Ovarian tissue transplantation: 10 years of experience at the Bologna University

Objective

The efficiency of ovarian tissue transplantation (OTT) was established in terms of ovarian function recovery (95% of cases), number of live births (over 200 worldwide to date) and induction of puberty. Unfortunately, the lack of international registries and the fact that many centers have not yet reported their outcomes, lead to poor knowledge of the exact fertility data. The aim of the study is to describe our experience with OTT to restore ovarian function and fertility.

Methods

This study was designed as a single-center, observational, retrospective, cohort study that includes women who underwent OTT between December 2012 and June 2023 at our center. After approval by the oncologist/hematologist, a small fragment of ovarian tissue was thawed and analyzed to detect the presence of micrometastases before OTT. Thawed ovarian tissue was grafted laparoscopically at multiple sites, including the remaining ovary and pelvic side wall (orthotopic transplantation) and/or abdominal wall (heterotopic transplantation). After OTT, ovarian function was monitored by hormonal assay, ultrasound and color Doppler at approximately 4-week intervals.

Results

Between December 2012 and June 2023, 30 women performed OTT. Prior to OTT, immunohistochemical and molecular analyses revealed no micrometastases in all thawed ovarian tissue samples. In our series of 30 women, 20 of women were on premature ovarian insufficiency (POI), and the remaining ten cases still had oligomenorrhea and difficulty getting pregnant. Among the women with POI before OTT and at least 6 months follow-up, recovery of endocrine function was observed in all but one woman who underwent orthotopic transplantation (13 of 14 cases), in one out of two women who underwent both orthotopic and heterotopic transplantation (1 of 2 cases) and in all women who underwent heterotopic transplantation (4 of 4 cases). Women who underwent OTT to enhance fertility had no alterations in menstrual cycle and hormonal levels. In total, ten pregnancies were obtained in 25 women, resulting in four live births, two ongoing pregnancies and four spontaneous abortions.

Conclusion

Our data can help patients and physicians in their discussions and decisions about the need and possibilities of preserving fertility.

Living-Donor Uterus Transplantation: A Clinical Review

Uterus transplantation (UTx) is currently the only available treatment for absolute uterine factor infertility. More than 90 uterus transplantations have been performed worldwide, mostly from living donors. Living-donor (LD) UTx is a challenging surgical procedure since it poses ethical issues, and it is a high-risk and invasive surgery with higher hysterectomy-related risks compared to conventional hysterectomy. A total of 59 living-donor hysterectomies have been reported in the literature, including 35 performed with a laparotomic approach, 20 with a robotic approach and 4 with a laparoscopic approach. The mean donor age was 45.6 ± 9.1 years, and 22 were unrelated with the recipients, 34 were emotionally related (27 mothers, 5 sisters, 2 mother's sisters). The mean recipient age was 28.8 ± 4.5 years. Mayer-Rokitansky-Küster-Hauser syndrome was the most common indication for uterus transplant. Robotic living-donor hysterectomy had the longest operative time but resulted in a lower blood loss and postoperative stay compared to laparotomic and laparoscopic approaches. Twenty-nine births from LD-UTx have been reported, four after robotic living-donor hysterectomy and twenty-five after a laparotomic procedure. UTx is now an effective treatment for women with UFI. While living-donor UTx in some cases may be considered an experimental procedure, it offers the extraordinary possibility to give women the opportunity to have a pregnancy. Many efforts should be made to reduce the potential risks for donors, including the use of mini-invasive techniques, and the efficacy of UTx in the recipients, giving the potential harm of immunosuppression in a recipient of a non-life-saving organ.

Assessing the Impact of High Body Mass Index (BMI) on the Efficacy of Assisted Reproductive Technologies (ART) in Saudi Women: A Cross-Sectional Study Examining Ovarian Reserve and Treatment Outcomes

INTRODUCTION

The global surge in high body mass index (BMI) and obesity has led to various health complications. While numerous studies have shown that obesity disrupts female fertility, the specific effects of obesity on the success rate of assisted reproductive technology (ART) treatments in Saudi women have been less explored. This study aimed to delve into this gap, especially focusing on the correlation between BMI, ovarian reserve parameters, and ART outcomes among Saudi women.

METHODS

A cross-sectional study was carried out from January to August 2023, concentrating on Saudi women aged 18 and above who underwent ART treatments for infertility. A total of 1071 women participated, with 155 completing an online survey and 916 responding through a hard copy from several Saudi hospitals. The data encompassed demographics, medical history, anthropometric details, ovarian reserve parameters, and ART results. For the analysis, Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, IBM Corp., Version 28.0, Armonk, NY) was utilized, applying descriptive statistics, the Chi-square test, and a linear regression model to discern connections between BMI, participant characteristics, and ART outcomes. A p-value of less than 0.05 was considered statistically significant.

RESULTS

Most participants were aged 25-34 (406) years and held a bachelor's degree (707). Over half (560) received fertility treatments in the past, with 37.9% (406) having polycystic ovary syndrome (PCOS) and 23.5% (252) with other fertility-impacting medical conditions. Interestingly, 62.1% (665) had not undergone any ART cycles. Of those who did, 51.6% (553) had clinical pregnancies leading to live births. About 23.8% (308) of those with clinical pregnancies faced miscarriages without successful live births. Furthermore, 17.6% (189) reported complications or side effects from past ART procedures, and 31.4% (336) were on ART-related medications or supplements. The linear regression highlighted that individuals with normal weight tended to undergo more ART cycles. However, those with a higher BMI exhibited increased chances of achieving clinical pregnancies and live births.

CONCLUSION

The study underscores the crucial relationship between BMI and ART efficacy in Saudi women. The data reveals that BMI can significantly influence ART treatment outcomes, especially concerning the number of cycles, clinical pregnancies, and live births. Consequently, BMI should be an essential consideration when evaluating and optimizing the success rates of ART procedures.

Live birth per embryo transfer with next generation sequencing preimplantation genetic testing: an analysis of 26,107 cycles

The technique and platform used for preimplantation genetic testing for aneuploidy (PGT-A) have undergone significant changes over time. The contemporary technique utilizes trophectoderm biopsy followed by next-generation sequencing (NGS). The goal of this study was to explore the role of PGT-A using NGS technique exclusively in contemporary in vitro fertilization (IVF) practice. For this, we performed a retrospective analysis of a large dataset collected from the Shady Grove Fertility (SGF) multicentre practice. All autologous IVF cycles which were followed by at least one single embryo transfer (ET) (fresh and/or frozen) between January 2017 to July 2020, were included. Our study group included patients who had PGT-A and the control group included patients who did not proceed with PGT-A. The primary outcome was the live birth rate (LBR) per transfer. All age-adjusted LBR was higher in the PGT-A group than the non-PGT-A group (48.9% vs. 42.7%, p < 0.001), except in women <35 years old among single embryo frozen ETs. Similarly, LBR in the PGT-A group was higher in all ages except in women <35 years old (48.7% vs. 41.7%, p < 0.001) when all single embryos fresh and frozen ETs were included. In patients of decreased ovarian reserve, transfer of euploid embryo was associated with higher LBR (46.7% vs. 26.7%, p < 0.001) whereas miscarriages were lower in patients with unexplained infertility (9.3% vs. 11.3%, p = 0.007 and endometriosis (8.9% vs. 11.6%, p < 0.001) following euploid embryo transfer. To conclude, the transfer of euploid embryos tested via NGS PGT-A was associated with improved LBR per transfer in women ≥35 years old.

Chromosomal polymorphisms in assisted reproduction: a systematic review and meta-analysis

This systematic review and meta-analysis investigated the effects of chromosomal polymorphisms in reproductive outcomes following IVF or ICSI. Literature in CENTRAL, CINAHL, EMBASE and MEDLINE were searched from 1974 to March 2020 with no language restrictions. Ten published cohort studies were chosen for analysis. Studies included females, males and couples undergoing assisted reproductive treatments with the presence or absence of chromosomal polymorphisms. Reproductive outcomes were reported and their quality assessed using the Newcastle-Ottawa Quality Assessment Scale. Meta-analysis of five cohort studies (9,659 participants) indicated that female carriers with chromosomal polymorphisms had a higher miscarriage rate compared to non-carriers (risk ratio (RR) 1.54 (95% CI 1.19-1.98), whereas no significant association was found for males (RR 0.96, 95% CI 0.64-1.43) and couples (RR 1.93, 95% CI 0.32-11.83) indicating that this effect appeared to be gender-dependent. There was no association between chromosomal polymorphisms and a higher rate of biochemical, clinical, ongoing pregnancy, and preterm and live birth.

Congenital Heart Disease and Fertility: A Danish Nationwide Cohort Study Including Both Men and Women

Background Despite an increasing number of patients with congenital heart disease (CHD) reaching reproductive age, the fertility of these patients remains undescribed. Therefore, the aim of the study was to evaluate the fertility in men and women with CHD by estimating the risk of infertility and comparing the birth rates, proportions of individuals becoming parents or remaining childless, and the number of children per parent with unaffected individuals. Methods and Results The study population consisted of individuals born between 1977 and 2000. Information on CHD, infertility, and live born children were obtained from the Danish health registries. Hazard ratios for infertility were analyzed using a Cox regression model. Differences of proportions and birth rates were calculated and compared between groups. Among 1 385 895 individuals, a total of 8679 (0.6%) were diagnosed with CHD. Men and women with simple or moderate CHD had no increased risk of infertility when compared with the reference population. Estimates for complex CHD groups were too imprecise for evaluation. Individuals with CHD were more often childless with consequently lower birth rates compared with unaffected individuals. However, those becoming parents had the same number of children as the reference population. Conclusions Men and women with simple or moderate CHD had the same risk of infertility as the reference population. Despite patients with CHD more often being childless, those becoming parents had the same number of children as parents without CHD. The current findings increase the knowledge regarding fertility in the CHD population.

Adverse drug reactions following lymphocyte immunotherapy for the treatment of infertility: A retrospective study

AIM

Unexplained infertility is a major burden for couples who want to have children. Lymphocyte immunotherapy (LIT) could be a therapeutic help for these couples. Although LIT has been carried out for decades, the data on the success of therapy are still controversial and there is hardly information on possible adverse drug reactions.

METHODS

In this study, we used a questionnaire to determine the frequency of local and systemic adverse drug reactions in our patients who were treated with LIT between 2017 and 2020 (n = 302). In addition, we asked about pregnancies and/or live births after LIT in a 2-year follow-up (n = 140).

RESULTS

Most of the patients reported the occurrence of mild local adverse drug reactions in a period of less than 4 weeks: Over 75% reported moderate erythema, itching or swelling, over 10% erythema, itching or swelling as more pronounced adverse drug reaction. Blistering was specified in 10% of the cases. Serious adverse drug reactions or adverse events were not described. In the follow-up, 69% of our patients stated a pregnancy after LIT, and 50% a life birth.

CONCLUSIONS

Overall, LIT represents a well-tolerated therapy for couples with unexplained infertility, however, more evidence is needed on the benefits.

Reconstructable Uterus-Derived Materials for Uterus Recovery toward Efficient Live Births

Uterine factor infertility is increasingly common in modern society and has severely affected human life and health. However, the existing biomaterial scaffold-mediated systems remain limited in efficient uterus recovery, leading to low pregnancy rate and live births. Here, reconstructable uterus-derived materials (RUMs) are demonstrated by combining uterus-derived extracellular matrix and seeded chorionic villi mesenchymal stem cells for uterus recovery, achieving highly efficient live births in rats with severe uterine injury. The RUMs can be designed into different states (such as, liquid RUMs and solid RUMs) and shapes (such as, cuboid, triangular-prism, and cube) in terms of requirements. The RUMs can effectively prevent intrauterine adhesion, and promote endometrial regeneration and muscle collagen reconstruction, as well as, accelerate wound healing by constructing a physical barrier and secreting cytokines, allowing efficient uterus recovery. The injured uterus nearly achieves complete recovery after treating with the RUMs and has normal pregnancies for supporting fetal development and live births, similar to the normal rats. The study provides a regenerative medicine therapeutics for uterine factor infertility.

Cancer treatment is associated with a measurable decrease in live births in a large, population-based study

Objective

To define the live birth rates in a large, population-based study of the most common reproductive-age cancers in women.

Design

Retrospective cohort study.

Setting

Population-based study.

Patients

Female cancer patients diagnosed with cancer at age 18 years old or older between 1952–2014 (n = 17,952) were compared to fertility of non-cancer controls (n = 89,436).

Interventions

Live births in cancer survivors were compared with those in healthy, age-matched controls. Cases and controls were matched in the ratio of 5:1 for birth year, birthplace (Utah, yes/no), and follow-up time in Utah.

Main Outcome Measure

Rate of at least one live birth, reported as an incidence rate ratio (IRR).

Results

Of all cancer survivors, 3,127 (17.4%) had at least 1 live birth after treatment in comparison to 19,405 healthy, age-matched controls (21.7%) with the same amount of time exposure for attempting pregnancy. Breast cancer was the most common cancer type (23.1% of patients in cohort). Compared with age-matched, healthy controls, IRR of live birth was 0.69 (95% confidence interval [CI], 0.67–0.70) for all cancer types, 0.25 (95% CI, 0.20–0.33) for leukemia, 0.40 (95% CI, 0.28–0.59) for gastrointestinal cancers, 0.44 (95% CI, 0.41–0.48) for breast cancer, 0.53 (95% CI, 0.47–0.59) for central nervous system cancers, and 0.57 (95% CI, 0.44–0.73) for soft tissue cancers. With all cancer types stratified by age at diagnosis, IRR for live births in cancer survivors aged >41 years at diagnosis was 0.48 (95% CI, 0.44–0.52); IRR was 0.64 (95% CI, 0.61–0.67) in the group aged 31–40 years and 0.71 (95% CI, 0.69–0.74) in the group aged 18–30 years after their cancer treatment.

Conclusions

Cancer and its treatment were associated with lower live birth rates when comparing women with cancer vs. age-matched, healthy controls.

Temporal changes in the probability of live birth among female survivors of childhood cancer: A Population-Based Adult Life After Childhood Cancer in Scandinavia (ALiCCS) study in five Nordic countries

BACKGROUND

During the past 4 decades, there has been a growing focus on preserving the fertility of patients with childhood cancer; however, no large studies have been conducted of live births across treatment decades during this period. Therefore, the authors estimated the potential birth deficit in female childhood cancer survivors and the probability of live births.

METHODS

In total, 8886 women were identified in the 5 Nordic cancer registries in whom a childhood cancer had been diagnosed during 1954 through 2006. A population comparison cohort of 62,903 women was randomly selected from the central population registries matched by age and country. All women were followed for live births recorded in medical birth registries. The cumulative probability and the risk ratio (RR) with 95% confidence intervals (CIs) of a live birth were calculated by maternal age across treatment decades.

RESULTS

The probability of a live birth increased with treatment decade, and, at age 30 years, the rate for survivors most recently diagnosed was close to the rate among the general population (1954-1969: RR, 0.65 [95% CI, 0.54-0.78]; 1970s: RR, 0.67 [95% CI, 0.60-0.74]; 1980s: RR, 0.69 [95% CI, 0.64-0.74]; 1990s: RR, 0.91 [95% CI, 0.87-0.95]; 2000s: RR, 0.94 [95% CI, 0.91-0.97]).

CONCLUSIONS

Female childhood cancer survivors had a lower probability of a live birth than women in the general population, although, in survivors diagnosed after 1989, the probability was close to that of the general population. Because the pattern of live births differs by cancer type, continuous efforts must be made to preserve fertility, counsel survivors, and refer them rapidly to fertility treatment if necessary.

LAY SUMMARY

The purpose of this study was to compare the probability of giving birth to a liveborn child in female survivors of childhood cancer with that of women in the general population. Survivors of childhood cancer had a lower probability of live births than women in the general population, although survivors diagnosed after 1989 had a probability close to that of the general population. Continuing focus on how to preserve the potential for fertility among female patients with childhood cancer during treatment is important to increase their chances of having a child.

Parental comorbidity and medication use in the USA: a panel study of 785 000 live births

STUDY QUESTION

How prevalent is paternal medication use and comorbidity, and are rates of these rising?

SUMMARY ANSWER

Paternal medication use and comorbidity is common and rising, similar to trends previously described in mothers.

WHAT IS KNOWN ALREADY

Maternal medication use and comorbidity has been rising for the past few decades. These trends have been linked to potential teratogenicity, maternal morbidity and mortality and poorer fetal outcomes.

STUDY DESIGN, SIZE, DURATION

This is a Panel (trend) study of 785 809 live births from 2008 to 2016.

PARTICIPANTS/MATERIALS, SETTING, METHODS

We used the IBM© Marketscan®™ database to gather data on demographic information and International Classification of Diseases codes and Charlson comorbidity index (CCI) during the 12 months prior to the estimated date of conception for mothers and fathers. We similarly examined claims of prescriptions in the 3 months prior to conception. We performed companion analyses of medications used for >90 days in the 12 months prior to conception and of any medication use in the 12 months prior to conception.

MAIN RESULTS AND THE ROLE OF CHANCE

We confirmed that both maternal medication use and comorbidity (e.g. hypertension, diabetes, hyperlipidemia) rose over the study period, consistent with prior studies. We found a concurrent rise in both paternal medication use 3 months prior to conception (overall use, 31.5-34.9% during the study period; P < 0.0001) and comorbidity (CCI of ≥1 and 10.6-18.0% over study period; P < 0.0001). The most common conditions seen in the CCI were chronic obstructive pulmonary disease for mothers (6.6-11.6%) and hyperlipidemia for fathers (8.6-13.7%). Similar trends for individual medication classes and specific comorbidities such as hypertension, diabetes and hyperlipidemia were also seen. All primary result trends were statistically significant, making the role of chance minimal.

LIMITATIONS, REASONS FOR CAUTION

As this is a descriptive study, the clinical impact is uncertain and no causal associations may be made. Though the study uses a large and curated database that includes patients from across the USA, our study population is an insured population and our findings may not be generalizable. Mean parental age was seen to slightly increase over the course of the study (<1 year) and may be associated with increased comorbidity and medication use.

WIDER IMPLICATIONS OF THE FINDINGS

As parental comorbidity and certain medication use may impact fecundability, temporal declines in parental health may impact conception, pregnancy and fetal outcomes.

STUDY FUNDING/COMPETING INTEREST(S)

None.

TRIAL REGISTRATION NUMBER

N/A.

Congenital Heart Diseases Impair Female Fertility

Background: The objective of this research was to evaluate the fertility of Taiwanese women with diagnoses of congenital heart diseases (CHDs). The study also investigated how different forms of CHDs may have variously influenced fertility. Methods: We directed this nationwide, population-based and retrospective matched-cohort research by using data from the Taiwan National Health Insurance Research Database. The CHD group (n = 6602) included women with congenital structural heart diseases, aged 16-45 years in 2000. The non-CHD group (n = 6602) was matched according to urbanization and income. The outcomes, involving live birth, abortion, and fertility rates, were followed until the end of 2013. Poisson regression was used to evaluate the incidence rate ratios (IRRs). Results: The CHDs had an inferior rate of live births (IRR 0.74 [95% CI 0.71-0.78]) than the non-CHD group. There was also a lower fertility rate in the CHD group (IRR 0.81 [95% CI 0.78-0.84]) than the non-CHD group. Abortion rates between the two groups were similar. Conclusion: Congenital structural heart disease compromises female fertility, even among patients with simple forms of CHDs. It is suggested that pregnant patients with CHDs are early appeared to and advised personally with multidisciplinary care to improve their outcomes.

Spontaneous pregnancies in female survivors of childhood allogeneic haemopoietic stem cell transplant for haematological malignancies

OBJECTIVE

Spontaneous pregnancies and live births are rarely reported after haematopoietic stem cell transplant (HSCT). We report spontaneous pregnancy outcomes of sexually active female survivors of childhood allogeneic HSCT, to provide more data for future counselling.

DESIGN, PATIENTS AND MEASUREMENTS

Retrospective review of all female survivors of childhood haematological malignancies who had allogeneic HSCT at the Royal Children Hospital between 1985 and 2011. Data were retrieved from medical records, updated from treating haematologist or endocrinologist, and were cross-referenced with self-reported questionnaires. Female survivors who were sexually inactive were excluded from analysis.

RESULTS

Six of 37 (16.2%) female survivors reported spontaneous pregnancies resulting in 8 live births. Amongst 22 women who received total body irradiation (n = 21) ± cranial irradiation or isolated cranial irradiation (n = 1), and high-dose cyclophosphamide, three reported pregnancy resulting in live births (14%), whilst three of 15 women who received chemotherapy alone had pregnancy with live births (20%).

CONCLUSIONS

Our current finding, albeit a small sample size, reinforces the importance of counselling female survivors of HSCT about the possibility of spontaneous pregnancy occurring despite documented ovarian failure and for need of contraception to avoid unplanned pregnancy.

Living-Donor Uterus Transplantation: Pre-, Intra-, and Postoperative Parameters Relevant to Surgical Success, Pregnancy, and Obstetrics with Live Births

Uterus transplantation (UTx) can provide a route to motherhood for women with Mayer–Rokitansky–Küster–Hauser syndrome (MRKHS), a congenital disorder characterized by uterovaginal aplasia, but with functional ovaries. Based on our four successful living-donor transplantations and two resulting births, this analysis presents parameters relevant to standardizing recipient/donor selection, UTx surgery, and postoperative treatment, and their implementation in routine settings. We descriptively analyzed prospectively collected observational data from our four uterus recipients, all with MRKHS, their living donors, and the two newborns born to two recipients, including 1-year postnatal follow-ups. Analysis included only living-donor/recipient pairs with completed donor/recipient surgery. Two recipients, both requiring ovarian restimulation under immunosuppression after missed pregnancy loss in one case and no pregnancy in the other, each delivered a healthy boy by cesarean section. We conclude that parameters crucial to successful transplantation, pregnancy, and childbirth include careful selection of donor/recipient pairs, donor organ quality, meticulous surgical technique, a multidisciplinary team approach, and comprehensive follow-up. Surgery duration and blood vessel selection await further optimization, as do the choice and duration of immunosuppression, which are crucial to timing the first embryo transfer. Data need to be collected in an international registry due to the low prevalence of MRKHS.

The effect of physical activity on reproductive health outcomes in young women: a systematic review and meta-analysis

BACKGROUND

In the context of increasing rates of overweight and obesity in young adult women, and the increasing numbers of women seeking help for fertility problems, it is important to understand whether physical activity (PA) could help with management of reproductive health problems, with or without weight loss.

OBJECTIVE AND RATIONALE

The primary aim of this systematic review and meta-analysis was to assess the effects of PA on selected reproductive health outcomes in young adult women, in order to inform best practice advice for women in terms of promoting fertility and reproductive health in young adulthood.

SEARCH METHODS

An electronic search of PubMed, EMBASE, MEDLINE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Web of Science, SportDiscus, and Cochrane was performed for studies published between January 2000 and May 2018. Keywords and Medical Subject Headings terms related to PA, reproductive health, and weight gain were used. Studies were selected if they were intervention studies, if PA was delivered as part of an intervention to pre-menopausal women, and if any reproductive health outcome was reported. Quality analysis was performed using the Tool for the assEssment of Study qualiTy and reporting in EXercise.

OUTCOMES

Eighteen studies, with a mix of four types of study design (4 randomized controlled trials (RCTs), 11 randomized comparison trials, 2 non-randomized comparison trials, and 1 single-arm clinical trial), were identified. Comparisons included fertility treatment (four studies) and common treatments for women with polycystic ovary syndrome (PCOS) symptoms (nine studies). Pooled analysis of data from three of the four studies with a control group showed higher pregnancy [risk ratio (RR) 2.10, 95% CI (1.32, 3.35); three studies] and live birth [RR 2.11, 95% CI (1.02, 4.39); two studies] rates in the intervention groups compared with non-therapy controls. Aggregated data from the fertility treatment comparative studies (i.e. those that compared PA with standard fertility treatment such as clomiphene, gonadotrophins, and/or IVF) showed no significant intervention differences: RR 1.46, 95% CI (0.87, 2.45) for clinical pregnancy (four studies) and RR 1.09, 95% CI (0.56, 2.12) for live births (two studies). Pooled analysis from the comparison trials that used pharmaceutical or dietary treatment for PCOS as comparison showed higher pregnancy rates [RR 1.59, 95% CI (1.06, 2.38); five studies] and live birth rates [RR 2.45, 95% CI (1.24, 4.83); two observations] in the PA intervention groups than in the comparison groups. Analysis of other outcomes, such as ovulation rates, menstrual regularity, and conception rates, showed no differences between the PA intervention and comparison groups.

WIDER IMPLICATIONS

There is emerging evidence from RCT that PA may improve pregnancy rates in women with reproductive health problems. Comparative studies indicate that PA intervention may be as effective as other commonly used clinical intervention strategies for improving reproductive health outcomes. While the type, intensity, frequency, and duration of optimal PA intervention, and the role of PA independent of weight loss, remain unclear, these preliminary findings suggest that PA may be an affordable and feasible alternative or complementary therapy to fertility treatments.

Children Conceived by Assisted Reproductive Technology Prone to Low Birth Weight, Preterm Birth, and Birth Defects: A Cohort Review of More Than 50,000 Live Births During 2011-2017 in Taiwan

Objectives: The use of assisted reproductive technology (ART) has increased rapidly in Taiwan. The purpose of this study is to discuss the risks of low birth weight, preterm birth, and birth defect for children conceived by assisted reproductive technology in Taiwan. Methods: Both National ART report database and National birth reports were obtained from the Health Promotion Administration in the Ministry of Health and Welfare in Taiwan. The cohort included live births (n = 1,405,625) and children conceived by ART (n = 50,988/172,818 cycles) from 2011 to 2017. The prevalence of low birth weight, preterm birth, and birth defect were compared between the ART and natural pregnancy groups. Results: Children conceived by ART displayed a higher rate of low birth weight as compared to those in the natural pregnancy group (p < 0.001), even when analyses were restricted to singleton births (p < 0.001). A higher rate of preterm birth (p < 0.001) was also observed in children conceived by ART even when analyses were restricted to singleton births (p < 0.05). A significant increased rate of birth defects was noted from children conceived by ART (p < 0.05). Conclusions: With the increasing need for and use of ART-conceptions, the likelihood of risks induced or related to Assistant Reproductive Technology (ART) has drawn considerable attention in recent years. Taiwan, as one of the leading countries with outstanding ART performances and modern medical care, the result of the current study suggests that further consideration and tighter regulations and policy are needed with regard to the use of ART.

Multiparity is associated with poorer cardiovascular health among women from the Multi-Ethnic Study of Atherosclerosis

BACKGROUND

Multiparity is associated with a greater risk of incident cardiovascular disease. However, the relationship of parity with cardiovascular health, as measured by the American Heart Association Life's Simple 7 metrics, is uncertain.

OBJECTIVE

We aimed to examine the association between parity and ideal cardiovascular health among 3430 women, aged 45-84 years, free of clinical cardiovascular disease enrolled in the Multi-Ethnic Study of Atherosclerosis.

STUDY DESIGN

The Multi-Ethnic Study of Atherosclerosis is a prospective cohort study that recruited middle-aged to older women and men from 6 centers in the United States between 2000 and 2002. The study population comprised 38% White, 28% Black, 23% Hispanic, and 11% Chinese American subjects. Parity (total number of live births) was self-reported and categorized as 0, 1-2, 3-4 and ≥5. The Life's Simple 7 metrics, defined according to American Heart Association criteria, include health behaviors (smoking, physical activity, body mass index, diet) and health factors (blood pressure, total cholesterol, and blood glucose). We categorized each metric into ideal (2 points), intermediate (1 point), and poor (0 points). A total cardiovascular health score of 0-8 was considered inadequate; 9-10, average; and 11-14, optimal. We used multinomial logistic regression to examine the cross-sectional association between parity and the cardiovascular health score, adjusted for sociodemographics, field site, hormone therapy, and menopause.

RESULTS

The mean (standard deviation) age was 62 (10) years. The mean (standard deviation) cardiovascular health score was lower with higher parity (8.9 [2.3], 8.7 [2.3], 8.5 [2.2], and 7.8 [2.0] for 0, 1-2, 3-4, and ≥5 live births, respectively). In comparison to inadequate cardiovascular health scores, the adjusted odds of average cardiovascular health scores were significantly lower for all parity categories relative to nulliparity (prevalence odds ratios [OR] for parity of 1-2, 0.64 [95% confidence interval 0.49-0.83]; 3-4, 0.65 [0.49-0.86]; ≥5, 0.64 [0.45-0.91]). Women with ≥5 live births had a lower prevalence of optimal cardiovascular health scores (OR 0.50 [0.30-0.83]). In the fully adjusted models, the association between parity and each Life's Simple 7 metric was only statistically significant for body mass index. Women with ≥5 live births had lower prevalence of ideal body mass index (OR 0.52 [0.35-0.80]). In addition, the test for interaction showed that the association between parity and cardiovascular health was not modified by race/ethnicity (P = .81 for average cardiovascular health scores and P = .20 for optimal cardiovascular health scores).

CONCLUSION

Multiparity was associated with poorer cardiovascular health, especially for women with ≥5 live births. More research is required to explore the mechanisms by which parity may worsen cardiovascular health.

Real prevalence of neural tube defects in Japan: How many of such pregnancies have been terminated?

The vital role of folic acid is to reduce the risk of having a neonate afflicted with neural tube defects. The prevalence of neural tube defects (myelomeningocele and anencephaly) has been reported in an incomplete form over the last 40 years in Japan. We aimed to evaluate the total number of neural tube defects including those delivered or terminated, to clarify the proportion of those terminated, and to internationally compare their prevalence. Through information on >311 000 deliveries obtained from 262 hospitals/clinics for 2 years of 2014 and 2015, we identified that the rate of total neural tube defects (termination of pregnancy, live births and stillbirths) was 8.29 per 10 000 deliveries for the year 2014 and was 8.72 for 2015, which were 1.5 and 1.6 times higher than the respective values (live births and stillbirths) reported. It is also observed that the ratio of the total number of myelomeningocele (termination of pregnancy, live births, and stillbirths) to that of anencephaly was approximately 1:1.2, that a half of pregnancies afflicted with neural tube defects were terminated, and that the proportion of termination of pregnancy due to myelomeningocele and due to anencephaly was 20% and 80%, respectively. Internationally, the real prevalence of neural tube defects in Japan was comparatively high, ranking fifth among the seven developed countries. In conclusion, the real prevalence of total neural tube defects was approximately 1.5 times higher than that currently reported by the Japan Association of Obstetricians and Gynecologists.

Forecasting Indian infant mortality rate: An application of autoregressive integrated moving average model

BACKGROUND:

The Infant Mortality Rate (IMR) reflects the socioeconomic development of a nation. The IMR was reduced by 28% between 2015 and 2016 (National Family Health Survey-4 [NFHS-4]) as compared to 2005–2006 (NFHS-3), from 57/1000 to 41/1000 live births. The target fixed by the Government of India for IMR in 2019 is 28/1000 live births (National Health Policy, 2017). One of the most common methods of forecasting this is the autoregressive integrated moving average (ARIMA) model. A forecast of IMR can help implementation of interventions to reduce the burden of infant mortality within the target range.

MATERIALS AND METHODS:

The objective of the study was to give a detailed explanation of ARIMA model to forecast the IMR (2017–2025). Secondary data analysis and forecast were done for the available year and IMR data extracted from “open government data platform India” website.

RESULTS:

The forecast of the sample period (1971–2016) showed accuracy by the selected ARIMA (2, 1, 1) model. The postsample forecast with ARIMA (2, 1, 1) showed a decreasing trend of IMR (2017–2025). The forecast IMR for 2025 is 15/1000 live births.

CONCLUSION:

In the current study, long-time series IMR data were used to forecast the IMR for 9 years. The data showed that IMR would decline from 33/1000 live births in 2017 to 15/1000 live births in 2025. When the actual data for another year (2017) are available, the model can be checked for validity and a more accurate forecast can be performed.

The efficacy of enoxaparin for recurrent abortion: a meta-analysis of randomized controlled studies

Introduction: The efficacy of enoxaparin for recurrent abortion remains controversial. We conduct a systematic review and meta-analysis to explore the influence of enoxaparin versus placebo on recurrent abortion.Methods: We search PubMed, Embase, Web of Science, EBSCO, and Cochrane Library databases through February 2019 for randomized controlled trials (RCTs) assessing the effect of enoxaparin versus placebo on recurrent abortion. This meta-analysis is performed using the fixed or random-effect model when appropriate.Results: Six RCTs involving 1034 patients are included in the meta-analysis. Overall, compared with control group for patients with recurrent abortion, enoxaparin has no obvious impact on live births (RR = 1.06; 95% CI = 0.97-1.16; p = .17), abortion rate (RR = 0.71; 95% CI = 0.45-1.10; p = .13), birth weight (std. MD = 0.38; 95% CI = -0.21-0.96; p = .21), preterm delivery (RR = 0.55; 95% CI = 0.30-1.00; p = .05), preeclampsia (RR = 1.52; 95% CI = 0.42-5.51; p = .52), and postpartum hemorrhage (RR = 1.17; 95% CI = 0.69-1.99; p = .55).Conclusions: Enoxaparin may provide no significant benefits to patients with recurrent abortion.

Oncologic and obstetrical outcomes with fertility-sparing treatment of cervical cancer: a systematic review and meta-analysis

OBJECTIVE

The objectives of this study were to evaluate the rates of recurrence, survival and pregnancy, and characterize pregnancy outcomes of early-stage cervical cancer(eCC) treated with fertility-sparing methods such as cervical conization (CON) and radical trachelectomy(RT) with or without pelvic lymphadenectomy.

STUDY DESIGN

This was a meta-analysis of observational studies analyzed by a random-effects model and a meta-regression to assess heterogeneity.

RESULTS

Sixty observational studies encompassing 2,854 patients were included; 17 of which evaluated CON and 43 RT. Three hundred and seventy-five patients were included in the CON group: 176(46.9%) stage IA1 and 167(44.5%) stage IB1. In the RT group, 2479 cases were included: 143(6.0%) stage IA1, 299(12.1%) stage IA2, 1987(79.9%) stage IB1. CON was performed in 347(92.5%) cases, resulting in a recurrence rate of 0.4%(95%CI: 0.0%-1.4%), a death rate of 0%(0%-0%), a pregnancy rate of 36.1%(26.4%-46.2%), a spontaneous abortion rate of 14.8%(9.3%-21.2%) and a preterm delivery rate of 6.8%(1.5%-15.5%). For the RT group, 2273(91.7%) underwent successful surgeries with a recurrence rate of 2.3%(1.3%-3.4%),a death rate of 0.7%(0.3%-1.1%), a pregnancy rate of 20.5%(16.8%-24.5%), a spontaneous abortion rate of 24.0%(18.8%-29.6%) and a preterm delivery rate of 26.6%(19.6%-34.2%). From a subgroup analysis, the recurrence rates for stage IA tumors treated with CON and RT were 0.4%(0.0%-1.9%) and 0.7%(0.0%-2.3%), respectively; and for stage IB were 0.6%(0.0%-2.7%) and 2.3%(0.9%-4.1%).

CONCLUSION

Fertility-sparing treatment including CON or RT for eCC is feasible and carefully selected women can preserve fertility and achieve pregnancy resulting in live births. CON seems to result in better pregnancy outcomes than RT with similar rates of recurrence and mortality.

Prevalence of Oral Clefts among Live Births in Gansu Province, China

Background: Oral clefts (OCs) are common human birth defects. Children with OCs in underdeveloped regions are more likely to suffer from poverty and hardship in their future lives. Here, we attempted to estimate the prevalence of OCs among live births in Gansu Province in 2008 to understand the epidemiologic pattern of the disease. Methods: A cross-sectional study was conducted from January 2008 to December 2008 in Gansu Province. The live births delivered between January and December 2008 with OCs were investigated through face-to-face questionnaire survey. Results: A total of 468 infants with OCs were identified among 347,137 live births in 2008 in Gansu Province, which yielded a prevalence of 1.35 per 1000 live births. The majority of these cases were CL (cleft lip) (prevalence = 0.85 per 1000 live births), and the prevalence of CLP (cleft lip and palate) and CP (cleft palate) was 0.34 and 0.11 per 1000 live births, respectively. We also found that the prevalence of OCs in Jiayuguan (3.39 per 1000 live births) and Dingxi (2.71 per 1000 live births) was higher than those of other cities in Gansu Province. Additionally, we failed to detect significant correlation between economic conditions of the cities and the prevalence of OCs in our study. Conclusions: The prevalence of OCs among live births in Gansu Province in 2008 was higher than the prevalence of OCs in other provinces in China. The high prevalence may reflect the need for further etiological studies to explore the potential risk factors in this region. In addition, more subtype information needs to be collected in future prevalence studies for better understanding of the epidemiologic pattern of the disease.

Weekend-free scheduled IVF/ICSI procedures and single embryo transfer do not reduce live-birth rates in a general infertile population

INTRODUCTION

Scheduling of ovum pickup only on weekdays may result in cases of apparently suboptimal timing for human chorionic gonadotropin and ovum pickup. This study aimed to assess whether live-birth rates were reduced in women with a potentially suboptimal day for human chorionic gonadotropin and ovum pickup to avoid weekend work, according to ultrasonographic data on the day of human chorionic gonadotropin planning.

MATERIAL AND METHODS

An evaluation of the optimal human chorionic gonadotropin priming date was performed in treatment protocols of 1000 consecutive patients undergoing their first in vitro fertilization/intracytoplasmatic sperm injection with single-embryo transfer. An ideal ovum pickup day was characterized by human chorionic gonadotropin-scheduling when three or more follicles reached 17 mm (day 0) or with one day of delay (day +1) (n = 760). A non-ideal ovum pickup was either early (day -1, -2, -3) (n = 24) or delayed (day +2, +3, +4) (n = 216). Live-birth rates in the ideal and non-ideal ovum pickup groups was set as primary outcome measure.

RESULTS

Early-ovum pickups were excluded as they were infrequent. No differences between ideal and delayed ovum pickup groups were found regarding number of oocytes retrieved (9.87 vs. 9.78, p = 0.990), pregnancy rates (28.3% vs. 29.6%, p = 0.701) or live-birth rates (26.2% vs. 25.9%, p = 0.939). However, sub analyses indicated that treatment with gonadotropin releasing hormone antagonists resulted in significantly lower clinical pregnancy rates in delayed ovum pickups (odds ratio 0.46, p = 0.014), compared with agonist treatments.

CONCLUSIONS

Weekend work may not be needed for in vitro fertilization/intracytoplasmatic sperm injection single-embryo transfer treatments. However, in gonadotropin releasing hormone antagonist cycles, delaying ovum pickup more than one day may result in unfavorable outcomes.

Congenital toxoplasmosis: Clinical features, outcomes, treatment, and prevention

Toxoplasmosis is caused by a coccidian parasite, Toxoplasma gondii. The parasite is highly prevalent both in humans and in warm-blooded animals. Cat family animals are definitive host, and these animals excrete the infective oocysts in their feces. Humans, though not definitive host, get infection by consuming water or food contaminated with cat feces. Rarely, infection can also take place through transfusing the infected blood, through transplantation of infected organs, or transplacentally from infected mother to fetus. Transplacental infection can cause congenital infection with varied degree of clinical manifestations, which depend on the age of fetus when infection took place. Diagnosis of congenital toxoplasmosis is difficult to establish until it is suspected and laboratory investigations are carried out. In more than 75% of cases, acute infection is missed due to very mild or unnoticeable clinical symptoms and signs. In India, a prevalence rate of 22.4% (8.8-37.3%) has been reported with an overall IgM positivity of 1.43%. It is estimated that approximately between 56,737 and 176,882 children per year are born in India with a possible risk of congenital toxoplasmosis. The diagnosis of congenital toxoplasmosis can be made by serological methods which are most commonly used. The other methods are parasite isolation by culture and molecular methods. Toxoplasmosis is treatable and transplacental transmission can be prevented by spiramycin, which concentrates in the placenta. However, if infection has done any damage to the fetus or the parasite has passed the placenta, spiramycin cannot reverse the damage. Prevention remains the best remedy.

Assisted reproductive technology use and outcomes among women with a history of cancer

STUDY QUESTION

How do the assisted reproductive technology (ART) outcomes of women presenting for ART after cancer diagnosis compare to women without cancer?

SUMMARY ANSWER

The likelihood of a live birth after ART among women with prior cancer using autologous oocytes is reduced and varies by cancer diagnosis but is similar to women without cancer when donor oocytes are used.

WHAT IS KNOWN ALREADY

Premenopausal patients faced with a cancer diagnosis frequently present for fertility preservation.

STUDY DESIGN, SIZE, DURATION

Population-based cohort study of women treated with ART in NY, TX and IL, USA.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Women with their first ART treatment between 2004 and 2009 were identified from the Society for Assisted Reproductive Technology Clinic Outcome Reporting System database and linked to their respective State Cancer Registries based on name, date of birth and social security number. Years were rounded, i.e. year 1 = 6-18 months before treatment. This study used reports of cancer from 5 years, 6 months prior to treatment until 6 months after first ART treatment. Women who only presented for embryo banking were omitted from the analysis. The likelihood of pregnancy and of live birth with ART using autologous oocytes was modeled using logistic regression, with women without prior cancer as the reference group, adjusted for woman's age, parity, cumulative FSH dosage, infertility diagnosis, number of diagnoses, number of ART cycles, State of residency and year of ART treatment. Results of the modeling are reported as adjusted odds ratios (AORs) and (95% confidence intervals).

MAIN RESULTS AND THE ROLE OF CHANCE

The study population included 53 426 women; 441 women were diagnosed with cancer within 5 years prior to ART cycle start. Mean (±SD) age at cancer diagnosis was 33.4 ± 5.7 years; age at start of ART treatment was 34.9 ± 5.8 for women with cancer compared with 35.3 ± 5.3 years for women without cancer (P = 0.03). Live birth rates among women using autologous oocytes differed substantially by cancer status (47.7% without cancer versus 24.7% with cancer, P < 0.0001), and cancer diagnosis (ranging from 53.5% for melanoma to 14.3% for breast cancer, P < 0.0001. The live birth rates among women using donor oocytes did not vary significantly by cancer status (60.4% for women with any cancer versus 64.5% for women without cancer), or by cancer diagnosis (ranging from 57.9% for breast cancer to 63.6% for endocrine cancer). Women with breast cancer make up about one-third of all cancers in this cohort. Among women with breast cancer, 2.8% of the 106 women who underwent ART within 6 months of being diagnosed with cancer used donor oocytes compared with 34.8% of the 46 women who received ART treatment a longer time after being diagnosed with cancer (P < 0.0001). We conjecture that the former group were either unaware that they had cancer or decided to undergo ART therapy prior to cancer treatment. However, their live birth rate was only 11.7% compared with 28.8%, the overall live birth rate for all women with cancer using autologous oocytes (P < 0.0001). The live birth rate for women diagnosed with breast cancer more than 6 months before ART (23.3%) did not differ significantly from the overall live birth rate for cancer (P = 0.49). If this difference is substantiated by a larger study, it would indicate a negative effect of severe recent illness itself on ART success, rather than the poor outcome being only related to the destructive effects of chemotherapies on ovarian follicles. Alternatively, because of the short time difference between cancer diagnosis and ART treatment, these pre-existing cancers may have been detected due to the increased medical surveillance during ART therapy. In women who only used autologous oocytes, women with prior cancers were significantly less likely to become pregnant and to have a live birth than those without cancer (adjusted odds ratio (AOR): 0.34, [95% confidence interval (CI): 0.27, 0.42] and 0.36 [0.28, 0.46], respectively). This was also evident with specific cancer diagnoses: breast cancer (0.20 [0.13, 0.32] and 0.19 [0.11, 0.30], respectively), cervical cancer (0.36 [0.15, 0.87] and 0.33 [0.13, 0.84], respectively) and all female genital cancers (0.49 [0.27, 0.87] and 0.47 [0.25, 0.86], respectively). Of note, among women with cancer who became pregnant, their likelihood of having a live birth did not differ significantly from women without cancer (85.8 versus 86.7% for women using autologous oocytes, and 85.3 versus 86.9% for women using donor oocytes).

LIMITATIONS, REASONS FOR CAUTION

Women may not have been residents of the individual States for the entire 5-year pre-ART period, and therefore some cancers may not have been identified through this linkage. As a result, the actual observed number of cancers may be an underestimate. In addition, the overall prevalence is low due to the age distributions. Also, because we restricted the pre-ART period to 5 years prior, we would not have identified women who were survivors of early childhood cancers (younger than age 13 years at cancer diagnosis), or who had ART more than 5 years after being diagnosed with cancer. Additional analyses are currently underway evaluating live birth outcomes after embryo banking among women with cancer prior to ART, cycles which were excluded from the analyses in this paper. Future studies are planned which will include more States, as well as linkages to vital records to obtain information on spontaneous conceptions and births, to further clarify some of the issues raised in this analysis.

WIDER IMPLICATIONS OF THE FINDINGS

Since the live birth rates using donor oocytes were not reduced in women with a prior cancer, but were reduced with autologous cycles, this suggests that factors acting in the pre- or peri-conceptional periods may be responsible for the decline.

STUDY FUNDING/COMPETING INTERESTS

The study was funded by grant R01 CA151973 from the National Cancer Institute, National Institutes of Health, USA. B.L. is a research consultant for the Society for Assisted Reproductive Technology. All other authors report no conflict of interest.

The success rate of IVF has significantly improved over the last decade

AIM

To demonstrate that success rates with in vitro fertilisation (IVF) have been improving despite decreasing the number of embryos transferred.

MATERIALS AND METHODS

This was a retrospective cohort study comparing live birth outcomes for women who started IVF between 2001 and 2005 with women who started between 2006 and 2010, using life table analysis to allow for the fact that women had differing number of cycles of treatment. The data were obtained from a single IVF centre, Monash IVF Geelong, Victoria. The 2001-2005 cohort consisted of 233 women, and the 2006-2010 cohort consisted of 453 women who started IVF between the specified dates. The main outcome measure was a live birth. Life table analysis was used to estimate the cumulative probability of a live birth after each cycle.

RESULTS

The estimate of cumulative live birth probability demonstrated that the chance of a live birth by cycle five was 75.8% in the 2001-2005 cohort, which significantly increased to 80.1% by cycle five in the 2006-2010 cohort (P = <0.05). There was a mean of 1.8 embryos transferred per embryo transfer in the 2001-2005 cohort, which decreased to a mean of 1.3 embryos transferred per embryo transfer in the 2006-2010 cohort. This was associated with a significant decrease in the multiple birth rate from 24.7% in the 2001-2005 cohort to 7.5% in the 2006-2010 cohort.

CONCLUSION

The IVF success rate has significantly improved despite the number of embryos transferred being reduced. This study provides further support for elective single embryo transfers.

Impact of whole systems traditional Chinese medicine on in-vitro fertilization outcomes

Patients undergoing IVF may receive either acupuncture or whole-systems traditional Chinese medicine (WS-TCM) as an adjuvant IVF treatment. WS-TCM is a complex intervention that can include acupuncture, Chinese herbal medicine, dietary, lifestyle recommendations. In this retrospective cohort study, 1231 IVF patient records were reviewed to assess the effect of adjuvant WS-TCM on IVF outcomes compared among three groups: IVF with no additional treatment; IVF and elective acupuncture on day of embryo transfer; or IVF and elective WS-TCM. The primary outcome was live birth. Of 1069 non-donor cycles, WS-TCM was associated with greater odds of live birth compared with IVF alone (adjusted odds ratio [AOR] 2.09; 95% confidence interval [CI] 1.36 to 3.21), or embryo transfer with acupuncture only (AOR 1.62; 95% CI 1.04 to 2.52). Of 162 donor cycles, WS-TCM was associated with increased live births compared with all groups (odds Ratio [OR] 3.72; 95% CI 1.05 to 13.24, unadjusted) or embryo transfer with acupuncture only (OR 4.09; 95% CI: 1.02 to 16.38, unadjusted). Overall, IVF with adjuvant WS-TCM was associated with greater odds of live birth in donor and non-donor cycles. These results should be taken cautiously as more rigorous research is needed.

External birth defects in Southern Vietnam: a population-based study at the grassroots level of health care in Binh Thuan Province

BACKGROUND

There currently exists no data on birth defects from population-based studies in Vietnam. Our study's aim was to assess external birth defect (EBD) prevalence among live newborns in Binh Thuan Province in Vietnam with the help of health workers at all levels of the health system.

METHODS

A 2-month training session for 452 health professionals (HP) practicing delivery care in 127 Commune Health Stations (CHS) and in 12 provincial or district hospitals (DH) was setup in 2006. After a successful 6-month pilot study, a one-year registry of EBDs was established in 2008. All live newborns were screened for EBDs within 24 hours after birth in all DH obstetric departments and in all CHSs. Trained local HPs collected information by filling out a predesigned form and by photographing the affected newborn. EBDs were coded using the International Classification of Diseases system-10, Clinical Modification. The study was repeated in 2010.

RESULTS

Throughout 2010, out of a total of 13,954 newborns, 84 cases with one or more EBDs were reported, representing an overall prevalence rate of 60.2 per 10,000 live births. The most common groups of EBDs were limbs (27.2/10,000), orofacial clefts (20.1/10,000) and the central nervous system (7.9/10,000).

CONCLUSIONS

This first population-based study in Vietnam, which required coordination efforts at the local level, provides baseline prevalences of external birth defects. Data on EBDs from this study in southern Vietnam may be useful for setting up a regional population-based registry of birth defects in Vietnam.

Maternal age and birth defects after the use of assisted reproductive technology in Japan, 2004-2010

BACKGROUND

Older mothers are becoming more common in Japan. One reason for this is the widespread use of assisted reproductive technology (ART). This study assesses the relationship between maternal age and the risk of birth defects after ART.

METHODS

Nationwide data on ART between 2004 and 2010 in Japan were analyzed. Diseases that were classified as code Q00-Q99 (ie, congenital malformations, deformations, and chromosomal abnormalities) in the International Classification of Diseases, tenth edition, were selected. There were 219,185 pregnancies and 153,791 live births in total ART. Of these, 1943 abortions, stillbirths, or live births with birth defects were recorded. Percentage of multiple birth defects in total birth defects, the prevalence, crude relative risk and 95% confidence interval per 10,000 pregnancies and per 10,000 live births were analyzed according to the maternal age class (ie, 25-29, 30-34 (reference), 35-39, and 40+ years).

RESULTS

Multiple birth defects were observed among 14% of the 25-29 year old class, and 8% among other classes when chromosomal abnormalities were excluded. The prevalence of chromosomal abnormalities per pregnancy and per live birth became significantly and rapidly higher in mothers in the age classes of 30-35 and 40+ years. Nonchromosomal birth defects per pregnancy decreased linearly with advanced maternal age, while the number of nonchromosomal birth defects per live birth formed a gradual U-shaped distribution. The prevalence per pregnancy of congenital malformations of the nervous system was significantly lower with advanced maternal age. The relative risk per live birth was significant regarding congenital malformations of the circulatory system for a maternal age of 40+ years. Some other significant associations between maternal age and birth defects were observed.

CONCLUSION

Maternal age is associated with several birth defects; however, older maternal age in itself does not produce noticeable extra risk for nonchromosomal birth defects overall.

Nationwide description of live Japanese births by day of the week, hour, and location

To characterize temporal variations of live births in Japan, we analyzed data on the 1,203,147 births of 1998. In hospitals, with 20+ beds, the daily average of live births was significantly lower at weekends and national holidays (mean=1,433, SD = 100) than on weekdays (mean = 1,957, SD = 126). Hourly distributions of live births showed a single sharp peak at 1:00-2:59 pm on weekdays with a small peak at an earlier hour on Saturdays, Sundays and national holidays. The results in clinics, with no bed or less than 20 beds, were similar to those in hospitals except on Saturdays. The difference in the daily average of live births between Saturdays and weekdays was smaller in clinics than that found in hospitals, and hourly distributions on Saturdays resembled those of weekdays but not Sundays or national holidays. Maternity homes showed no differences in the mean number of daily live births over the days of the week including national holidays, and no clear peak of percentage distributions of hourly live births on each day of the week. The present study suggests that the weekly and hourly variations observed in hospitals and clinics are not due to a biological rhythm of labor, but to obstetric intervention in the timing of delivery, either through induction of labor or elective cesarean section.