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Objective: The study aimed to assess whether sub-endometrial contractility is reduced by the use of intramuscular (IM) progesterone.Design: This is a randomized clinical trial. Patients assigned to a medicated day 5 frozen embryo transfer (FET) were randomly allocated to "vaginal progesterone" or "IM progesterone": patients randomized to the vaginal arm were treated with 200 mg micronized progesterone 3 times daily while patients randomized into the IM progesterone arm were treated with a single daily injection of 50 mg progesterone in oil. The main outcome measure was the number of sub-endometrial contractions (waves) per minute 1 day before a blastocyst embryo transfer.Results: Thirty-four patients were enrolled. The progesterone serum concentration was significantly higher in patients using the IM progesterone (85.2 ± 50.1 vs. 30.3 ± 11.2 nmol/L, respectively) but this did not translate into a lower sub-endometrial contractility (2.4 ± 4.8 vs. 1.4 ± 1.1 contraction/min, respectively). Clinical pregnancy rates were comparable between groups. The number of sub-endometrial waves was significantly lower among pregnant patients (p = 0.02).Conclusions: The use of IM progesterone in medicated FET cycles does not reduce the sub-endometrial activity compared to vaginal progesterone administration. Our data support a poor clinical pregnancy outcome with high wave activity, regardless of the progesterone mode. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to evaluate telomere homeostasis in sub-fertile compared to fertile human sperm. Methods: This observational, comparative study included 16 sub-fertile men who required intracytoplasmic sperm injection and 10 fertile men. At least 100 sperm cells from each participant were assessed. Main outcome measures were telomere length and telomere aggregates. Telomerase RNA component (TERC) copy number and telomere capture were assessed using fluorescence in situ hybridization technique and human telomerase reverse transcriptase (hTERT) using immunohistochemistry. Results: Clinical backgrounds were similar. The percentage of sperm cells with shorter telomeres was higher among the sub-fertile compared to the fertile participants (3.3 ± 3.1 vs. 0.6 ± 1.2%, respectively; P < 0.005). The percentage of cells with telomere aggregates was significantly higher in the sub-fertile group (15.12 ± 3.73 vs. 4.73 ± 3.73%; P < 0.005). TERC gene copy number was similar between groups. The percentage of cells that were positive for hTERT was lower in the sub-fertile group (3.81 ± 1.27 vs. 8.42 ± 1.80%; P < 0.005). Telomere capture rates were higher among the sub-fertile sperm cells ( P < 0.005). Conclusions: Sub-fertile sperm cells have short telomeres that are elongated by the alternative pathway of telomere capture. Dysfunctional telomeres may affect sperm fertilizability. [ABSTRACT FROM AUTHOR]

Objectives: To investigate female fertility in patients with rheumatoid arthritis (RA) exposed to biological drugs., Methods: In this retrospective cohort study, based on an electronic health record database, 4517 women with RA were compared to 1415 patients with psoriatic arthritis (PsA). Patients were 18-40 years-of-age at diagnosis. Biological treatments included tumor necrosis factor inhibitors, anti-CD-20 monoclonal antibodies, interleukin blockers and T-cell inhibitors. Main outcome measure was positive pregnancy test rate. Secondary outcome measures were pregnancy attempts and use of in vitro fertilization (IVF) RESULTS: Mean age at diagnosis and at initiation of biological treatments was not statistically different between RA and PsA (30.7 ± 6.3 vs. 30.9 ± 6; p = 0.260 and 34.2 ± 8 vs. 34.2 ± 7.5 years; p = 0.729, respectively). Both groups demonstrated lower rates of positive beta hCG after diagnosis, as compared to baseline rates before diagnosis. However, exposure to biological treatment did not negatively affect the likelihood of conception in either group. Beta hCG testing increased in both groups after initiation of biological treatments (RA p < 0.01, PsA p = 0.07). Use of fertility medications before diagnosis was about 8 % in both groups (p > 0.5). After diagnosis, before exposure, this percentage dropped to approximately 4 % in both groups (p > 0.5) but recovered to baseline values. Post-exposure IVF rate among RA patients was lower (p < 0.01) than the pretreatment state but was not significantly different in the PsA group., Conclusions: This large cohort study provides reassuring data regarding spontaneous and medicated fertility in patients exposed to biological medications. Further studies, as well as data on live birth rates are required to consolidate these findings., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Inc.)

Objective: To study the perinatal outcomes of children born from different conception methods: in vitro fertilization (IVF) with autologous oocytes or IVF with donor egg versus those conceived without medical assistance by using a sibling analysis., Design: Retrospective cohort study conducted using electronic medical record data from 2000 through 2018, of a national healthcare organization., Subjects: The cohort included mothers who had two pregnancies and their children. Cohort A compared women with two medically unassisted conceptions with those with an unassisted first conception followed by an IVF conception. Cohort B compared women with two medically unassisted conceptions with those with an unassisted conception followed by a second pregnancy from oocyte donation., Exposure: None MAIN OUTCOME MEASURES: Perinatal outcomes, including small for gestational age (SGA) and preterm birth (PTB) <37weeks were investigated. Secondary outcomes included low birth weight (LBW), very low birth weight (VLBW), and large for gestational age (LGA)., Results: Cohort A comprised women who had 2 medically unassisted pregnancies and those with 1 medically unassisted pregnancy followed by IVF (n=1080 in each). Gestational age at delivery for the second conception was significantly lower in the unassisted + IVF group compared to the medically unassisted group (38.1 ± 2.1 weeks vs. 39.1 ± 1.4 weeks, p=0.001). The unassisted + IVF group had higher rates of prematurity <37 weeks (12% vs. 3.5%, p=0.001) and SGA compared to the medically unassisted group (5.4% vs. 3.4%, p=0.048). The adjusted OR (aOR) for PTB was 3.32 (95% CI, 2.11 to 5.29) and for SGA aOR 1.88 (95% CI, 1.07 to 3.32.) Cohort B included 94 women in each group. No differences were found between the medically unassisted and medically unassisted + donor egg groups regarding PTB <37 weeks (p=0.52) and SGA (p=0.32). The rate of LGA was higher in the egg donation group (24% vs. 16.5%, p=0.02)., Conclusions: This sibling analysis suggests that IVF pregnancies with autologous eggs are more susceptible to PTB, LBW, VLBW, and SGA, while donor egg pregnancies appear relatively unaffected, except for higher rate of LGA., (Copyright © 2024. Published by Elsevier Inc.)

Objective: To assess the correlation between maternal mobility after cesarean delivery and postoperative morbidity., Methods: A prospective study was conducted in a tertiary hospital among patients after cesarean delivery. The women were recruited after surgery and before ambulation. Each participant received an accelerometer and routine instructions for mobilization. The patients were asked to wear the accelerometer constantly. It was collected at discharge. Electronic files were reviewed and patients' outcomes were analyzed. The Mann-Whitney U test was used to compare groups and a receiver operating characteristic curve was calculated for the threshold of number of steps., Results: Data were analyzed for 199 patients, among which 107 (54.4%) deliveries were urgent and 90 (45.6%) were elective. The median number of steps was higher for multiparous women compared to nulliparous women (P = 0.035). Patients who developed complications after discharge walked significantly less during their hospitalization compared to those who did not. There was a trend toward increased risk for in-hospitalization complications among patients who walked less while hospitalized. A threshold of more than 9716 steps per hospitalization was found to be associated with fewer post-discharge complications., Conclusion: There is a significant correlation between the extent of ambulation after cesarean delivery and fewer postoperative complications., (© 2021 International Federation of Gynecology and Obstetrics.)

Objective: The study aimed to assess whether sub-endometrial contractility is reduced by the use of intramuscular (IM) progesterone., Design: This is a randomized clinical trial. Patients assigned to a medicated day 5 frozen embryo transfer (FET) were randomly allocated to "vaginal progesterone" or "IM progesterone": patients randomized to the vaginal arm were treated with 200 mg micronized progesterone 3 times daily while patients randomized into the IM progesterone arm were treated with a single daily injection of 50 mg progesterone in oil. The main outcome measure was the number of sub-endometrial contractions (waves) per minute 1 day before a blastocyst embryo transfer., Results: Thirty-four patients were enrolled. The progesterone serum concentration was significantly higher in patients using the IM progesterone (85.2 ± 50.1 vs. 30.3 ± 11.2 nmol/L, respectively) but this did not translate into a lower sub-endometrial contractility (2.4 ± 4.8 vs. 1.4 ± 1.1 contraction/min, respectively). Clinical pregnancy rates were comparable between groups. The number of sub-endometrial waves was significantly lower among pregnant patients (p = 0.02)., Conclusions: The use of IM progesterone in medicated FET cycles does not reduce the sub-endometrial activity compared to vaginal progesterone administration. Our data support a poor clinical pregnancy outcome with high wave activity, regardless of the progesterone mode., (© 2017 S. Karger AG, Basel.)

Total motile count (TMC) is a useful tool for sperm evaluation, comprising both quantitative and motility parameters. Although frequently used, TMC has not yet been evaluated as a contributory variable for intracytoplasmic sperm injection (ICSI) cycles. In this study we evaluate the possible role of TMC as a prognostic parameter in cycles designated for ICSI. We also test the existence of a possible TMC-threshold value that might be predictive for ICSI cycle outcome in the everyday practice. This is a retrospective cohort study in which the research question is addressed by a locally weighted regression (LOESS) analysis. Primary outcome measures are fertilization rate, good quality embryos rate and implantation rate. A total of 666 patients were included, contributing 1456 cycles. The effect of TMC over the fertilization rate was significant, depicting an inverted U-shaped curve: with up to approximately 10 million motile sperm, fertilization rates increased as TMC increased, but from this point on decreased. A slight increment in the rate of good embryo formation with increasing value of TMC was noted, but this did not reach a statistical significance. TMC values demonstrated no effect in the case of implantation rates. ICSI may offer an advantage related to fertilization rates for the sub-fertile male population, with a motile sperm count up to 10 million.

Background: Although the comprehensive evaluation of the fetal heart includes echocardiography by an experienced pediatric cardiologist, economic constraints sometimes dictate the need to select patients., Objectives: To analyze the usefulness of fetal echocardiography in the detection of congenital heart disease according to the referral indication., Methods: This retrospective survey relates to all 3965 FE studies performed in our center from January 2000 to December 2004. The diagnosed cardiac anomalies were classified as significant and non-significant malformations. All FE studies were done by a single operator (A.L.) at Meir Medical Center, a referral center for a population of about 400,000. The 3965 FE studies were performed for the following indications: abnormal obstetric ultrasound scans, maternal and family history of cardiac malformations, medication use during the pregnancy, and maternal request. The relative risk of detecting CHD was calculated according to the various referral indications., Results: Overall, 228 (5.8%) cases of CHD were found. The most common indication for referral was suspicion of CHD during a four-chamber view scan in a basic system survey or during a level II ultrasound survey. No correlation was found between maternal age and gestational age at the time of scanning and the likelihood of finding CHD., Conclusions: Our data suggest that a suspicious level II ultrasound orthe presence of polyhydramnios is an important indication for FE in the detection of significant CHD.