Association between female infertility and stroke mortality: evidence from the PLCO cancer screening trial.

Objective: While infertility affects about 15% of women during their reproductive years, its long-term impact on stroke mortality after this period remains unclear. This study aims to investigate the association between infertility and stroke mortality in women using data from the Prostate, Lung, Colorectal, and Ovarian (PLCO) cancer screening trial. Methods: We analyzed data from 75,778 female participants aged 55-74 years with a median follow-up of 16.84 years. Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for stroke mortality, adjusting for potential confounders. Results: Among participants, 14.53% reported infertility. During follow-up, 1,159 women died from stroke. Compared to women without infertility, those with infertility had a higher risk of stroke mortality (HR 1.21, 95% CI 1.04-1.41, p = 0.016). This association remained statistically significant after adjusting for age, race, education level, marital status, smoking status, body mass index, history of hypertension, history of heart attack, history of diabetes mellitus, birth control pill use, hormone replacement therapy, endometriosis, first menstrual period and pregnancy history (HR 1.20, 95% CI 1.02-1.42, p = 0.029). Sensitivity and subgroup analyses yielded consistent results. Conclusion: The findings of this study indicate that infertility is associated with an increased risk of stroke mortality in women. Further research is needed to confirm these findings and elucidate the underlying mechanisms.

Canary in the Coal Mine? Male Infertility as a Marker of Overall Health.

Male factor infertility is a common problem. Evidence is emerging regarding the spectrum of systemic disease and illness harbored by infertile men who otherwise appear healthy. In this review, we present evidence that infertile men have poor overall health and increased morbidity and mortality, increased rates of both genitourinary and non-genitourinary malignancy, and greater risks of systemic disease. The review also highlights numerous genetic conditions associated with male infertility as well as emerging translational evidence of genitourinary birth defects and their impact on male infertility. Finally, parallels to the overall health of infertile women are presented. This review highlights the importance of a comprehensive health evaluation of men who present for an infertility assessment.

Influence of subfertility and assisted reproductive technology treatment on mortality of women after delivery.

OBJECTIVE: To compare incidence, risk factors, and etiology of women's deaths in fertile, subfertile, and undergoing assisted reproductive technology (ART) in the years after delivery. DESIGN: Retrospective cohort. SETTING: University hospital. PATIENT(S): Women who had delivered in Massachusetts. INTERVENTION(S): This study used data from the Society for Assisted Reproductive Technology Clinic Outcome Reporting System linked to vital records, hospital stays, and the Massachusetts death file. Mortality of patients delivered from 2004-2013 was evaluated through 2015. The exposure groups, determined on the basis of the last delivery, were ART-treated (linked to Society for Assisted Reproductive Technology Clinic Outcome Reporting System), subfertile (no ART but with indicators of subfertility including birth certificate checkbox for fertility treatment, prior hospitalization for infertility [International Classification of Disease codes 9 628 or V23], and/or prior delivery with checkbox or ART), or fertile (neither ART nor subfertile). Numbers (per 100,000 women-years) and causes of death were obtained from the Massachusetts death file. MAIN OUTCOME MEASURE(S): Mortality of women after delivery in each of the three fertility groups and the most common etiology of death in each. RESULT(S): We included 483,547 women: 16,429 ART, 11,696 subfertile, and 455,422 fertile among whom there were 1,280 deaths with 21.1, 25.5, and 44.7 deaths, respectively, per 100,000 women-years. External causes (violence, accidents, and poisonings) were the most common reasons for death in the fertile group. Deaths occurred on average 46 months after delivery. When external causes of death were removed, there were 19.1, 17.0, and 25.6 deaths per 100,000 women-years and leading causes of death in all groups were cancer and circulatory problems. CONCLUSION(S): The study presents reassuring data that death rates within 5 years of delivery in ART-treated and subfertile women do not differ from those in fertile women.

Fertility-sparing surgery for treatment of non-epithelial ovarian cancer: Oncological and reproductive outcomes in a prospective nationwide population-based cohort study.

OBJECTIVE: To compare the oncologic outcome of women who underwent fertility-sparing surgery (FSS) vs. radical surgery (RS) for treatment of NEOC in a prospective, nationwide, population-based study and report on the reproductive outcomes in women after FSS. METHODS: Using the Swedish Quality Register for Gynecological Cancer, we identified all women ages 18-40 treated with either FSS or RS for stage I NEOC between 2008 and 2015. Progression-free survival (PFS) and overall survival (OS) rates were compared using the Kaplan-Meier method. Data on use of assisted reproductive technology (ART) treatments and obstetrical outcomes after FSS were extracted from the National Quality Register for Assisted Reproduction (Q-IVF) and the Swedish Medical Birth Register. RESULTS: During the study period, 73 women ages 18-40 received a stage I NEOC diagnosis. The majority, 78% (n = 57), underwent FSS. The 5-year OS rate, regardless of surgical approach, was 98%. There were no statistical differences between OS and PFS rates in women treated with FSS, compared to RS. Recurrences were more common after RS than FSS: 12.5% (2/16) vs. 3.5% (2/57), respectively. Following FSS, 11 women gave birth to 13 healthy children (all conceived naturally). Additionally, 12% of the women in the cohort developed infertility and received ART treatment (n = 7). CONCLUSION: FSS is not associated with worse oncologic outcomes than RS in young women with early stage NEOC. The prognosis was excellent in both groups, with an OS of 98%. Natural fertility was maintained in women treated with FSS, only 12% required ART treatment.

Organisation of care for pregnancy in patients with congenital heart disease.

Improvements in surgery have resulted in more women with repaired congenital heart disease (CHD) surviving to adulthood. Women with CHD, who wish to embark on pregnancy require prepregnancy counselling. This consultation should cover several issues such as the long-term prognosis of the mother, fertility and miscarriage rates, recurrence risk of CHD in the baby, drug therapy during pregnancy, estimated maternal risk and outcome, expected fetal outcomes and plans for pregnancy. Prenatal genetic testing is available for those patients with an identified genetic defect using pregestational diagnosis or prenatal diagnosis chorionic villus sampling or amniocentesis. Centralisation of care is needed for high-risk patients. Finally, currently there are no recommendations addressing the issue of the delivery. It is crucial that a dedicated plan for delivery should be available for all cardiac patients. The maternal mortality in low-income to middle-income countries is 14 times higher than in high-income countries and needs additional aspects and dedicated care.

Obstetric and perinatal outcomes in singleton pregnancies resulting from the transfer of blastocyst-stage versus cleavage-stage embryos generated through in vitro fertilization treatment: a systematic review and meta-analysis.

OBJECTIVE: To perform a systematic review and meta-analysis of obstetric and perinatal complications in singleton pregnancies after the transfer of blastocyst-stage and cleavage-stage embryos generated through IVF. DESIGN: Systematic review. SETTING: University hospital. PATIENT(S): Singleton pregnancies resulting from ET at the blastocyst stage versus those at the cleavage stage. INTERVENTION(S): Medline, EMBASE, Cochrane Central Register of Clinical Trials DARE, and CINAHL (1980-2013) were searched. Two independent reviewers extracted data and assessed the methodological quality of the relevant studies using CASP scoring. Risk ratios and risk differences were calculated in Rev Man 5.1. MAIN OUTCOME MEASURE(S): Very preterm birth, preterm birth, small for gestational age, low birth weight, very low birth weight, congenital anomalies, perinatal mortality, preeclampsia, and placenta previa. RESULT(S): In vitro fertilization pregnancies occurring as a result of ET at the blastocyst stage were associated with a higher relative risk (RR; 95% confidence interval [CI]) of preterm (RR 1.27; 95% CI 1.22-1.31) and very preterm delivery (RR 1.22; 95% CI 1.10-1.35) in comparison with those resulting from the transfer of cleavage-stage embryos. The risk of growth restriction was lower in babies conceived through blastocyst transfer (RR 0.82; 95% CI 0.77-0.88). CONCLUSION(S): Data from observational studies show that ET at the blastocyst stage is associated with a higher risk of very preterm delivery. However, we were not able to adjust for confounders. Perinatal outcome data from existing randomized trials are needed to determine the safety of ET at the blastocyst stage compared with the cleavage stage.

Radical vaginal trachelectomy: a fertility-preserving procedure in early cervical cancer in young women.

BACKGROUND: Radical vaginal trachelectomy (RVT) is a fertility-preserving operation for young women who have cervical cancer in an early stage and want to have children. The demand for RVT is increasing, because more than 40% of all cases of cervical carcinoma affect women under the age of 44. Women are increasingly having their first child at later ages. METHODS: We present the results of RVT in more than 300 patients whom we operated on, review pertinent literature retrieved by a selective PubMed search, and evaluate treatment recommendations. RESULTS: The literature contains data on more than 1000 women treated with RVT and nearly 300 pregnancies after RVT. The 5-year recurrence and mortality rates are 2%-5% and 3%-6%, respectively. RVT is an oncologically safe treatment for women who want to have children. The main criteria for treatment with RVT are that the tumor should be no greater than 2 cm in diameter and that the lymph nodes should be histopathologically free of tumor tissue. The laparoscopic-vaginal technique is the best operative approach to assure a high rate of healing. Only one-third of all patients want to have children a short time after RVT. Their pregnancy rates resemble those of women in the general population. 50% of the children are born prematurely, mainly because of premature rupture of the membranes. Thus, pregnancies after RVT are considered high-risk pregnancies. CONCLUSION: As many as 48% of women with early-stage cervical carcinoma meet the criteria for RVT. RVT is an oncologically safe method that enables women with early-stage cervical carcinoma to become pregnant and have children. Pregnancy after RVT is associated with an elevated risk of preterm birth and should be managed according to standardized procedures.

Safety of uterine and/or ovarian preservation in young women with grade 1 intramucous endometrial adenocarcinoma: a comparison of survival according to the extent of surgery.

OBJECTIVE: To compare the survival of patients with grade 1 intramucous endometrial adenocarcinoma according to the extent of surgery. DESIGN: Retrospective cohort study. SETTING: Not applicable. PATIENT(S): A cohort of 489 patients who were 40 years of age or younger with grade 1 intramucous endometrial adenocarcinoma. INTERVENTION(S): The patients were divided into the following three groups: 101 patients who underwent uterine preservation, 184 patients who underwent ovarian preservation, and 204 patients who underwent hysterectomy with oophorectomy. MAIN OUTCOME MEASURE(S): The demographics and survival rates were compared. RESULT(S): In the multivariate analysis, no factors were associated with ovarian preservation. In the multivariate analysis, the factors that were associated with uterine preservation were a later year of diagnosis and young age. In a multivariate Cox model, ovarian and uterine preservation had no effect on either cancer-specific or overall survival. CONCLUSION(S): In patients with grade 1 intramucous endometrial adenocarcinoma, uterine and ovarian preservation were not associated with an increase in cancer-related mortality. Longer follow-up is needed to confirm the safety of a conservative approach toward the ovaries and/or the uterus.

Myeloproliferative disorders in pregnancy.

This article reviews pregnancy outcome in women diagnosed with a myeloproliferative neoplasm (MPN), and discusses possible risk markers and the pathogenesis of poor pregnancy outcome. An outline of the key factors regarding the diagnosis and management of MPN in women of reproductive potential is followed by a description of the authors' management strategy for standard and high-risk pregnancy in MPN patients.

Accuracy of sow culling classifications reported by lay personnel on commercial swine farms.

OBJECTIVE: To determine the accuracy of sow culling classifications reported by lay personnel on commercial swine farms. DESIGN: Retrospective cohort study. ANIMALS: A convenience sample of 923 sows from 8 conventional, farrow-to-wean farms that followed standard operating procedures. PROCEDURES: Sows were examined at slaughter, and lesions were recorded. Individual production records were reviewed to determine the farm-reported reason for culling the sows, and criteria were developed to assess the accuracy of recorded culling classifications. RESULTS: For 209 of the 923 (23%) sows, the farm-reported culling classification was judged to be inaccurate. The culling code was considered to be inaccurate for 62 of 322 (19%) sows reportedly culled because of old age, 48 of 172 (28%) sows reportedly culled because of failure to conceive, 31 of 90 (34%) sows reportedly culled because of poor body condition, and 23 of 73 (32%) sows reportedly culled because of poor farrowing productivity. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that for commercial swine farms, farm-reported culling code classifications were frequently inaccurate. This degree of inaccuracy may cause severe limitations for studies that rely on farm-reported assessments of clinical conditions.

Factors influencing adverse perinatal outcomes in pregnancies achieved through use of in vitro fertilization.

OBJECTIVE: To determine the associations of specific components of IVF treatment with abnormal perinatal outcomes. DESIGN: Case-control study. SETTING: University-based and community-based infertility centers. PATIENT(S): All viable pregnancies achieved through IVF procedures performed between January 1999 and March 2004. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Infertility etiology, gonadotropin exposure, embryo manipulation, and quality. RESULT(S): Of 455 viable pregnancies identified during the study period, 435 met inclusion criteria. While adjusting for maternal age, race, parity, body mass index, infertility center, and year of IVF procedure, multiple gestations were associated with a 12-fold increased risk of poor perinatal outcome compared to singletons. Ovarian hyperstimulation syndrome significantly increased the risk more than 3-fold (odds ratio = 3.14; 95% confidence interval, 1.08-9.14), while endometrial thickness was found to have a significant protective effect (odds ratio = 0.89; 95% confidence interval, 0.80-0.99). We found no effect of etiology of infertility, dose or type of medication used for stimulation, use of embryo-manipulation techniques, or quality on perinatal outcome. CONCLUSION(S): These data confirm and quantify the risk of perinatal morbidity associated with multiple births. After adjusting for multiple births, ovarian hyperstimulation syndrome and suboptimal endometrial development are associated with adverse outcomes in pregnancies achieved through IVF. Our findings suggest that it may be the endometrium rather than the embryo that influences fetal growth and perinatal outcomes after IVF.

Culling in 50 dairy herds in England.

A survey of 50 Friesian/Holstein dairy herds (average size 178 cows) in England investigated the rate of culling and the reasons for disposal and death over three years from 1990 to 1992. The average total annual culling rate was 23.8 per cent (22.0 per cent sold and 1.8 per cent died). Of the disposals, 54 per cent were culled by the end of their fourth lactation. Poor fertility was the most important reason for culling (36.5 per cent of disposals), followed by management policy (11.5 per cent), mastitis (10.1 per cent), bovine spongiform encephalopathy (BSE) (7.4 per cent) and lameness (5.6 per cent). The most common causes of death were mastitis (8.9 per cent) and BSE (11.5 per cent), but 46 per cent died for unknown reasons.

Arrested pregnancy syndrome in Haiti: findings from a national survey.

This report describes findings from a national survey of pregnant women in Haiti regarding the social epidemiology of pedisyon (perdition), or "arrested pregnancy syndrome," a condition believed to be associated with infertility. Data collected on mortality of respondents' sisters were used to indirectly measure the prevalence of this culture-bound syndrome in the adult female population and to compare its distribution in urban and rural areas. Perdition appears to be a fairly common event that affects a large proportion of Haitian women. Reported cases of pedisyon were significantly higher in urban areas, which also differed from rural areas on respondent education, economic status, use of prenatal care, and fertility. No differences were found on sociodemographic, health, or fertility variables when women reporting perdition deaths were compared with women who reported other sister deaths. The utility and limitations of the proxy respondent method are discussed. Possible explanations for the higher rate of pedisyon among urban Haitian women are discussed, and suggestions are made for future research on arrested pregnancy syndrome.