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Pregnancy diagnosis in canines is generally performed during embryonic phase, between 19 and 35 days of gestation. At this stage embryonic resorptions can be observed, which, according to the literature, affects 11-26% of conceptuses and 5-43% of pregnancies. Resorption has been hypothesized as a physiological event in uterine overcrowding, however other factors may be involved, such as infectious or non-infectious diseases. This study aimed to retrospectively evaluate the incidence of embryo resorption at ultrasonographic pregnancy diagnosis in different dog breeds, and to identify the main factors determining the occurrence of the resorption sites. 95 pregnancy diagnoses were performed 21-30 days post-ovulation by ultrasound examination on 74 different animals. Breed, weight, and age of the bitches were recorded, and the reproductive anamnesis was collected from their medical records. The overall pregnancy rate was 91.6%. In 48.3% of pregnancies (42/87), at least one resorption site was visible, and embryonic resorption rate was 14.2% (61 resorption sites/431 total structures). Binary logistic regression showed a significant effect of age (P < 0.001), but not the size of the litter (P = 0.357), nor the size of the mother (P = 0.281) or any previous reproductive problems (P = 0.077). Age was significantly higher in pregnancies with resorptions than in normal ones (60.88 ± 18.24 and 40.27 ± 15.74 months, respectively, P < 0.001). The embryonic resorption rate was in line with previous findings, while the incidence of affected pregnancies was higher. Although resorptions may occur physiologically in pregnancies with large litters, a relationship between embryo resorption and litter size was not identified in our sample group, while aging increased the resorption rates. This, together with the occurrence of repeated embryonic resorptions in some bitches included in the study, suggests how resorptions could also be the result of pathological events. The underlying mechanisms and other factors that may be involved need further clarification., Competing Interests: Declaration of competing interest None., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Repeated implantation failure (RIF) greatly influences pregnancy rate after assisted reproductive technologies (ART) with elusive causes. Our study aimed to explore coagulation parameters in association with RIF and establish a model to predict the risk of RIF in Chinese women.Coagulation parameters, including prothrombin time (PT), thrombin time (TT), activated partial prothrombin time (APTT), D-dimer (DD), fibrin degradation products (FDP), fibrinogen (FG), and platelet aggregation induced by arachidonic acid (AA) and adenosine diphosphate (ADP) were measured in RIF patients and controls. A logistic regression model was built by using the purposeful selection to select important factors for the prediction of RIF.Between 92 RIF patients and 47 controls, we found a statistically significant difference in all of the coagulation parameters except APTT, FDP and platelet aggregation induced by ADP. The purposeful selection method selected PT (odds ratio [OR] = 0.28, 95% CI: 0.12-0.66, P = .003), APPT (odds ratio [OR] = 0.76, 95% CI: 0.63-0.91, P = .004), TT (odds ratio [OR] = 0.75, 95% CI: 0.53-1.08, P = .124), and platelet aggregation induced by AA (odds ratio [OR] = 1.27, 95% CI: 1.11-1.44, P = .0003) as important predictors of RIF risk. ROC curve analysis indicated that the area under ROC curve (AUC) of the model was 0.85 with an optimal cut-off point of the predicted probability being P = .65, leading to a sensitivity of 0.83 and a specificity 0.75.We found that coagulation parameters including PT, APTT, TT and platelet aggregation induced by AA are predictive of RIF in Chinese women. Our results highlight the potential of anti-coagulation therapies to lower the risk of RIF.

Background: To investigate the roles of T, B, and natural killer (NK) cells in pregnancy outcome of women with recurrent implantation failure (RIF)., Methods: This retrospective cohort study enrolled 196 patients with RIF. Peripheral lymphocyte subsets were measured before and during pregnancy. The relationship between pregnancy outcome and level of lymphocytes was analyzed., Results: Peripheral CD19+ B cells in women who experienced miscarriage were significantly lower than those who subsequently had live birth. After adjusting for potential confounders in the multiple logistic regression models, each 1% increment in the peripheral CD19+ B cells before pregnancy [odds ratio (OR): 0.93] and during early pregnancy (OR: 0.83) was associated with a significantly decreased risk of miscarriage (p < 0.05). The risk of mis-carriage in patients with ≥ 15% CD19+ B cells before and during pregnancy was 39% and 21% lower, respectively, than in their counterparts with < 15% CD19+ B cells. The association between CD19+ B cells and the risk of miscarriage was nonlinear., Conclusions: Measurement of peripheral CD19+ subsets may help predict the pregnancy outcome in women with RIF.

Study Objective: The identification of less invasive methods with acceptable diagnostic value for evaluating intrauterine abnormalities can improve the satisfaction of patients and physicians. Although hysteroscopy plus biopsy has favorable predictive and diagnostic values, limited studies have evaluated its value, and the exact value of this method is not completely understood. The aim of this study was to evaluate the prevalence of chronic endometritis in patients with recurrent implantation failure (RIF) and recurrent pregnancy loss (RPL) by hysteroscopy and immunohistochemistry., Design: A cross-sectional study., Setting: An infertility clinic at Jundishapur University Hospital, Ahvaz, Iran., Patients: Women with RIF after IVF and RPL., Interventions: Hysteroscopy on the third to fifth day after finishing the menstruation cycle and then a biopsy for immunohistochemistry by a specific monoclonal antibody against the CD138 marker., Measurements and Main Results: In total, 85 patients with a mean age of 36.08 ± 5.76 years underwent hysteroscopy on the third to fifth day after finishing the menstruation cycle. At the end of hysteroscopy, a biopsy was taken and assessed using immunohistochemistry by a specific monoclonal antibody against the CD138 marker. Immunohistochemical staining findings of >5 plasma cells per 20 high-power fields were considered the gold standard. The prevalence of chronic endometritis (CE) in both groups and the diagnostic value of hysteroscopy were evaluated. All data were analyzed using the Fisher exact test and analysis of variance. The prevalence of RIF-related CE was 23.4% (11); 21.3% (10) of the cases were diagnosed by hysteroscopy. The prevalence of RPL-related CE was 36.8% (14) and 31.6% (12) based on hysteroscopy and immunohistochemistry staining, respectively. Subsequently, 10 patients (RIF/RPL-related CE with a positive hysteroscopic outcome) were selected randomly for in vitro fertilization therapy, and 3 (30%) of them eventually became pregnant. The sensitivity, specificity, and positive and negative predictive values of hysteroscopy in diagnosing CE were 86.36%, 87.30%, 70.37%, and 94.82%, respectively., Conclusion: Hysteroscopy is a reliable diagnostic technique in patients with RIF after in vitro fertilization and RPL that can reliably diagnose chronic endometritis., (Copyright © 2019. Published by Elsevier Inc.)

Objective: To estimate the procedure-related risk of miscarriage after amniocentesis and chorionic villus sampling (CVS) based on a systematic review of the literature and an updated meta-analysis., Methods: A search of MEDLINE, EMBASE and The Cochrane Library was carried out to identify studies reporting complications following CVS or amniocentesis. Eligible for inclusion were large controlled studies reporting data for pregnancy loss prior to 24 weeks' gestation. Study authors were contacted when required to identify additional necessary data. Data for cases that had an invasive procedure and controls were inputted into contingency tables and the risk of miscarriage was estimated for each study. Summary statistics based on a random-effects model were calculated after taking into account the weighting for each study included in the systematic review. Procedure-related risk of miscarriage was estimated as a weighted risk difference from the summary statistics for cases and controls. Subgroup analyses were performed according to the similarity in risk levels for chromosomal abnormality between the invasive-testing and control groups. Heterogeneity was assessed using the I 2 statistic. Egger's bias was estimated to assess reporting bias in published studies., Results: The electronic search yielded 2943 potential citations, from which 12 controlled studies for amniocentesis and seven for CVS were selected for inclusion in the systematic review. A total of 580 miscarriages occurred following 63 723 amniocentesis procedures, resulting in a weighted risk of pregnancy loss of 0.91% (95% CI, 0.73-1.09%). In the control group, there were 1726 miscarriages in 330 469 pregnancies with a loss rate of 0.58% (95% CI, 0.47-0.70%). The weighted procedure-related risk of miscarriage following amniocentesis was 0.30% (95% CI, 0.11-0.49%; I 2  = 70.1%). A total of 163 miscarriages occurred following 13 011 CVS procedures, resulting in a risk of pregnancy loss of 1.39% (95% CI, 0.76-2.02%). In the control group, there were 1946 miscarriages in 232 680 pregnancies with a loss rate of 1.23% (95% CI, 0.86-1.59%). The weighted procedure-related risk of miscarriage following CVS was 0.20% (95% CI, -0.13 to 0.52%; I 2  = 52.7%). However, when studies including only women with similar risk profiles for chromosomal abnormality in the intervention and control groups were considered, the procedure-related risk for amniocentesis was 0.12% (95% CI, -0.05 to 0.30%; I 2  = 44.1%) and for CVS it was -0.11% (95% CI, -0.29 to 0.08%; I 2  = 0%)., Conclusions: The procedure-related risks of miscarriage following amniocentesis and CVS are lower than currently quoted to women. The risk appears to be negligible when these interventions were compared to control groups of the same risk profile. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd., (Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.)

Endometriosis is currently considered as one of the most common diseases associated with infertility. A controversial issue is whether endometriosis per se exerts a detrimental effect on IVF outcomes. Failure of implantation due to endometriosis-associated infertility is a contradictory and widely discussed burden nowadays. The purpose of the study is to assess the quality of embryos and implantation rate in women with infertility associated with endometriosis. The study included infertile reproductive aged women, between 26 and 40 years who underwent IVF and ICSI procedures. The patients were divided into two groups: group I ( n  = 70) involved 70 patients with recurrent unilateral endometriomas, II control group ( n  = 50) with tubal factor infertility. The quality of the retrieved embryos was assessed according to the generally accepted classification of Gardner, indicating the rate of implantation in each group. Embryo transfer was performed in case of high quality embryos. Assessing the ovarian reserve indicators, in the group I patients with recurrent unilateral endometriomas the serum level of AMH was significantly lower (2.1 ± 1.75 vs. 3.2 ± 1.4, p  < .005), as well as the number of retrieved oocytes (8.1 ± 3.9 and 10.1 ± 6.8, p  < .005). The analysis of the results demonstrated that the duration of stimulation in the group patients with recurrent unilateral endometriomas was significantly higher in comparison with the group II (12.2 ± 1.8 and 10.2 ± 1.6 days, p  < .001). Nevertheless, the number of good quality embryos retrieved was comparable in both groups (2.2 ± 1.5 and 2.8 ± 1.8). In the group I patients with recurrent unilateral endometriomas, there was a statistically significant decrease of implantation rate (17.1% vs. 24% p  < .005). The results of the study revealed no statistical difference in embryo quality in the study cohort. However, it is important to note that a statistically significant difference in implantation rate in the group of endometriosis-associated infertility compared was obtained 1.5 times lower than in the control group (15.8% vs. 24.0% p  < .005). The achieved results demonstrated an adverse IVF outcome in infertile women with recurrent endometrioma compared to the control group.

Study Question: What is the risk of venous thromboembolism (VTE) in the 12 weeks following early pregnancy loss in pregnancies conceived by IVF?, Summary Answer: The VTE risk is low in the 12 weeks following early pregnancy loss in pregnancies conceived by IVF., What Is Known Already: There is an excess VTE risk during first trimester in complete IVF pregnancies leading to delivery. It is unknown whether this excess VTE risk also is present in IVF pregnancies terminated by early pregnancy loss (implantation failure, missed abortion, or spontaneous or induced abortion before 10 completed gestational weeks)., Study Design, Size, Duration: A nationwide registry-based cohort study including all Danish IVF pregnancies registered in the Danish IVF Register between 1995 and 2005. Women who underwent frozen embryo replacement or oocyte donation were not included., Participants/materials, Setting, Methods: We included all 24 931 IVF treatments leading to pregnancy among 19 260 women. We identified 16 701 complete IVF pregnancies, 7567 IVF pregnancies with early pregnancy loss, and 663 IVF pregnancies terminated by late abortion (≥gestational weeks 10). We followed women for 12 weeks after termination of pregnancy and calculated the absolute risk of VTE during follow-up with 95% CI. As a relative risk estimate, we calculated the risk ratio for VTE following IVF pregnancies with early loss compared to the VTE risk following complete IVF pregnancies., Main Results and the Role of Chance: During the 12 weeks of follow-up, only one case of VTE occurred in the group of early pregnancy loss, none in the late abortion group, and 13 VTE cases occurred in complete IVF pregnancies. The VTE risk per 10 000 pregnancies was 1.3 [0.03-7.4] for IVF pregnancies with early loss and 7.8 [4.1-13.3] for complete pregnancies; the corresponding risk ratio was 0.17 [0.02-1.3]. Thus, we found a low absolute VTE risk in the 12 weeks following early pregnancy loss in IVF pregnancies. The relative VTE risk was low in comparison to the VTE risk in early gestation reported for complete IVF pregnancies and for Danish background pregnancies., Limitations, Reasons for Caution: Despite the use of complete nationwide data, only a few VTE events were available for the statistical analyses thereby limiting the precision of our estimates. We included both inpatient and outpatient VTE hospital diagnoses, but we cannot rule out the occurrence of VTE cases not diagnosed at hospital and hence not registered in the National Patient Registry. No information was available on the use of prophylactic low molecular weight heparin: access to such might have helped to explain our findings, but would not have changed our conclusions., Wider Implications of the Findings: The results of the present study do not indicate a need for prophylactic anticoagulant therapy in women suffering early IVF pregnancy loss without other risk factors., Study Funding/competing Interest(s): No external funding was obtained for this study. There are no conflicts of interest to declare.

Recurrent pregnancy loss (RPL) is a physical and mental burden for women. In Vietnam, exploring the cause of miscarriages is still a challenge to clinical physicians. We aimed to investigate the etiology of RPL in the National Hospital of Obstetrics and Gynecology in Vietnam from 2012 to 2014. The cross-sectional study included 301 pregnant women with a history of RPL. The patients were examined and offered medical testing to determine the cause(s). Based on the testing, we determined causation for (11.29%) patients who had positive scores on an antiphospholipid antibody test and who were subsequently successfully treated for their problem.

Chronic intervillositis of unknown etiology (CIUE) is a poorly understood, relatively rare condition characterized histologically by the intervillous infiltration of mononuclear cells in the placenta. Clinically, CIUE is associated with poor pregnancy outcome (e.g., impaired fetal growth, preterm birth, fetal death) and high risk of recurrence in subsequent pregnancies. Because CIUE is not defined consistently, it is essential to clearly define this condition. We therefore review the published definitions of CIUE. In addition, we provide an overview of the reviewed histopathological and maternal characteristics, obstetric features, and pregnancy outcomes. Medical publication databases were searched for articles published through February 2017. Eighteen studies were included in our systematic review. The sole inclusion criterion used in all studies was the presence of intervillous infiltrates. Overall, CIUE was characterized by adverse pregnancy outcome. Miscarriage occurred in 24% of cases, with approximately half of these miscarriages defined as late. Impaired growth was commonly observed, 32.4% of pregnancies reached term, and the live birth rate was 54.9%. The high recurrence rate (25.1%) of the intervillous infiltrates in subsequent pregnancies underscores the clinical relevance of CIUE, the need for increased awareness among pathologists and clinicians, and the need for further research. Criteria for the diagnosis of CIUE are proposed and a Delphi study could be used to resolve any controversy regarding these criteria. Future studies should be designed to characterize the full clinical spectrum of CIUE., (Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Males are born in excess of females, a ratio expressed as M/T (males:total births). The ratio exhibits seasonal variation. Furthermore, acute stressful events may result in a transient dip in male births due to excess foetal losses, reducing M/T., Aims: This study was carried out in order to identify significant M/T dips after adjusting for seasonality., Study Design: Live births by gender and month were sought for acute stressful events. After seasonal correction (where appropriate), M/T dips were sought., Subjects: Live births., Outcome Measures: M/T dips., Results and Conclusions: This paper studied 112,226,306 live births. The following events showed dips ≤5th percentile 3-5months after these acute episodes: the Brooklyn Bridge protests, Katrina Hurricane for all 4 states and for each individual state (Alabama, Florida, Louisiana, Mississippi), the Battle in Seattle, the London bombings, The Madrid bombings (for Madrid and for Spain), the Breivik shooting, the Oklahoma City bombing and the Sandy Hook Elementary School shooting. The Virginia Polytechnic Institute and State University shooting the Fukushima Daiichi nuclear disaster also showed dips albeit slightly later. Seasonal adjustments should be taken into consideration in order to avoid Type 1 or 2 error pitfalls., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Limited evidence revealed conflicting results on relationship between phthalate exposure and clinical pregnancy loss (gestational weeks >6). A prospective cohort study in Chinese pregnant women (n = 3220) was conducted to investigate the association between urinary phthalate metabolites and clinical pregnancy loss (gestational weeks 6 to 27; n = 109). Morning urine samples during gestational weeks 5 to 14 (mean 10.42) were collected to measure monomethyl phthalate (MMP), monoethyl phthalate (MEP), monobutyl phthalate (MBP), monobenzyl phthalate (MBzP), mono (2-ethylhexyl) phthalate (MEHP), mono (2-ethyl-5-oxohexyl) phthalate (MEOHP) and mono (2-ethyl-5-hydroxyhexyl) phthalate (MEHHP). The concentrations of low- and high-molecular weight phthalate metabolites (ΣLMWP <250 Da and ΣHMWP >250 Da) were calculated. Adjusted logistic regression models showed increased risks of clinical pregnancy loss in women with higher creatinine- normalized concentrations of MEP, MBP, MEOHP, MEHHP, ΣLMWP and ΣHMWP. Stratified analysis by gestational weeks (10 weeks) of miscarriage indicated positive associations of MEP, MEOHP, MEHHP and ΣHMWP with embryonic loss (during gestational weeks 6 to 10). The only association of foetal loss (during gestational weeks 11 to 27) was observed with MEHHP. Our findings suggested that Chinese women who were exposed to phthalates during early pregnancy had an increased risk of clinical pregnancy loss, especially embryonic loss.

This seven-year retrospective study analysed the live birth rate (LBR) for women undergoing IVF treatment with various antral follicle counts (AFC). The LBR decreased with lower AFC ratings, and in 290 treatment cycles for women in the poorest AFC category, ≤4 follicles (group E), the LBR was the lowest at 10.7%. The pregnancy loss rate (PLR) significantly increased with poorer AFC categories, from 21.8% in AFC group A (≥20 follicles), to 54.4% in AFC group E (p<0.0001). This trend was repeated with advancing age, from 21.6% for younger women (<35years), to 32.9, 48.5 and 100% for ages 35-39, 40-44 and ≥45 years, respectively (p<0.0001). However, LBR within the specific AFC group E cohort was also age-dependent and decreased significantly from 30.0% for <35 years old, to 13.3, 3.9 and 0% for patients aged 35-39, 40-44 and ≥45 years, respectively. Most, importantly, LBR rates within these age groups were not dependent on the number of IVF attempts (1st, 2nd, 3rd or ≥4 cycles), which indicated that cycle number should not be the primary deciding factor for cessation of IVF treatment in responding women <45years old., (Copyright © 2016 Society for Biology of Reproduction & the Institute of Animal Reproduction and Food Research of Polish Academy of Sciences in Olsztyn. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.)

For heifers, beef and moderate-yielding dairy cows, it appears that the fertilisation rate generally lies between 90% and 100%. For high-producing dairy cows, there is a less substantive body of literature, but it would appear that the fertilisation rate is somewhat lower and possibly more variable. In cattle, the major component of embryo loss occurs in the first 16 days following breeding (Day 0), with emerging evidence of greater losses before Day 8 in high-producing dairy cows. In cattle, late embryo mortality causes serious economic losses because it is often recognised too late to rebreed females. Systemic concentrations of progesterone during both the cycle preceding and following insemination affect embryo survival, with evidence of either excessive or insufficient concentrations being negatively associated with survival rate. The application of direct progesterone supplementation or treatments to increase endogenous output of progesterone to increase embryo survival cannot be recommended at this time. Energy balance and dry matter intake during the first 4 weeks after calving are critically important in determining pregnancies per AI when cows are inseminated at 70-100 days after calving. Level of concentrate supplementation of cows at pasture during the breeding period has minimal effects on conception rates, although sudden reductions in dietary intake should be avoided. For all systems of milk production, more balanced breeding strategies with greater emphasis on fertility and feed intake and/or energy must be developed. There is genetic variability within the Holstein breed for fertility traits, which can be exploited. Genomic technology will not only provide scientists with an improved understanding of the underlying biological processes involved in fertilisation and the establishment of pregnancy, but also, in the future, could identify genes responsible for improved embryo survival. Such information could be incorporated into breeding objectives in order to increase the rate of genetic progress for embryo survival. In addition, there is a range of easily adoptable management factors, under producer control, that can either directly increase embryo survival or ameliorate the consequences of low embryo survival rates. The correction of minor deficits in several areas can have a substantial cumulative positive effect on herd reproductive performance.

Chromosomal abnormality is a leading cause of aging-related infertility, spontaneous abortion and congenital birth defects in humans. Karyotype analyses of spontaneously aborted human fetuses reveal high proportions (~50%) being chromosomal abnormal with the majority being trisomies of various chromosomes. As a model organism, mice are widely used for studies of reproduction and reproductive aging. Like older women, older mice exhibit high incidences of early embryo death. However, it is not known if aneuploidy is prevalent amongst resorptions in older mice. We have karyotyped 65 retarded/resorbed fetuses in 10-month-old C57BL/6 mice, and found that 55 (84.6%±8.8%, with 95% confidence) were euploid. Similarly, of 40 such fetuses from 17 month-old C57BL/6 mice, we found 38 (95±7%, with 95% confidence 95%) being euploid. Therefore, aneuploidy is not a leading cause of embryo death in older mice.

Limited information is available on the balance state of pro- and anti-inflammatory cytokines in patients with recurrent implantation failure (RIF). This study assessed the pro- and anti-inflammatory cytokines in plasma of 34 patients with RIF, compared with those of 25 women with a successful pregnancy in the first IVF/intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET) cycle. The IFN-γ, IL-1β, IL-6 and IL-4 concentrations were higher, whereas the TGF-β1 concentration was lower in the RIF group compared with the control group. Furthermore, the ratios of pro-inflammatory and anti-inflammatory cytokines IFN-γ/IL-4, IFN-γ/IL-10, IFN-γ/TGF-β1, IL-6/IL-10, IL-6/TGF-β1, IL-1β/TGF-β1 and TNF-α/TGF-β1 were higher in the RIF group (all P < 0.01). The results suggested a shift toward a pro-inflammatory state in peripheral blood of the patients with RIF., (Copyright © 2015 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.)

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., (© 2015 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.)

Male twin gestations exhibit higher incidence of fetal morbidity and mortality than singleton gestations. From an evolutionary perspective, the relatively high rates of infant and child mortality among male twins born into threatening environments reduce the fitness of these gestations, making them more vulnerable to fetal loss. Women do not perceive choosing to spontaneously abort gestations although the outcome may result from estimates, made without awareness, of the risks of continuing a pregnancy. Here, we examine whether the non-conscious decisional biology of gestation can be linked to conscious risk aversion. We test this speculation by measuring the association between household surveys in Sweden that gauge financial risk aversion in the population and the frequency of twins among live male births. We used time-series regression methods to estimate our suspected associations and Box-Jenkins modeling to ensure that autocorrelation did not confound the estimation or reduce its efficiency. We found, consistent with theory, that financial risk aversion in the population correlates inversely with the odds of a twin among Swedish males born two months later. The odds of a twin among males fell by approximately 3.5% two months after unexpectedly great risk aversion in the population. This work implies that shocks that affect population risk aversion carry implications for fetal loss in vulnerable twin pregnancies.

Objectives: Recurrent miscarriages are a current consultation pattern. Etiologic evaluation is classically proposed and preventive therapy should be discussed. We wanted to study our University Hospital pregnancies outcomes, following 3 repetitive early miscarriages, and how those patients are managed., Materials and Methods: A 10-years retrospective study has been performed in our center, with 296 patients found having a three-repetitive miscarriage experience. Information about diagnostic evaluation following miscarriages, preventive therapy initiation, and next pregnancy outcome has been provided., Results: Around 62.5% of the patients experienced a life-birth. When investigations were done (n=148), a 64.9% part of the patients had abnormal results. Life-birth rate was more important when there were normal karyotypes or no thrombophilia found (respectively p equal 0.30 and 0.45). We noticed a better prognostic in the group of patients with normal investigations results who had a preventive therapy (n=20, 85% of life-birth, P=0.19)., Conclusion: When done, investigations for recurrent miscarriages, allow the finding of an abnormality in two thirds of cases. Wonderingly, outcomes are very encouraging since that almost two thirds of the patients experienced life-birth. Investigations indications, results interpretations, and consecutive therapy should be well thought but preventive therapy seems to be efficient in the normal results patient group., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

The objective of this study was to identify detailed fertility traits in dairy and beef cattle from transrectal ultrasonography records and quantify the associated risk factors. Data were available on 148 947 ultrasound observations of the reproductive tract from 75 949 cows in 843 Irish dairy and beef herds between March 2008 and October 2012. Traits generated included (1) cycling at time of examination, (2) cystic structures, (3) early ovulation, (4) embryo death and (5) uterine score; the latter was measured on a scale of 1 (good) to 4 (poor) characterising the tone of the uterine wall and fluid present in the uterus. After editing, 72,773 records from 44,415 dairy and beef cows in 643 herds remained. Factors associated with the logit of the probability of a positive outcome for each of the binary fertility traits were determined using generalised estimating equations; linear mixed model analysis was used for the analysis of uterine score. The prevalence of cycling, cystic structures, early ovulation and embryo death was 84.75%, 3.87%, 7.47% and 3.84%, respectively. The occurrence of the uterine heath score of 1, 2, 3 and 4 was 70.63%, 19.75%, 8.36% and 1.26%, respectively. Cows in beef herds had a 0.51 odds (95% CI=0.41 to 0.63, P<0.001) of cycling at the time of examination compared with cows in dairy herds; stage of lactation at the time of examination was the same in both herd types. Furthermore, cows in dairy herds had an inferior uterine score (indicating poorer tone and a greater quantity of uterine fluid present) compared with cows in beef herds. The likelihood of cycling at the time of examination increased with parity and stage of lactation, but was reduced in cows that had experienced dystocia in the previous calving. The presence of cystic structures on the ovaries increased with parity and stage of lactation. The likelihood of embryo/foetal death increased with parity and stage of lactation. Dystocia was not associated with the presence of cystic structures or embryo death. Uterine score improved with parity and stage of lactation, while cows that experienced dystocia in the previous calving had an inferior uterine score. Heterosis was the only factor associated with increased likelihood of early ovulation. The fertility traits identified, and the associated risk factors, provide useful information on the reproductive status of dairy and beef cows.

Purpose: The purpose of this study was to classify pregnancy loss and fetal loss as well as the influence of maternal risk factors in multiple pregnancies., Methods and Materials: Details of the procedure and pregnancy outcome of all patients were extracted from the clinical audit database of two tertiary centers. The files were collected in the time from January 1993 to May 2011.  The procedure-related pregnancy and fetal loss rate was classified as all unplanned abortions without important fetal abnormalities or obstetric complications within 14 days after AC and CVS., Results: We had a total number of 288 multiple pregnancies with a total of 637 fetuses. After the exclusion of 112 pregnancies with abnormal karyotype or fetal abnormalities detected by ultrasound as well as cases of selective feticide, repeated invasive procedures and monochorionic-monoamniotic pregnancies, 176 pregnancies and 380 fetuses were left for final analysis. Overall 132 amniocenteses and 44 chorionic villous sampling procedures were performed. The total pregnancy loss rate was 8.0 % (14/176), 6.1 % (n = 8) for amniocentesis and 13.6 % (n = 6) for CVS.  The procedure-related pregnancy loss rate was 3.4 %, 2.3 % after amniocentesis (3 cases) and 6.8 % after CVS (3 cases). There was no statistical significance between the two procedures (p = 0.15)., Conclusion: The procedure-related loss rate of 3.4 % can be compared to the rates in the literature. The higher loss rates in multiple pregnancies than in singleton pregnancies have to be discussed when counseling parents., (© Georg Thieme Verlag KG Stuttgart · New York.)

Purpose: To compare plasminogen activator inhibitor type1 (PAI-1) mutation rates in different groups of patients with the record of recurrent miscarriage (RM) or implantation failure (IF) with special emphasis on the number of missed pregnancies and/or implantation failures (RM ≥ 2, IF ≥ 2, RM + IF ≥ 2, RM ≥ 3, IF ≥ 3 and RM + IF ≥ 3)., Method: Case-control study from PCR products and RFLP data of DNA from blood of patients who referred to the infertility clinic including 595 patients (421 RM ≥ 2, 119 IF ≥ 2 and 55 RM + IF ≥ 2) as the case groups and 100 healthy women as the control group., Results: All six different subgroups of patients showed increased frequencies of the mutant allele (4G) in comparison to the control group (p < 0.001) suggesting a role for PAI-1 mutation in RM and IF., Conclusions: The different patient subgroups suffer similar rates of risk in developing RM and IF when compared to controls.

Background: Despite several drawbacks, the Pearl Index continues to be the most widely used statistical measure of contraceptive failure. However, Pearl indices reported in studies of newer hormonal contraceptives appear to be increasing., Study Design: We searched PubMed and Medical Intelligence Solutions databases for prospective trials evaluating oral contraceptive (OC) efficacy to examine potential factors that could contribute to increasing Pearl indices., Results: Numerous potential factors were identified, including an increased rate of failures of newer OCs, deficiencies in methods of calculating contraceptive failure rates, differences in study design and changes in patient populations resulting in increased rates of contraceptive failures due to the inappropriate or inconsistent use of the method., Conclusions: The two most likely important contributors to the increase in Pearl indices are more frequent pregnancy testing with more sensitive tests and less adherent study populations. Because study populations appear to be increasingly representative of the likely actual users once the product is marketed, we can expect to see even higher failure rates in ongoing and future studies. This result poses challenges for companies and regulatory agencies., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Embryonic resorption is frequently observed in polytocous mammals. Often it occurs as partial litter resorption affecting only single conceptuses of a whole litter. The aim of the study was to describe the incidence and morphology of embryonic resorption in the European brown hare (Lepus europaeus). In 154 pregnancies viable conceptuses, conceptuses undergoing resorption and CL of pregnancy were ultrasonographically monitored during the entire gestation period. Resorptions were classified into (1) "pre-implantation resorptions," (2) "peri-implantation resorptions," and (3) "post-implantation resorptions." The incidence of resorption in the pre-implantation period was 9%, in the peri-implantation period 9%, and in the post-implantation period 24%. Post-implantation resorptions were found up to late pregnancy stages when fetal development was already in progress. The highest daily incidence of resorption was on Day 8 of the 42-day pregnancy. In 91% of the cases, the regression of one CL was observed, while an embryo was undergoing resorption at the same time. The number of resorptions did not significantly differ from the number of CL in regression during gestation, suggesting an interesting one-resorption-to-one-regression relationship. The ultrasonographic appearance of the luteal regression during pregnancy was similar to the morphology characteristic for postpartal luteolysis., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Study Question: What is the performance of a simple scoring system to predict whether women will have an ongoing viable intrauterine pregnancy beyond the first trimester?, Summary Answer: A simple scoring system using demographic and initial ultrasound variables accurately predicts pregnancy viability beyond the first trimester with an area under the curve (AUC) in a receiver operating characteristic curve of 0.924 [95% confidence interval (CI) 0.900-0.947] on an independent test set., What Is Known Already: Individual demographic and ultrasound factors, such as maternal age, vaginal bleeding and gestational sac size, are strong predictors of miscarriage. Previous mathematical models have combined individual risk factors with reasonable performance. A simple scoring system derived from a mathematical model that can be easily implemented in clinical practice has not previously been described for the prediction of ongoing viability., Study Design, Size and Duration: This was a prospective observational study in a single early pregnancy assessment centre during a 9-month period., Participants/materials, Setting and Methods: A cohort of 1881 consecutive women undergoing transvaginal ultrasound scan at a gestational age <84 days were included. Women were excluded if the first trimester outcome was not known. Demographic features, symptoms and ultrasound variables were tested for their influence on ongoing viability. Logistic regression was used to determine the influence on first trimester viability from demographics and symptoms alone, ultrasound findings alone and then from all the variables combined. Each model was developed on a training data set, and a simple scoring system was derived from this. This scoring system was tested on an independent test data set., Main Results and the Role of Chance: The final outcome based on a total of 1435 participants was an ongoing viable pregnancy in 885 (61.7%) and early pregnancy loss in 550 (38.3%) women. The scoring system using significant demographic variables alone (maternal age and amount of bleeding) to predict ongoing viability gave an AUC of 0.724 (95% CI = 0.692-0.756) in the training set and 0.729 (95% CI = 0.684-0.774) in the test set. The scoring system using significant ultrasound variables alone (mean gestation sac diameter, mean yolk sac diameter and the presence of fetal heart beat) gave an AUC of 0.873 (95% CI = 0.850-0.897) and 0.900 (95% CI = 0.871-0.928) in the training and the test sets, respectively. The final scoring system using demographic and ultrasound variables together gave an AUC of 0.901 (95% CI = 0.881-0.920) and 0.924 (CI = 0.900-0.947) in the training and the test sets, respectively. After defining the cut-off at which the sensitivity is 0.90 on the training set, this model performed with a sensitivity of 0.92, specificity of 0.73, positive predictive value of 84.7% and negative predictive value of 85.4% in the test set., Limitations, Reasons for Caution: BMI and smoking variables were a potential omission in the data collection and might further improve the model performance if included. A further limitation is the absence of information on either bleeding or pain in 18% of women. Caution should be exercised before implementation of this scoring system prior to further external validation studies, Wider Implications of the Findings: This simple scoring system incorporates readily available data that are routinely collected in clinical practice and does not rely on complex data entry. As such it could, unlike most mathematical models, be easily incorporated into normal early pregnancy care, where women may appreciate an individualized calculation of the likelihood of ongoing pregnancy viability., Study Funding/competing Interest(s): Research by V.V.B. supported by Research Council KUL: GOA MaNet, PFV/10/002 (OPTEC), several PhD/postdoc & fellow grants; IWT: TBM070706-IOTA3, PhD Grants; IBBT; Belgian Federal Science Policy Office: IUAP P7/(DYSCO, `Dynamical systems, control and optimization', 2012-2017). T.B. is supported by the Imperial Healthcare NHS Trust NIHR Biomedical Research Centre., Trial Registration Number: Not applicable.

The files for ultrasound diagnosis of gestating mares belonging to the French equine herd recorded for 3 consecutive years were joined with the files for foal birth of these same mares, allowing the statistical analysis of factors of pregnancy loss. For 28 872 positive diagnoses of gestation, 2898 losses were recorded, that is, a global rate of gestation interruption of 9.12%. The etiology of these interruptions is mainly extrinsic: the year and month of insemination, as well as region for climatic reasons. The intrinsic causes that are implicated are breed of the father (heavy breeds except the hypermetric ones lose fewer pregnancies than warm-blooded breeds), age of the mother (losses are lower in mares of 7 to 10 years of age) and status (mares with foals have fewer pregnancy losses than mares not having foaled the previous year), as well as fetuses with consanguinity (when this increases, the pregnancy losses increase as well). However, the additive genetic effect is extremely low; it corresponds to heritability below 5% and few effects of the environment, common to the offspring of the same mare, were identified. This therefore gives little hope of being able to select against the 'gestation loss' trait.

Objective: To evaluate serum human chorionic gonadotropin (hCG) ratio, progesterone and inhibin A as single parameters and in combination for the prediction of spontaneous resolution of pregnancies of unknown location (PUL)., Study Design: Prospective observational study of 105 consecutive patients with a diagnosis of PUL. Serum levels of hCG, progesterone and inhibin A were determined at the first visit and after 2 days. Patients were followed clinically until a final diagnosis of spontaneously resolving PUL, viable or non-viable intrauterine pregnancy, or ectopic pregnancy with need of laparoscopic intervention had been reached. Different combinations of hCG ratio (hCG at 48 h/hCG at 0 h), s-progesterone and s-inhibin A were investigated to find the best predictor for successful expectant management., Results: The final pregnancy outcomes were: 52 spontaneously resolving PUL (49.5%), 37 viable intrauterine pregnancies (35.2%), 8 non-viable intrauterine pregnancies (7.6%), 7 ectopic pregnancies (6.7%), and one molar pregnancy (1.0%). An hCG ratio<0.80 predicted spontaneously resolving PUL with positive and negative predictive values (PPV and NPV), sensitivity, and specificity of 0.98, 0.78, 0.72, and 0.99, respectively. In patients with hCG ratio ≥ 0.80, a combination of s-progesterone < 20 nmol/l and s-inhibin A < 30 pg/ml predicted spontaneously resolving PUL with PPV, NPV, sensitivity and specificity of 0.92, 0.96, 0.85, and 0.98 respectively., Conclusion: Our results suggest that patients with PUL and hCG ratio < 0.80 display a high probability of spontaneously resolving PUL with minimum need of follow-up. In cases of hCG ratio ≥ 0.80, a combination of s-progesterone < 20 nmol/l and s-inhibin A < 30 pg/ml, may be a reliable predictor of spontaneously resolving PUL. The safety of this approach should be tested in large prospective studies., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

Objective: To review the available evidence regarding pregnancy loss following first-trimester chorionic villus sampling (CVS) and mid-trimester genetic amniocentesis in twins., Methods: We searched the MEDLINE database from January 1990 to May 2011 for randomized and cohort studies reporting on the risk of pregnancy loss after first-trimester CVS performed between 9 and 14 weeks and after genetic amniocentesis performed between 14 and 22 weeks. Where appropriate, we calculated pooled proportions and relative risks with 95% CI., Results: No randomized studies were found. For CVS, nine studies fulfilled the inclusion criteria. The overall pregnancy-loss rate was 3.84% (95% CI, 2.48-5.47; n = 4). The rate of pregnancy loss before 20 weeks was 2.75% (95% CI, 1.28-4.75; n = 3) and before 28 weeks was 3.44% (95% CI, 1.67-5.81; n = 3). For amniocentesis, the overall pregnancy-loss rate was 3.07% (95% CI, 1.83-4.61; n = 4). The rate of pregnancy loss before 20 weeks was 2.25% (95% CI, 1.23-3.57; n = 2), before 24 weeks was 2.54% (95% CI, 1.43-3.96; n = 9) and before 28 weeks was 1.70% (95% CI, 0.37-3.97; n = 5). Pooled data from four case-control studies showed a higher risk (2.59% vs. 1.53%) of pregnancy loss before 24 weeks following amniocentesis (relative risk = 1.81; 95% CI, 1.02-3.19). There were no statistically significant differences in reported pregnancy loss between transabdominal and transcervical approaches, use of a single-needle system vs. a double-needle system and single uterine entry vs. double uterine entry in the CVS group. Similarly, in the amniocentesis group, there was no statistically significant difference in fetal loss between the single uterine entry vs. the double uterine entry., Conclusion: In the absence of randomized studies, it is not possible to estimate accurately the excess risk following invasive procedures in twins. Currently available data show similar overall pregnancy-loss rates for both amniocentesis and CVS with the excess risk of around 1% above the background risk., (Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.)

Folate, a key periconceptional nutrient, is ultraviolet light (UV-R) sensitive. We therefore hypothesise that a relationship exists between sunspot activity, a proxy for total solar irradiance (particularly UV-R) reaching Earth, and the occurrence of folate-sensitive, epigenomic-related neonatal genotypes during the first trimester of pregnancy. Limited data is provided to support the hypothesis that the solar cycle predicts folate-related human embryo loss: 379 neonates born at latitude 54°N between 1998 and 2000 were examined for three folate-sensitive, epigenome-related polymorphisms, with solar activity for trimester one accessed via the Royal Greenwich Observatory-US Air force/National Oceanic and Atmospheric Administration Sunspot Database (34,110 total observation days). Logistic regression showed solar activity predicts C677T-methylenetetrahydrofolate reductase (C677T-MTHFR) and A66G-methionine synthase reductase (A66G-MSR) genotype at discrete phases of trimester one. Total and maximal sunspot activity predicts C677T-MTHFR genotype for days 31-60 of trimester one (p=0.0181 and 0.0366, respectively) and A66G-MSR genotype for days 61-90 of trimester one (p=0.0072 and 0.0105, respectively). Loss of UV-R sensitive folate associated with the sunspot cycle might therefore interact with variant folate genes to perturb DNA methylation and/or elaboration of the primary base sequence (thymidylate synthesis), as well as increase embryo-toxic homocysteine. We hypothesise that this may influence embryo viability leading to 677CC-MTHFR and 66GG-MSR embryo loss at times of increased solar activity. This provides an interesting and plausible link between well recognised 'folate gene originated developmental disorders' and 'solar activity/seasonality modulated developmental disorders'., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

This study presents a Brazilian goat herd with reproductive failure over 2009-2010, in which there were abortions (22/50; 44%), embryonic resorption (6/50; 12%) and neonatal deaths (2/50; 4%). A diagnosis of leptospirosis was made, based on serology (microscopic agglutination test - MAT), bacterial culture, and polymerase chain reaction (PCR). Antibiotic therapy, specific vaccination protocols and changes in management practices were instigated. One year after the outbreak, diagnostic methods were repeated and reproductive performance re-analysed. Soon after the outbreak, 61/125 (48.8%) of the goats were seropositive for Leptospira. Pure isolates of Leptospira were not obtained, but Leptospira PCR testing was positive in 48/50 (96%) urine samples. After 1 year only 4.2% were seropositive and the occurrence of reproductive problems decreased roughly 10-fold, although five goats (10.4%) remained PCR-positive. A broad-based management approach, including serological and molecular diagnostic methods, vaccination, antibiotic treatment, and alteration of some environmental aspects, were critical to the control of this outbreak, thereby minimising subsequent reproductive failures and economic losses., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Objective: To compare the cost of two strategies for managing the patient with recurrent pregnancy loss (RPL)., Design: Cost analysis using a decision analytic model was used to compare obtaining an evidence-based workup (EBW) for RPL versus obtaining a karyotype of the products of conception (POC) and proceeding with an EBW only in the setting of euploid POC., Setting: Outpatient care., Patient(s): A simulated cohort of patients experiencing a second pregnancy loss., Intervention(s): Not applicable., Main Outcome Measure(s): Total cost of investigating the cause of RPL after a second pregnancy loss., Result(s): For all age categories, obtaining a karyotype of POC was less costly than an evidenced-based RPL evaluation. Monte Caro analysis demonstrated a net economic benefit for the karyotype strategy ($4,498 [±$792] vs. $5,022 [±$1,130])., Conclusion(s): Our model suggests an economic advantage for obtaining a karyotype of POC in women with second miscarriage., (Copyright © 2012 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To identify patient and cycle parameters that relate to spontaneous reduction in multiple pregnancies following in vitro fertilization (IVF) and embryo transfer (ET)., Study Design: A retrospective cohort study was conducted in an academic infertility center. All IVF cycles between January 2007 and June 2008 were evaluated and 69 infertile women were diagnosed with multiple gestation following IVF. Multiple pregnancy was diagnosed by transvaginal sonography at 6-7 weeks gestation following embryo transfer (ET). Repeat ultrasonography undertaken in late first trimester assessed ongoing multiple pregnancy versus occurrence of spontaneous reduction. Patient and IVF cycle parameters were compared between patients experiencing spontaneous reduction (n=26, cases) compared to those where the multiple pregnancy proceeded uneventfully (n=43, controls)., Results: Spontaneous reduction (SR) was observed in almost 38% of the studied multiple gestations (n=69). Women experiencing SR were significantly older (p=.047), of a leaner body mass (p=.049), and exhibited significantly higher serum estradiol (E(2)) levels in the early follicular phase (p=.016) compared to the controls. Endometrial thickness (EMT) on the day of hCG administration related inversely (p=.017), whereas the number of embryos transferred (ET) related positively with the likelihood of SR (p=.027). On multivariate analyses, EMT and the number of ET were identified as independent predictors of SR following IVF-ET; EMT of less than 10mm was associated with a fourfold increased likelihood of SR (OR 4.18; 95% CI 1.02-17.01) whereas each additional embryo transferred doubled the risk of SR in multiple pregnancies resulting from IVF (OR 2.39; CI 1.02-5.58)., Conclusions: In multiple pregnancies conceived following IVF, occurrence of SR is relatively common. Increasing number of ET and EMT measuring <10mm are identified as independent predictors of likelihood of SR. While advancing age, body mass and baseline E(2) levels were associated with likelihood of SR, these associations disappeared on adjusted analyses. The observed relationship between EMT and SR is novel: the underlying mechanisms are unclear and merit further investigation., (Copyright © 2012. Published by Elsevier Ireland Ltd.)

Objective: To estimate why the live birth rate per implanted embryo is higher in twin than in singleton pregnancies., Methods: Data from 1,159 singleton and 523 dichorionic twin pregnancies, obtained after assisted conception, were included. To account for the higher live birth rate observed in twin pregnancies, two possibilities were considered: embryo collaboration and assistance. To test these hypotheses, we compared the observed values for each possible outcome in twin pregnancies (double birth, single birth, double loss) with the expected values regarding as the null hypothesis that the survival of either embryo is independent from the presence of the other. The effect of maternal age was also examined., Results: Live birth rate, per implanted embryo, was higher in twin than in singleton pregnancies: 83% compared with 76% (odds ratio 1.53, 95% confidence interval 1.24-1.88; P<.001). There were significant differences between the observed outcomes in twin pregnancies and those expected assuming no interaction between embryos (P<.001). The number of double births was higher than expected (71.9% observed compared with 57.7% expected), whereas single births were lower to a similar extent (22% observed compared with 36.5% expected). In contrast, observed and expected double losses were similar (6.1% observed compared with 5.8% expected). Although the overall rate of miscarriage was higher for women aged 34 years and older, the difference in live birth rate between twin and singleton pregnancies was 2.4-fold higher than in younger women., Conclusion: The higher live birth rate occurring in twin pregnancies can be accounted for by assistance, whereby some embryos that would fail as singletons survive in a twin pregnancy when implanted along with a fit sibling. This effect is more pronounced in older mothers.

The Aim: The aim of the study was the analysis of antiphospholipid syndrome frequency in Polish women with pregnancy loss., Material and Methods: We analyzed 352 women with average age of 31.4 (+/- 4.3) who experienced one or more pregnancy losses. Patients from 5 University centers: Poznań, Białystok, Lublin, Wrocław and Bydgoszcz were divided into 3 groups. In the 1st group there were 150 women with recurrent early pregnancy losses before 10 weeks gestation, in the 2nd group we included 160 women with late pregnancy losses, in the 3rd group we analyzed 42 women with labor complicated by preeclampsia or placental insufficiency within or before 34 gestational week. All 352 women were screened for the presence of anticardiolipin antibodies (aCL), anti beta2glikoprotein I (abeta2GPI) and lupus anticoagulant (LA). The first two antibodies were investigated with ELISA test and the last one with APPT based test. Only the second positive result qualified patients as antiphospholipid antibody (aPL) positive. Antibodies against cardiolipin and beta2glicoprotein I were analyzed in three classes--IgA, IgG and IgM--where the laboratory criteria of positivity were titers above 40 unitsU/ml or above 99 centile., Results: 13 patients (3.69%) in the screened population of 352 women met the criteria of the antiphospholipid syndrome. The frequency of APS in women with early and late pregnancy losses were 1.33% and 6.25%, respectively. The most common antibody found was lupus anticoagulant (LA). In 3 women with late pregnancy loss all three antibodies were found. In women with premature deliveries complicated with preeclampsia and/or placental insufficiency the frequency of APS was 2.58%., Conclusion: 1. Screening of antiphospholipid syndrome should be routinely performed in women with late pregnancy loss 2. We can conclude that APS is rarely found in women with pregnancy loss before 10 gestational week.

It has been suggested that management system, milk yield, parity, body condition score and ambient temperature can significantly influence the rate of early pregnancy loss in dairy cattle. The objectives of this study were to establish the extent and patterns of early pregnancy loss from days 32 to 86 of gestation, and to check relationships between management system, milk yield, ambient temperature (quartile), body condition score, bull and parity on the early pregnancy loss rate for Simmental dairy cattle in Croatia. Animals were housed in two dairy farms with two different management systems (pasture based-group A, n=435 and intensive-group B, n=425) with a total of 151 heifers and 709 cows. Overall pregnancy losses were recorded in 67 (7.79%) animals, with late embryonic losses in 30 (44.77%) and early fetal losses in 37 (55.23%) animals (P>0.05). Early pregnancy losses were twofold higher in group B when compared to the group A (P<0.05). More than the half of pregnancy losses were recorded during the III quartile (P<0.05). There was no significant relationship between the paternal bull and pregnancy loss rate. Low body condition score (BCS 2-3) was associated with the highest, while BCS 3.25-4 showed the lowest pregnancy loss rate (P<0.05). The pregnancy loss rate increased in parallel with parity and milk yield increase., (Copyright © 2011 Elsevier B.V. All rights reserved.)

Inactivated virus vaccines have been widely used to control bluetongue after introduction of serotype 8 of the bluetongue virus (BTV) in northern Europe in 2006. To evaluate vaccination, quantitative knowledge of its possible side effects is needed. One current adverse reaction with inactivated vaccines is a rise in body temperature, which could reduce cow reproductive performance. The objective of this study was to quantify a possible side effect of vaccination on fertility before the implantation of the embryo of dairy cows under field conditions. The study was performed on herds that were not exposed to BTV. Fertility was assessed by return-to-service following artificial insemination (AI). Biological assumptions for a possible side effect of vaccination were conception failure and embryonic death. Associations between return-to-service rates and vaccine injections were assessed using mixed-logistic regression models and survival analysis. Two models were considered: a 3-week-return-to-service model comparing cows vaccinated between 3 days before and 16 days after AI and unvaccinated cows (assuming an effect on conception failure or early embryonic death), and a 90-day-return-to-service model comparing cows vaccinated between 3 days before and 42 days after AI and unvaccinated cows (assuming an effect on conception failure, early or late embryonic death). Only cows receiving a second vaccine injection between 2 and 7 days after AI had a significantly higher risk of 3-week-return-to-service (RR=1.19 [1.07-1.33]). This corresponds to an increase of return-to-service by 4 percentage points. A side effect of vaccination could be due to early embryonic death. The slight side effect on fertility associated with vaccination was low compared to effects of BTV-8 exposure on fertility., (Copyright © 2011 Elsevier B.V. All rights reserved.)

Objective: To compare the cytogenetic findings in a series of missed miscarriages evaluated by chorionic villus sampling, in relation to embryonic pole presence (embryonic or anembryonic)., Design: Prospective cross-sectional study., Setting: Tertiary referral hospital., Patient(s): Women presenting with a missed miscarriage., Intervention(s): Transcervical chorionic villus sampling and cytogenetic studies in the chorionic villi with use of the semidirect method., Main Outcome Measures(s): Embryonic pole presence or absence assessed by transvaginal ultrasound examination. Type of chromosomal anomalies found in both subgroups., Result(s): Although the chromosomal abnormality rate was similar for miscarriages with absent or present embryo (61% vs. 68% respectively), frequencies for viable autosomal trisomies (2.3% vs. 19%) and monosomy X (0% vs. 9.2%) were significantly lower when no embryonic pole was seen., Conclusion(s): Viable autosomal trisomies and monosomies X appear not to be a common cause of miscarriage with an early fetal demise (anembryonic miscarriage)., (Copyright © 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Of the 149 women with 0 pregnancy losses, 7 (5%) had factor XI level ≥150% versus 5 of 31 (16%) women with recurrent pregnancy loss. Three of the 5 women with high factor XI and recurrent pregnancy loss, with 19 previous pregnancy losses and 0 live births, were given enoxaparin during 5 subsequent pregnancies, and had 6 term live births and 1 miscarriage., (Copyright © 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Vanishing fetal twins occurred in 9% (264 out of 2,829) intracytoplasmic sperm injection pregnancies and are associated with a lower fetal loss rate in the first trimester. The live birth rate was higher in pregnancies associated with vanishing fetuses., (Copyright © 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To verify whether chromosomes 1, 4, and 6 have a role in determining oocyte viability., Design: Retrospective study., Setting: Reproductive Medicine Unit, Società Italiana Studi Medicina della Riproduzione, Bologna, Italy., Patient(s): Eighty-five patients with a normal karyotype who had undergone an assisted conception cycle with chromosomal analysis of first polar bodies for chromosomes 13, 15, 16, 18, 21, and 22 (first panel). A clinical pregnancy was obtained in 43 patients, whereas 42 patients were not pregnant., Intervention(s): After conclusion of clinical pregnancies to delivery or abortion, first polar bodies from 85 patients were reanalyzed for chromosomes 1, 4, and 6 (second panel)., Main Outcome Measure(s): Aneuploidy frequency, clinical pregnancy outcome., Result(s): The aneuploidy rate contributed by chromosome 1, 4, and 6 to the oocytes that were normal for the first panel was significantly higher in the nonpregnant patients (28%) versus the pregnant patients (11%), whereas no difference resulted between term pregnancies (11%) and abortions (10%). This trend was also observed when studying the first polar bodies from the oocytes that originated the transferred embryos. The frequency of aneuploidy for chromosomes 1 and 4 was comparable with that of chromosomes 15, 16, 21, and 22., Conclusion(s): Aneuploidy of chromosomes 1, 4, and 6 seems to be related to failed implantation and not to spontaneous abortions., (Copyright © 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To determine the rate of embryonic chromosomal abnormalities, thrombophilias, and uterine anomalies in women over the age of 35 years with recurrent pregnancy loss (RPL)., Design: Retrospective cohort study., Setting: Academic reproductive endocrinology and infertility clinic., Patient(s): Women>or=35 years old with >or=3 first trimester miscarriages., Intervention(s): None., Main Outcome Measure(s): Age, number of prior losses, cytogenetic testing of the products of conception (POC), uterine cavity evaluation, parental karyotype, TSH, and antiphospholipd antibody (APA) and thrombophilia testing. Aneuploidy in the POC in women with RPL was compared with sporadic miscarriages (or=35 years., Result(s): Among 43 RPL patients, there were 50 miscarriages in which cytogenetic analysis was performed. In the RPL group, the incidence of chromosomal abnormalities in the POC was 78% (39 out of 50) compared with a 70% incidence (98 out of 140) in the sporadic losses. Thrombophilia results in the RPL patients were normal in 38 patients, four patients had APA syndrome, and one had protein C deficiency. Forty out of 43 had normal uterine cavities. Both TSH and parental karyotypes were normal in all of the patients tested. When the evaluation of RPL included karyotype of the POC, only 18% remained without explanation. However, without fetal cytogenetics, 80% of miscarriages would have been unexplained., Conclusion(s): In older patients with RPL, fetal chromosomal abnormalities are responsible for the majority of miscarriages. Other causes were present in only 20% of cases., (Copyright (c) 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To evaluate and compare standard sperm parameters, lipid peroxidation of sperm plasma membranes, antioxidant capacity of seminal plasma, and sperm chromatin integrity in ejaculates from men whose partners have a history of recurrent pregnancy loss and from a control group of men with recent fertility., Design: Descriptive study., Setting: Reproduction Program, University of Antioquia, Medellín, Colombia., Patient(s): Twenty-three couples with history of recurrent pregnancy loss and 11 men with recent fertility., Intervention(s): Semen samples from control men and men whose partner had a history of recurrent pregnancy loss were examined for differences in semen parameters, lipid peroxidation, antioxidant capacity, DNA fragmentation index, and sperm preparation., Main Outcome Measure(s): Migration-sedimentation method was used to collect motile spermatozoa from fresh ejaculates for examination for semen parameters., Result(s): Men from the control group had spermatozoa with higher percentage of normal sperm morphology, concentration, progressive motility, and antioxidant capacity compared with men from the recurrent pregnancy loss group, who had spermatozoa with higher teratozoospermia and higher lipid peroxidation. Motile sperm fractions from both groups had spermatozoa with better sperm parameters compared with freshly ejaculated sperm., Conclusion(s): This study strengthens the current literature associating sperm quality with recurrent pregnancy loss, and emphasizes the importance of evaluating male factor by tests such as lipid peroxidation and measuring antioxidant capacity of seminal plasma in addition to conventional sperm parameters., (Copyright (c) 2010 American Society for Reproductive Medicine. All rights reserved.)

Objective: To evaluate factors predictive of clinical pregnancy and of pregnancy loss from assisted reproductive technology (ART) using data from the Society for Assisted Reproductive Technology database for 2004-2006., Design: Retrospective cohort., Setting: Clinic-based data., Patient(s): The study population included 225,889 fresh embryo transfer cycles using autologous oocytes and partner semen., Intervention(s): None., Main Outcome Measure(s): Clinical intrauterine gestation (presence of gestational sac) and live birth (>or=22 weeks gestation and >or=300 g birth weight)., Result(s): Increasing maternal age was significantly associated with a reduced odds of conception and increased fetal loss until 19 weeks gestation, but not with later pregnancy loss. Intracytoplasmic sperm injection (ICSI), assisted hatching, and increasing number of embryos transferred had significant positive effects on the odds of conception and pregnancy continuation through the first trimester, but did not affect the risk of later loss. Blacks, Asians, and Hispanics had significantly lower odds of clinical pregnancy compared with whites. Also compared with whites, Hispanics and Asians had a significantly greater risk of pregnancy loss in the second and third trimesters, and blacks had a significantly greater risk of pregnancy loss in all trimesters., Conclusion(s): Certain demographic and ART treatment parameters influenced chance of conception and early pregnancy loss, whereas black race and Hispanic ethnicity were also significantly associated with late pregnancy loss in ART-conceived pregnancies., (Copyright (c) 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Context: The definition of what constitutes a normal TSH during pregnancy is in flux. Recent studies suggested that the first trimester upper limit of normal for TSH should be 2.5 mIU/liter., Objective: The objective of the study was to evaluate the pregnancy loss and preterm delivery rate in first-trimester thyroid peroxidase antibody-negative women with TSH values between 2.5 and 5.0 mIU/liter., Design: The present study is a component of a recently published large-scale prospective trial that evaluated the impact of levothyroxine treatment on maternal and neonatal complications in thyroid peroxidase-positive women with TSH levels above 2.5 mIU/liter. The present study evaluated 4123 thyroid peroxidase antibody-negative women with TSH levels at or below 5.0 mIU/liter. Women were divided into two groups based on their initial TSH: group A, TSH level below 2.5 mIU/liter, excluding hyperthyroid women defined as an undetectable TSH with an elevated free T(4), and group B, TSH level between 2.5 and 5.0 mIU/liter., Setting: The study was conducted at two ambulatory clinics of community hospitals in southern Italy., Patients: A total of 4123 women were evaluated., Intervention: There was no intervention., Main Outcome Measures: The incidence of pregnancy loss and preterm delivery in group A as compared with group B was measured., Results: The rate of pregnancy loss was significantly higher in group B as compared with group A (6.1 vs. 3.6% respectively, P = 0.006). There was no difference in the rate of preterm delivery between the two groups., Conclusions: The increased incidence of pregnancy loss in pregnant women with TSH levels between 2.5 and 5.0 mIU/liter provides strong physiological evidence to support redefining the TSH upper limit of normal in the first trimester to 2.5 mIU/liter.

The objective was to determine physiological causes of low fertility in beef cows. Fertility was compared between low-fertility cows (34 British cows and 64 Brahman crossbred cows; cows that did not get pregnant when mated to fertile bulls in one or two previous breeding seasons); fertile cows (16 Brahman crossbreds; cows having a calf in several of the preceding breeding seasons), and virgin heifers (45 Brahman crossbreds, 2 yr of age). Females were mated to fertile bulls and killed 3 or 34 d after breeding to obtain reproductive tracts. There were no significant differences among groups in rates of ovulation or fertilization. Overall, 14% of females failed to ovulate and 24% that ovulated failed to undergo fertilization. The proportion of cows that were not detected in estrus before Day 34 of pregnancy was lower (P<0.01) for low-fertility British cows (5 of 16 cows, 31%) than for other groups, including low-fertility Brahman crossbred cows (23/32, 72%), fertile cows (8/9, 89%), and heifers (21/24, 88%). All cows that did not return to estrus by Day 34 had an identifiable conceptus. The proportion of conceptuses recovered at Day 34 that were classified as normal (weight and length) was lower (P<0.05) for cows with low fertility (British: 2/5, 40%; Brahman crossbred: 9/23, 39%) than for fertile cows (8/8, 100%) or heifers (18/21; 86%). Similarly, the proportion of cows in which a normal embryo was recovered (cows with normal embryos/number of cows mated) was lower (P<0.001) for low-fertility British cows (2/16, 13%) and low-fertility Brahman crossbred cows (9/32, 28%) than for fertile cows (8/9, 89%) and heifers (18/24, 75%). In conclusion, cows that were infertile in previous breeding seasons did not experience reduced ovulation or fertilization rates, but had greater embryonic mortality. These data highlighted the importance of ovulation and fertilization failure and embryonic mortality as important determinants of pregnancy success. Moreover, increased embryonic loss after Day 34 contributed to infertility in low-fertility cows., (2010 Elsevier Inc. All rights reserved.)

This study was conducted using 210 whole uteri collected from hunters' kills from July 2006 to March 2007 at Esiam and Sokode in the Ekumfi and Ho Districts respectively; and data on 148 dams from eight farms in the Greater Accra Region of Ghana from January to December 2007. The objective of the study was to investigate the effects of embryonic resorption, litter size and parity on sex ratio in the grasscutter. Embryonic resorption rate, which occurred at all stages of pregnancy, ranged between 41.3% and 47.2%, and was not biased towards male or female offspring. The rate of resorption also had no effect on sex ratio (r=-0.011, P=0.396). The study also showed that litter size in the grasscutter could be improved if embryo resorption is controlled. Primiparous dams had offspring with a sex ratio of 0.43+/-0.020 which was not significantly different from dams of parities 3 (0.47+/-0.040) and > or =4 (0.53+/-0.053). Parity 2 dams, however, had a significantly higher proportion of males (0.54+/-0.024). There was a tendency towards a decreasing proportion of males as litter size increased but the overall sex ratio observed in the farmed grasscutter (0.48) did not deviate significantly from the theoretical sex ratio of 0.50., (Copyright 2009 Elsevier B.V. All rights reserved.)

The use of sex-sorted sperm by the dairy industry is often limited by the geographical distance between potential sires and the sex-sorting facility. One method that may be used to overcome this limitation is sex-sorting sperm that have been previously frozen, or transported to the sorting facility as cooled liquid semen. In this study the in vivo fertility of frozen-thawed, sex-sorted, re-frozen-thawed (FSF) and cooled, sex-sorted, frozen-thawed (CSF) bull sperm was determined after artificial insemination (AI) of Holstein heifers. Semen from two bulls was frozen in straws, or transported to the sorting facility in an egg yolk diluent at 5 degrees C over 24h. Thawed or re-warmed semen was processed through a PureSperm density gradient, and sperm were sorted for sex and frozen (2 or 4 x 10(6)sperm/straw). Synchronised heifers (n=183) were inseminated with either non-sorted control sperm (Control; 20 x 10(6) dose) or with FSF or CSF 'X' sperm (2 or 4 x 10(6)/dose). Pregnancy rates (detected at 7-9 weeks) after AI with control sperm were higher than with FSF or CSF sperm (57.4 vs. 4.1 and 7.3% respectively; p<0.001). There was a significant difference between bulls (Bull 1: Control 63.0%, FSF 8.6%, CSF 10.0%; Bull 2: Control 45.5%, FSF 0%, CSF 4.8%; p=0.001). Five out of six (83.3%) pregnancies produced with sexed sperm were lost after pregnancy diagnosis. The exception was one heifer inseminated with CSF sperm (2 million sperm dose), which produced a heifer calf. In the non-sorted control group, three pregnancies were lost (8.3%) and three stillbirths occurred (8.3%). The low fertility and high rate of pregnancy loss in the sexed groups, in addition to environmental influences, may be attributed to impaired sperm function caused by sex-sorting and re-freezing, leading to poor embryo quality or altered gene expression. More precise timing of insemination and higher sperm doses might improve the fertility of FSF sperm. Moreover, the in vitro function of double-frozen sexed compared with non-sorted sperm requires further investigation.

The aim was to compare obstetric outcomes of IVF singleton pregnancies diagnosed with vanishing twin (VT) syndrome with those pregnancies originating as singleton pregnancies and with twin pregnancies. In this case control study, 57 patients diagnosed with VT syndrome were matched and compared with 171 singleton controls and 171 twin controls. Mean gestational age was 35.1+/-3.7 versus 38.2+/-2.6 weeks (P=0.001) for patients and singleton controls respectively. Birth weights were 2834.4+/-821.2 versus 3036+/-489.3g (P=0.02), proportion of low birth weight (< 2500 g) was 33.3 versus 11.7% (P=0.0001) and very low birth weight (< 1500 g) 3.5 versus 0.6% for patients and singleton controls respectively. The proportion of deliveries before 28 weeks of gestation was 7.0 versus 1.2% (P=0.01) for patients and singleton controls respectively. When comparing the study group to twin control pregnancies, a similar gestational age at delivery (35 weeks) and rate of preterm birth (23%) were found. In conclusion, pregnancies diagnosed with the VT syndrome after IVF carry a higher rate of adverse obstetric outcomes in terms of preterm deliveries and lower birth weight, compared with IVF pregnancies that were originally singleton. Additionally, significant similarities were observed in the obstetrics outcome of vanishing twin pregnancies and twin pregnancies., (2009 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.)

Embryo loss between embryonic Days 7 and 16 (Day 0=day of IVF) in nonlactating cattle, Bos taurus, was analyzed using transfer of 2449 (in groups of 3 to 30) in vitro-produced (IVP) blastocysts. In 152 transfers, pregnancy losses attributable solely to recipient failings amounted to between 6% (beef heifers) and 16% (parous dairy cows), of which 3% were caused by uterine infections. Neither season, year, nor the age of the embryos on retrieval affected pregnancy rates. The latter observation indicated that the reason that a recipient failed to retain embryos was already present at the time of transfer. Notably, the proportion of embryos recovered decreased (P=0.03) as more embryos were transferred, particularly at later stages (Day 14, P<0.01). The average length of embryos decreased by approximately 5% for every additional embryo transferred (P<0.0001). These effects may be linked to embryonic migration. Embryo mortality inherent to the embryo during the second week of pregnancy was 24%. Additionally, 9% of Day 14 embryos were of inferior quality, as they did not contain an epiblast. Combining embryo and recipient causes but excluding infection effects, embryonic loss of IVP embryos during the second week of pregnancy amounted to 26% (heifers) or 34% (parous dairy cows). The length of embryos doubled every day between Days 9 and 16, with a 4.4-fold range in sizes representing two thirds of the variation in length. Embryos retrieved from heifers were twice the size of those incubated in parous cows (P<0.0001), indicating faster embryonic development/trophoblast proliferation in heifers. Whereas season did not affect embryo recoveries, length was lower (50%) in winter (winter-autumn, P<0.05; winter-spring, P<0.001). Lastly, transuterine migration in cattle, when transferring multiple embryos, commenced at Day 14 (4%) and had occurred in all recipients by Day 16 (38% of embryos found contralaterally).

The endothelial protein C receptor (EPCR) is expressed by trophoblast cells. Mid-gestation pregnancy loss is described in animals with a haemochorial placenta lacking EPCR. The A6936G allele of the EPCR gene (PROCR) may be associated with lower EPCR densities on trophoblasts, but data are lacking for its effect on the risk of pregnancy loss in humans. A 1:2 case-control study on unexplained pregnancy loss was nested in the NOHA First cohort: 3,218 case couples and 6,436 control couples were studied for PROCR A6936G, coagulation factor V gene (F5) G1691A and coagulation factor II gene (F2) G20210A polymorphisms. Ethnicity and time of pregnancy loss defined through biometry-based gestational ages (embryonic loss < 10(th) week > or = foetal loss) were analysed. The PROCR A6936G allele, in mothers and fathers, was associated only with foetal loss in both Europeans and non-Europeans. Increasing probability levels of carrying a homozygous child were increasingly associated with the risk of foetal demise. The F5 G1691A and F2 G20210A alleles, only in mothers, were only and independently associated with foetal loss in Europeans. In our population, the PROCR A6936G allele describes women, but also men and thus couples, at risk for first unexplained foetal loss. This risk is independent of the foetal loss risk conferred to our local Mediterranean European women by the F5 G1691A and F2 G20210A alleles. Data confirm that the relationship between thrombophilias and pregnancy loss varies according to ethnicity and loss type.

This study analyses anomalous cases of gestation ending in pregnancy loss during the early foetal period and their effect on progesterone and plasma pregnancy-associated glycoprotein-1 (PAG-1) concentrations. Data derived from a large-scale ultrasound pregnancy diagnosis programme in high producing dairy cows. Over a 3-year period (2004-2007), a very low incidence (0.5%: 15 of 3094) of anomalous pregnancies was recorded. The results revealed that the following anomalies were detected on days 35-41 of gestation in cows carrying singletons with one single corpus luteum: embryo death in eight cows (0.3%); and embryo in the uterine horn contralateral to the corpus luteum in seven cows (0.2%). All these animals suffered pregnancy loss during the early foetal period. In cows carrying dead embryos, no signs of conceptus degeneration were observed on pregnancy diagnosis. Amnion size (approximately 25 mm diameter) and uterine horn fluid contents were estimated to be similar to those of the normal pregnant cows in this period. In the contralateral gestations, live embryos were observed in all ultrasound checks before pregnancy loss. Uterine fluid contents increased in the two cows in which gestation continued for more than a week. In the cases of embryo death but not in those of contralateral gestation, a drop in PAG-1 levels was noted prior to pregnancy loss. Two cows carrying dead embryos increased with time allantoic fluid contents. The PAG-1 values increased with time in one cow bearing a dead embryo (from 2.31 to 6.79 ng/ml) and in two of the contralateral gestations (from 1.66 to 2.33 ng/ml and from 0.39 to 6.79 ng/ml, respectively). Results of this study indicate that the foetal membranes continue to undergo some activity following embryo death, and that contralateral pregnancy may determine failure of the gestation process.