Factors Affecting The Outcome of in Vitro Fertilization (IVF)

The high prevalence of infertility motivated researchers to find a solution, henceforth In Vitro Fertilization was invented. Factors that affect the outcome of IVF may include sperm analysis, maternal Body Mass Index (BMI), maternal smoking habits, endometriosis, and maternal age. However, there are ongoing debates about the role of said factors regarding the outcome of IVF. The objective of this research is to analyze those factors. This research is a Case-Control study with an analytical observational design. Data were retrieved from patients’ medical records undergoing IVF in Graha Amerta Fertility Clinic from January 2019-October 2020. First, the Chi-Square Test revealed sperm abnormality (p=0.212), Maternal BMI (p=0.427), endometriosis (p=0.067), meaning there was no connection with the outcome of IVF. Simultaneously, maternal age (p=0.037) showed a connection with the outcome of IVF. From the Binary Logistic Regression Test, maternal age 36-40 years old (p=0.044) affects the outcome of IVF significantly. Concurrently maternal BMI, endometriosis, and sperm abnormality have p value>0.05 meaning it is insignificant to the outcome of IVF. This research concluded that sperm abnormality, maternal BMI, and endometriosis do not affect the outcome of IVF. There was no data about maternal smoking habits. Whilst maternal age affects the outcome of IVF. Conclusion: This research concluded that sperm abnormality, maternal BMI, and endometriosis do not affect the outcome of IVF. There was no data about maternal smoking habits. Whilst maternal age affects the outcome of IVF.

Early life factors as predictors of age-associated deficit accumulation across 17 years from midlife into old age

Background Early life exposures have been associated with the risk of frailty in old age. We investigated whether early life exposures predict the level and rate of change in a frailty index (FI) from midlife into old age. Methods A linear mixed model analysis was performed using data from three measurement occasions over 17 years in participants from the Helsinki Birth Cohort Study (n=2000) aged 57-84 years. A 41-item FI was calculated on each occasion. Information on birth size, maternal body mass index (BMI), growth in infancy and childhood, childhood socioeconomic status (SES), and early life stress (wartime separation from both parents), was obtained from registers and healthcare records. Results At age 57 years the mean FI level was 0.186 and the FI levels increased by 0.34 percent/year from midlife into old age. Larger body size at birth associated with a slower increase in FI levels from midlife into old age. Per 1kg greater birth weight the increase in FI levels per year was -0.087 percentage points slower (95% CI=-0.163, -0.011; p=0.026). Higher maternal BMI was associated with a higher offspring FI level in midlife and a slower increase in FI levels into old age. Larger size, faster growth from infancy to childhood, and low SES in childhood were all associated with a lower FI level in midlife but not with its rate of change. Conclusions Early life factors seem to contribute to disparities in frailty from midlife into old age. Early life factors may identify groups that could benefit from frailty prevention, optimally initiated early in life.

A nomogram for Antenatal Estimation of Cephalopelvic Disproportion in Primiparous Women based on MRI Measurements

Objective: To develop and validate a predictive model assessing the risk of cesarean delivery in primiparous women based on the findings of magnetic resonance imaging (MRI) studies. Design: Observational study Setting: University teaching hospital. Population: 168 primiparous women with clinical findings suggestive of cephalopelvic disproportion. Methods: All women underwent MRI measurements prior to the onset of labor. A nomogram model to predict the risk of cesarean delivery was proposed based on the MRI data. The discrimination of the model was calculated by the area under the receiver operating characteristic curve (AUC) and calibration was assessed by calibration plots. The decision curve analysis was applied to evaluate the net clinical benefit. Main Outcome Measures: Cesarean delivery. Results: A total of 88 (58.7%) women achieved vaginal delivery, and 62 (41.3%) required cesarean section caused by obstructed labor. In multivariable modeling, the maternal body mass index before delivery, induction of labor, bilateral femoral head distance, obstetric conjugate, fetal head circumference and fetal abdominal circumference were significantly associated with the likelihood of cesarean delivery. The discrimination calculated as the AUC was 0.845 (95% CI: 0.783-0.908; P < 0.001). The sensitivity and specificity of the nomogram model were 0.918 and 0.629, respectively. The model demonstrated satisfactory calibration. Moreover, the decision curve analysis proved the superior net benefit of the model compared with each factor included. Conclusion: Our study provides a nomogram model that can accurately identify primiparous women at risk of cesarean delivery caused by cephalopelvic disproportion based on the MRI measurements.

Gestational age and infection are greater predictors of placental histopathology than maternal prepregnancy BMI.

The placenta undergoes morphological and functional adaptions to adverse exposures during pregnancy. The effects of suboptimal maternal body mass index (BMI), preterm birth, and infection on placental histopathological phenotypes remain unclear, despite the association between these conditions and poor offspring outcomes. We hypothesized that suboptimal maternal prepregnancy BMI and preterm birth (with and without infection) would associate with altered placental maturity and morphometry, and that altered placental maturity would associate with poor birth outcomes. Clinical data and human placentae were collected from 96 pregnancies where mothers were underweight, normal weight, overweight, or obese, without other major complications. Placental histopathological characteristics were scored with an anatomical pathologist. Associations between maternal BMI, placental pathology (immaturity and hypermaturity), placental morphometry, and infant outcomes were investigated at term and preterm, with and without infection. Fetal vascular endothelium volumetric proportion was decreased, whereas syncytial knot volumetric proportion was increased, in placentae from preterm pregnancies with chorioamnionitis compared to term placentae. At term and preterm, pregnancies with overweight and obesity had a high percentage increase in proportion of immature placentae compared to normal weight. Placental maturity did not associate with infant birth outcomes. We observed placental hypermaturity and altered placental morphometry among preterm pregnancies with chorioamnionitis, suggestive of altered placental development, which may inform about pregnancies susceptible to preterm birth and infection. Our data increase our understanding of how common metabolic exposures and preterm birth, in the absence of other comorbidities or perinatal events, potentially contribute to poor pregnancy outcomes and the programming of offspring development.

Neonatal Birthweight, Infant Feeding, and Childhood Metabolic Markers

Objective Antenatal and early neonatal nutritional environment may influence later metabolic health. Infants of mothers with gestational diabetes mellitus (GDM) have higher risk for childhood obesity and metabolic syndrome (MetS). Leptin and adiponectin are known biomarkers for MetS and may guide interventions to reduce later obesity. We sought to examine the relationship between birthweight, early infancy feeding practices, and biomarkers for MetS in offspring of women with mild GDM. Study Design Secondary analysis of a prospective observational follow-up study on the offspring of women who participated in a multicenter randomized treatment trial on mild GDM. Children were evaluated by research coordinators and biospecimens collected at the age of 5 to 10. Plasma concentrations of leptin and adiponectin were compared between large for gestational age (LGA) and average birthweight (AGA) infants, and according to whether solid foods were introduced early (<6 months of age) or at the recommended age (≥6 months of age). Multivariable analysis adjusted for fetal sex, race/ethnicity, and maternal body mass index. Results Leptin and adiponectin were measured in 336 plasma samples. In bivariate analysis, compared with AGA children, LGA children had lower leptin (5.0 ng/mL [3.6–6.0] vs. 5.8 ng/mL [4.5 = 6.6], p = 0.01) and similar adiponectin (6.3 µg/mL [5.1–7.9] vs. 6.4 µg/mL [5.3–8.6], p = 0.49) concentrations. Maternal/child characteristics were similar between the early/delayed solid feeding groups. Leptin and adiponectin concentrations were similar in the early fed and delayed feeding groups (5.8 ng/mL [4.6–6.7] vs. 5.6 ng/mL [4.2–6.6], p = 0.50 and 6.4 µg/mL [5.4–8.1] vs. 6.4 µg/mL [5.1–8.8], p = 0.85, respectively). After controlling for covariates, children who were LGA and AGA at birth had similar leptin concentrations. Conclusion Birthweight and early infancy feeding practice are not associated with alterations in leptin and adiponectin in children of women with mild GDM. Key Points