Heterotopic pregnancy after assisted reproductive techniques with favorable outcome of the intrauterine pregnancy:A case report

BACKGROUND Heterotopic pregnancy(HP)is a rare condition in which both ectopic and intrauterine pregnancies occur.HP is uncommon after natural conception but has recently received more attention due to the widespread use of assisted reproductive techniques(ART)such as ovulation promotion therapy.CASE SUMMARY Here,we describe a case of HP that occurred after ART with concurrent tubal and intrauterine singleton pregnancies.This was treated successfully with surgery to preserve the intrauterine pregnancy,resulting in the birth of a low-weight premature infant.This case report aims to increase awareness of the possibility of HP during routine first-trimester ultrasound examinations,especially in pregnancies resulting from ART and even if multiple intrauterine pregnancies are present.CONCLUSION This case alerts us to the importance of comprehensive data collection during regular consultations.It is important for us to remind ourselves of the possibility of HP in all patients presenting after ART,especially in women with an established and stable intrauterine pregnancy that complain of constant abdominal discomfort and also in women with an unusually raised human chorionic gonadotropin level compared with simplex intrauterine pregnancy.This will allow symptomatic and timeous treatment of patients with better results.

The Impact of Seasonal Variation on Clinical Pregnancy and Live Birth Rates in Assisted Reproductive Technology: A Retrospective Cohort Study in Hainan

Objective:To investigate the influence of season on live birth and clinical pregnancy rates,as well as assisted reproductive technology(ART)outcomes,in the Hainan region.Methods:Patients were categorized into four groups based on the dates of artificial insemination and transplantation:spring,summer,autumn,or winter.The main outcome measures were clinical pregnancy rates and live birth rates.Secondary outcomes included body mass index(BMI),oocyte number,two pronuclei(2PN)cleavage rate,total gonadotropin(Gn)dosage and days,age,2PN fertilization rate,sperm concentration,sperm PR rate,anti-Müllerian hormone(AMH),and endometrial thickness.Outpatient semen quality indicators included sperm PR rate,total sperm count,sperm concentration,and total sperm motility.Results:This retrospective cohort study analyzed 2,016 artificial insemination cycles and 1,783 ovarian retrieval cycles from January 2017 to October 2022,and assessed the semen quality of 6,651 outpatients from May 2017 to October 2022.In artificial insemination cycles,sperm PR rate and clinical pregnancy rate were highest in winter,with a statistically significant difference between groups(P<0.05).Clinical pregnancy rate was influenced by both age and sperm PR rate(P<0.05).In ovarian retrieval cycles,the winter group had significantly higher clinical pregnancy,2PN fertilization,and 2PN cleavage rates than the other groups.The autumn group had higher live birth rates,though not significantly different.Additionally,winter months showed higher total sperm concentration and total sperm number compared to other seasons.Conclusion:Seasonality affected clinical pregnancy and live birth rates in artificial insemination cycles but not in ovarian retrieval cycles in the Hainan region.These findings suggest that while there is no need to choose a specific season for ovarian retrieval cycles,artificial insemination in winter may be preferable for patients.

Embryo quality and chromosomal abnormality in embryos from couples undergoing assisted reproductive technology using preimplantation genetic screening

Objective:To detect common chromosomal aneuploidy variations in embryos from couples undergoing assisted reproductive technology and preimplantation genetic screening and their possible associations with embryo quality.Methods:In this study,359 embryos from 62 couples were screened for chromosomes 13,21,18,X,and Y by fluorescence insitu hybridization.For biopsy of blastomere,a laser was used to remove a significantly smaller portion of the zona pellucida.One blastomere was gently biopsied by an aspiration pipette through the hole.After biopsy,the embryo was immediately returned to the embryo scope until transfer.Embryo integrity and blastocyst formation were assessed on day 5.Results:Totally,282 embryos from 62 couples were evaluated.The chromosomes were normal in 199(70.57%)embryos and abnormal in 83(29.43%)embryos.There was no significant association between the quality of embryos and numerical chromosomal abnormality(P=0.67).Conclusions:Embryo quality is not significantly correlated with its genetic status.Hence,the quality of embryos determined by morphological parameters is not an appropriate method for choosing embryos without these abnormalities.

Support from Healthcare Professionals for Couples/Partners Undergoing Assisted Reproductive Technology in Japan: A Literature Review

Background and Purpose: A growing number of couples/partners have been undergoing assisted reproductive technology (ART) in Japan. The purpose of this study was to clarify the support from healthcare professionals based on the support vectors in the Family Care/Caring Theory proposed by Hohashi (2015) through a literature review. Methods: Using Ichushi-Web, we searched for original articles using the keywords “assisted reproductive technology”, “infertility”, “family”, “couple”, “nursing”, “care”, and “support”. Thirteen articles suitable for the purpose of this study were subjected to content analysis. Family support was encoded and grouped into subcategories and categories, and classified according to support vectors. Results: A total of 21 categories of support from healthcare professionals was extracted. Intervention for family internal environment included seven categories, such as “Nursing professionals stay close to females”. Intervention for family system unit included five categories, such as “Nursing professionals adjust couple/partner relationships”. Intervention for micro system only included “Nursing professionals provide opportunities for peer support to the couples/partners” and intervention for macro system only included “Nursing professionals encourage medical doctors to relate to females”. Intervention for family chrono environment included seven categories, such as “Healthcare professionals resolve female’s anxieties”. Conclusion: The support from healthcare professionals could be organized by the support vectors of Family Care/Caring Theory, but intervention for supra system (culture, religion, etc.) was lacking. Moreover, because most support was directed toward females or couples/partners, male-focused direct and/or indirect support are also needed. .

Benign ovarian cysts in reproductive-age women undergoing assisted reproductive technology treatment

The scope of this review is to focus on the management of benign ovarian cyst in the reproductive-age group of women undergoing ART. Ovarian cysts are a common occurrence in this patient population. The differential diagnosis includes functional cysts, dermoid cysts, endometrioma. The appropriate evaluation includes medical history and physical examination, laboratory tests and imaging. The treatment options include conservative follow-up, medical treatment and surgery. This review will explore the differential diagnosis, appropriate work-up and treatment options to the various cyst types encountered.

Assisted Reproductive Technology for HIV-1 Serodiscordant Couples: A Review of Current Controversies

Since 1992, assisted reproductive technology （ART） has been reported as a viable means of helping HIV-1 serodiscordant couples achieve pregnancy while theoretically reducing the risk for viral transmission. While the sum of the evidence suggests that ART is effective and safe, numerous controversies still exist, The follow- ing review addresses several of the important issues involved in the use of ART for HIV-serodiscordant couples, including patient selection, semen processing techniques, post-process HIV testing, the use of lUI vs IVF-ICSI.

Towards better meta-analyses in assisted reproductive technology: Fixed, random or multivariate models?

AIM: To study the validity of the fixed, random, and multivariate meta-analytical models applied in meta-analyses in artificial reproduction technique. METHODS: Based on common characteristics of in vitro fertilization(IVF) meta-analyses, we simulated a large number of data to compare results issued from the fixed model(FM) with the random model(RM). For multiple endpoints meta-analysis(MA), we compared the univariate RM with the multivariate model(MM). Finally, we illustrate our findings in re-analyzing a recent MA. RESULTS: In our review, although a homogeneous effect was excluded in 89% of the MAs(11%), FM was utilized in 41 studies(82%). From simulations, a concordance of 59% ± 6% was found between the two tests, with up to 65% of falsely significant results with FM. The Q-test on studies characterized by substantial heterogeneity falsely accepted homogeneity in 46% of studies. Comparing separate univariate RM and MM on multiple endpoints studies, MM reduces the between endpoint discrepancy(BED) of 68%, and increases the power of 57% ± 8%. In the example dealing with the controversial effect of luteneizing hormone supplementation to follicle stimulating hormone during ovarian stimulation in IVF cycles, MM reduced BED by 66%, and consistent effects were found for all the endpoints, irrespective of partial reporting. CONCLUSION: The FM generally may produce falsely significant differences. The RM should always be used. For multiple endpoints, the MM constitutes the best option.

The Impact of Body Mass Index on Assisted Reproductive Treatments

Multiparity amongst women with a body mass index (BMI) ≥ 30 Kg/m2 is a common occurrence despite there being a known clear association with a decline in fecundity in women who are overweight or obese. These women, also pose further concerns, as they are at increased risk of antenatal complications such as preeclampsia and gestational diabetes. Over the years, a number of different modalities of fertility treatments have been tried and tested in this cohort of women to find the optimal treatment to improve their reproductive capacity. There has been an exponential increase in knowledge and understanding towards managing patients with a raised BMI, particularly through assisted reproductive treatments. Although the efficacies of various forms of fertility treatments have been shown to be affected by a rise in BMI, there is yet to be a definitive understanding as to the optimal management of these patients. The literature supports weight loss alone as an effective intervention in improving the reproductive capacity of women with a raised BMI with unexplained infertility. Furthermore, if live birth rate is taken as the desired outcome measure, then ovarian drilling and in vitro fertilisation (IVF) treatment have been shown to yield the best results in overweight and obese patients when comparisons are drawn to other interventions such as natural conception and treatment with clomiphene citrate.

Awareness and perception of assisted reproductive technology practice amongst women with infertility in Northern Nigeria

Background: Involuntary infertility is a tragedy in most African setting. This is due to premium placed on fertility as a result of roles children fulfill in the family and the society. Aetiologic factors of infertility in sub-Saharan Africa are mostly infection related and they are mainly associated with poor treatment outcome to conventional non assisted conception technique. Objective: To evaluate the level of awareness and perception of assisted conception treatment among women attending fertility clinic. Methods: A descriptive cross-sectional study. Results: One hundred and ninety six women attending fertility clinic were interviewed. Mean age was 34.8year and mean duration of infertility of 4.1 years. Of the 196 infertile women interviewed, 150 (76.5%) have heard of Assisted Reproductive Technology treatment. Sources of information were mainly family relation (46%) and friends (28.7%). Knowledge on some of Assisted Reproductive Technology practices showed that 50.7% were aware that the treatment could fail, 36.8% knew it could be applied for male infertility treatment, 9.3% and 18.7% respectively are aware that donor oocyte and sperm could be used for treatment. Perception on babies conceived from assisted conception treatment revealed that 52% of patients interviewed could not comment if they are normal and natural babies. Majority of patients could not affirm if they will agree to the use of donor gamete or zygote for their treatment. Conclusion: Awareness of assisted conception treatment was high, however knowledge on specifics of treatment was low and perception on some of the practices was unfavorable. Sensitization of the public will help overcome some beliefs that may be at tangent to some practices of assisted conception.

The relationship between maternal body fat and pre-implantation embryonic weight: Implications for survival and long-term development in an assisted reproductive environment

There can be little argument that embryo quality is one of the most critical factors in the success of assisted reproductive techniques. Yet the current methods of grading embryos are subjective at best. While a number of different groups have described more qualitative means of assessing embryo quality, the current standard remains morphology. Morphology has proven a good standard, but it does not allow for the detection of chromosomal abnormalities nor can it assess the biochemical status of the embryo prior to transfer. This laboratory recently described a method to estimate embryo weight and suggested weight might be a good indicator of biochemical status. The objective of the present study was to determine the relationship between maternal body composition and embryo weight and determine the influence maternal chemistry had on embryo development. The data continue to suggest that maternal body composition, especially body fat, influences the chemical nature of the embryo and may play a critical role in long-term survival.

Assessment of Risk of Carrier Waves in the Assisted Reproductive Laboratory

Assisted reproductive technology (ART) laboratories represent the marriage of the most basic of biological activities with the most cutting edge technologies. While this association has worked well, the mixture of biology and technology can create risks to normal embryo development. Recently a significant amount of literature has explored the risks of manmade, electrically induced magnetic fields and carrier waves on reproduction, which some studies have suggested will lower functional gamete numbers in the males and potentially induce genetic issues in embryos. However, little is known about these phenomena within the ART laboratory, a laboratory filled with electronic equipment. The object of the present study was to explore the potential exposure of gametes and early stage embryos to two of the most prevalent fields and waves utilized in manmade technologies seen in the general environment, electromagnetic fields (EMF) and radio frequency waves (RF), and determine the effect varying levels of these energetic forces had on gamete function and embryo development. Results indicated that while extremely high concentrations of EMF (approximately 50-100X of laboratory background) caused negative outcomes in both gametes and embryos, levels consistent will the majority of lab equipment did not appear to impact growth, or function. Further, even extremely high RF appeared to have no impact cellular function. Results suggest few issues with EMF or RF on gamete and embryo function at normal laboratory levels for the relatively short exposure times seen in the ART laboratory.

Live birth rates of assisted reproductive technology treatment and spontaneous conception among subfertile couples in Singapore: A follow-up study

Objective: To explore the potential predictors of a live birth (LB) outcome among subfertile couples of Asian ethnicity undergoing the first fertility treatment cycle;to assess the cumulative live birth rates after successive cycles;and to determine the incidence rate of spontaneous conception (SC).Methods:Subfertile couples were grouped according to treatment modalities at the first fertility treatment cycle: intrauterine insemination (IUI),in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI) and no treatment, and were followed-up for duration up to seven years. Multivariable logistic regression analysis was used for statistical analyses. Results: Age of female subjects [35-38 years, odds ratio (OR): 0.39;≥39 years, OR: 0.14], uterine factor subfertility (OR: 5.24), and treatment modalities (ORs: IUI 0.25, IVF 2.33 and ICSI 1.91) significantly predicted a LB outcome (P<0.05). The cumulative live birth rates were 11.7% IUI, 41.5% IVF, 27.5% ICSI and 22.6% from frozen embryo transfer cycles. The cumulative SC rate was 24.6% in the non-treated group and 10.7% in the treated group. All LBs from IVF cycles were delivered by the second cycle and within four years, compared to SC delivery of within five years in the non-treated group and six years in the treated group. Conclusions:Age of female subject, uterine factor and modalities of treatment are significant predictors for LB outcome at the first cycle. Higher delivery rates could be achieved following fewer successive IVF cycles and within a shorter duration compared to SC.

Implementation and Evaluation of Infertility Reflection in Early Pregnancy after the Use of Assisted Reproductive Technology: A Feasibility Study

Background: This study aims to evaluate the infertility reflection in early pregnancy after assistive reproductive therapy (ART), including 1) process evaluation (the use and evaluation of infertility reflection) and 2) outcome evaluation (satisfaction of care needs, anticipatory anxiety towards the loss of a pregnancy or fetus, cognition of infertility experience, and depression and anxiety). Methods: This program evaluation study used a one-group pre-post-test design. The participants were 50 primiparas who had undergone ART at two fertility treatment facilities in a metropolitan area in Japan. For the infertility reflection, they conducted an online reflection. Data were collected three times: at the 5th week of pregnancy (Time 1), the 8th week of pregnancy as the final consultation at the clinic (Time 2), and the 16th week of pregnancy as the final point of early pregnancy (Time 3). Results: The data from 40 participants were analyzed. More than 80% of the users of the online reflection positively evaluated the appropriateness and usefulness of the methods and contents. Organized thoughts and feelings by reflection were shown as the reasons for the usefulness. The evaluation of the online reflection showed a relatively strong correlation with the Care Need Satisfaction Scale (CNSS) for both Time 2 and Time 3, but the online reflection did not show a significant correlation with the other outcome variables. There were no significant differences in outcome variables between users and non-users of online reflection between Time 2 and Time 3. Conclusions: Attempts at the reflection in early pregnancy require modified methods that do not have a negative impact and lead to the fulfillment of needs.

Pregnancies Outcome after Assisted Reproductive Technology: A Multicenter Case Control Study in a Low Income Setting Douala, Cameroon

The objective was to assess the outcome of pregnancies after assisted reproductive technology (ART). It was a case-control study carried out in four health facilities in Douala-Cameroon, over a period of five years. The cases were pregnant women who conceived through ART and the controls were those who conceived naturally. Cases and controls were matched for maternal age and parity (one case for two controls). A logistic regression analysis was used to compute Odds ratios. Statistical significance was set at 0.05. A total of 174 women who conceived through ART and 348 who conceived naturally were enrolled. Some independent factors associated with ART were: age over 45 years [aOR: 7.55; 95% CI (1.55 - 36.76);p: 0.01], twin pregnancies [aOR: 16.55; 95% CI (7.91 - 34.60);p < 0.01], Cervical cerclage [aOR: 3.04; 95% CI (1.23 - 7.50);p: 0.01], miscarriages [aOR: 11.73; 95% CI (5.07 - 27.10);p: 0.01], elective cesarean section [aOR: 4.63; 95% CI (2.27 - 9.45);p: 0.01] and low birth weight [aOR: 3.32; 95% CI (1.90 - 5.82);p < 0.01]. Women who conceived by ART were older with higher rates of multiple pregnancy and complications. We recommend transfer of a single embryo.

Clinical study of different fertilization methods of assisted reproductive technology on neonatal birth defects

Objective:To investigate the incidence of neonatal birth defects in assisted reproductive technology(ART)by in vitro fertilization(IVF)and intracytoplasmic sperm injection(ICSI).Methods:The clinical data of 4229 cases of singleton deliver by infertile patients under 35 years old who received IVF/ICSI-ET in our center were analyzed.According to different fertilization methods,they were divided into IVF group(2967 cases)and ICSI group(1262 cases).The general situation of birth,birth defects and the location of defects were compared between the two groups.Results:a total of 38 cases of neonatal birth defects were found,the incidence of birth defects was 0.89%,including 30 cases(1.01%)in IVF group and 8 cases(0.64%)in ICSI group.There was no significant difference in the incidence of birth defects between the two groups(P>0.05).There was also no significant difference in birth weight,gestational age and gender ratio between the two groups(P>0.05).Conclusion:Different fertilization methods in assisted reproductive technology do not increase the incidence of neonatal birth defects.

Application of Nursing Risk Management in Assisted Reproductive Nursing

Objective: discuss and analyze the application effects of nursing risk management in assisted reproductive nursing. Methodology: this research was carried out by selecting 384 IVF-ET (In-vitro fertilization and embryo transfer) patients admitted by certain hospital during February 2016 to February 2018 as research objects, who are classified into general group and research group at random by numbering all randomly, with 192 objects per group for comparing adverse event rate and nursing quality of patients in these two groups. Result: the adverse event rate of patients in research group is 4.17%, while that in general group is 10.94%, with the adverse event rate in research group lower than that in general group (P < 0.05);the overall scores of nursing quality in research group is (96.37±9.37), while that in general group is (79.34±8.25), with the overall score in research group significantly higher than that in general group (P < 0.05);the nursing satisfaction of research group and general group are 95.31% and 84.38% respectively, with the satisfaction in research group significantly higher than that in general group (P < 0.05). Conclusion: in assisted reproductive nursing, the application of nursing risk management plays a critical role, which can not only reduce the adverse event rate, but also effectively improve the nursing quality of patients, as well as improve the nursing satisfaction of patients, thus being proven that nursing risk management shall be widely applied in clinical nursing.

Impact of COVID-19 pandemic on the pregnancy outcomes of women undergoing assisted reproductive techniques(ARTs):a systematic review and meta-analysis

The global outbreak of the coronavirus disease 2019(COVID-19) led to the suspension of most treatments with assisted reproductive technique(ART). However, with the recent successful control of the pandemic in China, there is an urgent public need to resume full reproductive care. To determine whether the COVID-19 pandemic had any adverse effects on female fertility and the pregnancy outcomes of women undergoing ART, a systematic review and meta-analysis was conducted using the electronic Chinese and English databases. Dichotomous outcomes were summarized as prevalence, and odds ratios(ORs)and continuous outcomes as standardized mean difference(SMD) with 95% confidence interval(CI). The risk of bias and subgroup analyses were assessed using Stata/SE 15.1 and R 4.1.2. The results showed that compared with women treated by ART in the pre-COVID-19 time frame, women undergoing ART after the COVID-19 pandemic exhibited no significant difference in the clinical pregnancy rate(OR 1.07, 95% CI 0.97 to 1.19;I^(2)=0.0%), miscarriage rate(OR 0.95, 95% CI 0.79 to1.14;I^(2)=38.4%), embryo cryopreservation rate(OR 2.90, 95% CI 0.17 to 48.13;I^(2)=85.4%), and oocyte cryopreservation rate(OR 0.30, 95% CI 0.03 to 3.65;I^(2)=81.6%). This review provided additional evidence for gynecologists to guide the management of women undergoing ART treatment during the COVID-19 pandemic timeframe.

Assisted coiling techniques in treatment of intracranial complex aneurysms

Objective To investigate the application of assisted coiling techniques in the treatment of complex intracranial aneurysms. Methods From Jun. 2007 to Aug. 2010,36 patients with 41 complex intracranial aneurysms were treated by varient endovascular methods,including balloon, stent-assisted coiling and double microcatheter coilingtechniques. Results Among the

ISSUES AND MEASURES ON ASSISTED REPRODUCTION BY ACUPUNCTURE ABROAD

As the application of acupuncture has been increased year by year in the field of overseas reproduction, it has become crucial to give a scientific and objective evaluation of the safety and efficacy of acupuncture in the field of assisted reproduction, which attaches great importance to the sustainable development of acupuncture in the field of reproduction. This article aims to introduce the current situation of overseas clinical study in the field of assisted reproduction, analyze the existing issues profoundly and put forward measures to solve them, in order to enhance the level of international clinical study of acupuncture.