P-715 (In)fertility perceptions in a cohort of 1569 women

Study question

Which are the perceptions and knowledge regarding female fertility and infertility of Spanish women?

Summary answer

Infertility carries a social stigma that prevents women from sufficient knowledge or professional aid to take their reproductive choices adequately.

What is known already

Infertility is a pathology that remains on an invisible plane for society. It is estimated that up to a third of all IVF cycles performed due to low ovarian reserve would be avoidable if women had received sufficient information at the right time. The factors that mainly contribute to this phenomenon are the marked social stigma that it entails, the lack of knowledge regarding tools, possibilities and real expectations in fertility and the low socio-sanitary involvement regarding tasks and campaigns to increase social awareness in this specific field.

Study design, size, duration

This is a cross-sectional study carried out using a population-based survey to identify different attitudes, knowledge and opinions regarding fertility and infertility. The survey was made public on April 30, 2019 and closed on May 10, 2019.

Participants/materials, setting, methods

A total of 1569 Spanish women answered all the questions included in the survey. No response or subject participation was excluded from the study. The platform used to create the questionnaire was Google Forms, which anonymizes the responses automatically. Data processing was performed using RStudio, an integrated development for R scripting.

Main results and the role of chance

Up to 1231 women had not had children at the time of the survey and 46% (566) of these cohort were either worried or very concerned about not being able to conceive naturally in the future. Also, 71% (871) of the same cohort were willing to have children of their own. In addition, 65% (1015) among those surveyed though that infertility had an important social stigma. With respect to gynecological health, 89% (1376) of women surveyed had had at least a gynecologic check-up at the time of answering the survey. However, up to 78% (921) of this cohort had never consulted their gynecologist regarding female fertility. Women surveyed were asked to predict the age at which conceiving a child both naturally and via assisted reproductive techniques started to become difficult. Respondents predicted that age to be 36.74 (IC95% [36.52, 36.96]) years and 39.79 (IC95% [39.58, 40.01]) years, respectively. Plus, 86% (1328) of women surveyed were in favor of elective fertility preservation and up to 72% (1127) thought that the Spanish State should either cover or aid economically this process. Finally, up to 72% (1115) of them thought they lacked important information to take their reproductive choices adequately.

Limitations, reasons for caution

Participants in the survey were exclusively contacted virtually. Even with the number of responses obtained and due to the descriptive nature of this study, it might not be representative of Spanish female society regarding the topics addressed. Also, the results here presented might not be extrapolable to other populations.

Wider implications of the findings

Considering the data presented in this work, education in fertility should start as soon as possible, ideally in high school. Finally, reproductive autonomy is being able to choose whether to have or not to have children, but the key is to always be able to make that decision.

Trial registration number

Not applicable

P–287 Uterine adenomyosis does not affect perinatal outcomes in ART treatments

Study question

Is adenomyosis associated with worse clinical and perinatal outcomes in ovum donation cycles?

Summary answer

Adenomyosis was associated with reduced live birth rate per embryo transfer but not with increased risk of miscarriage or worse perinatal outcomes than controls.

What is known already

The effect of adenomyosis on IVF/ICSI outcomes are controversial as studies addressing this issue are limited in number and heterogeneous. Conclusions withdrawn from previous works differ regarding the prospective or retrospective design of the study. Two different metanalysis conducted showed that adenomyosis reduced implantation and clinical pregnancy rate and increased miscarriage risk. However, current data regarding perinatal outcomes of assisted reproduction techniques cycles in patients diagnosed with uterine adenomyosis is scarce.

Study design, size, duration

A retrospective cohort study in which 3307 patients undergoing ovum donation cycles were included. Patients who underwent single embryo transfer (SET) between years 2018 and 2019 were included and divided into two groups: adenomyosis (n = 179) and controls (n = 3218).

Participants/materials, setting, methods

Inclusion criteria consisted of patients in an oocyte donation program who had fresh SET on day 5 blastocyst stage development. Patients diagnosed with miomas and/or severe endometriosis and those who had undergone previous uterine surgical interventions were excluded from the study. Cases consisted of patients with a history of either focal or diffuse adenomyosis diagnosed via transvaginal ultrasonography (TVUS).

Main results and the role of chance

Clinical pregnancy rate per embryo transfer was 82/179 (45.8%) in those women diagnosed with adenomyosis versus 1869/3218 (59.8%) in control group (OR = 0.57 95% CI. 0.41–0.78, p < 0.001). Miscarriage rate was similar in the two study groups and differences found were not statistically significant, being 15/82 (18.3%) for adenomyosis and 309/1869 (16.5%) for control group. A lower live birth rate per embryo transfer was observed in women diagnosed with adenomyosis versus control, being 68/179 (38%) and 1560/3128 (49.9%) respectively (OR = 0.615 95% CI 0.44–0.85, p = 0.002). There were no statistically significant differences between childbirth delivery methods (vaginal versus caesarean section). Furthermore, means of gestational age at the time of delivery, newborn size and weight and incidences of low birth weight, preterm birth and admission in neonate intensive care unit (NICU) did not differ between the two groups. In addition, IVF and perinatal outcomes were similar in patients with diffuse adenomyosis compared to focal adenomyosis.

Limitations, reasons for caution

This is an observational study and thus possible confounders cannot be completely excluded. Diagnostic of adenomyosis is complex and, despite imaging via TVUS is both sensitive and specific, different criteria may be combined in order to fully assess the diagnostic.

Wider implications of the findings: Published literature has described how adenomyosis negatively impacts clinical outcomes in ART cycles; however, data regarding perinatal results is scarce. This study is of interest as it provides a first insight for clinicians showing that adenomyosis affects clinical but not perinatal outcomes in ovum donation cycle.

Trial registration number

Not applicable