prescription drug insurance plan (36% of women aged 15-45 years) from 12 months prior until the end of pregnancy.

RESULTS

We analyzed 97,680 pregnancies. Prevalence of medication use was 74% pre-pregnancy, 56% during pregnancy, and 80% post-pregnancy. Most frequently used medications during pregnancy were antibiotics (47%), antiemetic drugs (23%), and non-steroïdal anti-inflammatory drugs (NSAIDs) [17%]. Medication users were more likely to have spontaneous abortions, preterm births, children with congenital malformations and postpartum depression than non-users (p<0.01).

CONCLUSION

Medications are commonly used during pregnancy. The QPC is a powerful tool for perinatal pharmacoepidemiological research.

The Quebec Pregnancy Cohort--prevalence of medication use during gestation and pregnancy outcomes

PURPOSE

We evaluated the potential and the validity of the Quebec Pregnancy Cohort (QPC) as a research tool in perinatal pharmacoepidemiology.

METHODS

The QPC was built by linking four administrative databases: RAMQ (medical and pharmaceutical data), Med-Echo (hospitalizations), ISQ (births/deaths), and MELS (Ministry of Education data). A self-administered questionnaire was sent to a random sample of women to collect lifestyle information. The QPC includes data on all pregnancies of women covered by the Quebec provincial prescription drug insurance between 1998 and 2008. Date of entry in the QPC is the first day of pregnancy, and women are followed during and after pregnancy; children are followed after birth up until 2009. The prevalence of prescribed medications before, during and after pregnancy was compared between time-window. Pregnancy outcomes were also estimated among pregnancies ending with a live born infant.

RESULTS

The QPC included 289,688 pregnancies of 186,165 women. Among them, 167,398 ended with a delivery representing 19.4% of all deliveries occurring in the Province of Quebec between 1998-2009. The total frequency of abortions was 35.9% in the QPC comparable to the 36.4% observed in the Province of Quebec. The prevalence of prescribed medication use was 74.6%, 59.0%, and 79.6% before, during and after pregnancy, respectively. Although there was a statistically significant decrease in the proportion of use once the pregnancy was diagnosed (p<.01), post-pregnancy prescribed medication use returned above the pre-pregnancy level. The prevalence of pregnancy outcomes found in the QPC were similar to those observed in the Province of Quebec.

CONCLUSION

The QPC is an excellent tool for the study of the risk and benefit of drug use during the perinatal period. This cohort has the advantage of including a validated date of beginning of pregnancy giving the possibility of assigning the exact gestational age at the time of maternal exposure.

Risk factors for early miscarriage among Chinese: a hospital-based case-control study

OBJECTIVE

To investigate the risk factors for early miscarriage among Chinese women.

DESIGN

Hospital-based matched case-control study.

SETTING

Academic medical center and maternal health hospital.

PATIENT(S)

620 women with early miscarriage (less than 13 weeks of gestation) and 1,240 normal pregnant women.

INTERVENTION(S)

Face-to-face questionnaire.

MAIN OUTCOME MEASURE(S)

Multivariable conditional odds ratio (OR) and 95% confidence interval (CI) to measure risk factors.

RESULT(S)

After adjustment for confounding factors, the following were independently associated with increased risk: history of miscarriage, repeated induced abortion, working night shifts, and frequent staying up late. Vitamin supplementation and regular physical activity reduced the risk of miscarriage. We did not find paternal age, alcohol consumption, or smoking status to be linked with early miscarriage.

CONCLUSION(S)

Our findings suggest that a healthy diet, regular physical activity, and planned pregnancy may be advantageous for women in pre-pregnancy or early pregnancy. Induced abortion, working night shifts, and frequent staying up late were associated with an increased risk of miscarriage. Further work in larger populations is warranted.

Age does not adversely affect sperm retrieval in men undergoing microdissection testicular sperm extraction

OBJECTIVE

To evaluate the effect of male age on the outcome of microdissection testicular sperm extraction (micro-TESE) and assisted reproductive technology.

DESIGN

Clinical retrospective study.

SETTING

Center for reproductive medicine at a tertiary university hospital.

PATIENT(S)

One thousand sixty-seven men with nonobstructive azoospermia.

INTERVENTION(S)

Micro-TESE, with intracytoplasmic sperm injection when sperm found.

MAIN OUTCOME MEASURE(S)

Sperm retrieval and clinical pregnancy.

RESULT(S)

Sperm were successfully retrieved by micro-TESE in 605 men (56.6%) overall. Sperm retrieval rates (SRRs) were higher in men ≥50 years old than men <50, (73% in men ≥50, 56% in men <50). Of the 44 men ≥50 years old, men who had successful micro-TESE had larger mean testis volume (20.8 cc vs. 12.5 cc), a higher frequency of hypospermatogenesis (5.6% vs. 0%), and a lower frequency of Sertoli cells only (12.5% vs. 80%) on diagnostic biopsy. Clinical pregnancy rates were lower in partners of men ≥50 than in partners of men <50 (48% in men <50, 25% in men ≥50). Lower pregnancy rates may be at least partially explained by older female partners for men ≥50 compared to men <50 (mean age 38.0 vs. 36.2 years). Sperm were successfully retrieved across all age groups, and there was no upper male age limit above which sperm could not be retrieved.

CONCLUSION(S)

Overall, SRRs in men undergoing micro-TESE are not negatively affected by age. Despite successful sperm retrieval in older men with micro-TESE, couples have the best chance of clinical pregnancy with a female partner <35 years old. Some older men with azoospermia may have secondary azoospermia with hypospermatogenesis, explaining the high sperm retrieval rate.

Fathers matter: the role of paternal age in infant mortality

Infant mortality is the most widely used indicator of a nation's health status and is associated with a plethora of maternal and socioeconomic factors. Although the association between young and old maternal age and the risk of infant mortality is well established, the link between paternal age and birth outcomes has received far less attention. This study seeks to examine the added impact of paternal age on infant mortality, above and beyond that of maternal age among married couples. Using the 2002 linked birth and infant death data set (N = 63,754), hazard odds ratios for the association between combined adolescent and adult maternal and paternal age and the risk of infant mortality were estimated. Maternal demographic characteristics, such as education and race/ethnicity were controlled. The findings indicate that, independent of maternal education and race/ethnicity, adolescent father adds additional risk, above and beyond that of maternal age, only when the mother is older (21-45 years; hazard ratio = 2.7). This study highlights that for married couples, adolescent fathers add to the risk of infant mortality when the mothers are older, providing insight into the role of paternal age in infant mortality. Implications for additional research are discussed.

Safety profile of the yellow fever vaccine Stamaril®: a 17-year review

Since the creation by the manufacturer in 1993, of an electronic pharmacovigilance database for all spontaneous, voluntary reports of adverse events (AEs) after vaccination, 276 million doses of Stamaril® have been distributed worldwide. We review this database for the safety of Stamaril with emphasis on yellow fever (YF) vaccine associated acute viscerotropic and neurotropic diseases, anaphylaxis and on specific at risk groups: elderly adults, pregnant and lactating women and the immunosuppressed. Findings confirm that the vaccine's safety profile in routine practice is favorable and consistent with the summary of product characteristics. Estimated reporting rates of serious adverse events associated after Stamaril vaccination are lower than the previously published and widely cited estimates of the worldwide reporting rate for YF vaccines in general. These data provide important additional information for the prescribers in assessing the risks and benefits associated with the use of Stamaril in individuals exposed to YF virus.

Obstetric outcomes of patients with abortus imminens in the first trimester

PURPOSE

We aimed to find out the effect of abortus imminens (AI) on obstetric outcomes of pregnancies which continued beyond the 24th week of gestation.

METHODS

In this prospective study, 309 patients with AI were divided into high-risk group (with a risk factor for spontaneous abortus) (n = 92) and low-risk group (without a risk factor) (n = 217). The control group (n = 308) was chosen randomly.

RESULTS

In AI group, preterm delivery, preterm premature rupture of membranes (PPROM), cesarean section (C/S) delivery, postpartum uterine atony and need of a neonatal intensive care unit (NICU) rates were significantly higher than control group. Gestational diabetes mellitus, PPROM, still birth, low APGAR scores were seen more frequently in the high-risk patients than in the control group. Furthermore in the high-risk group, preterm delivery, malpresentation, C/S delivery and need of NICU were increased much more than in the low-risk group. Gestational hypertension/preeclampsia, oligo/polyhydramniosis, intrauterine growth retardation, placenta previa, abruption of placenta, chorioamnionitis, congenital abnormalities, delivery induction, cephalopelvic disproportion, fetal distress and manual removal of placenta were not different among the groups.

CONCLUSIONS

Patients with AI history, especially with high-risk factors can have adverse obstetric and neonatal results. So their antenatal follow-up has to be done cautiously for the early signs and symptoms of these complications.