Transition to Parenthood after Unexplained Infertility: Interpretative Phenomenological Analysis

Prevalence rates of infertility show that one in every six couples worldwide have experienced fertility problems; however, there is still a relatively high chance of spontaneous conception for couples with unexplained infertility. Nevertheless, most existing research has focused on the infertility experience leading up to potential parenthood, rather than the actual parenting experience itself. Hence, this paper presents an in-depth exploration of the lived experiences and personal meaning of becoming parents of individuals affected by unexplained infertility. Semi-structured interviews were conducted, and transcripts were subjected to Interpretative Phenomenological Analysis (IPA). Four themes emerged: perception of fragility of life, father's embodied emotional connection with child, becoming a parent—identity shift, and imprint of infertility on relationships with a partner. The findings emphasize clinicians’ and researchers’ awareness of the need to process couple's grief and highlight the importance of addressing romantic relationship issues, experienced during the infertility period to facilitate couples transitioning to parenthood.

Assisted Reproductive Technology Required to Achieve High Conception Rates, Despite a Low Incidence of Hypogonadotrophic Hypogonadism in Thalassemia and Sickle Cell Disease Patients

Background Early and effective iron chelation has improved life expectancy and decreased disease complications for people with transfusion dependent thalassemia (TDT) and Sickle Cell Disease (SCD). Fertility challenges and pregnancy complications have historically limited reproductive options in this group, however improved disease management has made subfertility a chronic disease complication requiring attention. Despite this, there are very few reports on rates of conception and pregnancy outcomes in this population. Methods A 20 year retrospective analysis (1997 - 2017) was performed to evaluate fertility outcomes in women with TDT and SCD at an Australian referral centre. Patients with TDT and SCD who tried to conceive during the study period were included. Use of assisted reproductive technologies (ART), as well as pregnancy outcomes and neonatal and maternal complications were assessed. Results Eleven women with TDT and 3 with SCD tried to conceive during the study period. Median age at conception was 28 years (range 21-35). A total of 28 pregnancies and 25 live births were reported, including 2 spontaneous early pregnancy losses, a termination for anencephaly and a reduction of triplets. There was 1 multiple gestation in the cohort. At least 1 live birth occurred in 13 of the 14 women (93%). Spontaneous conception was reported in 9 women, of whom 8 had at least one resulting live birth, with a total of 15 live births from spontaneous conception. Of 5 women who were unable to conceive spontaneously, four had a diagnosis of hypogonadotrophic hypogonadism (HH) - two conceived following ovarian stimulation (OS), one required in vitro fertilization (IVF), and one did not pursue IVF following unsuccessful OS. The cause of subfertility was unknown in one patient, who conceived with IVF following failed OS. Three women who had an initial spontaneous conception required assisted reproductive technology (ART) for subsequent pregnancies, with no cause for subfertility identified. Mean ferritin at conception was 2911 mmol/L (range 164 to 8697mmol/L), and there was no association between ferritin at conception and need for ART. A trend was observed between increasing age and use of ART. Nine of the thirteen (69%) women who achieved pregnancy underwent Cesarean section for their first delivery. Prematurity (birth prior to 37 weeks' gestation) occurred in 5 (20%) of live births. Intrauterine growth restriction (IUGR) evidenced by birth weight <10 th centile for gestational age at birth was observed in 7 of 25 births (28%). This included one very low birth weight neonate delivered following induction for suspected IUGR. Respiratory distress syndrome occurred in two neonates in the setting of prematurity (delivered at 31 and 33 weeks gestation), both from women with TDT. Post partum hemorrhage (PPH) occurred after four deliveries in three women with TDT. There were no neonatal or maternal deaths. Conclusions Our data is the first analysis of fertility and pregnancy outcomes in Australian patients with TDT or SCD. Publications in this area are limited, and primarily report on pregnancy outcomes without capturing failure to conceive. Our findings are encouraging, with high conception rates achieved, with the use of ART where needed. Ferritin level did not predict difficulty with spontaneous conception and few of the women (29%) had HH, despite many having significant hyperferritinemia. Overall, 48% of live births resulted from ART, despite 58% of these patients not having a diagnosis of HH. This indicates that pituitary iron deposition with resultant HH alone does not adequately explain subfertility in this population. Our data also highlight the importance of affordable ART access for this patient population despite the clinical gains achieved with effective chelation therapy. Pregnancies were largely uncomplicated with excellent maternal and foetal outcomes. A high rate of IUGR was observed, supporting classification of pregnancy in this population as high risk. Rates of Cesarean section for first delivery were more than double the Australian average, likely in part due to high IUGR rates. Neonatal complications and PPH occurred at general population rates. Guidelines around pregnancy management in this population abound, however large prospective studies are needed to identify those at risk of sub- and infertility, even in the era of effective chelation. Disclosures No relevant conflicts of interest to declare.

Role of Laparoscopy in Diagnosis and Treatment of Endometriosis Associated with Infertility: A Prospective Analysis

Objective: Endometriosis is often considered as an enigma due to its varied clinical presentation and challenges in diagnosis. The objective of this study is to evaluate the role of laparoscopy in diagnosis and treatment of endometriosis associated with infertility.Materials and Methods: Infertile females diagnosed to have endometriosis during or before undergoing laparoscopic surgery from August 2018 to February 2020 were followed up for spontaneous conception for 6 months following laparoscopy. Revised American Fertility Society (r-AFS) scoring system was used to score endometriosis and stage the disease (stage I-IV). Surgical interventions were done on individual cases basis following ESHRE guidelines.Results: Fifty infertile females diagnosed with endometriosis during or before laparoscopy were recruited for the study. Mean age of patients was 28.58 (±4.21) years. Thirty-four (68%) patients had primary infertility and 16 (32%) has secondary infertility. Mean duration infertility was 3.33 (±1.43). Only 37 patients (74%) had evidence of endometriosis in pre-operative ultrasonography. During the follow up period of first 6 months after surgery 34 (68%) patients conceived spontaneously. Lower mean endometriosis score (p=0.00) and early stage of endometriosis (p=0.00) were associated with higher chances of conception. But, female age, duration and type infertility, USG findings, and type of surgical interventions did not affect pregnancy rate.Conclusion: Laparoscopy helps in diagnosis of endometriosis. Laparoscopic therapeutic interventions for endometriosis increase the probability of spontaneous conception in infertile females. Lower surgical score and early stages of endometriosis are associated with higher chance of conception.

5-methyltetrahydrofolate: A mandatory support for T677T MTHFR SNP women suffering from premature ovarian insufficiency, endometriosis and/or multiple ART failures

A patients, age 39 in 2019, suffering hypermenorrhea, secondary dysmenorrhea and endometriosis with pelvic adhesions, Normal physical examination with an AMH value of 0.877 ng/L . At this time the couple had been trying to conceive for over 2 years while taking nature made prenatal vitamins and the wife was given 9 rounds of clomid treatments (6–50 mg, 3- 100 mg). She was advised to take DHEA and then started IUI and IVF with no success. On August, 2020, it was elected to check the couple for MTHFR mutation. The woman was found to be homozygous for T677T MTHFR mutation and her spouse homozygous for the C1298C MTHFR mutation but with a subnormal sperm. The patient and her spouse were both advised to discontinue any vitamins containing folic acid and start vitamins with a daily dose of 1,000 mcg of 5-MTHF (folate) with chelated zinc and a vitamin B complex. On December, 2020 spontaneous conception occurred. On July 27, 2021, a healthy 48.26 cm (19 inches), 3 kg (6 pounds 9 ounces) girl was delivered by c-section. Keywords: MTHFR 677TT SNP; endometriosis; ART failures; premature ovarian insufficiency; 5MTHF.

Pregnancy outcome in a bicornuate uterus with bilateral pregnancy presenting as threatened abortion: a case report

Congenital uterine anomalies or mullerian anomalies are prevalent in 0.4 to 10% of women in general and are often manifested by reproductive challenges like miscarriage, premature labor, premature rupture of membranes or malpresentation. Having a bilateral pregnancy in a bicornuate uterus is extremely rare, especially if it is a spontaneous conception.

REPRODUCTIVE OUTCOMES AFTER ABDOMINAL MYOMECTOMY

Objective: To determine the frequency of reproductive outcomes after abdominal myomectomy in infertile women. Study Design: Case series. Place and Duration of Study: at Combined Military Hospital, Multan Pakistan, from Sep 2015 to Feb 2017. Methodology: This study included 60 women who underwent myomectomy to retain their capabilities of reproduction. Inclusion criteria were infertile women with uterine fibroids. Routine investigation was done to all patients like ultrasound and hysterosalpingogram before and after the procedure. The procedure of abdominal myomectomy was done under general anesthesia. All fibroids were enucleated and large blood vessels were tied. Vicryl no.1 was used to close the uterine defect. All patients were followed up for 3, 6 and 12 months interval and data was collected for conception, spontaneous conception, and conception with assisted reproductive technique, live birth and miscarriage. Results: In this study mean age was 27.33 ± 4.03 years, mean number of fibroid was 1.366 ± 0.48 and mean size of fibroid was 7.06 ± 1.64 cm. Twenty eight (46.7%) women had conceived after myomectomy, in which 92.9% had spontaneous conception and 7.1% by assisted reproductive technique. Conclusion: Abdominal myomectomy should be the standard treatment of infertile women with uterine fibroids if no other underline cause of infertility. Moreover, this study results also showed that younger patients might be benefited more in term of reproductive outcomes after abdominal myomectomy.

A Comparison of Preterm Birth Rate and Growth from Birth to 18 Years Old between in Vitro Fertilization and Spontaneous Conception of Twins

The aim of the present study was to compare the rate of preterm birth (PTB) and growth from birth to 18 years between twins conceived by in vitro fertilization (IVF) and twins conceived by spontaneous conception (SC) in mainland China. The retrospective cohort study included 1164 twins resulting from IVF and 25,654 twins conceived spontaneously, of which 494 from IVF and 6338 from SC were opposite-sex twins. PTB and low birth weight (LBW), and growth, including length/height and weight, were compared between the two groups at five stages: infancy (0 year), toddler period (1–2 years), preschool (3–5 years), primary or elementary school (6–11 years), and adolescence (10–18 years). Few statistically significant differences were found for LBW and growth between the two groups after adjusting for PTB and other confounders. Twins born by IVF faced an increased risk of PTB compared with those born by SC (adjusted odds ratio [aOR] 8.21, 95% confidence interval [CI] [3.19, 21.13], p < .001 in all twins and aOR 10.12, 95% CI [2.32, 44.04], p = .002 in opposite-sex twins). Twins born by IVF experienced a similar growth at five stages (0–18 years old) when compared with those born by SC. PTB risk, however, is significantly higher for twins conceived by IVF than those conceived by SC.

Pregnancy outcomes after spontaneous conception with previous spontaneous abortion preceding present pregnancy

Background: The objective of the present study was to study pregnancy outcomes in patients with Spontaneous conception with history of previous spontaneous abortion preceding present pregnancy.Methods: A prospective study included patients with spontaneous conception with history of previous spontaneous abortion preceding present pregnancy admitted in the department of obstetrics and gynecology, command hospital, Pune between October 2018 and April 2020. The patients were booked (minimum 3 visits in antenatal outdoor clinic) or admitted for the first time as an emergency. The detailed history about previous abortions was taken and routine as well as investigations for possible etiologies of previous abortions were done. Cases with history of mid-trimester abortion were investigated for cervical incompetence. All the patients were observed for complications during present pregnancy like threatened abortion, preeclampsia, preterm labour, intrauterine death and final outcome.Results: A total of 110 patients with history of previous spontaneous abortion were admitted, all patients were booked. Majority (51.8 %) of patients belong to the age group 25-30 years. All patients were with history of previous one abortion followed by pregnancy with spontaneous conception. The final outcomes were term live birth (86.4%), abortion (8.2%), preterm delivery (5.4%), and no still birth. Caesarian section was done in 32.7% patients for various indications.Conclusions: Previous history of spontaneous abortion is associated with adverse pregnancy outcome. There is increased risk of abortion, preterm delivery, need for caesarean sections and fetal loss in cases of previous spontaneous abortions. These complications and fetal loss can be reduced by booking the patients and giving due antenatal care.