Developmental stage and morphology of the competent blastocyst are associated with sex of the child but not with other obstetric outcomes: a multicenter cohort study.

STUDY QUESTION: Are transfer day, developmental stage and morphology of the competent blastocyst in pregnancies leading to live birth associated with preterm birth, birthweight, length at birth and sex of the child? SUMMARY ANSWER: A high score in blastocyst developmental stage and in trophectoderm (TE) showed a significant association with the sex of the child, while no other associations with obstetric outcomes were observed. WHAT IS KNOWN ALREADY: The association between blastocyst assessment scores and obstetric outcomes have been reported in small single-center studies and the results are conflicting. STUDY DESIGN, SIZE, DURATION: Multicenter historical cohort study based on exposure data (transfer day (blastocyst developmental stage reached by Day 5 or Day 6)) blastocyst developmental stage (1-6) and morphology (TE and inner cell mass (ICM): A, B, C)) and outcome data (preterm birth, birthweight, length at birth, and sex of the child) from women undergoing single blastocyst transfer resulting in a singleton pregnancy and live birth. PARTICIPANTS/MATERIALS, SETTING, METHODS: Data from 16 private and university-based facilities for clinical services and research were used. A total of 7246 women, who in 2014-2018 underwent fresh-embryo transfer with a single blastocyst or frozen-thawed embryo transfer (FET) with a single blastocyst resulting in a singleton pregnancy were identified. Linking to the Danish Medical Birth Registry resulted in a total of 4842 women with a live birth being included. Cycles with pre-implantation genetic testing and donated gametes were excluded. The analyses were adjusted for female age (n = 4842), female BMI (n = 4302), female smoking (n = 4290), parity (n = 4365), infertility diagnosis (n = 4765), type of treatment (n = 4842) and center (n = 4842); some analyses additionally included gestational age (n = 4368) and sex of the child (n = 4833). MAIN RESULTS AND THE ROLE OF CHANCE: No statistically significant associations between blastocyst assessment scores (transfer day, developmental stage, TE, ICM) and preterm birth (8.3%) or birthweight (mean 3461.7 g) were found. The adjusted association between blastocysts with a TE score of C and a TE score of A and length at birth (mean 51.6 cm) were statistically significant (adjusted mean difference 0.4 cm (95% CI: 0.02; 0.77)). Blastocysts transferred with developmental stage score 5 compared to blastocysts transferred with score 3 had a 34% increased probability of being a boy (odds ratio (OR) 1.34 (95% CI: 1.09; 1.64). Further, TE score B blastocysts compared to TE score A blastocysts had a 31% reduced probability of being a boy (OR 0.69 (95% CI: 0.60; 0.80)). LIMITATIONS, REASONS FOR CAUTION: It is possible that some residual confounding remains. WIDER IMPLICATIONS OF THE FINDINGS: Blastocyst selection during ART does not appear to introduce any negative effects on obstetric outcome. Therefore, clinicians and patients can be reassured that the assessment scores of the selected blastocyst will not in themselves pose a risk of preterm birth or affect birthweight and the length at birth. STUDY FUNDING/COMPETING INTEREST(S): Unrestricted grant from Gedeon Richter Nordics AB, Sweden. None of the authors have any competing interest to declare. TRIAL REGISTRATION NUMBER: N/A.

Mild stimulation approach for In Vitro Fertilization treatment: Retrospective data from one Danish Centre.

AIM OF STUDY: Over the last decade, the laboratory procedures in artificial reproduction have improved. Hyperstimulation causes an overload of eggs which will never be used. The present study was designed to evaluate the efficiency of a mild stimulation. To obtain oocytes for In Vitro Fertilization (IVF) a short antagonist protocol using Tamoxiphene and FSH was compared to conventional IVF. METHODS: A retrospective and observatory study including all patients with unexplained infertility. In total 720 cycles with mild stimulation protocol and 8,446 cycles with regular short antagonist IVF protocol were analysed. The observation period was from January 2011 until September 2017. All patients were recruited in the same time period and allocated to different treatments upon their request. Low stimulation using orally administrated anti-estrogenic drugs combined with FSH in the form of injections was used in order to obtain up to four mature follicles. RESULTS: The clinical pregnancy rate (CPR) per embryo transfer (ET) was 25% for the mild stimulation group. The CPR for the control group with conventional IVF was 23%. CONCLUSION: Mild stimulation may be an important step towards an easier IVF approach, more tolerable for women, easier and cheaper for the women and the society, while maintaining an acceptable success rate in terms of CPR. Large prospective studies need to be performed.

Old persons' contact with general practitioners in relation to health: a Danish population study.

The study describes health, social situation, and contact with general practitioners in a random sample of non-institutionalized persons 70-95 years old in Denmark. There was a strong correlation between health and contact with general practitioners. A small group, 3% of the respondents, had no health problems, but had been in contact with a general practitioner within the previous month. This group was characterized by a strong social network and a high degree of life satisfaction. Another small group, including 3% of the respondents, had extensive health problems, but had nevertheless not been in contact with a general practitioner within the previous year. This group was characterized by a weak social network and a low degree of life satisfaction.

[Self-reported health status and drug use among the elderly]. / Aeldres selvrapporterede helbred og laegemiddelforbrug.

A random sample of 1,261 non-institutionalised persons aged 70-95 years in four Danish communes replied to questionnaires on health, functional ability, drug use, and living situation in October-November, 1986. Twenty-four % assess their health as excellent, 27%, 39% and 10% good, fair, or poor. Younger persons report better self-assessed health than older, males better than females irrespective of age. Chronic ailments are reported by 51%, most frequent hypertension (24%), heart disease (17%), and chronic bronchitis/asthma (12%). More females than males and more old than young report chronic ailments. Seventy-six % have experienced one or more physical symptoms during the past month, most frequently aching in back and hips (39%) aching in knee and feet (36%), vertigo (27%), swollen legs (25%), and headaches (19%). Fourty-six % report one or more mental symptoms during the past month, most frequently difficulties falling asleep (30%), fatigue without specific reason (21%), and depression (18%). Females report more symptoms than men, older persons report more symptoms than younger. Fourty-nine % report difficulties in hearing during conversations among several persons, 24% in conversations with one other person. Twenty-three % have difficulties reading printed text. Fifty-nine % report memory problems. Functional ability is described by 13 daily activities and 31% can perform all activities without trouble, 29% with some trouble but without help, whereas 13 and 27% need help for one, or more of these activities. More females than males and more older than younger need help.(ABSTRACT TRUNCATED AT 250 WORDS)

[Which pensioners receive home help? A sociomedical survey of 1,261 persons 70-95 years of age]. / Hvilke pensionister får hjemmehjaelp? Socialmedicinsk undersøgelse af 1.261 70-95-årige.

The aim of the article is to describe variables associated with use of home help. A random sample of 1,261 non-institutionalised elderly persons aged 70-95 years in four communes answered a questionnaire on their health and social situation during the winter 1986/87. Twenty-five percent receive home help: 13%, 26% and 49% in the age groups 70-74, 75-79, and 80-95, respectively. Among those living alone more males than females receive home help (41% vs. 35%), as compared with those not living alone (M: 12%, F: 22%). Individuals receiving home help are characterised by reduced functional capacity; reduced vision, hearing, and memory; reduced quality of life resources (e.g. lonlieness, depression, no future plans). The proportion receiving home help is independent of social class but decreases with increasing income. It is also independent of the extent of the informal social network and the frequency of contacts, however, those receiving home help receive more help from children and kin. A multivariate analysis shows that functional capacity, age, and income are the main predictors. Eight percent think they need (more) home help, 24% among those already using this service and 3% among non-users. In conclusion, home help in Denmark seems to be provided to the oldest elderly persons with the poorest physical and psychological functional abilities.

Medical students experience early patient contact in general practice. A description and evaluation of a new course in the medical curriculum.

In the first year of the medical curriculum at the University of Copenhagen, a new discipline has been introduced, in which general practice has the key position in providing experiences of early patient contact to the students. The course consists of three principal elements: student-patient contacts in the patient's home; lessons with the general practitioner; and lessons at the Institute of General Practice. The compulsory course is completed by a student's report, and the first course has been evaluated by qualitative analysis of these reports and by questionnaires to the students and GPs. The results indicate that it is possible to provide considerable improvement of the medical education as regards communication skills and understanding of the patients' perceptions, by letting the student establish contact with a patient in the very beginning of the curriculum. General practice provides an appropriate setting for this education for both teachers and patients.

Risk factors in eighty-plus year-olds living at home: an investigation of a Danish community.

A series of risk factors involving the health of the elderly were investigated among persons aged eighty years and older living at home in the community of Holbaek, Denmark. The investigation included a total of 459 participants, 84 percent of this age group. After a two-year period of observation, it was found that 75 percent were still living at home, less than 1 percent were hospitalized, 10 percent had moved to nursing homes, and 14 percent had died. A total of 62 percent had lived at home during the entire period without hospitalization. By means of comparing conditions of health in 1977 and subsequently in 1979, it is possible to point out a series of predictors which are statistically significant but of limited clinical value. The article concludes that it is scarcely possible to achieve more in the prophylaxis of acute breakdown in the life of the old people with the present Danish health policy. Two possibilities were suggested: twenty-four-hour care services, or strengthening of the informal social network.