Impact of governmental support to the IVF clinical pregnancy rates: differences between public and private clinical settings in Kazakhstan-a prospective cohort study

Predictive Role of Progesterone Levels for IVF Outcome in Different Phases of Controlled Ovarian Stimulation for Patients With and Without Endometriosis: Expert View

The study aimed to review the role of basal, trigger, and aspiration day progesterone levels (PLs) as predictors of in vitro fertilization (IVF) success for patients with and without endometriosis. A non-systematic review was conducted by searching papers published in English during the period of 1990-2023 in MEDLINE and PubMed, Embase, The Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Cochrane Methodology Register), and Web of Science. The most widely used IVF predictor success was the trigger day progesterone serum level. Many studies utilize the threshold level of 1.5-2.0 ng/ml. However, the predictive power of only progesterone level failed to show high sensitivity and specificity. Contrary, progesterone level on the trigger day combined with the number of mature retrieved oocytes had the highest predictive power. High baseline progesterone level was associated with poor IVF outcomes. Research on progesterone and IVF success in patients with endometriosis is limited but indicates that endometriosis patients seem to benefit from higher progesterone concentrations (≥ 37.1 ng/ml) in IVF cycles. Currently, there is limited data for a definitive insight into the mportance of progesterone in the estimation of IVF success. Nonetheless, this summarized evidence could serve as up-to-date guidance for the role of progesterone in the prediction of IVF outcomes, both in patients with and without endometriosis.

Epidemiology of spontaneous pregnancy loss in Kazakhstan: A national population-based cohort analysis during 2014-2019 using the national electronic healthcare system

INTRODUCTION

Spontaneous pregnancy loss (SPL) is a common health problem that affects 1:10 of childbearing women, and is linked with physical and psychological complications. As the number of nationwide studies on the incidence of SPL is few, especially from middle-income countries, in this study we investigated the epidemiology, complications and outcomes of SPL before 22 weeks of gestation by analyzing large-scale healthcare data from the Unified Nationwide Electronic Healthcare System (UNEHS) in Kazakhstan.

MATERIAL AND METHODS

A population-based study among women who experienced SPL in any healthcare setting of the Republic of Kazakhstan during the period of 2014-2019. The International Classification of Diseases (ICD) 10th edition and ICD 9th edition's procedural codes were utilized to retrieve data using relevant diagnostic and procedural codes.

RESULTS

In total, 207 317 records of women who have experienced an SPL before 22 weeks of gestation were analyzed from all Kazakhstani regions. The estimated prevalence of SPL was 8.7%, with a 20% decline over a 6-year period. The SPL cases ratio comprises on average 6.2 per 1000 reproductive-age women. Incomplete miscarriage (ICD-10 code "O03.4") was the most common type (37.8%), followed by blighted ovum (ICD-10 code "O02.0"; 34.1%) and missed abortion (ICD-10 code "O02.1"; 13.5%). The most common management methods were dilation and curettage of the uterus (ICD-9 code "69.0"; 84.7%) and aspiration curettage of the uterus (ICD-9 code "65.0"; 15%), whereas medical management was rarely performed (2.6%).

CONCLUSION

The information available in UNEHS adequately identifies types of miscarriages and treatment methods. Although the prevalence of SPL before 22 weeks of gestation is decreasing, management of miscarriages requires closer attention.

Recurrent Pregnancy Loss Etiology, Risk Factors, Diagnosis, and Management. Fresh Look into a Full Box

Recurrent pregnancy loss is a complex health challenge with no universally accepted definition. Inconsistency in definitions involves not only the number of spontaneous abortions (two or three) that are accepted for recurrent pregnancy loss but the types of pregnancy and gestational age at miscarriage. Due to the heterogeneity of definitions and criteria applied by international guidelines for recurrent pregnancy loss, the true incidence of recurrent miscarriage, which is reported to range from 1% to 5%, is difficult to estimate. Moreover, the exact etiology of recurrent pregnancy loss remains questionable; thus, it is considered a polyetiological and multifactorial condition with many modifiable and non-modifiable factors involved. Even after thoroughly evaluating recurrent pregnancy loss etiology and risk factors, up to 75% of cases remain unexplained. This review aimed to summarize and critically analyze accumulated knowledge on the etiology, risk factors, relevant diagnostic options, and management approach to recurrent pregnancy loss. The relevance of various factors and their proposed roles in recurrent pregnancy loss pathogenesis remains a matter of discussion. The diagnostic approach and the management largely depend on the etiology and risk factors taken into consideration by a healthcare professional as a cause of recurrent miscarriage for a particular woman or couple. Underestimation of social and health consequences of recurrent pregnancy loss leads to compromised reproductive health and psychological well-being of women after miscarriage. Studies on etiology and risk factors for recurrent pregnancy loss, especially idiopathic, should be continued. The existing international guidelines require updates to assist clinical practice.

The Prevalence, Indications, Outcomes of the Most Common Major Gynecological Surgeries in Kazakhstan and Recommendations for Potential Improvements into Public Health and Clinical Practice: Analysis of the National Electronic Healthcare System (2014-2019)

OBJECTIVES

Major gynecological surgeries are indicated for the treatment of female genital pathologies. It is key to examine trends in gynecologic surgical procedures and updated recommendations by international gynecological societies to find opportunities for improvement of local guidelines. To date, a very limited number of reports have been published on the epidemiology of gynecological surgeries in Kazakhstan. Moreover, some local guidelines for gynecological conditions do not comply with the international recommendations. Thus, this study aims to investigate the prevalence, indications, and outcomes of the most common major gynecological surgeries by analyzing large-scale Kazakhstani healthcare data, and identifying possible opportunities for improvement of the local public health and clinical practice.

METHODS

A descriptive, population-based study among women who underwent a gynecological surgery in healthcare settings across the Republic of Kazakhstan during the period of 2014-2019 was performed. Data were collected from the Unified Nationwide Electronic Health System (UNEHS).

RESULTS

In total, 80,401 surgery cases were identified and analyzed in the UNEHS database for a period of 6 years (2014-2019). The median age of the participants was 40 years old, with 61.1% in reproductive age. The most prevalent intervention was a unilateral salpingectomy-29.4%, with 72.6% patients aged between 18-34 years. The proportion of different types of hysterectomies was 49.4%. In 20% of cases, subtotal abdominal hysterectomy was performed due to uterine leiomyoma. The proportion of laparoscopic procedures in Kazakhstani gynecological practice is as low-11.59%.

CONCLUSIONS

The Kazakhstani public health and gynecological care sector should reinforce implementation of contemporary treatment methods and up-to-date policies and guidelines. The overall trends in surgical procedures performed for gynecological pathologies, including uterine leiomyoma and ectopic pregnancy treatment, should be changed in favor of the minimally invasive methods in order to adopt a fertility-sparing approach.

Quality-of-Life Assessment of Women Undergoing In Vitro Fertilization in Kazakhstan

Infertility is a problem that affects millions of couples worldwide and has a significant impact on their quality of life. The recently introduced "Fertility Quality of Life Questionnaire (FertiQoL)" quickly became a gold standard for evaluation of the quality of life of patients suffering from infertility. The aim of this study was to determine the quality of life of Kazakhstani women coping with infertility problems by FertiQoL and assess the validity of the questionnaire. This cross-sectional study involved women of reproductive age undergoing an in vitro fertilization (IVF) cycle at a large IVF center in Kazakhstan in the period from 1 September 2020 to 31 September 2021. A total of 453 women out of 500 agreed to participate in the study, and the response rate was 90.6%. The overall Core FertiQoL was 56.95 ± 14.05, and the Treatment FertiQoL was 66.18 ± 11.13 points. Respondents with secondary infertility had statistically significantly higher Emotional (p < 0.001), Mind-body (p = 0.03), Social (p < 0.001), Environment (p = 0.02), and Treatment (p < 0.001) domains of FertiQoL than women with primary infertility. Respondents with a low income had the lowest levels of Total FertiQoL (56.72 ± 11.65). The longer duration of infertility of women undergoing IVF treatment presented the worse scale of Treatment and Total FertiQoL. Cronbach's alpha revealed good internal reliability for all FertiQoL subscales on the Kazakhstan women's questionnaire and averaged 0.8, which is an indicator of a high degree of reliability. The Total FertiQoL of Kazakhstan women undergoing IVF treatment was 59.6 ± 11.5, which is considerably lower than European countries. We identified statistically significant differences across medical and demographic groups. As this questionnaire had validity in Kazakhstan survey it possibly be used for both medical counseling and future investigation in our country.

Prevalence and predictive factors for infertility-related stress among infertile couples: A cross-sectional study from Jordan and the occupied Palestinian territories

OBJECTIVES

To assess the level of infertility-related stress, associated socio-economic, and demographic factors among infertile couples living in Jordan and those living under the chronic Israeli-Palestinian conflict in the occupied Palestinian territories.

METHODS

A cross-sectional study was carried out in a number of fertility and reproductive clinics in Jordan and occupied Palestinian territories over a period of 6 months. Trained clinical pharmacists interviewed the identified couples.

RESULTS

A total of 443 participants were interviewed. Three variables were significantly and independently associated with global stress scores. The need of parenthood appears higher in women than men among infertile couples in Jordan and Palestine (p=0.005). The country of origin (p<0.001) made the greatest contribution of unique variance followed by family type (p=0.035). Additionally, a significant contribution to the model was carried out by the number of clinicians who followed up on the case (p=0.013). The average total cost of treatment since the problem had been diagnosed was 2936±4529 Jordanian dinar, which may be of concern to both Jordanians and Palestinians given the limited resources available in developing nations.

CONCLUSION

This study shows a significant degree of stress among infertile couples. The place of origin, family structure, and presence of medical insurance had a significant impact on the infertility global stress score. This study emphasizes the necessity for specific psychological therapies that are currently lacking in public healthcare practices in both Jordan and Palestine.