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Dayan N.,McGill University | Lanes A.,University of Ottawa | Lanes A.,CHEO Research Institute | Walker M.C.,CHEO Research Institute | And 5 more authors.
Fertility and Sterility | Year: 2016

Objective To evaluate maternal and neonatal outcomes in women with chronic hypertension who conceive using assisted reproductive technologies (ART). Design Population-based retrospective cohort study. Setting Obstetric hospitals. Patient(s) Singleton pregnancies of at least 20 weeks' gestational age to women 18 years and older who delivered a live or stillborn infant between April 1, 2006, and March 31, 2012, categorized as exposed based on a diagnosis of chronic hypertension in the mother predating the index pregnancy. Intervention(s) Medically assisted pregnancy including in vitro fertilization/intracytoplasmic sperm injection (IVF-ICSI), intrauterine insemination, and ovulation induction. Main Outcome Measure(s) Primary outcome: placental-mediated complications of pregnancy (preeclampsia/eclampsia, stillbirth, fetal growth restriction/low birthweight [<10th percentile], or clinically significant placental abruption); secondary outcomes: cesarean delivery (planned/unplanned), prematurity (<37 or <32 weeks), and neonatal death. Result(s) Our cohort included 807,765 singleton pregnancies. We used log binomial regression to compute the adjusted relative risks of the various outcomes in women with hypertension as compared with healthy women in ART and unassisted pregnancies. When we tested an interaction term between hypertension and ART in multivariate models, women with ART pregnancies were at higher risk of placental-mediated complications than were those with unassisted pregnancies (adjusted risk ratio 1.48; 95% confidence interval, 1.35, 1.56). The risk was even greater in hypertensive women who used ART (adjusted risk ratio 6.77; 95% confidence interval, 4.72, 9.72). Our findings persisted when assessing IVF only and when evaluating nulliparas. Conclusion(s) Hypertension is more frequent in ART-treated women. Hypertension increases the risk of placental complications, which appear to be compounded in ART versus unassisted pregnancies. © 2016 American Society for Reproductive Medicine.

Hodes-Wertz B.,New York University | Grifo J.,New York University | Ghadir S.,Reproductive Center | Kaplan B.,Fertility Centers of Illinois | And 3 more authors.
Fertility and Sterility | Year: 2012

Objective: To determine any beneficial effects of preimplantation genetic screening (PGS) of all chromosomes by array comparative genomic hybridization (aCGH), with either day 3 or blastocyst biopsy, for idiopathic recurrent pregnancy loss (RPL) patients compared with their expected loss rate. Design: Case series report. Setting: Multiple fertility centers. Patient(s): A total of 287 cycles of couples with idiopathic RPL (defined as two or more losses). Intervention(s): PGS was done with day 3 biopsy (n = 193) or blastocyst biopsy (n = 94), followed by analysis with aCGH. Main Outcome Measure(s): Spontaneous abortion rate, euploidy rate. Result(s): A total of 2,282 embryos were analyzed, of which 35% were euploid and 60% were aneuploid. There were 181 embryo transfer cycles, of which 100 (55%) became pregnant with an implantation rate of 45% (136 sacs/299 replaced embryos) and 94 pregnancies (92%) were ongoing (past second trimester) or delivered. The miscarriage rate was found to be only 6.9% (7/102), compared with the expected rate of 33.5% in an RPL control population and 23.7% in an infertile control population. Conclusion(s): Current PGS results with aCGH indicate a significant decrease in the miscarriage rate of idiopathic RPL patients and high pregnancy rates. Furthermore, this suggests that idiopathic recurrent miscarriage is mostly caused by chromosomal abnormalities in embryos. © 2012 by American Society for Reproductive Medicine.

Sterling L.,University of Toronto | Liu J.,University of Toronto | Okun N.,Mount Sinai Hospital | Sakhuja A.,University of Toronto | And 3 more authors.
Fertility and Sterility | Year: 2016

Objective To determine whether the diagnosis of polycystic ovary syndrome (PCOS) independently predicts increased rates of pregnancy complications relative to control subjects, after adjusting for important confounders. Design Retrospective cohort. Setting Not applicable. Patient(s) A review of all pregnancies after fresh IVF with or without intracytoplasmic sperm injection transfers from December 2006 to 2012 (n = 1,084) identified 394 eligible singleton births (71 women with PCOS; 323 controls without). Intervention(s) Not applicable. Main Outcome Measure(s) Singleton births were assessed for selected adverse pregnancy and birth outcomes. Result(s) Women with PCOS demonstrated a higher risk of developing the following pregnancy complications after adjusting for differences in age, parity, body mass index, and time to conception: gestational diabetes (adjusted odds ratio [AOR] 3.15, 95% confidence interval [CI] 1.35-7.33), hypertensive disorders of pregnancy (AOR 4.25, 95% CI 1.94-9.32), preterm birth <37 weeks (AOR 2.30, 95% CI 1.07-4.97), and large for gestational age >90th percentile (AOR 2.77, 95% CI 1.21-6.35). The increased risk of preterm birth <37 weeks was eliminated after adjusting for development of hypertensive disorders of pregnancy, whereas the increased risk of large for gestational age remained significant after adjusting for gestational diabetes mellitus status. Time to conception did not differ significantly between groups, nor did rates of antepartum hemorrhage, cesarean section, or perinatal mortality. Conclusion(s) Polycystic ovary syndrome independently predicts higher risk of adverse pregnancy outcomes after adjusting for differences in maternal age, parity, body mass index, and time to conception. This new information may be of relevance in counseling and monitoring women with PCOS, although larger prospective studies may be needed to validate our findings. © 2016 American Society for Reproductive Medicine.

Pagnoux C.,Sinai University | Pagnoux C.,University of Toronto | Mahendira D.,St. Michaels Hospital | Mahendira D.,University of Toronto | And 2 more authors.
Best Practice and Research: Clinical Rheumatology | Year: 2013

Despite the rarity of vasculitides, fertility and pregnancy outcome in the setting of vasculitis have become a major topic of interest within the past decade. The potential impact of vasculitis therapies, particularly cyclophosphamide, has been examined to some extent, but data are limited on the possible impact of the disease itself on fertility. Ideally, pregnancy should be planned when the vasculitis is in remission. The outcome for mothers and newborns is usually good when vasculitis is known before the pregnancy and is in remission, but every pregnant woman must be monitored by a specialised health-care team consisting of obstetricians specialised in high-risk births and internists/rheumatologists with expertise in managing these rare conditions. Most maternal complications during pregnancy are indeed due to vasculitis damage: hypertension in Takayasu arteritis (TAK) or granulomatosis with polyangiitis (GPA)/microscopic polyangiitis (MPA) with renal insufficiency, asthma or cardiac damage in eosinophilic granulomatosis with polyangiitis (EGPA) and subglottic and/or bronchial stenosis(es) in GPA. Pregnancy loss can occur in about 10% of cases in GPA, up to 20% in EGPA, 20-30% in Behçet's disease and up to 25% in TAK, and several studies found high rates of preterm births, at least with some vasculitides. Vasculitis manifestations in newborns from mothers with known vasculitis are very rare and usually transient. © 2012 Elsevier Ltd. All rights reserved.

Zhang Z.,Kings College | Liu J.,Kings College | Meriano J.,LifeQuest Center for Reproductive Medicine | Ru C.,Soochow University of China | And 5 more authors.
Proceedings - IEEE International Conference on Robotics and Automation | Year: 2016

Mammalian sperms reorient against fluid flow in the female reproductive tract, known as rheotaxis. Compared to chemotaxis that provides short-distance guidance, rheotaxis provides long-distance guidance for a sperm to find the egg cell. However, only a low number of sperms are capable of rheotaxis and their tail behavior during reorientation is not yet known. We have developed an automated system to manipulate human sperm orientation in fluid flow and quantitatively reveal sperm behavior changes during rheotaxis. The system automatically detects multiple sperms, selects the sperm for analysis, controls fluid flow, and quantifies sperm tail behavior. Sperm head angle is used as feedback to control fluid flow and select reorienting sperms. High accuracy of head angle tracking and automated sperm selection enables the capturing of dynamic sperm turning behavior in a large sample size. Algorithms are developed to track sperm tail skeletons and quantify tail beating amplitude and asymmetry, based on which the first quantitative analysis of sperm tail behavior in rheotaxis is obtained. Experimental results reveal, for the first time, that the sperms that are capable of reorienting against fluid flow beat their tails more asymmetrically than those sperms that are unable to reorient against fluid flow while no significant difference was found in their tail beating amplitudes. © 2016 IEEE.

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