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To study the effect of increasing endometrial thickness on live birth rates in fresh and frozen-thaw embryo transfer (FET) cycles.Retrospective cohort study.National data from Autologous in vitro fertilization (IVF) embryo transfer and FET cycles in Canada from the Canadian Assisted Reproductive Technology Registry Plus (CARTR Plus) database for records between January 2013 and December 2019.Thirty-three Canadians clinics participated in voluntary reporting of IVF and pregnancy outcomes to the Canadian Assisted Reproductive Technology Registry Plus database, and a total of 43,383 fresh and 53,377 frozen transfers were included.None.Clinical pregnancy, pregnancy loss, and live birth rates.In fresh IVF-embryo transfer cycles, increasing endometrial thickness is associated with significant increases in the mean number of oocytes retrieved, peak estradiol levels, number of usable embryos, clinical pregnancy rates, live birth rates, and mean term singleton birth weights, and a decrease in pregnancy loss rates. However, live birth rates plateau after 10-12 mm. In contrast, in FET cycles live birth rates plateau after the endometrium measures 7-10 mm. The improvement in live birth rates with increasing endometrial thickness was independent of patient age, timing of embryo transfer (e.g., cleavage stage vs. blastocyst stage), or the number of oocytes at retrieval.In cycles with a fresh embryo transfer, live birth rates increase significantly until an endometrial thickness of 10-12 mm, while in FET cycles live birth rates plateau after 7-10 mm. However, an endometrial thickness6 mm was associated clearly with a dramatic reduction in live birth rates in fresh and frozen embryo transfer cycles.

To evaluate maternal and neonatal outcomes in women with chronic hypertension who conceive using assisted reproductive technologies (ART).Population-based retrospective cohort study.Obstetric hospitals.Singleton pregnancies of at least 20 weeks' gestational age to women 18 years and older who delivered a live or stillborn infant between April 1, 2006, and March 31, 2012, categorized as exposed based on a diagnosis of chronic hypertension in the mother predating the index pregnancy.Medically assisted pregnancy including in vitro fertilization/intracytoplasmic sperm injection (IVF-ICSI), intrauterine insemination, and ovulation induction.placental-mediated complications of pregnancy (preeclampsia/eclampsia, stillbirth, fetal growth restriction/low birthweight [10th percentile], or clinically significant placental abruption); secondary outcomes: cesarean delivery (planned/unplanned), prematurity (37 or32 weeks), and neonatal death.Our cohort included 807,765 singleton pregnancies. We used log binomial regression to compute the adjusted relative risks of the various outcomes in women with hypertension as compared with healthy women in ART and unassisted pregnancies. When we tested an interaction term between hypertension and ART in multivariate models, women with ART pregnancies were at higher risk of placental-mediated complications than were those with unassisted pregnancies (adjusted risk ratio 1.48; 95% confidence interval, 1.35, 1.56). The risk was even greater in hypertensive women who used ART (adjusted risk ratio 6.77; 95% confidence interval, 4.72, 9.72). Our findings persisted when assessing IVF only and when evaluating nulliparas.Hypertension is more frequent in ART-treated women. Hypertension increases the risk of placental complications, which appear to be compounded in ART versus unassisted pregnancies.

Objective: To determine whether young women with Turner's syndrome who had normal bone mineral density (BMD) before the induction of puberty maintain normal BMD in young adulthood. Design: Controlled clinical study. Setting: A private hospital clinical research setting. Patients: Young women with Turner's syndrome in Tanner stage V of puberty with previously normal BMD. Interventions: Oral conjugated estrogens and progesterone acetate were administered continuously for a mean (±SD) of 4.1 ± 1.0 years. Bone mineral densities and blood samples were evaluated. Main Outcome Measure(s): The BMD of the lumbar spine and the femoral neck was determined during young adulthood. The change in BMD over the previous 6 years also was evaluated. Serum concentrations of the carboxy-terminal propeptide of type 1 collagen and of the carboxy-terminal cross-linked telopeptide of type 1 collagen were measured. Result(s): The BMD of the lumbar spine was reduced significantly in our patients. There was no change in the BMD of the femoral neck or lumbar spine over a period of 6.1 years. Concentrations of the carboxy-terminal propeptide of type 1 collagen were decreased, whereas concentrations of the carboxy-terminal cross-linked telopeptide of type 1 collagen were increased. Conclusion(s): Young women with Turner's syndrome do not attain normal peak bone mass even when estrogen replacement therapy is begun in adolescence. Their low BMD seems to be due to decreased bone formation and increased bone resorption.

Objective To study the current literature on the association between IVF treatment and maternal serum screening marker levels and nuchal translucency thickness. Design Systematic review. Settings Not applicable. Patient(s) Eligible studies included those with an exposed group of pregnant women that used IVF with or without intracytoplasmic sperm injection to conceive and a control group of pregnant women who conceived spontaneously. Intervention(s) IVF treatment to conceive. Main Outcome Measure(s) Outcomes evaluated included maternal serum screening markers (pregnancy-associated plasma protein A [PAPP-A], alpha-fetoprotein, hCG, unconjugated estriol, dimeric inhibin-A) and nuchal translucency thickness. Result(s) Database searches identified 4,118 titles and abstracts that were independently screened, which resulted in 76 articles that were assessed for eligibility. Additionally, one study was added for consideration based on expert knowledge. There were 29 cohort and 11 case-control studies in the descriptive review. The most commonly reported markers were PAPP-A and free β-hCG, which were reported in 28 and 26 studies, respectively. The studies that reported effect sizes for PAPP-A and free β-hCG were not statistically significant. Conclusion(s) A decrease in PAPP-A and an increase in total hCG was consistently reported among the included studies. However, owing to the variability in the levels of the other maternal serum screening markers reported and the inability to conduct a meta-analysis, we were unable to generalize about the differences between prenatal screening results in the IVF population.

Objective To compare reproductive outcomes of patients with very low, low, normal, and high antral follicle counts undergoing unstimulated therapeutic donor insemination (TDI) cycles. Design Retrospective cohort study. Setting University-affiliated regional fertility clinic. Patient(s) Four hundred fifty-nine patients who had 1,107 TDI treatment cycles from January 2006 to December 2013. Intervention(s) Unstimulated therapeutic donor insemination. Main Outcome Measure(s) Clinical pregnancy rates and miscarriage rates as surrogate markers for oocyte quality. Result(s) The overall pregnancy rate per cycle start was 12.46% in the study population. There was no difference in per-cycle or cumulative pregnancy rates among patients with very low, low, average, or high antral follicle counts within each patient age group of ≤35, 36–39, and ≥40 years. The overall miscarriage rate per pregnancy was 13.61%. When stratified by patient age, there was no correlation between miscarriage rate and antral follicle count. Conclusion(s) AFC is not a predictor of pregnancy or miscarriage rates in patients undergoing unstimulated TDI.

Objective: To evaluate whether girls with Turner's syndrome have an increased risk for cardiovascular disease due to alterations in their lipoprotein metabolism. Design: Controlled clinical study. Setting: Private academic hospital. Patient(s): Fifteen untreated girls with Turner's syndrome were studied initially; 11 of these patients were evaluated further while on therapy. Intervention(s): Serum lipids, lipoprotein lp(a), and plasminogen activator (PA) inhibitor-1 were measured before and during 6 months of either GH or estrogen (E) treatment. Main Outcome Measure(s): Serum lipids, lipoprotein lp(a), and PA inhibitor-1 (PAI-1). Result(s): Total and low-density lipoprotein (LDL) cholesterol, triglycerides, lipoprotein lp(a), and PA inhibitor-1 levels were normal in Turner's syndrome patients compared with age matched controls; HDL cholesterol was increased. During GH treatment, a significant decrease in total and LDL cholesterol was noted, whereas lipids, lipoprotein(a), and PA inhibitor-1 levels did not change with E therapy. Conclusion(s): The normal lipoproteins of untreated adolescents with Turner's syndrome, as well as the further decrease of total and LDL cholesterol during GH treatment, would seem to indicate that lipoproteins do not increase the cardiovascular risk of these girls.