Pregnancy Outcomes Associated with Ovarian Hyperstimulation Syndrome:A Retrospective Cohort Study of Infertile Women

Objective To assess the relationship between ovarian hyperstimulation syndrome(OHSS)and adverse outcomes using population-based data in the United States.The hypothesis is that patients with OHSS were more likely to deliver preterm and more likely to have hypertensive disorders.Methods This retrospective cohort study identified 94 patients with OHSS and 183 matched referents in eight counties in Minnesota.Data were collected regarding pregnancy history,infertility treatment,and pregnancy outcomes.Using the Rochester Epidemiology Project,study subjects were identified from female patients,aged 18 to 49 years,who were diagnosed with infertility from January 2,1995 to December 1,2017,and had a pregnancy greater than 20 weeks'gestation.The primary outcome was preterm delivery or hypertensive disorder of pregnancy incidence in the OHSS group when compared with control patients.Chi-squared test,t test,and multivariate logistic models were used where appropriate.Results Patients with OHSS were more likely to deliver preterm(odds ratio,2.14;95%confidence interval,1.26–3.65;P<0.01),and their neonates were more likely to be small for gestational age(odds ratio,4.78;95%confidence interval,1.61–14.19;P<0.01).No significant differences between the groups were observed in any other outcome.Patients with OHSS are more likely to deliver preterm if they undergo fresh transfer compared with a freeze all and subsequent frozen transfer(odds ratio,3.03,95%confidence interval,1.20–7.66,P=0.02).Conclusion OHSS may lead to preterm birth and small-for-gestational-age neonates,which changes patient counseling and leads to arranging specialized obstetrical care for these patients with OHSS.

Analysis of factors related to early miscarriage after in vitro fertilization embryo transfer

Aims:This research aims to explore the factors related to early spontaneous miscarriage after in vitro fertilization and embryo transfer(IVF-ET)pregnancy,and to provide guidance for improving pregnancy outcomes.Methods:We retrospectively analyzed the data for clinical pregnant women(2591 cycles)undergoing IVF-ET at the reproductive center of Peking University People’s Hospital from January 2017 to December 2018;This included 544 ET cycles and 2047 frozen embryo transfer cycles.The analysis of factors associated with early miscarriage in the overall population of IVF/intracytoplasmic sperm injection(ICSI)pregnancies(including fresh and thawing cycles)was performed.Results:The risk of early miscarriage in the 35–39 age group was 1.35 times higher than that in the<35 age group(OR=1.35[1.05,1.73],p=0.02).In addition,the risk of early miscarriage was 3.88 times higher in the group40 years old than in the group<35 years old(OR=3.88[2.68,5.62],p<0.001).Endometrial thickness also affected the miscarriage rate;the early miscarriage risk with endometrial thickness8.5 mm was 0.78 times than that of the<8.5 mm group(OR=0.78[0.62,0.98],p=0.03).The early miscarriage rate during frozen embryo transfer was 1.48 times higher than that during fresh embryo transfer(OR=1.48[1.08,2.02],p=0.01),while in the fresh cycle,the risk of early miscarriage with high-quality embryos was 0.5 times lower than that with nonhigh quality embryos(OR=0.5[0.27,0.9],p=0.02).In the frozen cycle,the risk of early miscarriage in natural cycle transplantation was 0.73 times that in hormone replacement treatment(HRT)cycle transplantation(OR=0.73[0.54,0.97],p=0.03).Conclusions:Advanced age is an independent risk factor for early miscarriage,while endometrial thickness at the date of transplantation is an independent protective factor.The risk of early miscarriage in fresh-cycle transplanted embryos is significantly lower than that in frozen embryos,and the number of high-quality embryos in the fresh cycle lowers the miscarriage rate significantly.Natural cycle transplantation has a lower rate of early miscarriage than hormone replacement therapy.