Two sides of a coin: women’s experiences and providers’ perceptions of assisted conception in urban India

Background: The uptake of assisted reproductive treatments has increased radically in urban India. We aimed to understand women’s lived experiences of assisted conception, and ART providers’ perception of their patients’ experiences.Methods: This study was cross-sectional and we used a qualitative approach and key informant interviews to understand the experiences of women and the treatment providers. Participants were ten women who had conceived through assisted reproductive treatment and ten ART providers. The data was analyzed using Braun and Clarke’s thematic analysis method.Results: During the treatment process, women felt consumed by their need to conceive. They reported that it was difficult for them to focus on other equally important aspects of their life. Stress, depression and anxiety associated with the uncertainty of their treatment outcome were prevalent. Women were also worried about miscarriage, safety and health of their baby, and forming an attachment with their fetus during the pregnancy. Providers’ concurred that women experience significant mood fluctuations in the form of stress, anxiety and depression which impacts treatment adherence and outcome. Women who have adequate spousal and family support are able to navigate the ART process better than women who lack social support.Conclusions: Findings imply the need for screening and brief psychological interventions at different stages of fertility treatment and during the antenatal and postnatal period to enhance women’s emotional well-being.

Exploring the Multiplicity of Embodied Agency in Colombian Assisted Reproduction

Analyses of assisted reproductive technologies have demonstrated how objectification and agency can coexist in infertility centres. How objectification creates opportunities for empowerment, however, has not yet been explored. In analysing women’s narratives of assisted conception in Colombian infertility clinics, I demonstrate the complexity in women’s embodied experiences of various objectifying stages of assisted conception and argue that their experiences produced multiple forms of embodied agency. Women used diagnostic procedures to learn about their bodies and infertility complications, which augmented their authority over their bodies and treatment. They drew upon their embodied knowledge to reduce treatment anxieties, while sensations such as pain were made purposeful, and hence meaningful, as women strove to reconfigure the significance of the embodied sensations of conception in a context of medicalized reproduction. In these narratives, we see that lived bodies are productive agents of social change, generating meanings and working to reshape dominant social understandings.

Comprehensive analysis of early pregnancy loss based on cytogenetic findings from a tertiary referral center

Background Pregnancy loss is one of the most common complications during pregnancy. Clinical consultation based on etiology analysis are critical for reducing anxiety and distress. This study aimed to perform a comprehensive analysis for products of conception (POC) in miscarriage based on genetic etiology and clinical information. Methods A retrospective study was conducted according to cytogenetic findings of 1252 POC from spontaneous pregnancy loss over 11 years. The frequencies and profiles of chromosomal abnormalities were discussed according to the classification of women with different maternal ages, previous miscarriage history, normal live birth history, and different modes of conception. Results A total of 667 (53.2%) chromosomal abnormalities were observed, including 592 (47.3%) cases of numerical abnormalities, 38 (3.0%) cases of structural abnormalities, and 37 (3.0%) cases of mosaic aberrations. In women above 40 years of age, the rates of chromosomal abnormalities and viable autosomal trisomy were significantly higher than those in women with ≤ 29, 30–34, and 35–39 years of age (p < 0.05). The frequency of abnormal karyotype in women with normal live birth history was 61.1%, significantly higher than 52.5% in women without normal live birth history (p < 0.05). There was no significant differences among women without, with 1–2, and ≥ 3 previous miscarriages regarding the rate of abnormal karyotype (p > 0.05); viable autosomal trisomy was less common in women with ≥ 3 previous miscarriages than women with < 3 miscarriages. The frequency of chromosomal abnormalities was 49.0% and 55.0% in women with assisted conception and natural conception (p > 0.05), respectively; monosomy X was more frequently detected in women with natural conception than assisted conception. Conclusion The frequencies and profiles of chromosomal abnormalities in early miscarriages are strongly associated with clinical information including maternal age, previous miscarriage, live birth history, and mode of conception. Cytogenetic analysis of POC should be recommended to women with a first miscarriage and women with normal live birth history.

Fertility and subfertility

This chapter covers issues related to fertility and subfertility. It starts with lifestyle assessments that should be done as part of preconceptual care, and explains the psychological effects and counselling for subfertility alongside both male and female factors that affect difficulties in conceiving. Tests and investigations are covered for both partners, and the role of the fertility nurse specialist is defined. Ovulation induction, assisted conception, inter-uterine insemination, and IVF are all described. Pre-implantation genetic diagnosis is given a brief overview, and the chapter also explores adoption and surrogacy. Fertility preservation and the role of the Human Fertilization and Embryology Authority are covered.

Effectiveness of modified downregulation for women with moderate and severe adenomyosis of the uterus prior to frozen thawed embryo transfer (MODA) study protocol: a pragmatic randomised-controlled trial

IntroductionAdenomyosis can adversely reduce chances of pregnancy in couples undergoing assisted conception. We aim to evaluate the effect of two different downregulation protocols on the reproductive outcomes in women with moderate and severe adenomyosis undergoing frozen-thawed embryo transfer (FTET).Methods and analysisWe will conduct a two-armed pragmatic randomised clinical trial comparing modified downregulation with gonadotrophin-releasing hormone (GnRH) analogue for 6 weeks to standard downregulation with GnRH analogue for 1 week prior to FTET. Our primary outcome is clinical pregnancy, defined as a viable intrauterine pregnancy confirmed by ultrasound at greater than 6 weeks gestation, with other secondary reproductive, neonatal and safety outcomes. We aim to randomise 162 patients over 3 years to achieve 80% power for detecting a 20% difference in the primary outcome at 5% significance.Ethics and disseminationTo date there is no consensus on the optimal protocol for management of subfertile women with adenomyosis. Modified downregulation could improve the clinical pregnancy rate by reducing the endometrial inflammatory reaction and/or myometrial contractility and their impact on uterine receptivity in women with moderate and severe adenomyosis of the uterus undergoing FTET. The MODA trial is designed to offer pragmatic, real-life evaluation of the optimal protocol for downregulation for this population during assisted conception treatments. Our findings will be published in peer-reviewed journals and presented at national and international scientific meetings and congresses. Ethical approval was granted by the NHS Research Ethics Committees (19/LO/1567).Trial registration numberNCT03946722.

A Study to decrease the incidence of PPH in our hospital setting

Objective: This study aimed to measure incidence, identify risk factors (pre‐existing or acquired) forPPH and to prevent progression to severe PPH. Methods: This is a prospective observational study.The causes are likely to be multifactorial with shifting demography and health status widely cited,e.g. age, obesity, comorbidity, multiple pregnancy and ethnicity. Results: Prepregnancy factors forPPH include age, ethnicity, BMI, previous PPH and assisted conception Conclusion: Prophylacticuterotonic agents in high-risk patients, use of intramuscular or intravenous oxytocin, timelyapplication of B –lynch suture, adequate and timely arrangement of blood and blood factors can helpprevent PPH.